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Pain/Opioid

Priorities | Impacts | Promising Practices

January 13, 2026

Chronic pain—pain that lasts longer than three months—is more prevalent and more severe in Veterans than in the general population and often interferes with daily functioning.[1] Chronic pain increases Veterans’ risk for a range of conditions, including opioid use disorder.

The Pain/Opioid Consortium of Research (Pain/Opioid CORE), part of VA’s Health Systems Research (HSR), strives to enhance collaboration and advance Veteran-centered research on pain conditions and opioid use disorder (OUD). Working with partners such as VA’s Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP), Office of Patient-Centered Care and Cultural Transformation (OPCC&CT), and the Office of Mental Health Substance Use Disorder program, the Pain/Opioid CORE also helps move research findings into wider use as clinicians, program managers, and Pain/Opioid CORE researchers collaborate to implement and evaluate ways to address chronic pain and OUD among Veterans.

The Pain/Opioid CORE is led by HSR’s Alicia Heapy, PhD; William Becker, MD; and Erin Krebs, MD, MPH, who is also an investigator with HSR’s Center for Care Delivery and Outcomes Research (CCDOR) and Associate Director of Engagement with VA’s Rehabilitation & Engineering Center for Optimizing Veteran Engagement & Reintegration (RECOVER).

Alicia Heapy, PhD

Alicia Heapy, PhD

William Becker, MD

William Becker, MD

Erin Krebs, MD, MPH

Erin Krebs, MD, MPH

Pain/Opioid CORE Scope

  • Pain and/or OUD prevention, harm reduction, and treatment approaches.
  • Pain and/or OUD care delivery models.
  • Practice and policy initiatives related to pain and/or OUD.
  • Negative consequences of prescription opioids.

Within this scope, the Pain/Opioid CORE is also interested in the physical and mental health conditions that co-occur with pain and OUD, including other use disorders. Treatment approaches of interest include medications and non-invasive non-drug therapies.

[1] Pain.pdf (va.gov)

Pain/Opioid CORE Priorities

  • Advance VA pain and OUD priorities.
  • Enhance pain and OUD research capacity.
  • Facilitate Veteran- and partner-engaged pain and OUD research with a focus on chronic multisite pain, OUD harm reduction, and pain/OUD self-management.
  • Communicate evidence and key impacts widely.

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Pain/Opioid CORE Impacts

  • Contributed to the National Academies of Sciences, Engineering, and Medicine’s Committee on Evaluating the Effects of Opioids and Benzodiazepines on All-Cause Mortality in Veterans: Pain/Opioid CORE leaders and Veteran Engagement Panel members provided consultation to the committee, and CORE leaders conducted an analysis that was included as an appendix to a published report.
  • Helped advance Veteran engagement in the research process: A study led by a Pain/Opioid CORE investigator described infrastructure and practices used by seven HSR-funded research networks, including the Pain/Opioid CORE, to engage Veterans as partners in the research process. Results helped inform a consensus across VA’s Office of Research and Development (ORD) regarding Veteran engagement groups and are being shared to facilitate adoption of promising engagement practices.
  • Conducted research that informed development of the Active Management of Pain (AMP) program: The eight-week AMP program, sponsored by the Pain Management Program (PMOP), aims to help Veterans manage chronic pain by combining behavioral health strategies with physical therapy techniques to improve quality of life and functionality. AMP was rolled out nationwide in early 2023 and was informed, in part, by findings from an HSR study. The Pain Services Evaluation Program (PSEP), led by a Pain/Opioid CORE investigator, is conducting a mixed methods evaluation of AMP to monitor program implementation, factors that influence implementation, and program impact.
  • Host two Veteran Engagement Panels (VEPs): The Pain/Opioid CORE’s VEPs are diverse groups of Veterans from across the United States. The VEPs help advance patient-centered research and care in VA by integrating Veterans’ perspectives into studies, interventions, and quality improvement projects.
  • Host a Career Development Workgroup: This monthly workgroup supports early career investigators and those new to pain or opioid-related research by providing a forum for career development and presentations from emerging researchers.
  • Support Rapid Start Funding (RSF): RSF awards support pain and OUD research, particularly by early career investigators, that is consistent with Pain/Opioid CORE priorities and likely to inform future applications for VA funding or answer priority questions. Recently, the Pain/Opioid CORE has partnered with OPCC&CT to fund pilot projects that focus on quality improvement and evaluation of Whole Health approaches for pain and OUD.

Recent Projects Involving Pain/Opioid CORE Investigators and/or Funding

  • Examining Massage for Veterans with Chronic Neck Pain. This study found that massage therapy significantly reduced neck pain severity for up to six months after treatment, suggesting that massage therapy is a practical, non-pharmacological approach to pain management—although ongoing efforts might be required to maintain lowered pain scores.
  • Exploring Chronic Pain, Substance Use, and Primary Care Among Veterans with Homeless Experience. This study, based on work supported by a Pain/Opioid CORE RSF award, explored the association of chronic pain and problematic substance use with unfavorable primary care experiences among Veterans with homeless experience. Findings indicate that chronic pain is associated with unfavorable primary care experiences among Veterans with homeless experience, potentially contributing to poor care outcomes.
  • Increasing Buprenorphine Access for Patients with Chronic Pain. Limited education about and support for buprenorphine, an effective pain medication that is safer than traditional opioids, can result in under-prescribing in primary care. The findings of this quality improvement project suggest that a facilitated procedure to transfer Veterans on buprenorphine for chronic pain from a specialty pain clinic back to primary care can help increase buprenorphine prescribing for pain in primary care.
  • Testing Options for Pain Management Using Non-pharmacological Strategies. To overcome underutilization of non-pharmacological therapies for pain, this ongoing study is testing the effects of Options for Pain Management Using Non-pharmacological Strategies, an intervention that includes a decision aid to help patients understand, compare, and find strategies that fit best with their goals and lifestyle; and coach-led motivational interviewing to foster self-efficacy, prepare Veterans to discuss non-pharmacological treatments with their providers, and build patients’ confidence to manage their pain.
  • Comparing Care Models for Managing Pain and Reducing Opioid Use. This 10-site randomized trial compared the effects of integrated pain team (IPT) vs. pharmacist collaborative management on pain and opioid dosage. After one year, Veterans who received the two types of care didn’t differ in pain or daily opioid dose; both groups had small improvements in pain and substantial reductions in daily doses of opioids. The findings provide evidence that these interventions can safely and effectively reduce opioid dosages, and support the implementation of primary care-based collaborative care interventions to improve pain and opioid management among patients prescribed long-term opioid therapy for chronic pain.

The Pain Management Collaboratory (PMC) is a joint activity of the National Institutes of Health, Department of Defense, and VA that supports 16 large studies embedded in the Veteran and military health systems. These pragmatic trials examine the effectiveness of non-drug approaches to pain management and their implementation in the health system.

  • Learning to Apply Mindfulness to Pain (LAMP): Supported by the Pain Management Collaboratory (PMC), the LAMP study found that two scalable, telehealth mindfulness-based interventions improve pain-related function and biopsychosocial outcomes among Veterans with chronic pain. The study’s findings were highlighted in 24 news stories from 18 media outlets and discussed on four podcasts.
  • Cooperative Pain Education and Self-Management (COPES): COPES is a technology-based cognitive behavioral therapy program for chronic pain that Veterans can complete from home and on their own schedule. The PMC-supported COPES ExTRA trial found that COPES improved pain, functioning, and sleep outcomes among Veterans with chronic musculoskeletal pain. (Results not yet published.)

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Promising Practices

  • The LAMP and COPES telehealth treatments are being moved into clinical care. These asynchronous remotely delivered versions of mindfulness and cognitive behavioral therapy for chronic pain are low burden for Veterans, use fewer clinical resources than treatments with in-person or real-time videoconferencing interactions, and increase access to pain care.
  • The current VA Clinical Practice Guideline for opioid prescribing for chronic pain treatment recommends switching to buprenorphine for individuals on high-dose long-term opioid therapy in whom opioid harms outweigh benefits and patient-centered tapering has failed or is not preferred by the patient. Studies [2] by Pain/Opioid CORE investigators have increased the prevalence of this practice in and outside VA.

A number of Pain/Opioid CORE investigators are affiliated with HSR’s Quality Enhancement Research Initiative (QUERI). QUERI deploys and evaluates implementation and quality improvement strategies to expand evidence-based pain care and treatments for opioid use disorders in Veterans.

  • QUERI’s Consortium to Disseminate and Understand Implementation of Opioid Use Disorder Treatment (CONDUIT) brought together six related projects to expand access to effective treatments for pain and opioid use disorder across diverse settings, including facilitating implementation in primary care, acute care, specialty care, and telehealth.
  • Improving Pain-Related Outcomes for Veterans QUERI (IMPROVE QUERI), the Triple Aim QUERI (TAQ), and the Measurement Science QUERI support evaluations of five distinct pain care models. These models represent the breadth of VA pain care and are Veteran- as well as provider-focused.

[2] Buprenorphine, Pain, and Opioid Use in Patients Taking High-Dose Long-Term Opioids; Switching from High-Dose, Long-Term Opioids to Buprenorphine.

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