Volume 53 Number 1, 2016
Pages xvii — xx
Pain research using Veterans Health Administration electronic and administrative data sources
Erica A. Abel, PhD, et al.
Pain researchers may use electronic health records
and other Veterans Health Administration (VHA) data
sources to examine the prevalence, treatment, effect,
and outcomes of pain and pain management in Veterans.
This article presents the results of a survey of pain
researchers. We asked about their experiences with,
opinions about, confidence in, and perceived barriers
to using VHA data sources. Most of those surveyed reported
using VHA data sources. Less than half thought
the sources were adequate for pain research. Despite
some challenges, pain researchers are using VHA data
sources to improve healthcare services for Veterans
with pain.
http://dx.doi.org/10.1682/JRRD.2014.10.0246
Association between pain outcomes and race and opioid treatment: Retrospective cohort study of Veterans
Diana J. Burgess, PhD, et al.
Previously, we found rates of opioid prescriptions
to be lower among black versus white Department of
Veterans Affairs primary care patients with a diagnosis
of chronic noncancer pain. In this study, we found
that these racial differences in opioid prescription
were not associated with poorer pain outcomes for
black patients; receipt of an opioid prescription was
generally not associated with perceptions of treatment
effectiveness and was associated with greater
pain interference for both white and black Veterans.
Findings raise questions about the benefits of opioids
for chronic pain, in light of the risks, and point to the
need for alternative treatment approaches.
http://dx.doi.org/10.1682/JRRD.2014.10.0252
Correlates of prescription opioid therapy in Veterans with chronic pain and history of substance use disorder
Travis I. Lovejoy, PhD, MPH, et al.
This study characterized opioid prescription in
a sample of Veterans Health Administration patients
with chronic pain and lifetime substance use disorder
histories. Participants prescribed long-term opioid
therapy had a greater number of pain diagnoses and
endorsed poorer pain-related function than those not
prescribed opioid therapy or those prescribed shortterm
opioid therapy. Findings highlight the poor
pain-related functioning in patients with history of
substance use disorder who are prescribed long-term
opioid therapy.
http://dx.doi.org/10.1682/JRRD.2014.10.0230
Does comorbid chronic pain affect posttraumatic stress disorder diagnosis and treatment? Outcomes of posttraumatic stress disorder screening in Department of Veterans Affairs primary care
Samantha D. Outcalt, PhD, et al.
Department of Veterans Affairs primary care
clinics routinely perform screening tests for posttraumatic
stress disorder (PTSD). It is important to
understand what happens after a Veteran screens positive
for PTSD in primary care. This study examined
how comorbid chronic pain could affect this process.
We examined 4,244 primary care patients with a positive
PTSD screen and compared outcomes based on
whether they also had a pain diagnosis. We found
that patients with coexisting pain had a slightly lower
rate of mental health visits than those without pain.
There were no differences in rates of PTSD diagnosis
or new antidepressant medication prescription.
http://dx.doi.org/10.1682/JRRD.2014.10.0237
Fibromyalgia syndrome care of Iraq- and Afghanistan-deployed Veterans in Veterans Health Administration
April F. Mohanty, MPH, PhD, et al.
Among Iraq- and Afghanistan-deployed Veterans,
1 percent were diagnosed with fibromyalgia syndrome.
Most had combined care (defined as regular
primary care combined with mental health and/or
rheumatology specialty care visits), which can be important
for expert management of fibromyalgia syndrome
and common comorbidities. Combined care is
a recommended practice, but in our sample, it was associated
with greater likelihood of prescription of opioid
medications, which is not a recommended treatment
for fibromyalgia syndrome. Combined care was
also associated with greater likelihood of prescription
of nonopioid pain medications. These results indicate
possible benefits of combined care but also reflect the
probable greater complexity of Veterans receiving
combined care.
http://dx.doi.org/10.1682/JRRD.2014.10.0265
Iraq and Afghanistan Veterans report symptoms consistent with chronic multisymptom illness one year after deployment
Lisa M. McAndrew, PhD, et al.
We used data from a prospective longitudinal
study of Operation Iraqi Freedom/Operation Enduring
Freedom (OIF/OEF) Veterans to determine the
frequency of symptoms consistent with chronic multisymptom
illness (CMI). CMI is characterized by
multiple chronic symptoms. We found that 1 yr postdeployment,
49.5 percent of OIF/OEF Veterans met
criteria for mild to moderate CMI and 10.8 percent
met criteria for severe CMI. Veterans with symptoms
consistent with CMI reported significantly worse
physical health function than Veterans who did not
report symptoms consistent with CMI. This study
suggests that the presence of CMI should be considered
in the evaluation of OIF/OEF Veterans.
http://dx.doi.org/10.1682/JRRD.2014.10.0255
Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans
Diana M. Higgins, PhD, et al.
Chronic pain and overweight/obesity occur at
particularly high rates among Veterans in Veterans
Health Administration care. To better understand the
overlap of these conditions and the effect of additional
medical and mental health conditions on these
co-occurring conditions, we examined rates of back
pain and arthritis among a national sample of Veterans
with overweight/obesity. A majority of these
Veterans (72%) reported back and/or arthritis pain.
Women Veterans were more likely to report arthritis
and combined back pain and arthritis. Veterans who
reported pain were more likely to report additional
health conditions, which may make treating cooccurring
overweight/obesity and chronic pain more
challenging.
http://dx.doi.org/10.1682/JRRD.2014.10.0251
Sex differences between Veterans participating in interdisciplinary chronic pain rehabilitation
Jennifer L. Murphy, PhD, et al.
The purpose of this research study was to see
whether differences existed between male and female
Veterans who took part in a residential treatment
program for chronic pain. We looked at differences
in how they changed during and after the
program. The results indicate that some differences
existed in the men and women who participated in
the treatment and in how they benefitted. Since the
number of women using the Department of Veterans
Affairs for their healthcare is rising, this research
helps to understand who may choose to participate
in programs for chronic pain and how to adjust their
pain treatment.
http://dx.doi.org/10.1682/JRRD.2014.10.0250
Potential neurobiological benefits of exercise in chronic pain and posttraumatic stress disorder: Pilot study
Erica Scioli-Salter, PhD, et al.
Individuals with both chronic pain and posttraumatic
stress disorder (PTSD) may experience greater
pain, distress, and disability than if they have either
condition alone. Research indicates that individuals
with pain and/or PTSD may have abnormally low
levels of the antistress, antinociceptive hormones
neuropeptide Y (NPY) and allopregnanolone and
pregnanolone (together termed ALLO) and that exercise
may help to increase these levels. This study
investigated how cortisol, dehydroepiandrosterone,
NPY, and ALLO respond to a maximum load exercise
stress test in relation to pain sensitivity in a
group of trauma-exposed men and women with and
without PTSD and chronic pain. Both NPY and
ALLO levels correlated with cardiorespiratory fitness,
as well as with pain threshold and tolerance,
respectively. The findings suggest that improving fitness
through exercise training may reduce pain sensitivity
in this population.
http://dx.doi.org/10.1682/JRRD.2014.10.0267
Opioid use and walking among patients with chronic low back pain
Sarah L. Krein, PhD, RN, et al.
Managing chronic back pain, a common problem
among Veterans, is a significant challenge. Opioid
medications are frequently used to manage pain,
but this is of concern because of documented problems
with their safety and effectiveness. However, whether
patients who receive opioids might engage in other recommended
forms of therapy, such as physical activity,
is unknown. Our study findings suggest that with additional
support, patients taking opioids may engage in
walking to help manage their back pain, emphasizing
the importance of encouraging the use of alternative
pain management strategies for these patients.
http://dx.doi.org/10.1682/JRRD.2014.08.0190
Perceptions of other integrative health therapies by Veterans with pain who are receiving massage
Carol Elizabeth Fletcher, PhD, RN, et al.
Veterans are seeking complementary and integrative
health (CIH) therapies in addition to conventional
care for issues such as chronic pain and
posttraumatic stress disorder. In response, the Department
of Veterans Affairs (VA) has begun offering
therapies such as massage and yoga, but as with
any new program there are challenges. Veterans benefit
when other Veterans describe their experiences
to clarify the successes and problems that Veterans
have when obtaining, or trying to obtain, CIH therapies
through the VA. Understanding Veterans??? experiences
is essential if the VA wishes to successfully
provide CIH therapies to Veterans.
http://dx.doi.org/10.1682/JRRD.2015.01.0015
Initial development of a patient-reported instrument assessing harm, efficacy, and misuse of long-term opioid therapy
William C. Becker, MD, et al.
We identified a need for a comprehensive, feasible,
and clinically actionable instrument to monitor
long-term opioid therapy in primary care, where
most opioids are prescribed. The present study describes
the initial development steps of a preliminary
version of such an instrument, the Patient Reported
Indications for Opioid Reassessment (PRIOR). Forty-
seven subject matter experts in the clinical field
of long-term opioid therapy highly rated 37 items
related to harm, efficacy, and misuse. These items
were modified and tested for Veteran comprehension
in this study developing the preliminary PRIOR.
http://dx.doi.org/10.1682/JRRD.2014.11.0285
Stepped care model for pain management and quality of pain care in long-term opioid therapy
Brent A. Moore, PhD, et al.
The Pain Care Quality (PCQ) extraction tool
was used to examine the effect of interventions to
improve primary care provider???s quality of pain
care. The study examined electronic health records
of patients receiving opioid medication in one Veterans
Health Administration (VHA) healthcare system
over 4 years and a non-VHA Federally qualified
health center over 2 years. Documentation of reassessment
of pain and pain education improved in the
VHA. Results suggest that the PCQ extraction tool is
feasible and may be responsive to change in the context
of efforts to promote organizational improvements
in pain care of Veterans.
http://dx.doi.org/10.1682/JRRD.2014.10.0254
Implementation of telementoring for pain management in Veterans Health Administration: Spatial analysis
Evan P. Carey, MS, et al.
In 2011, the Veterans Health Administration
(VHA) started a telementoring program called the
Specialty Care Access Network-Extension for Community
Healthcare Outcomes (SCAN-ECHO) for
pain management in seven healthcare networks.
This analysis examines the implementation of Pain
SCAN-ECHO by mapping the location of Veterans
with chronic pain, VHA healthcare resources, and
the reach of the program in a sample network. For
all seven networks, we investigated the relationship
between distance to nearest in-person specialty pain
care and access to a primary care provider participating
in Pain SCAN-ECHO.
http://dx.doi.org/10.1682/JRRD.2014.10.0247
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Last Reviewed or Updated Wednesday, February 24, 2016 11:04 AM
