About PRIME’s Research

More than two-thirds of the Center’s core investigators are VA clinicians, and the Center has a strong track record in research that incorporates, supports, and directly informs clinical practice.

While PRIME’s research is aligned with national research strategies, it is also driven by clinical needs at the local, VISN and national levels, and the Center has conducted ground-breaking work in the use of administrative and clinical research records to address clinical research questions. Additionally, the Center has developed and rigorously evaluated clinical processes using quality improvement processes, longitudinal clinical pilot studies, clinical trials, and large-scale implementation studies.

PRIME investigators also invest considerable energy on dissemination and education of findings that can directly impact clinical practice by conducting regular webinars; hosting mini-residency trainings; offering clinical supervision; mentoring fellows and scholars; and participating on national, regional, and local VHA clinical and training steering committees.

Pain and Opioids Research

Since its inception, pain and pain management have been a focus area of research for the PRIME Center, and this focus has seen continued growth. The Center has added a Quality Enhancement Research Initiative (QUERI) program; HSR Investigator Initiated Research (IIR) projects; and several National Institutes of Health (NIH), Department of Defense (DoD), and VA jointly funded pragmatic trials.

The PRIME Center strategic goals have been adopted from the Federal Pain Research Strategy (FPRS), a research agenda created by a federal advisory committee of pain experts and designed to advance research in pain and pain management. These objectives have been further refined and adapted, based on local expertise and ongoing projects. The PRIME Center contributes to the FPRS goal of forming a national research network for pain within VA. Dr. Heapy chairs the National Pain Research Working Group, a group of approximately 80 VA-affiliated pain researchers.

Serving as the first federally-funded national pain center, multiple PRIME investigators contributed significantly to the HSR State of the Art Conference on non-pharmacological pain treatments for chronic musculoskeletal pain. 

Pain, Health Equity, and Research Networks

Projects in this portfolio are designed to a) longitudinally follow patients with pain and better define the epidemiology of pain in disparate populations (women, racial and ethnic groups, older adults); and b) Develop a pain research network.

• HSR&D-funded studies and projects:
  • Musculoskeletal Diagnosis Cohort Study
  • Women Veteran’s Cohort Study 2
  • Pain Care Quality and Integrated and Complementary Health Approaches
  • VA National Pain Research Working Group
  • HSR&D Cyberseminar Spotlight on Pain Management series
  • VA CHS Work Group/VACS Opioid Work Group

• Other funded studies:
  • Yale University (funded by the Food & Drug Administration): Linking data sources to elucidate non-fatal and fatal opioid-related overdoses and the role of FDA-regulated products

Pain Management Models of Care

Projects in this portfolio focus on developing, evaluating, and improving models of care for pain management; determining the benefits, risks, and costs of pain treatment; and assessing the effects of policy changes on pain care.

• HSR-funded studies and projects:
  • Association of complementary and integrative health (CIH) interventions with opioid use and related risks among Veterans with musculoskeletal disorders (MSD) and PTSD
  • IMPROVE (Improving Pain-Related Outcomes for Veterans) QUERI
  • Analgesic safety and effectiveness in older Veterans with arthritis
    
• Other funded studies:
  • National Center for Complementary and Integrative Health: Implementation of a pragmatic trail of whole health team vs. primary care group education to promote non-pharmacological strategies to improve pain, functioning, and quality of life in Veterans; and Engaging Veterans seeking service-connection payment in pain treatment.

Comorbidities and Chronic Pain

The projects in this portfolio seek to determine the bidirectional relationship between common comorbidities and chronic pain. Projects include:

• Pain-related anxiety intervention for smokers with chronic pain: A comparative effectiveness trial of smoking cessation counseling
• Secondary analysis of multiple ongoing and completed trials to examine the relationship between pain and common comorbidities such as depression, PTSD, and substance use disorder.

Self-Management Strategies

The projects in this portfolio seek to determine the optimal approaches for using self-management techniques and strategies to manage chronic pain.

• HSR-funded studies and projects:
  • The opioid consent: Helping optimize information for cancer and effective pain management project
  • Patient-centered pain care using artificial intelligence and mobile health tools
  • A proactive walking trial to reduce pain in Black Veterans
  • IMPROVE (Improving Pain-Related Outcomes for Veterans) QUERI: Cooperative Pain Education and Self-management (COPES)

• Other funded studies:
  • NIH/DoD/VA: Pain Management Collaboratory Coordinating Center and the Pain Management Collaboratory COPES-ExTRA
  • Patient-Centered Outcomes Research Institute: Comparative effectiveness of patient-centered strategies to improve Pain management and opioid safety for Veterans
  • Patterson Trust: Self-management intervention among women Veterans with chronic back pain.
  • VISN 1 Career Development Awards: Pain and shared medical appointments to refocus treatment; and empowering management of pain outcomes among women via empathic relationships

Women’s Health Research

Women Veterans are a minority in VA healthcare and important differences in care have been identified. Based on this important clinical need, the PRIME Center's second focus area is women's health. The Center is supported in this work by long-standing and effective partnerships with VA Office of Women's Health, as well as a large number of cross-COIN and other VA medical center collaborations. The Center has four specific goals for its women’s health research focus.

Goal 1. Advance access to high quality, patient driven healthcare for women Veterans, address gaps in resources and gender variability, improve access to reproductive health care, utilize telehealth to improve access, and use information technology to advance population health.

• HSR funded studies and projects:
• Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) QUERI
• Evaluating quality and coordination of outsourced care for women Veterans
• Patterns and experience of VA maternity care coordination for women Veterans (COMFORT)
• Women Veteran’s Cohort Study 2
• Examining VACAA implementation and care coordination for Women Veterans
• Weight loss treatment and CBT for Veterans with binge eating
• Recovering from intimate partner violence through strengths and empowerment (RISE): Tailoring and evaluating a patient-centered counseling intervention for women Veterans

Goal 2. Integrating women Veterans’ health care delivery through strategic collaborations.

• HSR-funded studies and projects:
  • Women’s Health Research Consortium/Practice-Based Research Network

• Other studies and projects:
  • Patterson Trust: Self-management intervention among women Veterans with chronic back pain.
  • VISN 1 Career Development Awards: Pain and shared medical appointments to refocus treatment; and empowering management of pain outcomes among women via empathic relationships
  • VA Office of Women's Health: Care Coordination and Management—Guideline concordant COPD care for women Veterans; and examining the impact of comprehensive primary care for women Veterans
  • Office of Rural Health: Women Veterans’ Care Coordination and Management

Goal 3. Enhance women Veterans’ experience by providing tools and resources to women's health leaders in the field.

• VA Office of Women's Health: Identification of women’s health-related conditions in an electronic health record
• VISN 1 Career Development Awards: Detection of intimate partner violence perpetration among Veterans

Goal 4. Address the unique health needs of women Veterans through enhanced clinical programs and research.

• Women’s Health Fellowship
• Women’s Health Research Network: Journal supplements in Medical Care, Gerontologist, and Women’s Health Issues
• Mentoring of VA HSR Career Development awardees focusing on women’s health

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