The APPROACH Trial: Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health (A VA National Demonstration Project)

Project Summary

The APPROACH Trial: Assessing Pain, Patient Reported Outcomes and Complementary and Integrative Health (A VA National Demonstration Project) is a large-scale (n=18,000) pragmatic comparative effectiveness clinical trial to assess the effectiveness of five types of complementary and integrative health (CIH) approaches on chronic pain and pain-related conditions among Veterans with chronic musculoskeletal pain.  The trial will examine 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. The study will be conducted at 18 VA Whole Health Flagship sites, in partnership with VA Office of Patient Centered Care and Cultural Transformation, the office overseeing CIH policy.

Co-Principal Investigators

Stephanie Taylor, PhD, MPH

Stephanie Taylor, PhD


Steven Zeliadt, PhD, MPH

Impact and Contribution to PMC and Society

Much is unknown about how to best deliver complementary and integrative health approaches to maximize the reduction of chronic pain in veterans, and the general public, at large.  By examining the relative effectiveness of self-care CIH (e.g., yoga, meditation, tai chi) versus practitioner-delivered CIH (e.g., acupuncture, chiropractic care), or a combination of self care and practitioner care, we hope to offer information for self-care CIH and best recommended practices for pain management.  The overall aim is to improve Veterans pain, several pain-related comorbid conditions, and opioid use.


Institutions:  VA Los Angeles Healthcare System, VA Puget Sound Health Care System

Institute Providing Oversight:  Department of Veterans Affairs, Health Services Research & Development (HSR&D)

Program Officer: 
Courtney Paolicelli (VA HSR&D)

Project Scientist:  Stephen Marcus Identifier:  None yet

Trial Status:  Planning phase

Project Narrative

Musculoskeletal pains are prevalent among Veterans. Complementary and integrative health (CIH) therapies are important non-pharmacologic treatment options for pain and its comorbid conditions. As such, CIH provision and research in the VA are now mandated in Subtitle C of the Comprehensive Addiction and Recovery Act (CARA) of 2016. Many providers encourage patients to take a more active role in their pain treatment by using self-care practices such as meditation/mindfulness, Tai Chi and yoga instead of relying solely on practitioner-delivered treatment such as acupuncture or chiropractic care.

A critical question for the field is whether adding this type of self-care strategy to practitioner-delivered CIH increases effectiveness in the treatment of pain. However, very few have examined the comparative effectiveness of practitioner-delivered CIH versus CIH self-care, and almost none have explored the pressing question of whether adding self-care to practitioner-delivered CIH is a more effective approach than either strategy alone. This question is of particular importance to the VA as it moves forward in developing policies and processes on the implementation of both practitioner-delivered CIH care as well as dissemination strategies for Veterans to learn self-care approaches.

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