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VA RESEARCH QUARTERLY UPDATE
This Issue: Chronic Disease Care | Table of Contents: Spring 2017 | Download this issue

New Initiatives | Announcements

Spotlight on pain management


Medication is only one approach to pain management.
<em>(Photo: ©iStock/ibreakstock)</em>
Medication is only one approach to pain management. (Photo: ©iStock/ibreakstock)

Medication is only one approach to pain management. (Photo: ©iStock/ibreakstock)

The VA Health Services Research and Development (HSR&D) service held its state of the art conference on pain management in March 2017. A presentation on recommendations from the conference, "Non-Pharmacological Approaches to Chronic Musculoskeletal Pain Management," is available as a cyber-seminar on the HSR&D website.

The presenters were Dr. Erin Krebs with the VA Minneapolis Health Care System, Center for Chronic Disease Outcomes Research, and Dr. Robert Kerns with the VA Connecticut Health Care System, Pain Research, Informatics, Multimorbidities, and Education Center.

Debilitating pain is endemic in the United States—studies show that 20 to 30 percent of U.S. adults experience chronic pain. For patients within the Veterans Health Administration, that rate rises to 50 to 60 percent. Over 5 million Veterans were diagnosed with a musculoskeletal disorder during the period from 2000 to 2011. The most common conditions were nontraumatic joint disorders, back conditions, and osteoarthritis.

Pain and mental health disorders often go hand in hand. Many Veterans who experience chronic pain have a co-occurring mental health condition and/or a substance use disorder. Illustrating this vulnerability, VA patients have twice the rate of accidental poisoning deaths than that of the U.S. population as a whole. Most often those deaths involve opioid overdose. The greater the dose of prescribed opioids, the higher the risk of accidental death and suicide, say researchers.

To address these concerns within VA, several work groups were convened at the conference to address these five areas:

  • effectiveness of therapies for chronic musculoskeletal pain
  • delivery and dosing strategies
  • patient selection
  • implementation challenges and strategies
  • outcome measures for prospective research

The workgroups concluded that there was strong evidence that investigators need to focus on hybrid effectiveness-implementation trials for cognitive behavioral therapy, mindfulness meditation, and acceptance and commitment therapy.

There was promising evidence that investigators should focus research on the effectiveness of meditation, biofeedback, hypnosis, and relaxation therapies.

The researchers noted that there were several challenges to evaluating the efficacy of the above therapies, but ended with these recommendations:

1. Nondrug pain treatments should be integrated into the primary-care setting in VA.

2. VA should invest in more effective strategies for tracking utilization of these therapies for pain management.

3. HSR&D should put together a group to develop a small set of outcomes measures to be used in pain research.


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