Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain

Benjamin Kligler, Matthew Bair, Ranjana Banerjea, Lynn DeBar, Stephen Ezeji-Okoye, Anthony Lisi, Jennifer L. Murphy, Friedhelm Sandbrink, Daniel C. Cherkin

Research output: Contribution to journalReview article

5 Citations (Scopus)

Abstract

As a large national healthcare system, Veterans Health Administration (VHA) is ideally suited to build on its work to date and develop a safe, evidence-based, and comprehensive approach to the care of chronic musculoskeletal pain conditions that de-emphasizes opioid use and emphasizes non-pharmacological strategies. The VHA Office of Health Services Research and Development (HSR&D) held a state-of-the-art (SOTA) conference titled “Non-pharmacological Approaches to Chronic Musculoskeletal Pain Management” in November 2016. Goals of the conference were (1) to establish consensus on the current state of evidence regarding non-pharmacological approaches to chronic musculoskeletal pain to inform VHA policy in this area and (2) to begin to identify priorities for the future VHA research agenda. Workgroups were established and asked to reach consensus recommendations on clinical and research priorities for the following treatment strategies: psychological/behavioral therapies, exercise/movement therapies, manual therapies, and models for delivering multimodal pain care. Participants in the SOTA identified nine non-pharmacological therapies with sufficient evidence to be implemented across the VHA system as part of pain care. Participants further recommended that effective integration of these non-pharmacological approaches across the VHA and especially into VHA primary care, pain care, and mental health settings should be a priority, and that these treatments should be offered early in the course of pain treatment and delivered in a team-based, multimodal treatment setting concurrently with active self-care and self-management approaches. In addition, we recommend that VHA leadership and policy makers systematically address the barriers to implementation of these approaches by expanding opportunities for clinician and veteran education on the effectiveness of these strategies; supporting and funding further research to determine optimal dosage, duration, sequencing, combination, and frequency of treatment; emphasizing multimodal care with rigorous evaluation grounded in team-based approaches to test integrated models of delivery and stepped-care approaches; and working to address socioeconomic and cultural barriers to veterans’ access to non-pharmacological approaches.

Original languageEnglish (US)
Pages (from-to)16-23
Number of pages8
JournalJournal of General Internal Medicine
Volume33
DOIs
StatePublished - May 1 2018

Fingerprint

Veterans Health
Musculoskeletal Pain
United States Department of Veterans Affairs
Chronic Pain
Pain
Veterans
Self Care
Research
Consensus
Therapeutics
Musculoskeletal Manipulations
Exercise Therapy
Combined Modality Therapy
Health Services Research
Pain Management
Health Policy
Administrative Personnel
Opioid Analgesics
Primary Health Care
Mental Health

Keywords

  • chronic pain
  • complementary and alternative medicine
  • psychological therapies
  • self-management
  • veterans

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain. / Kligler, Benjamin; Bair, Matthew; Banerjea, Ranjana; DeBar, Lynn; Ezeji-Okoye, Stephen; Lisi, Anthony; Murphy, Jennifer L.; Sandbrink, Friedhelm; Cherkin, Daniel C.

In: Journal of General Internal Medicine, Vol. 33, 01.05.2018, p. 16-23.

Research output: Contribution to journalReview article

Kligler, Benjamin ; Bair, Matthew ; Banerjea, Ranjana ; DeBar, Lynn ; Ezeji-Okoye, Stephen ; Lisi, Anthony ; Murphy, Jennifer L. ; Sandbrink, Friedhelm ; Cherkin, Daniel C. / Clinical Policy Recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain. In: Journal of General Internal Medicine. 2018 ; Vol. 33. pp. 16-23.
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