The National Center for Complementary and Integrative Health (NCCIH) at the National Institutes of Health (NIH) has recommended conducting larger-scale research studies, focusing on nondrug approaches for pain management in active military and veterans. The NCCIH is assessing the feasibility of conducting these studies in cooperation with the US Department of Defense (DoD) and the US Department of Veterans Affairs (VA).
In an NIH news release, Lloyd Michener, MD, professor and chair, Department of Community and Family Medicine, Duke University, Durham, North Carolina—chair of the working group—points out that the “high rates of chronic pain in the military and veteran populations are alarming. New strategies for managing this widespread condition are urgently needed.”
To combat this, the working group recommended the proposed research should center on assessing the impact of pain on patient function and quality of life as primary outcome measures, with changes in the use of opioids and other drugs as a secondary outcome. They also recommend evaluating an integrated package of nondrug treatments, an integrative model of care, or a holistic approach to care rather than focusing on individual complementary health approaches. The research should also focus on patients in the early stages of chronic pain, leverage natural experiments and existing resources whenever possible, and be pragmatic and embedded in the delivery of care.
Josephine P. Briggs, MD, NCCIH director, states in the release that the working group’s report “provides valuable guidance on how NCCIH can collaborate effectively with the DoD and VA to enhance the tools available for pain management. Although the proposed research would focus on military personnel and veterans, the findings could benefit all Americans who are at risk for chronic pain.”
Eric Schoomaker, MD, PhD, professor of military and emergency medicine at the Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, and former US Army Surgeon General, emphasizes that pain is a major focus of research at the DoD, VA, and NCCIH.
“Our working group believes that by bringing the DoD and VA infrastructure together with NCCIH’s research expertise, we can create unique opportunities to learn more about how to integrate complementary health approaches into pain management,” Schoomaker adds.
The release notes that the working group prepared its report following a series of five meetings at which the group heard presentations by experts in pain research; study design; complementary and integrative approaches; and DoD and VA initiatives, practices, and priorities. A representative of a veterans’ advocacy organization and a veteran who has struggled with chronic pain also addressed the group.
The release also states that in addition to Michener and Schoomaker, the working group included Stephen Ezeji-Okoye, MD, deputy chief of staff, VA, Palo Alto, Calif; Tracy Gaudet, MD, director, Office of Patient Centered Care, Veterans Health Administration; and Richard Niemtzow, MD, PhD, MPH, consultant to the US Air Force Surgeon General and assistant professor at USUHS.