Whole Health Team vs. Primary Care Group Education to Promote Non-Pharmacological Strategies to Improve Pain, Functioning, and Quality of Life in Veterans

Project Summary

This pragmatic, randomized, controlled trial aims to test three different approaches to chronic pain management for veterans with chronic pain, who may or may not be on opioids. The approaches consist of two active interventions and one usual-care intervention. The active interventions are (1), a Whole Health Team approach to managing chronic pain in veterans, and (2) a  Primary Care Group Education approach, which is essentially a modified form of group Cognitive Behavioral Therapy for Chronic Pain.  The third approach is the control condition which is the usual VA primary care for chronic pain. The two active interventions will then be compared to one another and each of those will be compared to usual primary care approach.

Co-Principal Investigators


Karen Seal, MD


William Becker, MD

Impact and Contribution to PMC and Society

There is a critical need to identify effective models of integrative, non-pharmacological pain management approaches in a broad population of veterans with chronic pain.  Results of this study will contribute to the overall mission of the NIH/VA/DoD initiative to build national-level infrastructure that supports integrative, nonpharmacological pain management in veterans and military service personnel.


Northern California Institute for Research and Education (NCIRE)), affiliated with San Francisco VA Health Care System, and VA Connecticut Health Care System

Institute Providing Oversight:  National Center for Complementary and Integrative Health (NCCIH)

Program Officer: 
Pete Murray, (NCCIH)

Project Scientist:  Jeremy Brown, National Institute of Neurological Disorders and Stroke (NINDS)/ National Institute of General Medicine Sciences (NIGMS)

ClinicalTrials.gov Identifier:  NCT04330365

Trial Status:  UH3 phase; not yet recruiting

Project Narrative

Over 100 million Americans—nearly one-third of the U.S. population—suffer from chronic pain or pain that persists after tissue damage has healed. Veterans of war suffer disproportionately from chronic pain, with as many as 50% of all veterans reporting one or more chronic pain complaints. War-related emotional and physical trauma increases risk for mental health comorbidity, pain-related disability and adverse outcomes related to overuse of medication, especially opioids. There is a critical need to identify effective models of integrative, non-pharmacological pain management approaches in a broad population of veterans with chronic pain.

The overarching goal of the (w)HOPE study is to establish and implement a new Whole Health paradigm for chronic pain care, emphasizing non-pharmacological pain self-management that reduces pain symptoms and improves overall functioning and quality of life in veterans. Our specific aim is to conduct a pragmatic implementation-effectiveness trial in which we will develop, pilot and implement two care delivery approaches for over 600 veterans with moderate to severe chronic pain.

Dr. William Becker and Dr. Karen Seal spoke with the Pain Management Collaboratory Coordinating Center to talk briefly about their trial.

Veterans will be randomized to receive either:

  • an intensive Whole Health Team (WHT) approach, or
  • a less intensive Primary Care Group Education (PC-GE) approach, which will be a modified form of Cognitive Behavioral Therapy for Chronic Pain.

This trial will be conducted across four geographically distinct locations throughout the continental United States.

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