{"doi":"10.1093/pm/pnae047","title":"Perspectives on pain management from the veterans health administration and the defense health agency","abstract":null,"journal":"Pain Medicine","year":2024,"id":636231,"datarank":0.10397207708399181,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.0,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1651130,"name":"Deydre Teyhen","orcid":null,"position":1,"is_corresponding":false},{"id":1651131,"name":"Paul Cordts","orcid":null,"position":2,"is_corresponding":false},{"id":439785,"name":"Benjamin Kligler","orcid":"0000-0002-6053-2602","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"Perspectives on pain management from the veterans health administration and the defense health agency","abstract":"Over the past decade, the Department of Defense (DOD) and the Defense Health Agency (DHA) have partnered with the Department of Veterans Affairs (VA) and the Veterans Health Administration (VHA) on a comprehensive approach to pain designed to return patients to function and restore health while minimizing the risk of overreliance on opioid medications. Together, the two agencies have been developing a whole person, integrative approach to pain management—with attention to the growing evidence in support of nonpharmacological strategies for chronic pain. Although the specifics of pain management continue to differ somewhat between the two agencies for a variety of reasons, including the differing age and demographics of the populations being served, for both DHA and VHA, the core strategy has been a focus on the stepped care model of pain management (see Figure 1). A stepped care model focuses on providing the appropriate level of care based on the patient’s pain and their potential for developing chronic pain. Care can range from self-management, primary care services, specialty care, and all the way up to advanced pain management. The VA-DOD Clinical Practice Guideline for Opioid Therapy for Chronic Pain1 and the Pain Management Task Force Report2 (dvcipm.org/clinical-resources/pain-management-task-force/) have been foundational to the approach in both agencies. VHA stepped care model of pain management. The concept of Whole Health—which has been steadily gaining traction in the VHA over the past 10 years, to the point that in Fiscal Year 2023 over 1.8 million Veteran (roughly 29% of active users of VHA) participated in some way in the Whole Health approach—is a natural fit with the stepped care approach. Whole Health is defined by the National Academy of Sciences Engineering and Medicine as: Whole health is physical, behavioral, spiritual, and socioeconomic well-being as defined by individuals, families, and communities. To achieve this, whole health care is an interprofessional, team-based approach anchored in trusted longitudinal relationships to promote resilience, prevent disease, and restore health. It aligns with a person’s life mission, aspiration, and purpose.3 Pain management has been one of the primary areas of focus for the implementation of Whole Health. In 2017, VHA Health Systems Research and Development Service sponsored a “State of the Art” Conference on Nonpharmacological Management of Chronic Musculoskeletal Pain to examine the evidence for the wide range of approaches used across the healthcare community and reach a consensus on which of these had sufficient evidence to be offered as part of VHA medical benefits. The outcomes of this process helped inform the policy directive enacted that same year mandating that eight evidence-based complementary and integrative health (CIH) approaches be offered—where clinically appropriate and safe—across the VHA system. These include acupuncture, massage therapy, meditation, guided imagery, biofeedback, yoga, tai chi, and clinical hypnosis—which alongside other Whole Health approaches like health coaching and peer-to-peer support are now thoroughly incorporated into the Stepped Care Model in the VHA. Both DHA and VHA have been deeply involved in the Pain Management Collaboratory (PMC),4 with the shared goal of finding the best way to translate science into practice by focusing on pragmatic clinical trials. To help prevent the onset of chronic pain that may require opioid management, the DHA has been partnering especially closely with researchers both inside and outside the PMC using stepped care models. One of these recent efforts, sponsored by the Congressionally Directed Medical Research Program (CDMRP), looked to assess the implementation of a stepped risk-stratified model of care using a biopsychosocial framework for low back pain in the Military Health System.5 In another recent effort, funded through the PMC, Drs. Fritz, Rhon, and colleagues are exploring another stepped care model for low back pain,6 assessing physical therapy, Move2Health health coaching, and Mindfulness-Oriented Recovery Enhancement (MORE) to effectively treat and prevent chronic low back pain. Other PMC efforts occurring in the DHA are examining the impact of behavior health providers integrated into primary care and the use of brief booster contacts to assist in the management of chronic pain,7 and quantifying the effectiveness and cost-effectiveness of guideline adherence to the management of low back pain,8 with a focus on preventing chronification of low back pain and reducing long-term opioid use. On the VHA side, much of the research emerging from the PMC is already having an impact on the implementation of pain management in the health system. For example, the remotely delivered mindfulness approach for chronic pain being studied in the Learning to Apply Mindfulness to Pain (LAMP) trial by Dr Burgess and colleagues9—which appears to have a statistically and clinically meaningful impact on reducing chronic pain and improving overall quality of life in Veterans—is currently being modified so that components can be implemented by Whole Health coaches over the coming 1-2 years. The Assessing Pain, Patient-reported Outcomes, and Complementary and Integrative Health (APPROACH) trial being led by Drs Taylor and Zeliadt examines the relative effectiveness of practitioner-delivered CIH approaches like acupuncture and chiropractic vs more self-management directed interventions like yoga and tai chi vs a combination of the two in a population of over 6000 Veterans with chronic pain.10 This trial is now entering the analysis phase, and we expect that the findings will help inform our policies and implementation strategy for CIH in the VHA. Adequately managing chronic pain continues to be a challenge for all health care systems, including VHA and the DHA. By investing in support for pragmatic trials in military populations that address common chronic pain conditions as well as the need to minimize opioid utilization, we hope to improve our collective ability to translate science into practice. By committing to see pain as a “whole person” issue rather than simply a disease, and by maximizing the use of behavioral and nonpharmacological approaches—supported by the powerful evidence being generated by the PMC and other research efforts—we will continue to face and overcome that challenge for our active duty and Veteran populations. The views expressed in this editorial are those of the author and do not necessarily reflect the official policy or position of the Defense Health Agency, Department of Defense, nor the US Government. There was no outside funding supporting this submission. Conflicts of interest: None of the authors have any conflicts of interest to report. This article appears as part of the supplement entitled “Pain Management Collaboratory: Updates, Lessons Learned, and Future Directions.” This manuscript is a product of the Pain Management Collaboratory. For more information about the Collaboratory, visit https://painmanagementcollaboratory.org/.","is_dataset_classified":null,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"39514884","pmcid":null,"openalex_id":"https://openalex.org/W4404173680","authors":[],"funders":[{"funder_name":"NCCIH NIH HHS","grant_id":"U24 AT009769","title":null}],"total_grants":1,"fwci":null,"citation_percentile":null,"influential_citations":0,"citation_trend":[{"year":2024,"count":1}],"oa_status":"hybrid","license":"public-domain","oa_locations":[{"url":"https://academic.oup.com/painmedicine/article-pdf/25/Supplement_1/S4/60543653/pnae047.pdf","host_type":"journal"},{"url":"https://academic.oup.com/painmedicine/article-pdf/25/Supplement_1/S4/60543653/pnae047.pdf","host_type":"publisher"},{"url":"http://dx.doi.org/10.1093/pm/pnae047","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/39514884","host_type":"repository"}],"fields_of_study":["Musculoskeletal pain and rehabilitation","Opioid Use Disorder Treatment","Pain Management and Opioid Use"],"mesh_terms":[],"keywords":["Administration (probate law)","Pain management","Agency (philosophy)","Medicine","Nursing","Physical therapy","Political science"],"sdg_mappings":[{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-06T16:37:39.908579Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}