Studying Nonpharmacological Approaches for
Pain Management in Clinical Settings
Pragmatic Clinical Trials (PCTs)
The PMC Pragmatic Clinical Trials are studying nonpharmacological approaches for pain management and comorbid conditions in settings serving military personnel, veterans and their families. The 16 trials were selected based on the importance of the scientific questions, and their potential to address impediments to research within health care delivery organizations. The demonstration projects utilize a phased award UG3/UH3 mechanism, with a planning (UG3) and an implementation (UH3) phase. All projects are milestone-driven, and moving to the implementation phase (UH3) will be dependent upon the successful progress made during the planning phase (UG3).
Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health (A VA National Demonstration Project) (APPROACH trial)
The APPROACH Trial: Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health is a large-scale pragmatic clinical trial that examines the potential for patients to benefit from a pairing of CIH self-care (yoga, tai chi, mindfulness) approaches and practitioner-delivered CIH (acupuncture, massage) versus either practitioner-delivered or self-care alone among Veterans with chronic musculoskeletal pain.
Co-Principal Investigators:
Stephanie Taylor, PhD, MPH and Steven Zeliadt, PhD, MPH
Chiropractic Care for Veterans: A Pragmatic Randomized Trial Addressing Dose Effects for cLBP (VERDICT trial)
The VERDICT project evaluates patient and clinician perceptions of non-specific treatment factors, effectiveness of study interventions, and the impact of varying doses of standard chiropractic care and chronic pain management on clinical outcomes across three VA facilities.
Co-Principal Investigators:
Christine Goertz, DC, PhD and Cynthia Long, PhD
Comparing Cognitive Behavioral Therapy and Acupuncture for managing Chronic Pain (COMBAT Pain)
The COMBAT Pain trial examines whether adding brief cognitive and behavioral interventions for chronic pain to acupuncture improves engagement, functioning, and pain outcomes for military members, retirees and their families who are seen in primary care settings.
Co-Principal Investigators:
Paul Crawford, MD
Jeffrey Goodie, PhD, ABPP
Don McGeary, PhD, ABPP
COoperative Pain Education and Self-management: Expanding Treatment for Real-world Access (COPES ExTRA trial)
The overall goal of this project is to conduct a pragmatic trial to examine the real world effectiveness of an IVR-based form of CBT-CP called Co-operative Pain Education and Self-management (COPES) versus in-person CBT-CP provided by clinicians previously trained through VHA’s evidence based psychotherapy program.
Co-Principal Investigators:
Alicia Heapy, PhD and Diana Higgins, PhD
Engaging Veterans Seeking Service-Connection Payments in Pain Treatment (SBIRT-PM trial)
This project tests the effectiveness and cost-effectiveness of Screening, Brief Intervention and Referral to Treatment for Pain Management (SBIRT-PM). SBIRT-PM can provide an effective and cost-effective approach to reducing veterans’ pain and risky substance use, primarily by increasing the use of nonpharmacological approaches to pain management. (SBIRT-PM)
Co-Principal Investigators:
Marc Rosen, MD and Steve Martino, PhD
Implementation Facilitation of SBIRT-PM for Veterans Separating from Military Service (M2VA-PCP trial)
This study looks at the use of SBIRT-PM-trained case managers in the Military2VA (M2VA) program to improve veterans’ clinical outcomes (reducing the pain and risky substance use) and increase the engagement in non-pharmacological pain treatments.
Co-Principal Investigators:
Marc Rosen, MD and Steve Martino, PhD
Improving Veteran Access to Integrated Management of Low Back Pain (AIM Back trial)
There are critical unanswered questions surrounding best practices for addressing chronic back pain in the veteran population. This pragmatic trial compares the effectiveness of two nonpharmacological care pathways and seeks to improve access to recommended therapies, minimize utilization of higher-risk treatments such as opioids and surgery, and optimize long-term outcomes for reduced pain.
Co-Principal Investigators:
Steven George, PT, PhD and Susan Nicole Hastings, MD
Learning to Apply Mindfulness to Pain (LAMP trial)
The LAMP project (Learning to Apply Mindfulness to Pain) is studying two approaches for delivering nonpharmacological treatment for chronic pain—in this case, Mindfulness-Based Interventions (MBIs) that incorporate mobile application technology—that will be able to reach large numbers of veterans.
Principal Investigator:
Diana Burgess, PhD
Pain Management Teams using Whole Health to Optimize Function and Safety in Veterans (TEAMWORK trial)
The overarching goal of the TEAMWORK study is to improve the care of Veterans with chronic pain prescribed long-term opioid therapy by studying models of interdisciplinary team-based care. The study will compare the impact of pain management teams with and without Whole Health Coaches and evaluate pain and opioid safety outcomes.
Co-Principal Investigators:
Sara Edmond, PhD
Karen Seal, MD, MPH
William Becker, MD
PROmoting Pain Self-Management (PROs trial)
The PROs trial will evaluate two different interventions that provide holistic pain care; Empowered Relief and Move to Health. The results of this project will provide critical information and strategies to provide holistic pain management for persons receiving care in the Military Health System.
Co-Principal Investigators:
Julie M. Fritz, PT, PhD, FAPTA and Dan Rhon, PT, DPT, DSc, OCS, FAAOMPT
Resolving the Burden of Low Back Pain in Military Service Members and Veterans: A Multi-Site Pragmatic Clinical Trial (RESOLVE trial)
This multi-site PCT compares an active CPG implementation model with the current usual physical therapy care in service members and veterans with Low Back Pain (LBP) in order to evaluate an education/audit/feedback model, as well as compare it to usual care for decreasing pain and lessening reliance on analgesic medication.
Co-Principal Investigators:
Christopher Dearth, PhD and Bradford D. Hendershot, PhD
SMART Stepped Care Management for Low Back Pain in the Military Health System (SMART Stepped Care trial)
The Sequential Multiple Randomization Trial for Low Back Pain (SMART LBP Trial) enables better integration of the biopsychosocial model and improve Stepped Care management with a pragmatic, randomized controlled trial targeting chronic low back pain at four large military installations in the United States.
Co-Principal Investigators:
Julie M. Fritz, PT, PhD, FAPTA and Dan Rhon, PT, DPT, DSc, OCS, FAAOMPT
Targeting Chronic Pain in Primary Care Settings Using Behavioral Health Consultants (BHC-CP trial)
This trial seeks to identify evidence of meaningful outcomes of Brief Cognitive Behavioral Therapy for Chronic Pain interventions within the context of primary care settings, such as decreased opioid medication, fewer emergency room visits for pain care, and greater satisfaction with treatment plans.
Co-Principal Investigators:
CAPT Jeffrey Goodie, PhD; Don McGeary, PhD
Tele-Collaborative Outreach to Rural Patients with Chronic Pain (CORPs trial)
The CORPs Trial is a pragmatic approach to study the effectiveness of a tele-collaborative pain care intervention (CORPs) vs. minimally enhanced usual care (MEUC) among rural veterans with chronic musculoskeletal pain.
Co-Principal Investigators:
Travis Lovejoy, PhD, M.P.H. and Benjamin Morasco, PhD
Ultrasound Guided Percutaneous Peripheral Nerve Stimulation: A Nonpharmacological Alternative for the Treatment of Postoperative Pain (Ultrasound Guided PNS trial)
This trial, determines the effect of a novel, nonpharmacologic analgesic technique—percutaneous peripheral nerve stimulation (PNS)—on postoperative analgesia and opioid requirements, as well as physical and emotional functioning, the development of chronic pain, and ongoing quality of life.
Principal Investigator:
Brian Ilfeld, MD, MS
PI Interviews
Benjamin Morasco, PhD, and Travis Lovejoy, Phd, MPH talk about access to quality pain management care for veterans living in rural areas and their...Read More >>
PIs Don McGeary, PhD, ABPP, and CAPT Jeff Goodie, PhD, ABPP, joined PMC to talk about their trial Targeting Chronic Pain in Primary Care...Read More >>
Steve Martino, PhD and Marc Rosen, MD, talked with the PMC about their efforts to study veteran engagement for pain treatment when seeking remuneration...Read More >>
Marc Rosen, MD, and Steve Martino, PhD, joined PMC to talk about their SBIRT trial which is studying the engagement of Veterans in pain...Read More >>
A Q&A with Stephanie Taylor, Ph.D., M.P.H. The APPROACH Trial: Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health (A VA National Demonstration...Read More >>
COPES ExTRA trial Co-PIs Alicia Heapy, PhD and Diana Higgins, PhD, talked with PMC about improving access to psychology-based approaches for chronic pain treatment...Read More >>
PMC interviewed Dr. Christine Goertz to talk about the VERDICT trial, which is focused on “dosing” of chiropractic services.
Drs. George and Hastings talked with the PMC about the AIM Back Trial, which is looking at increasing and improving access to non-drug care...Read More >>
PMC talked with Julie Fritz about the SMART Trial, on which she is co-PI with Dan Rhon.
Diana Burgess, PhD is a social psychologist and Core Investigator of Center for Care Delivery and Outcomes Research and Professor of Medicine at the...Read More >>
Video: Ultrasound-Guided Peripheral Nerve Stimulation for Postoperative Pain Management Brian Ilfeld, MD, MS, talked with the Pain Management Collaboratory Coordinating Center about his pragmatic...Read More >>
Brian Ilfeld, MD, is studying the use of ultrasound-guided peripheral nerve stimulation to treat postoperative pain after ambulatory surgery, specifically after shoulder and ankle...Read More >>
Karen Seal, MD, MPH, explains integrative and integrated healthcare, as well as the VA's Whole Health model, its components, and its benefits. Dr. Seal...Read More >>
Our PMC editor sat down with Dr. Seal to talk about alternative approaches to pain management, integrative medicine, the VA's Whole Health model for...Read More >>
The proper way to dispose of opioids is often unclear, and often misconstrued by the headlines. William Becker, M.D. and Benjamin Oldfield, M.D., talk...Read More >>
A large percentage of prescription opioids aren't taken for the full duration or amount prescribed; and since drug disposal information isn't always clear, pills...Read More >>
Drs. Will Becker and Ben Oldfield address the confusion and opioid disposal options in this video and in their journal review of the media's...Read More >>
(Video) Steven George, PT, PhD, touches on study with the Pain Management Collaboratory and how he came to study pain management.
Discussing Whole Health Team vs. Primary Care Group Education to Promote Non-Pharmacological Strategies to Improve Pain, Functioning and Quality of Life in Veterans
Diana Burgess, PhD, talks about how she got involved in studying pain management and working with the Pain Management Collaboratory.
Featured Publications
The PMC offers a unique opportunity to fill important knowledge gaps regarding Nonpharmacological treatment approaches for pain. In this op/ed Dr. Christine Goertz argued...Read More >>
This manuscript described the primary outcomes from a CBT-based intervention designed to address headache attributable to mild TBI and comorbid PTSD in Veterans. We...Read More >>
Four PMC PIs note a need for better pathways for pain management in the United States, given the divide between the way pain care...Read More >>
Cristine Goertz, DC, PhD, Co-PI of the PMC VERDICT trial is co-author on an article designed to be a decision aid for doctors of...Read More >>
