Research on pain and pain management in Veterans Health Administration: Promoting improved pain care for veterans through science and scholarship

Abstract

In late 1998, the Veterans Health Administration (VHA), one of the largest healthcare delivery systems in the United States, enacted its National Pain Management Strategy designed to provide a systemwide standard of care to reduce suffering from preventable pain. This overarching goal of the Strategy has elevated pain management to a top priority within the VHA and sparked innovation in planning and providing high-quality pain care to the >54 million veterans receiving healthcare at its facilities nationwide. An explicit component of the Strategy is a focus on pain-relevant research. As evidence of the success of the Strategy in this regard, the number of pain-relevant investigator-initiated research projects that the VHA Office of Research and Development (ORD) has funded increased from about 10 in fiscal year 2000 to 47 in the most recent fiscal year. For further promotion of networking among investigators, increased investigator-initiated and collaborative research, and VHA research priorities, a Pain Research Working Group has been developed. At present, membership in this group consists of over 50 Department of Veterans Affairs (VA) and non-VA investigators. Face-to-face meetings and semimonthly conference calls among members have led to the development of several more focused groups of investigators who share interests in research on specific targeted areas. Cluster groups have currently developed in the areas of diversity; assessment of pain in persons with cognitive impairments; pain and psychiatric comorbidities; pain and polytrauma; and pain, opioid therapy, and substance abuse. Each of these groups has already developed specific projects such as conducting systematic reviews of the relevant theoretical, clinical, and empirical literatures and developing a research agenda. Publication of this special issue of the Journal of Rehabilitation Research and Development was identified as an important outlet for dissemination of the findings and recommendations of these pain research cluster groups. Articles in this special issue focus on a broad range of VA investigative research. The multiple disciplines and perspectives of the contributors reflect the multidisciplinary and multidimensional nature of the field of pain management. The contributions include several scholarly reviews of particularly timely and important topics for the VHA. These reviews and conceptual articles are complemented by several original research reports that promise to significantly contribute to the existing evidence in key areas of investigation that are also particularly relevant to veteran care. Also important to note is that this special issue focuses on clinical or applied research with relatively direct implications for enhancing pain care. As my colleagues, Christine Elnitsky and Martha Bryan, and I emphasize in the accompanying guest editorial, basic laboratory science research represents an important and growing component of the VHA ORD pain-relevant research portfolio. A quick scan of the issues' contributions reveals several interesting observations that may help clarify some of the central clinical issues confronting the field of pain management. Of particular note is the apparent focus on pain and psychiatric and medical comorbidities. Articles by Matthew Bair, Jillian Shipherd, Cheryl Villano, and their colleagues focus on depression and posttraumatic stress disorder (PTSD) as particularly high-frequency psychiatric comorbidities that have drawn considerable attention among both VA and non-VA investigators. These investigators are interested in understanding not only the epidemiology of these disorders but possible mechanisms that may account for their apparent coprevalence. Of particular note, Shipherd and her colleagues provided some of the first evidence, albeit from retrospective chart review, to suggest that PTSD treatment may positively affect pain severity. Three additional articles report on medical comorbidities that are also particularly relevant to veteran care. …