Finding a Better Way to Treat Chronic Pain in Veterans

A new study finds that an interdisciplinary, individualized approach to pain management, including coaching support and health goal planning, may reduce the impact of chronic pain on veterans. The findings were published in the journal JAMA.

Chronic pain, defined as pain lasting more than three months, affects up to 40% of veterans—about twice the rate seen in the general population, says William Becker, MD, professor of medicine (general internal medicine) at Yale School of Medicine. It can result from injuries sustained in combat and can be compounded by mental health issues, such as post-traumatic stress disorder.

For the past two decades, the U.S. Department of Veterans Affairs (VA) has prioritized improving chronic pain management for veterans, according to Becker. “The VA was one of the first health systems to realize that treating chronic pain with opioids doesn’t work well and that unmanaged pain contributes to addiction,” he says. “So in 2016, they established nonpharmacological treatment at all VA centers through a whole health team intervention that provided integrative therapies.”

To evaluate this holistic approach, Becker, in collaboration with Karen Seal, MD, of the University of California, San Francisco, and colleagues, conducted the first randomized trial to test its effectiveness against other models of care.

For the study, the researchers assigned 764 VA patients with chronic pain to one of three groups: a whole health team intervention, cognitive behavioral therapy in a group setting, or usual care. The whole health team, which included a wellness coach and a clinician trained in integrative therapies, considered each patient's personal values and life goals.

The researchers found that after 12 months, the whole health model led to a significant improvement in pain interference—the extent to which pain disrupts a person’s ability to function—compared with cognitive behavioral therapy or usual care.

“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 says.

Becker adds that the research highlights the importance of not defaulting to medication.

“Let's start expanding access to these nonmedication treatments because they work, make people feel good, and they don't have many side effects or harms,” he says. “Our study supports the VA’s investment in this whole health model of care and shows that providing people with an array of tools is better than our standard treatment.”