A:  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.

A: 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).

A: 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.

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.