In 1998, former Under Secretary for Health, Kenneth Kizer, launched the Department of Veterans Affairs (VA) National Pain Management Strategy to provide a system-wide standard of care to reduce suffering from pain. Among the several goals of this initiative is an explicit emphasis on promoting pain-relevant research. Since inception of this initiative , Congress has called upon VA to strengthen its commitment to pain research and requires annual reporting on its pain research program.
Two provisions of the 2010 Patient Protection and Affordable Care Act called on the Secretary of Health and Human Services to enter into an agreement with the Institute of Medicine "to increase the recognition of pain as a significant public health problem in the United States" and to conduct a thorough review of the current federally funded pain research portfolio to identify gaps and eliminate redundanciesIn response, the IOM published, "Relieving Pain in America: A Blueprint for Transforming Pain Prevention, Care, Education, and Research" in 2012. The report called upon VA to join with other agencies to transform the care of persons with pain, by educating and training providers and consumers of pain management services, improving its collection and use of data , and conducting additional pain research to address key gaps. Among its recommendations for research, the report encourages increased support for interdisciplinary research, longitudinal research, and training of pain researchers. The report emphasizes the development of strategies to minimize disparities in pain care, and identifies Veterans as one of several vulnerable groups. The VA provides a unique laboratory to conduct effectiveness and implementation research required for this transformation.
Also in response to Congress, a Federal Interagency Pain Research Coordinating Committee (IPRCC) recently completed a comprehensive analysis of all research projects that were federally funded in fiscal year 2011. The results have been posted on the IPRCC public website: http://iprcc.nih.gov/news/IPRCC-Pain-Research-Portfolio-Analysis-Report.htm. This analysis shows that VA funding accounts for 5.8% of the total federal pain research portfolio (NIH is by far the largest funder of pain research). Gaps across all government agencies were highlighted including: treatment screening tools, novel therapies, process and outcome measurement, population level assessment of quality of care and access (including addressing disparities), and research focusing on overlapping conditions, especially trauma, headache, and neuropathic pain.
There is a strong and growing commitment to funding pain research through the intramural research program of VA's Office of Research and Development (ORD). The VA pain research portfolio has increased each year in terms of number of projects funded and total dollars spent. In Fiscal Year 2014, ORD invested $22 million in support of 89 investigator-initiated research projects and career development awards for early career investigators focused on pain. All four branches of ORD, Basic Laboratory, Clinical, Rehabilitation, and Health Services Research and Development, support awards relevant to pain, including treatment, diagnosis, adverse events, basic mechanisms, etiology, health services and population research areas.
In FY 2014, VA Health Services Research and Development (HSRandD) Service funded a new Center of Innovation (COIN) at the VA Connecticut Healthcare System, called the Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center. PRIME's mission is to study the complex interactions between pain and associated chronic illness and behavioral health factors to develop and implement effective interventions that can reduce pain and suffering by employing principles of medical informatics, health services research, and behavioral science. A key objective is to enhance local and national capacities for a broad research and education agenda that focuses on pain and pain management and provide explicit support for the National Pain Management Strategy. Specific areas of health services research include:
1.studying how best to promote access, continuity, and sustainability of safe and effective interventions for pain and pain-related disability across the spectrum of acute, chronic non-cancer, and cancer related pain, pain in the context of palliative care, and prevention of development of chronic pain;
2.exploring how to increase the extent to which patient risks, preferences, and priorities are incorporated in pain treatment;
3.reducing ethnic/racial, geographic, gender related, and age-related disparities in access and delivery of effective pain care; and
4.examining how to promote organizational change that can increase health related quality of life and reduce symptom burden for Veterans with pain and comorbid chronic disease.
At the core of the PRIME Center is another initiative, Collaborative Research to
Enhance and Advance Transformational Excellence (CREATE), designed to promote partnered-research focusing on areas of particular importance to VHA. A pain management CREATE titled, "Enhancing Patient Aligned Care Team Delivered Pain Management" addresses gaps in pain care in the primary care setting, particularly the need for better data on musculoskeletal pain and care, concerns about the existing VHA approach to screening for the presence and intensity of pain, safe prescribing of opioids, and promotion of pain self-management.
The VA/Department of Defense Health Executive Committee Pain Management Work Group also continues to focus on enhancing pain research. Among its objectives is to strengthen interagency research partnerships and collaborations, specifically those that may improve transitions for military service members with pain who seek care within VHA. Several initiatives, including the development of a universal approach to pain assessment using the NIH sponsored PROMIS measures, further testing of the related Defense and Veterans Pain Rating Scale, the Regional Anesthesia Military Battlefield Pain Outcomes Study and related studies of combat injured, and the evaluation of quality improvement initiatives such as the Joint Pain Education Program and Tiered Acupuncture Training Project, remain a priority.
Lastly, in 2013, VHA named a National Advisor for Pain Research to create synergy between pain research, policy, and practice initiatives. Supporting this effort is a national Pain Research Working Group (PRWG), comprised of over 75 scientists and scholars.This group advances VA's pain research agenda and promotes its impact. The group has published special topic issues in leading scientific journals including the Journal of Rehabilitation Research and Development, Pain Medicine, Translational Behavioral Medicine, and Clinical Journal of Pain that highlight some of the important contributions of PRWG members. A monthly "Spotlight on Pain Management" webinar series offered through a partnership among the Pain Management Program Office, the PRIME Center, and HSRandD's Center for Information Dissemination and Educational Resources (CIDER) supports the shared interests of VA's research, practice, and policy communities in advancing the National Pain Management Strategy.