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ABOUT PAIN MANAGEMENT

• Nearly 40 million American adults

experience severe pain, and an estimated 

25.3 million had pain every day over a 

three-month period, an NIH study found.

• Chronic pain can cause disability, loss of

work productivity, and increased health 

care costs.

• Unrelieved and persistent chronic pain

contributes to depression, anxiety, poor 

sleep patterns, decreased quality of life, 

and substance use disorders.

• Medication is the most common

treatment for both acute and chronic 

pain. For patients interested in treatments 

other than or in addition to medication, 

complementary and integrative 

medicine—such as acupuncture and 

yoga—is a popular option.

VA RESEARCH ON PAIN 

MANAGEMENT: OVERVIEW

• VA researchers are working to develop

new approaches to alleviate Veterans’ pain, 

which may result from spinal cord injury, 

burns, amputations, traumatic brain injury, 

cancer, or musculoskeletal conditions. 

Some types of chronic pain, such as the 

nerve pain experienced by many people 

with spinal cord injury, are very difficult to 

treat. VA research on pain covers a wide 

range of topics, such as drug discovery and 

the impact of pain on daily function and 

quality of life.

• The Center for Neuroscience and

Regeneration Research, a collaboration 

between VA and its partners, conducts 

biomedical research that contributes to the 

scientific understanding of pain, especially 

nerve pain. The center is dedicated to 

molecular and cell-based discoveries on 

nervous system function.

• VA’s Pain, Research, Informatics, Medical

Comorbidities, and Education (PRIME) 

Center, part of the VA Connecticut 

Healthcare System, conducts research to 

improve pain care and sponsors education 

activities for Veterans and clinical staff.

• The Chronic Pain Rehabilitation Program

at the James A. Haley Veterans Hospital in 

Tampa, Fla., is a nationally known center 

for chronic pain research, treatment, and 

education. The CPRP offers inpatient and 

outpatient rehabilitation programs to 

help Veterans manage their chronic pain 

conditions.

• The Pain Management and Patient Aligned

Care CREATE has three goals: to enhance 

Veterans’ access to pain care, to use health 

information technology to promote 

better pain care for Veterans, and to build 

sustainable improvements in pain care.

• VA’s Stepped Care Model for Pain

Management gives clinicians the ability to 

assess and treat pain within a primary care 

setting, while enabling them to use other 

treatment options including specialized 

care and multidisciplinary approaches. The 

model is designed to ensure VA clinicians 

are fully trained in pain management 

techniques, that pain assessment is 

performed consistently throughout VA, 

and that Veterans receive prompt and 

appropriate treatment.

• VA researchers are working to better

understand chronic low back pain in older 

adults through a series of papers and an 

NIH task force. As many as 40 percent of 

Veterans over 65 years old have chronic 

back pain.

SELECTED MILESTONES AND 

MA JOR EVENTS 

1988 – Established a chronic pain 

rehabilitation program in Tampa, Fla., to 

help Veterans with chronic pain cope with 

their conditions 

1988 – Distributed the first national pain 

management strategy, which established 

pain management as a national VA priority

2003 – Mandated, in a VA directive, that all 

patients be systematically screened for the 

presence and intensity of pain

VA research on 

PAIN MANAGEMENT

Pain is one of the most common reasons Americans 

consult a physician, and it is cited as the most common 

symptom in Iraq and Afghanistan Veterans returning 

from deployment when they first visit VA for care.

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Nearly 40 million American adults 

experience severe pain, and an estimated 

25.3 million had pain every day over a 

three-month period, an NIH study found.

2009 – Established the stepped care 

model for pain management as VA’s 

nationwide standard of pain care

2014 – Announced, along with NIH, 

a five-year, $21.7 million qualityimprovement initiative to explore nondrug approaches to managing pain and 

related health conditions 

2015 – Found that ion channels—

specialized proteins in the membrane 

of brain cells—are heavily implicated 

in the biological mechanisms that 

generate and sustain neuropathic pain 

RECENT STUDIES: SELECTED 

HIGHLIGHTS

• Patients on higher opioid doses are 

at greater risk of suicide than those on 

lower doses, according to researchers 

in the VA Ann Arbor Healthcare System 

and their colleagues. Providers may 

want to view high opioid dose as a 

marker of elevated suicide risk, suggest 

the researchers. (Pain, Jan. 5, 2016)

• Researchers in the Southeast 

Louisiana VA Health Care System and 

their colleagues developed new pain 

medications called endomorphin 

analogs. This type of medication 

produced fewer and less dangerous 

side effects than pain medications 

such as morphine in an animal study. 

The promising findings, though 

preliminary, suggest that endomorphin 

analogs may reduce the instances of 

abuse, respiratory depression, motor 

impairment, tolerance, and glial 

activation in patients with acute and 

chronic pain. (Neuropharmacology,

Dec. 31, 2015)

• Repetitive transcranial magnetic 

stimulation decreases persistent 

daily headache pain in Veterans with 

mild traumatic brain injury. A study 

at the VA San Diego Healthcare System 

found that transcranial magnetic 

stimulation resulted in more than 50 

percent headache intensity reduction 

one week after treatment. Headache is 

one of the most common chronic pain 

conditions in active duty personnel 

and Veterans with mild traumatic brain 

injury. (Neuromodulation, Nov. 10, 2015)

• In a pilot study, researchers at the 

Durham VA Medical Center and Duke 

Integrative Medicine Clinic found 

that Swedish massage is feasible and 

effective for reducing pain caused by 

knee osteoarthritis. If these results are 

confirmed by a larger study, massage 

could become an important part 

of regular care for pain. (Journal of 

Alternative and Complementary Medicine, 

June 2, 2015)

• A panel led by VA researchers 

developed an algorithm and 

supportive materials to guide 

the care of older adults with 

hip osteoarthritis, an important 

contributor to chronic lower back pain. 

The report was the first in a series 

designed to examine the multiple 

causes of lower back pain in older 

adults. (Pain Medicine, May 1, 2015)

• Implementation of the Opioid 

Safety Initiative in the Minneapolis 

VA Health Care System led to a 

significant reduction in highdose opioid prescribing. Setting 

dosing limits and establishing patient 

assessment and treatment guidelines 

improved the quality and consistency 

of prescription practices, say the 

researchers. (Pain Medicine, May 1, 2015)

For more information on VA studies 

on pain management and other key 

topics relating to Veterans’ health, 

please visit 

www.research.va.gov/topics

PAIN MANAGEMENT

Updated September 2016 • For a digital version of this fact sheet with active links to sources, visit www.research.va.gov/topics