December 2016

In this Issue: Improving Treatment of Pain among Veterans
» Table of Contents

Improving Treatment for Veterans with Pain and Chronic Conditions

Feature Article

The mission of HSR&Ds Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center in West Haven, CT is to study the interactions between pain and associated chronic conditions and behavioral factors. This helps VA develop and implement effective interventions that can reduce pain and its negative impacts on emotional and physical functioning. PRIME's current and planned projects use a variety of technologies, including interactive voice response (IVR), the Internet, smartphone applications, and video conferencing to promote effective and safe pain control. The centerpiece of PRIME is the CREATE titled Pain Management and Patient Aligned Care. This Pain CREATE currently focuses on the following three projects.

• Musculoskeletal Diagnoses (MSD) Cohort: Examining Pain and Pain Care in the VA, which is working to characterize the population of Veterans with MSD with regard to the long-term course of their pain diagnosis, along with other comorbid conditions such as depression and substance use disorder, pain care outcomes, and costs of care. [See individual study descriptions below for more information about this research.]
• Effective Screening for Pain, which is evaluating the effects of an enhanced, computer-aided pain screening and assessment protocol to allow for the use of pain and functioning scores as an alternative to the 0-10 clinician-assessed pain rating scale.
• Comprehensive Opioid Management in Patient-Aligned Care Teams that is testing a telehealth-based self-management training system to promote improved care for Veterans receiving chronic opioid therapy.

In addition, VA's Quality Enhancement Research Initiative (QUERI) recently launched a national network of Programs designed to improve Veterans' health by more rapidly implementing research evidence into practice, including Improving Pain-Related Outcomes for Veterans (IMPROVE), which is working with VA national leaders to implement strategies that reduce chronic pain among Veterans and risky opioid prescribing practices, as well as offering non-pharmacologic alternatives. IMPROVE QUERI has assembled an expert team of implementation scientists, clinical researchers with expertise in pain management – and has partnered with clinical leadership, including VHA Pain Management, Primary Care Services, and Pharmacy Benefits Management (PBM) to create projects that address cross-cutting issues in multi-modal pain care, including:

• Reaching Veterans who have limited or no access to pain management resources by using technology to deliver an evidence-based cognitive-behavioral therapy directly to their homes.
• Decreasing the number of Veterans using high-dose opioid and opioid-benzodiazepine combination therapy by having pharmacists follow-up with Veterans who express willingness to consider tapering dosages – and by increasing the number of these Veterans using non-pharmacologic treatment modalities.
• Conducting a qualitative evaluation of the VISN 21 Pain & Opioid Safety Initiative (OSI) academic detailing program (interviewing academic detailers and providers) to determine best practices and lessons learned that can be shared nationally with other VISNs implementing an academic detailing program.

For more information about PRIME, please contact Lori Bastian, MD, MPH, at Lori.Bastian@va.gov; for more information about IMPROVE QUERI, contact Leonore Okwara, MPH, at Leonore.Okwara@va.gov.