December 2016

In this Issue: Improving Treatment of Pain among Veterans
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State-of-the-Art Conference: Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management

Feature Article

As an integrated healthcare system with loyal patients, VA is ideally suited to develop an integrated approach for pain management. To this end, HSR&D held a state-of-the-art conference (SOTA) titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" from November 3-4, 2016 in Alexandria, VA. The invitation-only conference brought together VA and non-VA pain experts who reviewed literature and completed pre-conference workgroup assignments in preparation for the face-to-face SOTA conference. Co-chairs Robert Kerns, PhD, from HSR&D's Pain Research, Informatics, Multi-morbidities, and Education, (PRIME) Center, and Erin Krebs, MD, MPH, from HSR&D's Center for Chronic Disease Outcomes Research (CCDOR), worked with an expert SOTA planning committee to develop the agenda and assignments. Invited participants were divided into four workgroups:

• Psychological/behavioral therapies (cognitive behavioral therapies, mindfulness, meditation);
• Exercise/movement therapies (strength/resistance, yoga, tai chi, walking);
• Manual therapies (acupuncture, massage, chiropractic); and
• Models for delivering multi-modal pain care (i.e., collaborative care, telecare, stepped-care).

Following deliberations, workgroup leads presented a summary of their findings, which included a review of the major issues that were discussed, as well as draft policy and research recommendations.

A panel that included Carolyn Clancy, MD, VA Deputy Under Secretary for Health for Operational Excellence; Tu Anh Ngo, PhD, MPH, Pain Council Co-Chair and Opioid Safety Initiative Lead, VA New England Healthcare System; Eve Reider, PhD, Division of Extramural Research, NIH National Center for Complementary & Integrative Health; and Eric Schoomaker, MD, PhD, Uniformed Services University of Health Sciences, Department of Defense, reacted to the work group findings and was followed by open discussion with all SOTA participants. The SOTA ended with a discussion of next steps led by David Atkins, MD, MPH, VA's Acting Chief Research and Development Officer. Initially the SOTA planning committee, along with other group leads, will work to further refine the workgroup reports. Other activities may include a briefing to VHA Senior leadership on priority policy and research recommendations, identifying recommended measurement instruments and guidance for use, and developing manuscripts to be published in a special supplement to the Journal of General Internal Medicine.