The Background

There is growing awareness that pain, both acute and chronic, and its management is a significant public health concern.  Evidence documents that Military Service members and Veterans living in the United States today report pain at particularly high rates, many of whom were among the 2.5 million active military deployed since 2001 in Operations Enduring Freedom, Iraqi Freedom, and New Dawn in Iraq and Afghanistan. In this population, pain may be particularly complex, since it frequently coexists with other medical and mental health and substance use disorders and behavioral health and social risk factors, among other issues.

“Relieving Pain in America: A Blueprint for Transforming Pain Prevention, Care, Education, and Research” from the National Academy of Medicine (formerly, the Institute of Medicine) and the National Pain Strategy published by the US Department of Health and Human Services have helped to usher in a period of transition in the approach to pain management. Informed by the acknowledgement of pain as a public health crisis, these policy statements call for a comprehensive transformation in the way pain is assessed and managed.  Authors highlight that pain care should be patient-centered, integrated, evidence-based, multimodal and interdisciplinary, replacing the currently common approach in which pain is managed by monotherapy delivered by a single provider.  With growing concerns over the harms associated with pharmacological and invasive medical procedures, there has been a shift towards recommendations for multimodal care that incorporates nonpharmacological approaches to pain management as first-line therapy.  These recommendations are supported by growing evidence of their effectiveness and minimal associated risks.

The Initiative

With goals to improve capacity, tools, and skills available to health care providers for managing pain in military and veteran health systems, this new initiative has been launched as a joint activity of the National Institutes of Health (NIH), the Department of Defense (DOD), and the Department of Veterans Affairs (VA).

The NIH-DOD-VA Pain Management Collaboratory (PMC) is an unprecedented cooperative activity involving multiple NIH institutes, centers, and offices and the DOD and VA research programs. This initiative builds on three ongoing activities: a long-term history of collaboration between the NIH, DOD, and VA; the NIH Health Care Systems Research Collaboratory; and the work and most recent report of the NCCIH Advisory Council Working Group, entitled Strengthening Collaborations with the U.S. Department of Defense and U.S. Department of Veterans Affairs: Effectiveness Research on Mind and Body Interventions.

The Collaboratory

The Pain Management Collaboratory is comprised of 13 large-scale, multisite, pragmatic clinical trials that focus on implementation and evaluation of nonpharmacological approaches for the management of pain and common co-occurring conditions in Military and Veterans healthcare systems. The Pain Management Collaboratory Coordinating Center (PMC3) facilitates and supports the individual trials through its leadership core and domain-oriented working groups, which foster collaboration and harmonization across the trials.

Evidence of effectiveness of nonpharmacological interventions for pain management continues to grow, but gaps between science and implementation in clinical practice remain. The objective of the PMC is to address key scientific knowledge and clinical practice gaps in the delivery of high-quality pain care for Military Servicemembers and Veterans.

The lead funding organizations of the PMC and PMC3 include the National Center for Complementary and Integrative Health (NCCIH) of the National Institutes of Health (NIH), the Department of Defense (DOD), and the Department of Veterans Affairs (VA). An additional seven NIH institutes, centers and program offices serve as co-sponsors of the clinical trials.

Our Purpose and Mission

The PMC is addressing a critical gap between science and practice in pain management. Despite growing evidence of the efficacy and effectiveness of nonpharmacological approaches for pain management, no large scale, pragmatic effectiveness studies have been conducted that can inform clinical practice.

Our purpose is to develop, support, and enact the implementation of large-scale, pragmatic clinical research in Military and Veteran healthcare delivery organizations that studies nonpharmacological approaches to pain management in innovative and integrative models of pain care delivery.

Our mission to improve the capacity, tools, and skills available to health care providers to provide timely, equitable and cost-effective integrated, patient-centered, multimodal and interdisciplinary pain care that incorporates evidence-based nonpharmacological approaches to pain management while reducing the reliance on opioid and other potentially harmful medications and invasive procedures.