Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration
Authors
Mattocks, Kristin M.Rosen, Marc I.
Sellinger, John
Ngo, Tu
Brummett, Brad
Higgins, Diana M.
Reznik, Thomas E.
Holtzheimer, Paul
Semiatin, Alicia M.
Stapley, Todd
Martino, Steve
UMass Chan Affiliations
Department of Population and Quantitative Health SciencesDocument Type
Journal ArticlePublication Date
2020-05-01Keywords
Interdisciplinary Pain CarePain Management
Veterans
Health Services Administration
Military and Veterans Studies
Pain Management
Pathological Conditions, Signs and Symptoms
Therapeutics
Metadata
Show full item recordAbstract
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.Source
Mattocks K, Rosen MI, Sellinger J, Ngo T, Brummett B, Higgins DM, Reznik TE, Holtzheimer P, Semiatin AM, Stapley T, Martino S. Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration. Pain Med. 2020 May 1;21(5):970-977. doi: 10.1093/pm/pnz341. PMID: 31886869; PMCID: PMC7208326. Link to article on publisher's site
DOI
10.1093/pm/pnz341Permanent Link to this Item
http://hdl.handle.net/20.500.14038/41479PubMed ID
31886869Related Resources
Rights
Copyright 2019 American Academy of Pain Medicine. This work is written by US Government employees and is in the public domain in the US.ae974a485f413a2113503eed53cd6c53
10.1093/pm/pnz341