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Health Services Research & Development

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HSR&D In Progress

December 2016

In this Issue: Improving Treatment of Pain among Veterans
» Table of Contents

Examining Pain and Pain Care in the VA

Ongoing study

In the VA healthcare system, Veterans with musculoskeletal diagnoses (MSD), including back and neck problems, osteoarthritis, and other inflammatory and degenerative disorders, have long been managed in the primary care setting. Yet, little is known about the characteristics of Veterans with MSD, the development and persistence of pain, pain management variability-associated medical and mental health conditions, and outcomes and costs of treatments. These data can help identify gaps in care which inform quality improvement efforts. Investigators in this longitudinal, prospective cohort study are using existing national VA electronic clinical and administrative data to examine variations in pain, pain treatment, comorbidities, and outcomes, including costs, by patient and VA facility characteristics.

Thus far, preliminary work has facilitated the rapid construction of the MSD cohort. To date, investigators have identified more than 4 million Veterans that received VA care for MSD between 2000 and 2012. In 2011, over 320,000 Veterans met criteria for an MSD diagnosis, of which 64% had no prior mention of an MSD. Women Veterans constitute an increasing proportion of MSD patients (6% in 2001 vs. 10% in 2011). Over time, Veterans with MSD reported increasing levels of pain on the numeric rating scale, increasing from 2.15 in 2001 to 2.63 in 2011.


Study findings will help guide VA clinical operations in their efforts to reduce variation in care access and process quality across the VA healthcare system. Study findings also will play a key role in the development of VA pain management performance measures through a key collaboration with VA's Office of Analytics and Business Intelligence.

Principal Investigator: Joseph Goulet, PhD, is part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center in West New Haven, CT.

Goulet J, Kerns R, Bair M, et al. The musculoskeletal diagnosis cohort: Examining pain and pain care among Veterans. Pain. August 2016; 157(8):1696-703.

See HSR&D Project Abstract

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