AURORA, CO — Pain care practices at VHA facilities vary widely, possibly contributing to veterans’ likelihood of using opioids.

That’s according to a new study published in the Journal of General Internal Medicine, which looked at treatment options for military veterans with chronic pain. The study was conducted by researchers from the Colorado University School of Medicine, the VA Eastern Colorado Health Care System’s Center of Innovation for Veteran-Centered and Value Driven Care and the UC Colorado School of Medicine.1

The reviewed focused on care provided to 1.1 million veterans at 176 VHA medical centers between 2010 and 2015. While, at some VAMCs, as many as one-third of the veterans seeking care for chronic pain began long-term opioid therapy, only 5% were prescribed extended narcotics at the others.

“We found that there were not consistent practices between VHA facilities,” said senior author Joseph Frank, MD, MPH. “While there is a consensus that multiple approaches to care are important, there is a wide variation in availability of those options at some centers.”

Overall, 10 pain-related treatment options, including physical and occupational therapy, and nonopioid pain-relief medications were reviewed. The researchers determined that, when a facility had a wider range of treatment options, veterans were less likely to begin long-term opioid therapy. Yet, they also found that sites that offering more nonopioid medications eventually had higher rates of opioid use by veterans.

“This study is a first step in understanding the institutional cultures that may contribute to the use of opioids to treat chronic pain,” said Frank. “We need to continue our work to understand better ways to provide nonopioid treatments across diverse, real-world clinical settings. We’ll need the help of healthcare leaders and investments by healthcare systems to gather evidence on non-medication treatments. We’ll measure success in quality of life and in prevention of opioid-related harms.”

1Carey EP, Nolan C, Kerns RD, Ho PM, Frank JW. Association Between
Facility-Level Utilization of Non-pharmacologic Chronic Pain Treatment and Subsequent Initiation of Long-Term Opioid Therapy. J Gen Intern Med. 2018 May;33(Suppl 1):38-45. doi: 10.1007/s11606-018-4324-y. PubMed PMID: 29633137; PubMed Central PMCID: PMC5902343.