HomeMy WebLinkAbout062226 - VA's Whole Health Approach for Chronic Pain ManagementALERT: BE CAUTIOUS This email originated outside the organization. Do not open attachments or click on links if you are not expecting them.
VA's Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no random
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NewsFlash
VA's Whole Health Approach for Chronic Pain Management <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govde
livery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/KlRGu8ZDKo_HBagQpubeSw0MPpUXJHerriZKD_T7QYk=452>
Karen H. Seal, MD, MPH; Benjamin J. Morasco, PhD; Aaron M. Martin, PhD; Kavitha P. Reddy, MD; Theresa M. Van Iseghem, PsyD; Rendelle E. Bolton, PhD; Barbara G. Bokhour, PhD, MPH; Jennifer
Murphy, PhD; Lauren M. Denneson, PhD; Denise Esserman, PhD; Eugenia Buta, PhD; Natalie Purcell, PhD, MPA; Daniel Bertenthal, MPH; Jacob T. Painter, PharmD, MBA, PhD; Linda R. Abadjian,
PhD; Liliana C. Moore, MA; Allan C. Chan, MBA, MSCIS; Nicole McCamish, MA; Shira Maguen, PhD; Thomas C. Neylan, MD; Carolyn J. Gibson, PhD, MPH; William C. Becker, MD for the wHOPE
Study Group
The US Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals, but no randomized
clinical trials have tested its benefits.
The Comprehensive Addiction and Recovery Act was aligned to promote nonopioid, nonpharmacological pain management strategies for Veterans, with a long term goal of promoting patient-centered
care through dissemination of a whole health model. Not long after the Congressional mandate, VA began making evidence-based integrative therapies (eg, yoga, chiropractic, mindfulness)
available to Veterans.
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In March of 2026, VA researchers published a multi-site clinical trial in the Journal of American Medical Association (JAMA) <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournal
s%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery/2/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/-K9YHQZ7Nd1FpRqt-9LQKhZGfbYfo1VF4Unuzpph9vE=452>
<https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery%23joi260024f1/1/0100019ef12389ae-ef882e33-8cc0
-4e46-9be0-7d4ade8d6e3f-000000/r7CI1zhi-M7-NCYpju79IJa6VkbbPt2QYnPo4-bZPHA=452> seeking to answer the question if VA's whole health team approach reduces pain interference more than
cognitive behavioral therapy (CBT) or routine care.
Whole Health Options and Pain Education (wHOPE) was a randomized clinical trial of 764 VA patients experiencing chronic pain <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournal
s%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery/3/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/aFqRyqWrAdw79KXlJ1jpyJmbKsSrwFiayTmvHffMHf4=452>
. The multi-year study took place from the fall of 2020 until through the start of 2025 at six VA health care systems serving Veterans in California, Connecticut, Florida, Massachusetts,
Missouri, and Oregon.
Intervention and Outcomes: <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery/4/0100019ef12389ae-ef
882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/cCiPMA4HHOQ4e7_mQHeSUb-50sfHhSWNvKZxWP2t8Yg=452>
Participants were randomly assigned at the individual level to either Whole Health, Cognitive-Behavior Therapy, or Usual Primary Care. The follow-up period for the three arms was 12
months. The primary outcome was change in pain interference.
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FORWARD MARCH: Get in contact with a person at your VA facility to learn more about local Whole Health clinics, programs, services, and more <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.va.go
v%2FWHOLEHEALTH%2Fwhole-health-facility-contacts.asp%3Futm_medium=email%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/NoZHzQGxS_mcbDmheNtkBcFZ8YK7erocF8YwEN6
12OA=452> .
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Secondary outcomes included change in pain intensity, functioning, quality of life, changes in use of pain medications, including opioids (if applicable) and changes in nonpharmacological
pain self-management activities. Participants completed assessments at baseline, 3, 6, 9, and 12 months.
Intervention Arms: <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery/5/0100019ef12389ae-ef882e33-8
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Whole Health - The Whole Health Team (WHT) intervention arm included four core elements: 1) An interdisciplinary WHT (primary care provider, Whole Health coach, and a complementary and
integrative health [CIH] clinician); 2) Personalized Health Planning with prioritization of multi-modal non-pharmacological and CIH pain management approaches; 3) Whole Health Coaching
sessions to assist patients in developing and implementing a Personalized Health Plan for chronic pain care; and 4) the web/mobile Whole Health Resource Directory provided to patient
participants (in addition to their providers) to support non-pharmacologic/CIH chronic pain care.
Cognitive-Behavior Therapy (CBT) - an abbreviated form of Cognitive Behavioral Therapy for Chronic Pain (CBT-CP) adapted for group use in primary care.
Usual Primary Care Arm – patients continued to receive usual care from their primary care team.
Results: <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery/6/0100019ef12389ae-ef882e33-8cc0-4e46-9
be0-7d4ade8d6e3f-000000/fxwk6yuWF4Rn26Vu2U9ynpdKdawywlPZoJbm-grzmeg=452>
In all, 764 were randomized to whole health team (n = 343), cognitive behavioral therapy (n = 339), or usual care (n = 82) groups. Of those randomized, 632 (82.7%) completed 12-month
follow-up. Overall, the mean (SD) age of participants was 60.5 (12.3) years; 508 (66.5%) were men. At baseline, 550 (72.0%) reported severe chronic pain (limiting activities on most
days or every day during the past 3 months), participants had a median (IQR) of 3 (2-4) pain conditions, and the mean (SD) pain interference score was 6.5 (1.9). At baseline, 194 participants
(25.4%) reported taking opioids for pain conditions. The mean (SD) physical functioning score was 25.4 (8.9); 404 (52.9%) screened positive for depression, 278 (37.5%) screened positive
for PTSD, and 138 (18.1%) reported high-risk drinking.
After 12 months, the whole health group had significant reductions in pain interference (from 6.6 to 4.9), which were larger than gains made for participants randomized to CBT (from
6.4 to 5.5) or usual care (from 6.4 to 5.7). These results support use of the whole health team approach to attain a statistically significant but small improvements in pain interference
in VA patients with chronic pain.
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Funding/Support <https://links-1.govdelivery.com/CL0/https:%2F%2Fjamanetwork.com%2Fjournals%2Fjama%2Ffullarticle%2F2848379%3Futm_medium=email%26utm_source=govdelivery%23joi260024f1/2/0100019ef12389ae
-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/fQ0-h-8qFdfcVFIyUaMnVfXI5nVPvF9rD4Uy-f5KQeg=452> : This study was made possible by grant number U24AT009769 and cooperative agreement UH3AT009765
<https://links-1.govdelivery.com/CL0/https:%2F%2Fclinicaltrials.gov%2Fstudy%2FNCT04330365%3Futm_medium=email%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/L
j8bhlQciwfW3olpidONxGug4s4_knBrBKtzWHk2-zI=452> . This article is a product of the Pain Management Collaboratory (for more information about the Collaboratory, visit https://painmanagementcollaborato
ry.org/). This work was also supported with resources and the use of the facilities of the US Department of Veterans Affairs.
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Help enhance Veteran care by forwarding this research article to your colleagues.
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About NW MIRECC
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VA's NW MIRECC serves to improve the mental health and well-being of Veterans through research and dissemination of information to providers both within VA and the general public. VHA
continually evolves and cultivates ongoing cutting-edge medical research and innovation <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.mirecc.va.gov%2Fvisn20%2FAbout_NWMIRECC%2Fnwmirecc-histor
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of America’s patriots. VA's Veterans Integrated Service Network (VISN) 20 serves Alaska, Washington, Oregon, most of Idaho, and one county each in Montana and California. Operating
across three time zones over 817,417 square miles, VISN 20 is the largest geographic region of VA, spanning 23% of US land mass. NW MIRECC brings together complementary research, education,
and clinical programs from VA Puget Sound (VAPSHCS) and the VA Portland Health Care System (VAPORHCS). The collaborative approach to mental health research, education and treatment
has had a profound impact on the lives of Veterans.
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. The mission of NW MIRECC is to improve the quality of life and function of Veterans by developing, evaluating, and promoting the implementation of effective treatments for Posttraumatic
Stress Disorder (PTSD) and its complex comorbidities. PTSD comorbidities include the behavioral consequences of repetitive blast mild Traumatic Brain Injury (mTBI), Substance Use Disorder
(SUD), chronic pain (in particular, post-concussive headaches), cognitive impairment, and increased risk for neurodegenerative disorders (chronic traumatic encephalopathy [CTE] and
Alzheimer’s disease [AD]). VA MIRECC's provide for the improvement of the provision of health-care services and related counseling services to eligible veterans suffering from mental
illness (especially mental illness related to service-related conditions) through—
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• the conduct of research (including research on improving mental health service facilities of the Department and on improving the delivery of mental health services by the Department);
• the education and training of health care personnel of the Department; and
• the development of improved models and systems for the furnishing of mental health services by the Department.
As part of the VISN 20 NW MIRECC mission to enhance access to mental health expertise, the NW MIRECC collaborates and consults with other MIRECCs and Centers of Excellence, as well as
with other VA, Department of Defense (DoD), Federal, State departments of Veterans Affairs, community agencies, and experts. The close geographic proximity (40 miles) of DoD Joint Base
Lewis-McChord/Madigan Army Medical Center to VAPSHCS has provided an exciting opportunity to develop innovative and productive research, education, and clinical care collaborations
with DoD personnel that address PTSD and its associated conditions in their early stages in active-duty Servicemembers.
VA ranks as one of the nation's leaders in health research. Every year, thousands of research studies are conducted at VA medical centers, outpatient clinics, and nursing homes. For
example, the VA has:
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• Developed artificial limbs that allow amputees to have more independence and better quality of life
• Invented the cardiac pacemaker
• Performed the first successful liver transplantation
• Developed the nicotine patch to help people stop smoking
• Played a major role in the development of the CT/CAT scan to view the inside of the body
• Tested new drugs and treatments for diseases such as AIDS, Diabetes, Alzheimer's and Osteoporosis
NW MIRECC research studies significantly contribute to advancements in our understanding of medical problems that lead to health improvements for Veterans and civilians alike. Research
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A 47-foot Motor Lifeboat crew from Coast Guard Station Yaquina Bay responds to a report of multiple surfers in distress who were being pushed up against rocks near Agate Beachgate Beach,
Oregon, Feb. 12, 2023. An MH-65 Dolphin helicopter aircrew from Coast Guard Air Facility Newport transported all three people to shore, where members from Newport Fire Department were
waiting to provide assistance. (U.S. Coast Guard courtesy photo)
About VA Research
VA Research relies on a dynamic ecosystem - a network of interconnected partners that collectively help ensure that Veterans are our focus and benefit from real-world research and innovation.
Congress oversees the VA Research program, establishes funding, and helps to define scope. Congress can dictate specific conditions, diseases, or populations to be studied. Through
legislation, Congress ensures that VA's research remains Veteran-focused and delivers on the VA mission.
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President Harry S. Truman shakes hands with a young man in a wheelchair at the Veterans' Hospital in Seattle, Washington. From: Naval Photo Center // President Truman forged VA's Public-Private
partnership through Public Law 79-293 for VA to bond partnerships with academic affiliate universities and medical schools. Public Law 79-293 drove further modernization and expansion
of the VA medical system and partnerships with research universities.
Medical Schools and Academic Medical Centers help accelerate VA Research and directly improve Veteran health care; 97% are affiliated with the VA. In return, Veterans get access to top
quality care and state-of-the-art equipment. Over 70% of all US physicians trained at a VA medical center. VA Medical Centers are an integral part of the VA Research program. Of the
174 VA medical centers across the country, 106 support a robust research program. Because medical centers and research are connected, Veterans quickly benefit from the results of new
discoveries. VA Researchers ensure Veterans receive state-of-art treatments, procedures, and medications each day. Nearly 90% of VA Researchers are also faculty at a US medical or osteopathic
school.
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Veteran Service Organizations and Partners (VSOs) advocate for Veterans and collaborate with the VA and Congress. VSOs work closely with the VA to ensure that the unique needs of Veterans
are represented in research and research funding. Non-Profit Research Corporations (NPCs) support VA research and provide a flexible funding mechanism for approved research and education
activities. NPCs have been an integral partner and supporter of VA research since 1988. NPCs are state-chartered corporations legally distinct from VA that receive and manage research
grants from other agencies and private sector organizations. There are presently 77 NPCs nationwide.
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Vet Centers are community-based counseling centers <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.vetcenter.va.gov%2F%3Futm_medium=email%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc
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counseling to eligible Veterans, active-duty Army, Navy, Marine Corps, Coast Guard, Air Force, and Space Force service members, including National Guard and Reserve components, and
their families. Vet Center Call Center 1-877-927-8387 (1-877-WAR-VETS) <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.vetcenter.va.gov%2FVETCENTER%2Fmedia%2FCall-Center-PSA.asp%3Futm_medium=em
ail%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/jDLpqBeQ-GcP1ahCQdtfkos2T2_pNDjMaODWRBUg1Vk=452> is an around the clock confidential call
center where Veterans, service members and their families can talk about their military experience or any other issue they are facing in transitioning after military service or trauma
and get connected to their nearest Vet Center. The National Suicide Hotline Designation Act authorized 988 as the new three-digit number for the National Suicide Prevention Lifeline.
The Veterans Crisis Line can help even if you're not enrolled in VA benefits or health care. Available 24/7: Dial 988 then Press 1, chat live (VeteransCrisisLine.net/Chat <https://links-1.govdeliver
y.com/CL0/https:%2F%2Fwww.veteranscrisisline.net%2Fget-help-now%2Fchat%2F%3Futm_medium=email%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/dlsSMnLxmye6aBq6ZM
bWDdjhJpF5fWScFQjDCzZjWYk=452> ), or text 838255.
Use of these Materials and Finding VA Health Care: Please note that the health care information provided in these materials is for educational purposes only. It does not replace the
role of a medical practitioner for advice on care and treatment. If you are looking for professional medical care, find your nearest VA medical center by using the Veterans Integrated
Service Network (VISN) map <https://links-1.govdelivery.com/CL0/https:%2F%2Fdepartment.va.gov%2Fintegrated-service-networks%2F%3Futm_medium=email%26utm_source=govdelivery/1/0100019ef12389ae-ef882e33
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govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/BBZ13lQzMyBPVhKcfIqY7p1syzzTIWDjItP1LBBUUXQ=452> . NewsFlash <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.mirecc.va.
gov%2Fvisn20%2FNewsflash%2Findex.asp%3Futm_medium=email%26utm_source=govdelivery/2/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/08VCP2aBpU9GPeiurvSUubzbsN4oKZ05tg3mrq9P1EY=452>
and Financial Readiness <https://links-1.govdelivery.com/CL0/https:%2F%2Fwww.mirecc.va.gov%2Fvisn20%2FNewsflash%2FFinancialReadiness.asp%3Futm_medium=email%26utm_source=govdelivery/2/0100019ef12389
ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/mv3m0Lj8HODQV81vOJzSD-o9tYSvXhmys_43_GAfw5A=452> resources are also for educational purposes only. It does not replace the role of a financial
advisor for advice on savings and investments. Investing in your future means saving for retirement, college or a rainy day fund. If you're working with an investment professional,
or someone is trying to sell you an investment, check them out before handing over your hard-earned money <https://links-1.govdelivery.com/CL0/https:%2F%2Fadviserinfo.sec.gov%2F%3Futm_medium=email%2
6utm_source=govdelivery/1/0100019ef12389ae-ef882e33-8cc0-4e46-9be0-7d4ade8d6e3f-000000/eQ3RVbjsAbrjajoN7HQ78b7riW7dW-Y5iQ2BCWhR5QA=452> . NewsFlash pages may contain links that will
take you outside of the Department of Veterans Affairs website. VA does not endorse and is not responsible for the content of the linked websites.
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