Priorities
Existing Priorities
The Pain/Opioid CORE's existing research priorities are informed by two VA Health Systems Research (HSR) State of the Art (SOTA) Conferences focused on nondrug therapies for chronic musculoskeletal pain management and opioid safety. Many unanswered scientific questions exist related to the broad areas of pain, opioid prescribing, and opioid use disorder.
The Pain/Opioid CORE research priorities from the 2016 and 2019 HSR SOTA Conferences are summarized below. For more information, see summaries and detailed reports
Expand All | Contract
All
Psychological and behavioral therapies for chronic pain
- Effectiveness of therapies where more evidence is needed
- Approaches to address clinician and health system barriers to use of evidence-based therapies
Exercise and movement therapies for chronic pain
- Effectiveness of aquatic vs. land-based therapies for back pain and fibromyalgia
- Approaches to improve dosing, optimizing benefits, and maintenance of evidence-based therapies including exercise therapies (e.g., strengthening, aerobic) and movement-based mind-body therapies (e.g., yoga, tai chi)
Manual therapies for chronic pain
- Effectiveness of manipulation, acupuncture, and massage for specific conditions with insufficient evidence
- Approaches to improve dosing, optimizing benefits, maintenance, and assess fidelity of evidence-based approaches including manipulation, massage, and acupuncture for low back and neck pain
Chronic pain care delivery models
- Effectiveness of care delivery approaches such as peer-delivered care and prognostic/risk stratification
- Multisite effectiveness-implementation research on evidence-based collaborative care and stepped care models
Management of opioid use disorder (OUD)
- Approaches to address clinician and health system barriers to broad implementation of medication treatment for OUD (MOUD)
- Interventions to improve retention of patients in treatment and reduce inappropriate discontinuation of MOUD by providers
- Effectiveness of various OUD treatment adherence monitoring strategies
- Effectiveness of psychosocial treatments and community/peer/family support strategies in patients with OUD
- Approaches to implementing chronic disease management model for MOUD
- Approaches to link patients with nonfatal overdose to MOUD treatment
Long-term opioid therapy (LTOT) for pain
- Benefits and harms of opioid dose reduction and discontinuation in LTOT
- Effectiveness of approaches to support opioid tapering (e.g., collaborative care, tapering protocols, nondrug therapies, clinician training, patient education, interventions to enhance engagement, technology-based interventions)
- Effectiveness of buprenorphine for opioid risk reduction and opioid dose reduction/discontinuation in LTOT for chronic pain
- Clinical diagnostic and management strategies for patients with opioid dependence/LTOT who do not have opioid use disorder
- Effectiveness of 1) continuing vs. discontinuing low-dose intermittent opioids among patients on established LTOT and 2) initiating low-dose intermittent opioid medications vs. non-opioid medications for older adults with chronic pain
Co-occurring pain and substance use disorders (SUD)
- Approaches to implementing and integrating behavioral and exercise/movement therapies for patients with co-occurring pain and SUD
- Approaches to enhance patient activation, engagement, and adherence to behavioral and movement therapies among patients with pain and SUD
- Effectiveness of buprenorphine for chronic pain among patients with comorbid chronic pain and SUD
- Effectiveness of approaches to manage perioperative pain among patients on MOUD (medication treatment for opioid use disorder)
Cross-cutting issues in nondrug management of chronic pain
- Approaches to enhance patient activation, engagement, and adherence to active evidence-based therapies
- Comparisons of treatment delivery strategies for evidence-based therapies (e.g., brief or single session vs. standard course)
- Outcomes of combining or sequencing nondrug therapy interventions
- Treatment dosing and maintenance strategies for evidence-based non-drug therapies
- Evaluation of implementation strategies to increase uptake of effective treatments
Additional Priority Areas Identified by the CORE
After the CORE was funded in 2019, a detailed multi-step process to identify additional priority areas was undertaken. The process included analyzing a portfolio of funded studies, reviewing the evidence landscape, and conducting a Delphi voting process with researchers, partners, and HSR leaders. By examining VA and NIH grant funding from FY17-FY21 and performing a scoping review of systematic reviews, we identified gaps and trends in pain and opioid-related research. A final list of 15 candidate topics were discussed at the 2022 CORE annual meeting, including with the CORE's Veteran Engagement Panel, and led to the selection of three additional priority areas:
Chronic multi-site pain
- Validity, reliability, and feasibility of approaches to assess multisite pain/multiple pain conditions
- Implications of multisite pain/multiple pain conditions for prognosis and treatment outcomes
Harm reduction among persons who use illicit opioids
- Effectiveness of public-health or individual-health targeted interventions to reduce overdose in persons who use drugs
- Barriers and facilitators to, and opportunities for, expansion of evidence-based interventions to reduce overdose in persons who use drugs
- Adaptation of effective public-health or individual-health targeted interventions to reduce overdose from non-VA to VA settings
Self-management interventions for pain and/or OUD
- Effectiveness of self-management, self-care, or self-directed interventions
- Approaches to increase engagement in self-management approaches (e.g., motivational interviewing, or value congruent communication)
