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This Issue:The Aging Veteran | Table of Contents: Summer 2018 | Download this issue

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JGIM Supplement features VA research on alternate approaches to pain


 Researchers at a VA state-of-the-art conference investigated non-opioid therapies for chronic pain.  (Photo ©iStock/People Images)
Researchers at a VA state-of-the-art conference investigated non-opioid therapies for chronic pain. (Photo ©iStock/People Images)

Researchers at a VA state-of-the art conference investigated non-opioid therapies for chronic pain. (Photo ©iStock/People Images)

Thirteen articles based on outcomes and policy recommendations from VA's Health Service Research and Development state-of-the-art conference on "Non-pharmacologic Approaches to Chronic Musculoskeletal Pain Management" were published in a special supplement of the Journal of General Internal Medicine. The conference brought together experts from VA, the Department of Defense, and the National Institutes of Health to discuss the existing knowledge base on non-opioid therapies for chronic pain.

The thrust of the SOTA was to review the effects of complementary and integrative health (CIH) on pain and opioid use; discuss the different approaches to chronic pain; and share ideas on the larger topic of non-opioid therapies.

"Evidence clearly shows that no single therapy is the best approach for a majority of patients with chronic musculoskeletal pain," Drs. Robert Kerns, Erin Krebs, and David Atkins wrote in the introduction. "Like analgesic medication, non-pharmacologic therapies generate meaningful clinical improvement in only a subset of patients." 

Because there is no one best therapy for chronic pain, they recommend that health systems and payers offer multiple options for pain management to patients. CIH therapies like yoga, massage, or mindfulness-based stress reduction are equally as important as structured exercise or cognitive behavioral therapy, they point out.

It is also important for clinicians to use a multimodal, stepped model of care that allows individual Veterans to try different kinds of therapy, if the first one doesn't work. The researchers suggest that type of multimodal care can be best implemented by primary care physicians who don't just treat patients for pain, but also for other contributing conditions like diabetes.

Because VA is an integrated health system that provides comprehensive care, wrote the authors, it is well-suited to offer the type of multimodal care that is best for chronic pain patients.


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