December 2016

VA HSR&D researchers conduct an extensive number of investigations designed to improve clinical decision-making and care, inform patients, evaluate changes in the healthcare system, and inform VA policymaking. In Progress is a quarterly publication that will highlight ongoing HSR&D research on various topics.

In This Issue: Improving Treatment of Pain among Veterans

Among adults in the United States, 20% to 30% report chronic pain. Moreover, low-back pain, neck pain, and other musculoskeletal disorders are three of the top five causes of disability, with a cost to society of $500-$635 billion annually.^1,2 Among Veterans treated in the VA healthcare system, chronic non-cancer pain is highly prevalent (50% to 60% of patients) and is a major contributor to poor health-related quality of life.³ In addition, among Veterans with pain, higher prescribed opioid doses are associated with higher risk of accidental poisoning death and suicide death.⁴ This issue features several ongoing HSR&D and QUERI studies that will help VA provide safe and effective pain management for all Veterans.

Feature Articles

Improving Treatment for Veterans with Pain and Chronic Conditions
HSR&D funds the Pain Research, Informatics, Multi-morbidities, and Education Center that studies the interactions between pain and associated chronic conditions and behavioral factors, and the Improving Pain-Related Outcomes for Veterans QUERI program, which is working with VA national leaders to implement strategies that reduce chronic pain among Veterans and risky opioid prescribing practices, as well as offering non-pharmacologic alternatives.

Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management
This article discusses the HSR&D state-of-the-art conference (SOTA) titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" that was held in November. The invitation-only conference had VA and non-VA pain experts participate in workgroup deliberations on several topics vital to improving the management of chronic pain.

Additional Ongoing Studies

Patient-Centered Pain Care Using Artificial Intelligence and Mobile Health Tools
This randomized study is applying state-of-the-art principles from "reinforcement learning" (a field of artificial intelligence, or AI) to develop a personalized, cognitive behavioral therapy pain management service that automatically adapts to each Veteran's unique and changing needs.

Examining Pain and Pain Care in the VA
Investigators in this study are using national VA data to examine variations in pain, pain treatment, comorbidities, and outcomes, including costs, by patient and VA facility.

A Walking Program to Reduce Pain among Black Veterans
This study will test the effectiveness of an intervention that emphasizes walking and cognitive behavioral therapy techniques, specifically targeting known barriers to effective pain care among black Veterans with chronic musculoskeletal (MSK) pain.

Peer-Coach Led Intervention to Improve Pain Symptoms
Investigators are evaluating a Peer Coach-Led Intervention for the Improvement of Pain Symptoms (ECLIPSE)—a randomized controlled trial designed to test the effectiveness of a peer coach-delivered pain self-management intervention.

Cost-Effectiveness of Complementary and Alternative Treatments to Reduce Pain
This is the first widespread study of the overall impact of complementary and integrative health use on healthcare utilization and healthcare cost at the VA.

References

1. Kennedy J, Roll J, Schraudner T, et al. Prevalence of persistent pain in the U.S. adult population: New data from the 2010 National Health Survey. Journal of Pain. October 2014;15(10):979-984.

2. Murray C, Atkinson C, Bhalla K, et al. The state of the US health, 1990-2010: Burden of diseases, injuries, and risk factors. JAMA. August 14, 2013:31D(6):591-608.

3. Improving Pain-Related Outcomes for Veterans (IMPROVE).

4. See slides for citation.