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VA Research Spotlight

Highlights of VA research on pain management

October 17, 2018

Pain

Pain Fact Sheet

VA's National Pain Management Strategy provides a system-wide standard of care to reduce suffering from preventable pain. As part of that strategy, the department's pain research portfolio covers a wide range of topics, from drug discovery, to complementary and integrative treatments, to the impact of pain on daily function and quality of life. The strategy helps set the direction of VA pain research, which in turn helps inform and refine the strategy.


VA Research Quarterly Update

JGIM Supplement features VA research on alternate approaches to pain JGIM Supplement features VA research on alternate approaches to pain

Researchers with VA's Health Service Research and Development service published 13 articles based on recommendations from the state-of-the-art conference on "Non-pharmacologic Approaches to Chronic Musculoskeletal Pain Management." The conference brought together experts from VA, the Department of Defense, and the National Institutes of Health to discuss non-opioid therapies for chronic pain. (August 2018) Read more



VA researcher is strong advocate for combining therapies for chronic pain VA researcher is strong advocate for combining therapies for chronic pain

Dr. Matthew Bair is a general internal medicine physician and VA health services researcher. His primary research interest is pain management in the primary care setting. Over the last 15 years Bair has been part of a team of pain researchers that have worked to improve pain management in the primary care setting, particularly combining pharmacologic (the use of drugs) and non-pharmacologic treatment for Veterans. (August 2018) Read more



Three questions for pain expert Dr. Erin Krebs Three questions for pain expert Dr. Erin Krebs

Dr. Erin Krebs is a physician and researcher at the Minneapolis VA Health Care System. In March 2018, she and her colleagues published a study in JAMA that compared the use of opioid medications with non-opioid medications for the treatment of chronic knee, hip, or back pain. The results were surprising: Treatment for 12 months or more with opioid medications was not superior to non-opioids when it came to improving pain-related function. (May 2018) Read more



Helping Veterans safely stop long-term opioid use Helping Veterans safely stop long-term opioid uses

Dr. Joseph Frank is a primary care physician and researcher at the VA Eastern Colorado Health Care System in Denver. His research is focused on improving the safety and effectiveness of chronic pain care for Veterans. As a physician, he is particularly interested in how VA can provide chronic pain care in primary care settings. (March 2018) Read more





Brief screening key to referral for VA chronic pain treatment Brief screening key to referral for VA chronic pain treatment

Researchers Drs. Steve Martino and Marc Rosen are conducting a study that will use the VA compensation and pension exam as a way to reach Veterans who are applying for a service-connected disability. The study is part of a larger grant designed to investigate non-drug approaches to pain management within the DoD and VA. (December 2017) Read more



VA Research Infographics

Gender differences in the use of complementary and integrative health by Veterans with chronic musculoskeletal pain Gender differences in the use of complementary and integrative health by Veterans with chronic musculoskeletal pain

VA Research Currents

Iowa study aims to help Vets with TBI struggling with migraines, light sensitivityIowa study aims to help Vets with TBI struggling with migraines, light sensitivity
Dr. Levi Sowers, with VA's Center for the Prevention and Treatment of Visual Loss, is studying post-trauma and migraine headaches. He wants to learn how to use light stimulation and other innovative techniques to ease the pain.... (05/31/2018)



Meditation in motionMeditation in motion
VA researchers are studying whether tai chi, an ancient Chinese mind-body therapy, can help relieve the chronic pain, fatigue, and other symptoms experienced by many Gulf War Veterans.... (05/24/2018)



White matter damage linked to chronic musculoskeletal pain in Gulf War VeteransWhite matter damage linked to chronic musculoskeletal pain in Gulf War Veterans
A study from the Madison VA Hospital in Wisconsin has linked structural damage in the white matter of the brain to chronic musculoskeletal pain in Gulf War Veterans.... (10/26/2017)



Study data lacking on benefits and risks of medical marijuana for chronic pain and PTSDStudy data lacking on benefits and risks of medical marijuana for chronic pain and PTSD
According to a literature review commissioned by the VA Quality Enhancement Research Initiative, evidence is lacking on the effects of medical marijuana for many types of chronic pain and for PTSD.... (08/24/2017)

VA Research in Action

Opioid overdose education and naloxone distributionOpioid overdose education and naloxone distribution

In 2014 and 2015, researchers evaluated the feasibility of VA’s distributing naloxone to Veterans at risk for an opioid overdose. Knowledge gained from this project was applied in a variety of ways, and VA now has the largest naloxone distribution program of any U.S. health care system.



Stepped-care and collaborative-care models for chronic musculoskeletal painStepped-care and collaborative-care models for chronic musculoskeletal pain
Stepped-care and collaborative-care models, validated in VA research trials, have become central to VA’s standard approach to treating chronic pain among Veterans.

VA Research News Briefs

Possible explanation for how melatonin promotes sleep

Possible explanation for how melatonin promotes sleep - Photo: ©iStock/jhorrocksPhoto: ©iStock/jhorrocks

(04/25/2018)
Researchers at the Harry S Truman Memorial VA Hospital have identified a possible mechanism that explains how melatonin promotes sleep. Melatonin, sold in supplement form, is widely prescribed nowadays as a sleep aid, but how exactly it works is unclear. Researchers studied how the brains of mice responded to melatonin. They found that orexin neurons in the brain expressed MT1, a melatonin receptor protein. When the researchers infused melatonin into the brain, the mice showed increased REM sleep and reduced wakefulness. Melatonin infusion inhibited orexin neurons. The results show that melatonin may act via the MT1 receptors to inhibit orexin neurons and promote sleep. The researchers point out that while the finding helps explain an existing treatment, it also may lead to new ones.  (Journal of Pineal Research, April 14, 2018)

Brain peptide implicated in migraine pain

Brain peptide implicated in migraine pain - Photo for illustrative purposes only. ©iStock/laflorPhoto for illustrative purposes only. ©iStock/laflor

(09/20/2018)
VA and University of Iowa researchers may have identified one of the sources of migraine pain. Researchers injected mice with calcitonin gene-relate peptide (CGRP), a substance naturally found in the brain that is believed to be related to nerve hypersensitivity and photosensitivity in migraine. They found that CGRP caused spontaneous pain in the mice, regardless of whether they were in light or darkness. When the researchers gave the mice an antibody that blocks CGRP receptors, the pain went away. They also found that the nonsteroidal anti-inflammatory drug meloxicam did not block the effects of CGRP. The antimigraine drug sumatriptan partially blocked CGRP response in male mice, but not females. (Pain, Sept. 1, 2018)



Development of a new non-addictive pain drug - ©iStock/SeventyFour©iStock/SeventyFour

Development of a new non-addictive pain drug

(09/14/2018)
A team including a researcher from the W.G. Hefner VA Medical Center in Salisbury, North Carolina, is working on a pain medication that could potentially work as well as opioids without being addictive. They developed a new compound, AT-121, that works on the mu opioid receptor, a type of neuron that opioids interact with to block pain. AT-121 also activates the nociceptin receptor, which blocks the addictive side effects of opioids. Using non-human primates, the researchers showed that AT-121 gave the same level of pain relief as opioids without the risk of addiction that comes with opioids. The results suggest that this new drug could have potential to both safely and effectively relieve pain, and also treat prescription opioid abuse. More studies will be needed before AT-121 can be tested in humans. (Science Translational Medicine, Aug. 29, 2018)



New approach to target drug treatment to painful joints - Photo: ©iStock/solidcoloursPhoto: ©iStock/solidcolours

New approach to target drug treatment to painful joints

(08/15/2018)
Baltimore VA Medical Center researchers have designed a method that could more effectively deliver drugs directly to the joints to treat rheumatoid arthritis. Arthritis medications can cause damage to other organs because they affect the whole body rather than just the joints. Researchers used a liposome (a sphere of molecules surrounding another material, such as a medication) containing the peptide ART-1 to target medication to joint cells. A peptide is a chain of amino acids. ART-1 has been shown to bind to the endothelial cells in joints. Researchers injected this compound into rats with arthritis. They found that the injection containing ART-1 suppressed the disease better than a control that did not have ART-1. The ART-1 liposome also appeared to be safer than liposomes not directed by the peptide, which interacted with more parts of the body than the joints. The results show that ART-1 could be used to home in on the joints to treat rheumatoid arthritis. (Journal of Controlled Release, Aug. 4, 2018)



Battlefield acupuncture may reduce opioid use after surgery - Photo by Robert Turtil, for illustrative purposes only.Photo by Robert Turtil, for illustrative purposes only.

Battlefield acupuncture may reduce opioid use after surgery

(08/08/2018)
Battlefield acupuncture may reduce the need for opioid use after surgery, found a John D. Dingell VA Medical Center study. In battlefield acupuncture, needles are placed in and around the ear to influence how the central nervous system processes pain. In a study of 39 patients, those who had this treatment after general surgery had significantly lower opioid use in the following 24 hours, compared to those not given acupuncture. Patients in the acupuncture group also had 15 percent less post-operative nausea and vomiting. Previous studies have shown that this type of acupuncture can reduce the stress response after surgery, aiding in recovery. The results suggest that battlefield acupuncture could be a low-cost, effective, safe, and easy to implement means of reducing post-operative pain, say the researchers. (2018 World Congress on Regional Anesthesia & Pain Medicine, April 19, 2018)

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