September 2021

In This Issue: Helping Veterans Cope with and Conquer Pain
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Overview: Helping Veterans Cope with and Conquer Pain

In 2019, 20% of adults in the United States had chronic pain and 7% of adults had chronic pain that frequently limited their life or work, referred to as “high-impact pain.” A National Health Interview Survey also showed that both chronic pain and high-impact pain increased with age and were higher among women than men – and highest among adults ages 65 and older.¹ Joint and back pain and other musculoskeletal ailments are the most common diagnoses among Iraq and Afghanistan Veterans. In a 2017 report by the National Institutes of Health (NIH), 66% of American Veterans reported having pain in the three months before they were surveyed, with 9% classified as having severe pain. Severe pain was 40% greater in Veterans than non-Veterans, especially among those who served in recent conflicts.²

HSR&D’s Pain/Opioid CORE (COnsortia of REsearch) works to foster high-quality, high-impact, and Veteran-centered research focused on improving care for and reducing opioid harms. Pain management interventions and care delivery, including studies of VA practice and policy initiatives, as well as pain care delivery approaches, are a key theme of the CORE. As with all HSR&D COREs, leadership (Alicia Heapy, PhD, William Becker, MD, and Erin Krebs, MD, MPH) works to conduct a portfolio review of current and past HSR&D studies, as well as NIH, Department of Defense, and PCORI studies. Operations partners include VA’s National Pain Management Program Office, Integrative Health Coordinating Center (IHCC), Specialty Care Services, and National Mental Health Program.

HSR&D also contributes to VA’s efforts to ease pain and its burden among Veterans by supporting several centers that focus on pain research:

• HSR&D’s Pain, Research, Informatics, Medical Comorbidities, and Education (PRIME) Center conducts research to improve pain care and sponsors education activities for Veterans and clinical staff.
• HSR&D’s Center for Care Delivery and Outcomes Research (CCDOR) develops and evaluates interventions and implementation strategies that improve healthcare delivery, Veteran engagement in healthcare, and Veterans’ health and functioning in their communities, with a particular focus on trauma recovery, chronic pain, and reducing the harm from opioids. 

Further, chronic pain has been linked to dependence on opioids. The prevalence and severity of chronic pain is higher in Veterans, and Veterans are more likely to experience opioid overdose. In partnership with multi-level stakeholders, VA/HSR&D’s Quality Enhancement Research Initiative (QUERI) deploys and evaluates implementation and quality improvement strategies to expand evidence-based pain care and treat opioid use disorders in Veterans; for example:

• The Consortium to Disseminate and Understand Implementation of Opioid Use Disorder (OUD) Treatment (CONDUIT) QUERI works with several operations partners (i.e., VA Pharmacy Benefits Management) to support providers at more than 50 VA sites in facilitating Veterans’ access to effective treatments for OUD and chronic pain across diverse settings through the use of telehealth technology and referral to specialty services.
• TelePain Evaluation, Metrics & Pain Outcomes (TEMPO) QUERI works with VA’s National Pain Management, Opioid Safety, and Prescription Drug Monitoring Program Office to evaluate the clinical impact and costs of implementing virtual interdisciplinary pain teams (TelePain) enterprise-wide that deliver evidence-based pain care.

In addition to these centers, HSR&D currently supports a wide variety of pain research on topics that range from Virtual Pain Care for High-Risk Veterans on Opioids during COVID-19 (and Beyond) to Improving Outcomes for Older Veterans with Chronic Back Pain and Depression to Improving Pain and Sleep Outcomes for Veterans with Chronic Pain, to name a few. See below for more about specific HSR&D studies on pain.

1. Zelaya C, et al. Chronic pain and high-impact pain among U.S. adults, 2019. NCHS Data Brief (No. 390), November 2020. National Center for Health Statistics. Centers for Disease Control and Prevention.
2. Pain Management. VA Office of Research & Development. July 19, 2021.