Pain Medicine Supplement Features Articles by VA Researchers

BACKGROUND:
Chronic pain is reported by more than one-third of Veterans in VA care. This and other factors have made VA a fertile ground for pain research, including a national Opioid Safety Initiative (OSI) that has reduced overall opioid use. This Pain Medicine Supplement highlights health services research conducted by HSR&D investigators at the Pain Research, Informatics, Multimorbidities and Education (PRIME) Center of Innovation in West Haven, CT, as well as other pain researchers. Serving as the only federally funded national pain center, PRIME played a leadership role in the HSR&D-sponsored state-of-the-art conference "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management. The PRIME Center's strategic goals were adapted from the National Institutes of Health Federal Pain Research Strategy (FPRS) – a strategic plan designed to advance research in pain and pain management. Investigators in this Supplement focused on four FPRS goals: 1) Define the Epidemiology of Pain; 2) Develop, Evaluate, and Improve Pain Management; 3) Determine the Relationship between Pain and Common Comorbidities, and 4) Determine Optimal Self-Management Strategies for Chronic Pain.

Articles in this Supplement include, but are not limited to:

• Lynch and colleagues used data from the Women Veterans' Cohort Study to examine the impact of cigarette smoking on pain intensity among Veterans with and without the hepatitis C virus (HCV). They found that while the association between pain and smoking was significant and positive for Veterans with and without an HCV diagnosis, the association was significantly higher for patients with an HCV diagnosis than without.
• Oldfield and colleagues assessed the impact of a novel clinical program – the Opioid Reassessment Clinic (ORC) – that was designed to address the unsafe use of opioid prescribing for pain. Results suggest the ORC is effective in reducing total prescribed opioid doses – and in transitioning patients to partial-agonist therapy.
• Charokopos and colleagues conducted a systematic review of the literature to assess whether obstructive sleep apnea (OSA) is a risk factor for subjective pain intensity and experimental pain tolerance. Whereas several studies found a positive association between OSA and higher pain intensity and lower tolerance, there was considerable variability among outcomes. Several studies also reported that receipt of continuous positive airway pressure (CPAP) reduced pain intensity.
• Higgins and colleagues examined predictors of enrollment in a trial of in-person vs. technology-based cognitive behavioral therapy (CBT) for patients with chronic low back pain. Patients not receiving opioids were more likely to enroll, perhaps reflecting a preference for non-pharmacological approaches. Identifying predictors of enrollment in CBT may help increase recruitment efficiency and assist in targeting patients who may benefit but are not currently interested in treatment.

The range of articles in this supplement highlights the contributions a coordinated research strategy can make to address important knowledge gaps and clinical and policy priorities. With the goal of accelerating implementation of evidence-based care for pain, researchers should continue to engage in effective partnerships within VA to ensure that research continues to positively impact patient care.

Pain Medicine. September 2018;19(Suppl 1).