Veterans Reveal Positive Aspects of Routine VA Pain Screening
Improving processes of chronic pain care has become a public health priority and is one of the main reasons patients seek help in the primary care setting. Screening for pain in routine care is one of the efforts that VA has adopted in its national pain management strategy. Due to the high prevalence of pain among Veterans, its co-occurrence with common mental health conditions, and Veterans' unique exposure to distressing events, they are a critical population for studying both the positive and negative aspects of pain screening. Therefore, this study sought to understand Veterans' perspectives and preferences about the experience of being screened for pain in primary care. Using data from a study conducted from 2012 to 2017 that evaluated a strategy to improve the use of the "5th Vital Sign" of pain in primary care, investigators identified a convenience sample of 36 Veterans from five primary care clinics and three VA healthcare systems who were then interviewed about pain screening. Study participants had pain ranging from 0-10 on the NRS (Numeric Rating Scale): two Veterans had no pain at the time of the interview, while 63% of Veterans reported moderate-to-severe pain at 4 or above.
- Generally, Veterans believed that routine pain screening is positive. Findings reveal five themes that summarize Veterans’ experience and preferences of being screened for pain:
- Pain screening can determine the tone and guide the focus of the visit.
- Screening can initiate communication about pain, which is important because some Veterans feel that discussing pain indicates weakness.
- Screening can facilitate patient recall and reflection, allowing the patient to bring up symptoms that may have been overlooked in the past or would have gone unmentioned.
- Screening can help identify under-reported psychological pain, mental distress, and suicidality that might not come up without provider probing.
- Screening allows patients to offer recommendations to improve screening for pain; e.g., Veterans emphasized that screening language and specific word choices matter.
- Results indicate that Veterans perceive meaningful, positive impacts of routine pain screening that, as of yet, have not been considered in the literature. Specifically, routine screening for pain may help capture mental health concerns that may otherwise not emerge.
- Study participants were interviewed about the process of pain screening as a whole rather than about a specific way to measure pain.
This study was funded by HSR&D (CRE 12-030), and Dr. Timko is supported by an HSR&D Research Career Scientist award. Dr. Giannitrapani, Dr. Haverfield, Ms. Lo, Mr. McCaa, Dr. Timko, and Dr. Lorenz are part of HSR&D’s Center for Innovation to Implementation (Ci2i). Dr. Dobscha is part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC), and Dr. Kerns is with HSR&D’s Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center.
Giannitrapani K, Haverfield M, Lo N, McCaa M, Timko C, Dobscha S, Kerns R, and Lorenz K. “Asking is Never Bad, I Would Venture on That:” Patients’ Perspectives on Routine Pain Screening in VA Primary Care. Pain Medicine. March 6, 2020; Epub ahead of print.