Participants in the whole-health program engaged more in nondrug and complementary and integrative health therapies such as yoga, physical therapy and acupuncture. Photo from the VA Tennessee Valley Healthcare System.
WASHINGTON, DC — A large, multisite randomized trial has delivered the first rigorous test of the VA’s Whole Health approach to chronic pain, finding that an interdisciplinary whole-health team modestly outperformed both cognitive behavioral therapy (CBT) and usual care in reducing how much pain interferes with veterans’ daily lives. That’s good news for the one in three veterans who combat chronic pain daily.
“We are so grateful for this rigorous evaluation, and the outcomes support further efforts in whole health implementation,” said Kavitha P. Reddy, MD, interim director of VA’s Office of Patient Centered Care and Cultural Transformation (OPCC-CT).
In the last decade, the VA has trained nearly 2000 staff members as whole-health coaches. Coaches work one on one and in groups to build personalized health plans based on veterans’ own goals and values, then help translate those goals into sustained behavior change. The program emphasizes health enhancement rather than simply treating disease.
The consistent coaching relationship and individualization distinguish the whole-health model from conventional pain management, which typically relies on medication or a fixed course of therapy regardless of a patient’s individual circumstances.
The Study
The wHOPE trial enrolled 764 veterans with chronic pain at six VA health systems between September 2020 and January 2024, with final follow-up completed in January 2025 and results published online in JAMA in April.1 It is the first randomized clinical trial to test the whole health model, which Congress mandated for veterans with chronic pain in 2016 but which had never been evaluated against standard treatments in a large study.
“The VA Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized clinical trials have tested its benefits,” wrote the wHOPE Study Group, led by Karen H. Seal, MD, MPH, chief of the integrative health service at the San Francisco VA Health Care System, in explaining the rationale for the trial.
The 764 participants, whose mean age was 60.5 years and who were 66.5% male, had experienced at least moderate chronic pain for six months or longer and received primary care through the VA. The researchers randomized participants in an 11:11:2 ratio, resulting in 343 veterans in the whole-health arm, 339 receiving cognitive behavioral therapy (CBT) for chronic pain and 82 receiving usual care for 12 months. All interventions were delivered virtually.
Click to Enlarge: The Veterans Affairs’ Whole Health Approach for Chronic Pain Management Source: JAMA Network
The whole-health team paired a primary physician or nurse practitioner with a second clinician providing nonpharmacological or integrative pain care and a health coach, who built individualized care plans with each veteran. The CBT arm consisted of seven group sessions focused on pain-management skills.
At 12 months, veterans in the whole-health group saw their mean Brief Pain Inventory interference scores, which range from 0 to 10, with higher scores indicating worse interference, drop from 6.55 to 4.91, while the CBT group mean score fell from 6.42 to 5.49 and the usual-care arm mean BPI declined 6.38 to 5.69 in usual care. The whole-health approach outperformed CBT by a mean difference of -0.58 points (97% CI, -1.11 to -0.05; P=0.02) and usual care by -0.77 points (99% CI, -1.40 to -0.15; P=0.002). CBT did not significantly outperform usual care (mean difference, -0.19; P=0.46).
“These results support use of the whole-health team approach to attain a statistically significant but small improvement in pain interference in VA patients with chronic pain,” the authors concluded.
In addition, participants in the whole-health program engaged more in nondrug and complementary and integrative health therapies such as yoga, physical therapy and acupuncture. In addition, the group reported a better overall perception of their pain over time, as measured by patient-reported global impression of change.
“VA patients’ and staff’s commitment to the study made it possible to generate meaningful evidence supporting whole health as a mind and body, patient-centered approach to pain care that really works,” Seal said.
None of the secondary outcomes differed significantly between the whole health and CBT groups or between CBT and usual care. Suicidal ideation, tracked as an adverse event, was reported in 15.9% of participants in the CBT group, 13.7% in the whole-health group and 13.4% in usual care.
In fact, the link between chronic pain and suicidality is a major driver of the VA’s efforts to effectively treat ongoing pain. The VA has previously noted that “people with moderate or severe pain are three times more likely to have suicidal ideation”2 and that among veterans it “is associated with PTSD and the interference of pain in daily activities and function.”3
Broader Evidence
The wHOPE results, published in JAMA, echo earlier, larger-scale VA data. A 2025 study in the Journal of Pain Research tracked 53,412 veterans with chronic pain across 18 Whole Health Flagship medical centers over 18 months.4 Among veterans who initiated whole-health services or complementary and integrative health therapies such as chiropractic care, acupuncture, massage, yoga and meditation, use of invasive pain procedures fell 42% at three months and remained 22% lower over the longer term. Veterans who used complementary and integrative therapies exclusively saw an 18% reduction in invasive procedures.
“Whole Health care, including [complementary and integrative health] therapies, may help patients interrupt patterns of escalating and invasive pain care and decrease costs,” the study’s authors wrote.
Part of a Larger Shift Away From Opioids
The whole-health model has also been credited with supporting VA’s broader retreat from opioid-centric pain management. The department has reduced the number of veterans with opioid prescriptions by 67% since 2012, from 874,897 to 288,820 in 2023, while veterans on high-dose opioids fell 81%, and those combining opioids with benzodiazepines dropped 90% over the same period.5 VA attributes much of that progress to its opioid safety initiative and its stepped care model for pain management, which layers foundational services, including nutrition, exercise, sleep and relaxation training, under the whole health umbrella.
The wHOPE researchers cautioned that their results may not generalize broadly. Participants were mostly white and male, reflecting the population at the six participating VA sites, and only a small percentage of eligible veterans enrolled. Clinicians and patients were not masked to treatment assignment, and outcomes varied somewhat by site. As a result, the authors called for further study in more diverse populations and settings.
Even so, the trial gives VA clinicians randomized evidence that an individualized, interdisciplinary approach offers a more effective alternative to standard pain-management options.
Reddy noted, “The wHOPE trial represents a remarkable step forward in research related to delivery of the whole health approach which seeks to empower and equip veterans to meet their health and well-being goals and live life to the fullest.”
- Seal KH, Morasco BJ, Martin AM, et al. The Veterans Affairs’ Whole Health Approach for Chronic Pain Management: The wHOPE Randomized Clinical Trial. JAMA. 2026;335(20):1774–1786. doi:10.1001/jama.2026.5006
- de Heer EW, Ten Have M, van Marwijk HWJ, et al. Pain as a risk factor for suicidal ideation. A population-based longitudinal cohort study. Gen Hosp Psychiatry. 2020 Mar-Apr;63:54-61. doi: 10.1016/j.genhosppsych.2018.11.005. Epub 2018 Nov 22. PMID: 30528078.
- Blakey, S. M., Wagner, H. R., Naylor, J., et al. 2018. Chronic pain, TBI, and PTSD in military veterans: A link to suicidal ideation and violent impulses? J Pain 2018 Jul;19(7):797-806. doi: 10.1016/j.jpain.2018.02.012. Epub 2018 Mar 8. PMID: 29526669; PMCID: PMC6026045.
- Zeliadt SB, DeFaccio R, Carey EP, et al. Longitudinal Utilization of Invasive Pain Treatment Procedures Among Veterans with Chronic Pain Following Use of Whole Health Services and Complementary and Integrative Health Therapies. J Pain Res. 2025 Feb 11;18:647-661. doi: 10.2147/JPR.S480718. PMID: 39958580; PMCID: PMC11829604.
- U.S. Department of Veterans Affairs. VA Reduces Opioids by 67% Since 2012. Press release, news.va.gov/press-room/va-reduces-opioids-by-67-since-2012/.
