JGIM Supplement Features VA Research on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain Management
April 19, 2018
In the 1990s, chronic pain was considered a disease that warranted aggressive and humane treatment, including the use of opioids, but by 2016, an opioid “epidemic” was considered a plague that must be eradicated. As an integrated healthcare system with loyal patients, VA is ideally suited to develop an integrated approach to the treatment of chronic pain. To this end, HSR&D held a state-of-the-art conference (SOTA) titled “Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management” in 2016, which included researchers, clinical experts, and various stakeholders (i.e., VA, DoD, National Institutes of Health). Funded by HSR&D, the Journal of General Internal Medicine (JGIM) published a Supplement as one of the products of that SOTA. Articles discuss an array of evidence-based treatment strategies for pain, including but not limited to:
- Edmond and colleagues examined non-pharmacological pain treatment strategies among 460 OEF/OIF/OND Veterans with chronic pain who were enrolled in VA care. Study results show that while one in five Veterans reported past-week opioid use, the majority (72.4%) used a non-opioid medication. In addition, some differences were observed in the use of non-pharmacological treatment based on demographic and clinical characteristics, which may indicate differences in Veteran treatment preferences or provider referral patterns.
- Lovejoy and colleagues compared rates of non-opioid analgesic pharmacotherapy and clinician referrals for non-pharmacologic pain treatment, complementary and integrative pain therapies, and specialty mental health and substance use disorder treatment between patients discontinued from opioid therapy due to aberrant behaviors versus other reasons. Patients discontinued due to aberrant behaviors were more likely to receive opioid tapers, new non-opioid analgesic medications, or dose changes to an existing non-opioid analgesic medication – or to be referred for specialty substance use disorder treatment. Findings highlight the variability in referral rates for different types of non-opioid pain treatments and challenges accessing specific types of pain care.
- Lozier and colleagues examined the frequency and correlates of use and self-rated helpfulness of non-pharmacologic treatments (NPTs) for chronic pain among 517 patients who were prescribed long term-opioid therapy. Findings show that 71% of patients used one or more NPTs for pain in the past six months, with clinician-directed NPT higher than self-directed NPT. More than half of the patients (range 51% to 79%) rated the use of NPTs assessed as helpful or very helpful.
- An editorial by Kerns, Krebs, and Atkins discusses the path forward – both clinical and research recommendations that focus on effective non-opioid therapies and integrated programs.
Journal of General Internal Medicine. May 2018, Supplement;33(1).