Objective: Over the past decade, the Department of Veterans Affairs (VA) has experienced a sizeable shift in its approach to pain. The VA's 2009 Pain Management Directive introduced the Stepped Care Model, which emphasizes an interdisciplinary approach to pain management involving pain referrals and management from primary to specialty care providers. Additionally, the Opioid Safety Initiative and 2017 VA/Department of Defense (DoD) clinical guidelines on opioid prescribing set a new standard for reducing opioid use in the VA. These shifts in pain care have led to new pain management strategies that rely on multidisciplinary teams and nonpharmacologic pain treatments. The goal of this study was to examine how the cultural transformation of pain care has impacted providers, the degree to which VA providers are aware of pain care services at their facilities, and their perceptions of multidisciplinary care and collaboration across VA disciplines.
Methods: We conducted semistructured phone interviews with 39 VA clinicians in primary care, mental health, pharmacy, and physical therapy/rehabilitation at eight Veterans Integrated Service Network medical centers in New England.
Results: We identified four major themes concerning interdisciplinary pain management approaches: 1) the culture of VA pain care has changed dramatically, with a greater focus on nonpharmacologic approaches to pain, though many "old school" providers continue to prefer medication options; 2) most facilities in this sample have no clear roadmap about which pain treatment pathway to follow, with many providers unaware of what treatment to recommend when; 3) despite multiple options for pain treatment, VA multidisciplinary teams generally work together to ensure that veterans receive coordinated pain care; and 4) veteran preferences for care may not align with existing pain care pathways.
Conclusions: The VA has shifted its practices regarding pain management, with a greater emphasis on nonpharmacologic pain options. The proliferation of nonpharmacologic pain management strategies requires stakeholders to know how to choose among alternative treatments.
Keywords: Interdisciplinary Pain Care; Pain Management; Veterans.
2019 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.
Evidence Brief: The Quality of Care Provided by Advanced Practice Nurses.2014 Sep. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011–. VA Evidence Synthesis Program Evidence Briefs. 2011–. PMID: 27606392 Free Books & Documents. Review.
Evidence Brief: Effectiveness of Intensive Primary Care Programs.2013 Feb. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011–. VA Evidence Synthesis Program Evidence Briefs. 2011–. PMID: 27606397 Free Books & Documents. Review.
Evidence Brief: Comparative Effectiveness of Appointment Recall Reminder Procedures for Follow-up Appointments.2015 Jul. In: VA Evidence Synthesis Program Evidence Briefs [Internet]. Washington (DC): Department of Veterans Affairs (US); 2011–. VA Evidence Synthesis Program Evidence Briefs. 2011–. PMID: 27606388 Free Books & Documents. Review.
Project STEP: Implementing the Veterans Health Administration's Stepped Care Model of Pain Management.Pain Med. 2018 Sep 1;19(suppl_1):S30-S37. doi: 10.1093/pm/pny094. Pain Med. 2018. PMID: 30203015
Women Veterans' Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care.Womens Health Issues. 2020 Mar-Apr;30(2):113-119. doi: 10.1016/j.whi.2019.10.003. Epub 2019 Nov 14. Womens Health Issues. 2020. PMID: 31735581