Office of Research & Development

VA RESEARCH QUARTERLY UPDATE
 

New Initiatives

VA, NIH seek alternatives to addictive opioids


One project in the new VA-NCCAM initiative will develop a collaborative treatment model between chiropractors, primary care providers, and mental health providers for Veterans with spine pain and related mental health conditions. (© <em>Photo by Scott T. Baxter/Getty Images</em>)
One project in the new VA-NCCAM initiative will develop a collaborative treatment model between chiropractors, primary care providers, and mental health providers for Veterans with spine pain and related mental health conditions. (© Photo by Scott T. Baxter/Getty Images)

One project in the new VA-NCCAM initiative will develop a collaborative treatment model between chiropractors, primary care providers, and mental health providers for Veterans with spine pain and related mental health conditions. (© Photo by Scott T. Baxter/Getty Images)

According to a recent Army study in the Journal of the American Medical Association, nearly half of all troops who have come home from Afghanistan and Iraq are coping with chronic pain. Chronic pain profoundly affects Veterans' quality of life, interfering with work, recreation, and social interaction. Says Indianapolis VA researcher Dr. Matthew Bair, "It's important that we treat chronic pain, and the most common way we treat it is with medication."

Providers have turned increasingly to opioid analgesics, psychoactive drugs that derive naturally from the poppy plant, such as morphine and codeine, or that are made synthetically, such as methadone and oxycodone. In any given year, about one-third of Veterans in VA care are prescribed an opioid, and one-third of those are on long-term opioid prescriptions.

While opioids are commonly prescribed, their chronic use can cause many unwanted side effects. Moreover, opioids are not consistently effective, can exacerbate pain conditions in some patients, and can be misused. Accordingly, VA and the National Institutes of Health (NIH) announced in September 2014 a five-year, $21.7-million quality-improvement initiative to explore non-drug approaches to managing pain and related health conditions such as PTSD, drug abuse, and poor sleep.

"Pain is the most common reason Americans turn to complementary and integrative health practices," said Dr. Josephine P. Briggs, director of NIH's National Center for Complementary and Alternative Medicine. "The need for non-drug treatment options is a significant and urgent public health imperative. We believe this research will provide much needed information that will help our military and their family members, and ultimately anyone suffering from chronic pain and related conditions."

The 13 research projects funded under the initiative will be undertaken at VA medical centers and at academic institutions throughout the nation.

In a related event, VA's National Center for Ethics in Health Care has created a podcast to help clinicians better understand the requirements of VHA's new Directive 1005, titled "Informed Consent for Long-Term Opioid Therapy for Pain." VA employees can find the podcast on the National Center's Intranet site.

The new consent procedures excluded patients being treated for cancer pain. At the request of VA's National Center on Ethics in Health Care, HSR&D has issued a call for research proposals to look at the risks of opioid medications in treating cancer pain and the impact of informed-consent processes on this group.


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