Frequently Asked Questions
Pain is a feeling of physical or emotional discomfort, with a wide range of degrees, from mild nuisance pain to intense debilitating pain. Pain can be acute or chronic and can influence a person’s physical and mental well-being, as well as daily functioning, depending on the degree and frequency of pain.
Chronic pain is typically defined as pain lasting for three months or longer. People meeting this definition are certainly not alone; a CDC study noted that 20% of the adult population in the United States have chronic pain1. Chronic pain is often successfully managed and does not significantly interfere with work and other important activities, allowing most people who have it to live high-quality lives; however, for others, chronic pain may be associated with significant debilitation and emotional distress. While chronic pain can most often be successfully managed, it often cannot be cured. Examples of conditions that are associated with chronic pain include: traumatic injuries, arthritis, neuropathy, migraines, and nerve damage. Chronic pain is complex and often brings with it a host of other symptoms and illnesses like fatigue, depression, anxiety, poor sleep, difficulty with coordination, and impaired mental function.
When thinking about pain management, we consider other models of disease management, like what we do for cardiovascular disease, diabetes, or major depressive disorders, where we are attempting to control the experience of pain or pain intensity to allow people to function both physically and mentally. Like cardiovascular disease, diabetes, and major depression, we call on a multi-step, integrated approach with the patient taking measures to make healthy lifestyle choices to minimize the pain, along with medical interventions, assistance from clinicians and alternative therapies like massage, acupuncture, mindfulness therapies, and more. While we are still in need of research to determine the most effective components of a pain management plan for individuals with chronic pain, we know that a comprehensive pain assessment must consider biological, psychological and social contributors to the pain experience. The information from these considerations will inform the development of a personalized plan that addresses physical and social role functioning, emotional well-being, mental health and substance use disorder comorbidities, and health risk behaviors (e.g., overweight/obesity, smoking).
Although clinicians play important roles in pursuing a comprehensive pain assessment and management plan, it is also essential that people with chronic pain learn optimal pain management strategies in order to minimize the pain itself, and its impact on their ability to function, so that they can lead healthy and fulfilled lives. Cognitive behavioral therapy (CBT) teaches people coping skills—learning how to manage stress, and how to use distraction or other strategies to minimize their attention on pain—in order to participate in normal daily activities and enjoy life. Meditation can help with reducing tension and improving concentration, as well as help distance one’s focus from pain. Yoga can also help with improving strength, balance and flexibility, all of which can aid in pain relief. Additional strategies people with pain can do to help themselves include: getting regular exercise, maintaining a healthy weight and diet, eliminating the use of tobacco products, and minimizing the use of alcohol.
Rates of chronic pain are much higher for veterans and military service members than in the civilian population, and the negative impact on their lives has been shown to be greater.1 With Operations Enduring Freedom, Iraqi Freedom, and New Dawn in Iraq and Afghanistan, we are seeing unprecedented battle field survival. According to Lieutenant General Eric J. Schoomaker, US Army (Retired), and Professor Emeritus, Uniformed Services University of the Health Sciences (USUHS), “If [soldiers] can survive initial battlefield impact, they have high survival rate, with improvement [in medical triage care] from past wars to what we have seen in Iraq and Afghanistan. So, now, more than ever, pain management plans are necessary to manage pain.” Additionally, injuries can occur in training or simply from recreational activities on base. Chronic pain, Post-Traumatic Stress Disorder (PTSD), and Traumatic Brain Injury (TBI) co-exist and far exceed the boundaries of just pain. These conditions impact families, work, and so much more. Military families often move from post to post, so, if we are able to standardize pain management for them, they could get the same care and support, no matter their location.
The Pain Management Collaboratory (PMC) was envisioned as a strategy to develop, promote, and implement cost-effective large-scale pragmatic clinical research on chronic pain and pain management. Research focuses on nonpharmacological approaches to pain management and other comorbid conditions among military service members and their families as well as the veteran population. Findings and products from this research are of particular interest to health care administrators in both military and veteran health care systems.
Modeled after the NIH Health Care Systems Research Collaboratory, the Pain Management Collaboratory consists of 11 funded pragmatic clinical trials (PCTs) and a coordinating center (PMC3). The trials are designed to evaluate the effectiveness of the broad array of nonpharmacological approaches, including psychological, behavioral, exercise, movement, and manual approaches such as chiropractic or acupuncture. The trials are pragmatic in the sense that they are embedded and/or conducted in the context of dozens of clinical practice settings in either military health settings or veteran health settings. Trials are designed to provide healthcare providers with real-world evidence on the benefits and risks of particular treatment options.
This collaboration is unique in that it marks one of the first times the National Institutes of Health (NIH), the U.S. Department of Defense (DoD), and the U.S. Department of Veterans Affairs (VA) have worked together to address health care issues of great concern to national leadership.
On behalf of the NIH-DoD-VA Pain Management Collaboratory, the Pain Management Collaboratory Coordinating Center (PMC3) provides national leadership and serves as a national resource for development and refinement of innovative tools, best practices, and other resources in the conduct of high-impact pragmatic clinical trials on nonpharmacological approaches for pain management and other comorbid conditions in veteran or military health care systems, as well as to facilitate, coordinate and optimize the Collaboratory’s 11 pragmatic trials to encourage their success. Under the direction of PMC3 Principal Investigators, Robert Kerns, Ph.D., Cynthia Brandt, M.D., M.P.H., and Peter Peduzzi, Ph.D., the PMC3 uses its expertise in pain management, the electronic health record (EHR), data systems and the design and coordination of multi-site pragmatic trials to accomplish these objectives in collaboration with our NIH, DoD, VA and academic affiliate partners at Yale University and nationwide.
There is a need to change the culture of pain management. Pain is often a complex problem in that everyone experiences it differently, and in western medicine, we have very little pragmatic, clinical research on options for managing it effectively, nonpharmacological or otherwise. Currently, people with chronic pain, and their supporting clinicians, do not have research-based alternatives to opioids, and the opioid epidemic is proving that these pharmacological approaches are have only minimal benefit for the management of chronic pain at best and risk of substantial harms. Research brings us an understanding of biological, psychological and social, interpersonal and cultural factors in the experience of pain and how these factors inter-relate to determine the development of pain and chronic pain, and its influence on a variety of factors including physical well-being and function. The goal of the Pain Management Collaboratory’s pragmatic clinical trials is to evaluate the effectiveness of a broad array of nonpharmacological approaches to treating pain, including psychological, behavioral, exercise, movement, and manual approaches. The results of research conducted by the Pragmatic Clinical Trials of the PMC will play a significant role toward shaping DoD, VA, and national pain treatment policy, in addition to promoting the vision of timely and equitable access to high quality, integrated, patient-centered, evidence-based, multimodal and interdisciplinary pain care for all.
- Dahlhamer J, Lucas J, Zelaya, C, et al. Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults — United States, 2016. MMWR Morb Mortal Wkly Rep 2018;67:1001–1006. DOI: http://dx.doi.org/10.15585/mmwr.mm6736a2