Giving Veterans an Active Voice in Creating a Veteran-Centered Chronic Pain Research Agenda

BACKGROUND:
Chronic pain is the leading cause of disability among U.S. Veterans, affecting up to 70% of this population. Although rates of initiating opioid treatment have fallen in VA as a result of the Opioid Safety Initiative, many Veterans are still receiving opioids for pain. Veterans Action League (VAL) 2.0 was a two-year community engagement project (2019–2021) that sought to develop a national Veteran-centered chronic pain research agenda that includes Veteran-generated recommendations for chronic pain management and chronic pain research priorities. Think tank meetings were held across five states (Florida, Georgia, Illinois, North Carolina, and Virginia) with 129 attendees, including Veterans (n = 111) and community stakeholders (n = 18). Attendees shared opinions, challenges, and barriers faced by Veterans and clinicians when managing and treating chronic pain, as well as strategies for improving chronic pain management and treatment options.

FINDINGS:

• Veterans’ most frequently cited need for chronic pain management and treatment was better access to care, with easier appointment booking and shorter wait times.
• Veterans also requested improved coordination among providers, and more thorough, holistic assessments for identifying contributors to their chronic pain.
• Some Veterans perceived that many providers overprescribed opioids as a “quick fix,” while other Veterans warned that the anti-opioid pendulum had swung too far. Veterans across states strongly agreed that they wanted to be offered choices for chronic pain management, with their options clearly outlined and their preferences sought.
• Veterans’ preferred approaches for managing chronic pain were diverse and included acupuncture, an anti-inflammatory diet, and epidural injections.
• Many Veterans voiced that they would like to see more studies on the efficacy of non-traditional therapies, including cannabis, chiropractic treatments, and therapeutic massage.
• Other recommendations included research in areas including care coordination, mental health support, and structural support (access to care, including telehealth) for chronic pain management.

IMPLICATIONS:

• Healthcare providers should consider integrating a patient-centered focus in primary and specialized care visits with Veterans.
• Policy makers should ensure that policies integrate Veterans’ needs and care preferences, and address care coordination barriers, especially those related to community providers.
• The VAL 2.0 methodology can be implemented with other historically marginalized populations to address healthcare topics that are most important to the chosen community.

AUTHOR/FUNDING INFORMATION:
Dr. Weaver is a Research Career Scientist with HSR&D’s Center of Innovation for Complex Chronic Healthcare.

Krause-Parello C, Flynn L, Pratt B, et al. and Weaver F. Veterans Action League 2.0: Creating a Veteran-Centered Chronic Pain Research Agenda. Journal of Community Engagement and Scholarship. March 23, 2023;15(2).