VA Ahead of Schedule in Improving Chronic Pain Care

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By Annette M. Boyle

PHILADELPHIA — While VHA must face the challenge of meeting the needs both of aging veterans and recently deployed servicemembers returning from Afghanistan and Iraq, the two groups have at least one problem in common: a high incidence of chronic pain.

In fact, chronic pain plagues more than 50% of all veterans served by the VA. Among incoming veterans to the VHA, 56% report chronic musculoskeletal discomfort.

Rollin “Mac” Gallagher, MD, MPH, deputy national program director for Pain management, VA Central Office, and co-chair, VA-DoD Health Executive Council Pain Management Work Group

That makes pain management “a huge clinical issue for the VA,” according to Rollin “Mac” Gallagher, MD, MPH, deputy national program director for Pain Management, VA Central Office, and co-chair, VA-DoD Health Executive Council Pain Management Work Group.

“One of the biggest challenges is that, as last year’s Institute of Medicine (IOM) report on pain said over and over again, very clearly, our workforce is generally not well-trained in pain medicine — not just at the VA and DoD, but everywhere,” Gallagher told US Medicine.

More than 100 million Americans experience chronic pain, excluding children and patients in nursing homes, chronic-care facilities, prisons and the military, according to the IOM report “Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research.”

“Given the prevalence of chronic pain, it is not realistic or desirable to relegate pain management to pain specialists alone. There are fewer than 4,000 such specialists in the U.S., with limited geographic coverage. Ideally, primary-care physicians would coordinate pain management, but such a change cannot be achieved without significant improvements in education and training,” said Philip Pizzo, MD, chair of the IOM committee that wrote the report in a presentation earlier this year to the U.S. Senate Committee on Health, Education, Labor & Pensions.

A year after the report’s release and well ahead of the suggested schedule, the VA and DoD have implemented many of its recommendations. These include:

  • Creating a comprehensive, population-level strategy for pain prevention, treatment, management and research;
  • Reducing barriers to the care of pain;
  • Supporting collaboration between pain specialists and primary-care clinicians;
  • Enhancing patient education and self-management; and
  • Expanding pain education and training opportunities for health professionals.

Two other goals addressed the collection and reporting of data on pain and facilitating research.

“The VA has the only electronic medical record that covers a very, very large population and is available for investigators to use for research and to make policy decisions that move the field forward,” Gallagher said. “In addition, the VA has built an infrastructure for health systems research that no one else has in the country, the Health Services Research & Development group.”

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