“Things Just Need to be More Personal”: Veterans VOICE Their Preferences for Pain Management

Veterans’ Perspectives highlights research conducted by HSR and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the January - February 2026 Issue:

• Introduction: As the Veterans’ Pain Care Organizational Improvement Comparative Effectiveness (VOICE) clinical trial collected data to compare two pain management interventions, HSR investigators also sought a better understanding of what Veterans valued in their pain care.
• The Interviews: HSR investigators conducted qualitative, semi-structured interviews with Veteran patients who participated in the VOICE interventions, seeking information about their experience and suggestions for improvement.
• Findings: The interviews revealed key determinants of Veterans’ satisfaction with their pain care. These factors were common to both VOICE interventions.
• The Role of Telehealth: During the COVID-19 pandemic, VOICE investigators conducted supplemental interviews to gain insights into Veteran patients’ experiences with virtual pain care.
• Implications: These Veteran priorities and suggestions may inform the design, implementation, and refinement of pain management interventions throughout VA and other healthcare systems.

Introduction

About 30 percent of Veterans suffer from chronic pain, placing them at high risk for pain-related disability, medication overdose, and opioid-related death. As a growing body of research reveals the limited benefits and potential harms of long-term opioid therapy, VA has recognized a need to develop innovative, multimodal approaches to chronic pain care that can be widely implemented and integrated into primary care.

The Veterans’ Pain Care Organizational Improvement Comparative Effectiveness (VOICE) study, conducted in VA primary care clinics from 2017 to 2022, compared two promising care models for improving pain and reducing opioid use in VA primary care: the integrated pain team (IPT), a holistic approach that addressed the physical, psychological, and social aspects of pain, and the pharmacist collaborative management (PCM) intervention, in which a clinical pharmacist, in consultation with a physician, worked directly with the patient to optimize their medication regimen. Both models involved clinicians working directly with patients, and both featured a key difference from traditional pain care: they did not require up-front commitments from Veteran participants to reduce their opioid dosages.

Between these two groups, outcomes in the VOICE randomized clinical trial did not significantly differ; both interventions resulted in modest improvements in pain and substantially lower opioid dosage.

Because research indicates both patients and clinicians find chronic pain care challenging and frustrating, the VOICE trial had another purpose: to examine patients’ experiences with the VOICE study interventions in search of insights that may inform the design and implementation of effective chronic pain interventions. 

The Interviews

Concurrent with the VOICE study, a team of investigators from two HSR Centers of Innovation (COINs)— the Center for Care Delivery and Outcomes Research (CCDOR) at the Minneapolis VA and the Center for Data to Discovery and Delivery Innovation (3DI) at the San Francisco VA —conducted two sets of qualitative, semi-structured interviews with a total of 63 Veterans who participated in the VOICE interventions. The first interview set examined Veterans’ experiences and solicited suggestions for improvements to the interventions. The second, devised and conducted during the COVID-19 pandemic, examined Veterans’ experiences with telehealth in VOICE and asked about the pandemic’s effect on their access to pain treatments.

After the interviews were completed, HSR investigators analyzed responses to identify themes across both sets.

Findings

Veterans enrolled in both VOICE interventions described how they learned to better live with and self-manage pain. Across interventions, four key factors facilitated a positive patient experience:

1. Meaningful involvement in care planning, decision making, and goal setting. Veterans wanted to be engaged in their care in a meaningful way, with their concerns and preferences heard and respected. They wanted to have choices in their care. The study found that meaningful engagement empowered patients to take ownership of their health by using self-management tools and strategies:
   
   

   It's almost like they catered to me. They made sure I was able to do everything, and made sure I felt good... Everything was always left up to me... They never forced anything... They'd ask me.

   I think it helped me speak out when there's something that I'm not comfortable with or not too crazy about, usually I don't want to try to step on the doctor's toes, and you know, I want to be open, but I think now... it helped me express when there's something I have a lot of questions about or that I'm uncomfortable with, that I voice those concerns.

2. An opportunity to develop a long-term, therapeutic relationship with a clinician or care team. Veteran patients valued a clinical relationship characterized by warmth, empathy, and genuine concern, as well as ongoing, focused, personalized attention and continuity from the same clinicians over the 12-month period:
   
   

   The communication part got really good after we got to know each other and settled in, and they knew my case better.

   It seemed like she genuinely cared about how I was going to feel, and how life is going to be going forward. I kind of put my doubts away. And [I] really got into what they recommended and what they wanted me to do.

3. An adequate variety and accessibility of options for treatment and self-management. Veteran patients valued access to a variety of both pharmacological and non-pharmacological treatments, and it was important that the recommended options such as acupuncture, chiropractic care, and exercise therapy be easy to access. Veterans appreciated having multiple treatment options and individualized care plans. Access challenges, particularly during the COVID-19 pandemic, created frustration when patients couldn’t follow through on recommended services:
   
   

   Acupuncture was working real good.... the doctor was trying to get me in every two weeks. But because of the long wait lines at the VA at the time I could get in every six weeks, which he says is counter-productive because, you know, I needed it more frequently than that.

Some less satisfied Veterans felt their care focused too much on opioid reduction, rather than on comprehensive pain management:

[The care]…could've been more in depth instead of just... oh, we're going to take your meds.

4. Responsive communication and care coordination support. This included easy access to clinicians, clear points of contact, and active assistance with referrals and care navigation. Veterans appreciated accessible and responsive clinicians, having a single point of contact, and active support with care coordination, including help with referrals and navigating the healthcare system:
   
   

   It's just helpful to know that somebody is going to call and immediately react to your concerns.

    [I can] not say enough about how helpful [it was] having that knowledge that somebody that can do something is going to be calling.

The Role of Telehealth

During the pandemic, the study evaluated Veterans’ experiences with telehealth. Veterans found it to be more convenient than in-person visits, but also felt some issues required an office visit. Most preferred a mix of in-person, video, and phone options—but found that the mode of delivery was less important than the quality of communication and the strength and durability of the clinician-patient relationship.

• I think things just need to be more personal, regardless of if it's video... Even if it is a video conference, it's best I think if you have some continuity... with the same physician over the course of some time.

• I think maybe getting the opportunity to meet the individual that you'll be working with is always, in my mind, helpful because I know who I'm working with. The remainder of [visits] being over the phone would be fine.

Implications

Despite significant differences between IPT and PCM interventions, these fundamental factors affecting satisfaction were common to both approaches. The findings suggest that, as VA and other health systems design and implement pain care interventions, these factors should be key priorities: building strong patient-clinician relationships, fostering shared decision-making, ensuring access to a variety of treatment options, and providing responsive communication and care coordination.

Publications

Purcell N, DeRonne BM, Salameh HA, et al. What Makes for a Positive Patient Experience in Chronic Pain Care? A Qualitative Evaluation of Factors Affecting Veteran Patient Satisfaction Across Two Individualized Pain Care Interventions in VA Primary Care. Journal of General Internal Medicine. May 27, 2025; online ahead of print.

Hagedorn HJ, Purcell N, DeRonne BM, et al. Incorporating Patient and Provider Voices into the Veterans Pain Care Organizational Improvement Comparative Effectiveness Study: Informing Future Implementation. Journal of General Internal Medicine. June 6, 2025; online ahead of print.

Krebs EE, Becker WC, Nelson DB, et al. Care Models to Improve Pain and Reduce Opioids Among Patients Prescribed Long-Term Opioid Therapy: The VOICE Randomized Clinical Trial. JAMA Internal Medicine. December 9, 2024;185(2):208-220.

Natalie Purcell, PhD, MPA, is Qualitative Core Director at HSR’s Center for Data to Discovery and Delivery Innovation (3DI), Whole Health Program Director at the San Francisco VA Health Care System, and an associate professor of social and behavioral sciences at the University of California, San Francisco.

Hildi J. Hagedorn, PhD, is a core investigator with HSR’s Center for Care Delivery and Outcomes Research (CCDOR), a professor in the department of psychiatry at the University of Minnesota, and an implementation scientist with the VA Center for Excellence in Substance Addiction Treatment & Education (CESATE).

Beth DeRonne, PharmD, is a core investigator with HSR’s CCDOR and a pharmacist with the Minneapolis VA Health Care System.

Erin Krebs, MD, is a core investigator with HSR’s CCDOR, Chief of General Internal Medicine at the Minneapolis VA Health Care System, and a professor of medicine at the University of Minnesota Medical School.

Karen H. Seal, MD, MPH, is a core investigator with at HSR’s Center for Data to Discovery and Delivery Innovation (3DI), Chief of Integrative Health at the San Francisco VA Health Care System, and a professor of medicine and psychiatry at the University of California, San Francisco.

William C. Becker, MD, is the Director of the Opioid Reassessment Clinic at the VA Connecticut Healthcare System and a professor of internal medicine at Yale University.

Hope Salameh, MPH, is a Clinical Research Coordinator with HSR’s Center for Care Delivery and Outcomes Research (CCDOR).

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The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.