Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain
Author: Benjamin Kligler1,2, Matthew J Bair3,4, Ranjana Banerjea3, Lynn DeBar5,6, Stephen Ezeji-Okoye3, Anthony Lisi3,7, Jennifer L Murphy3, Friedhelm Sandbrink3, Daniel C Cherkin8
Affiliation:
1 Veterans Health Administration, Washington, DC, USA. Benjamin.Kligler@va.gov.
2 Icahn School of Medicine at Mount Sinai, New York, NY, USA. Benjamin.Kligler@va.gov.
3 Veterans Health Administration, Washington, DC, USA.
4 Indiana University School of Medicine, Indianapolis, IN, USA.
5 Kaiser Permanente Center for Health Research, Portland, OR, USA.
6 Oregon Health Sciences University, Portland, OR, USA.
7 Yale University School of Medicine, New Haven, CT, USA.
8 Kaiser Permanente, Washington Health Research Institute, Seattle, WA, USA.
Conference/Journal: J Gen Intern Med
Date published: 2018 May 1
Other:
Volume ID: 33 , Issue ID: Suppl 1 , Pages: 16-23 , Special Notes: doi: 10.1007/s11606-018-4323-z. , Word Count: 327
As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled "Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management" in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda. Workgroups were established and asked to reach consensus recommendations on clinical and research priorities for the following treatment strategies: psychological/behavioral therapies, exercise/movement therapies, manual therapies, and models for delivering multimodal pain care. Participants in the SOTA identified nine non-pharmacological therapies with sufficient evidence to be implemented across the VHA system as part of pain care. Participants further recommended that effective integration of these non-pharmacological approaches across the VHA and especially into VHA primary care, pain care, and mental health settings should be a priority, and that these treatments should be offered early in the course of pain treatment and delivered in a team-based, multimodal treatment setting concurrently with active self-care and self-management approaches. In addition, we recommend that VHA leadership and policy makers systematically address the barriers to implementation of these approaches by expanding opportunities for clinician and veteran education on the effectiveness of these strategies; supporting and funding further research to determine optimal dosage, duration, sequencing, combination, and frequency of treatment; emphasizing multimodal care with rigorous evaluation grounded in team-based approaches to test integrated models of delivery and stepped-care approaches; and working to address socioeconomic and cultural barriers to veterans' access to non-pharmacological approaches.
Keywords: chronic pain; complementary and alternative medicine; psychological therapies; self-management; veterans.
PMID: 29633133 PMCID: PMC5902342 DOI: 10.1007/s11606-018-4323-z
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