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

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

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.

KEY WORDS

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

Notes

Acknowledgements

The SOTA was funded through the Veterans Health Administration Office of Health Services Research and Development. The authors would like to acknowledge the leadership of Dr. David Atkins, Ms. Geraldine McGlynn, and Ms. Karen Bossi in supporting the work of the conference, as well as that of the conference co-chairs Dr. Erin Krebs and Dr. Robert Kerns, whose intellectual effort in planning and chairing the conference is represented in the content of this manuscript. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the US Government.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

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Copyright information

© Society of General Internal Medicine (outside the USA) 2018

Authors and Affiliations

  • Benjamin Kligler
    • 1
    • 2
  • Matthew J. Bair
    • 1
    • 3
  • Ranjana Banerjea
    • 1
  • Lynn DeBar
    • 4
    • 5
  • Stephen Ezeji-Okoye
    • 1
  • Anthony Lisi
    • 1
    • 6
  • Jennifer L. Murphy
    • 1
  • Friedhelm Sandbrink
    • 1
  • Daniel C. Cherkin
    • 7
  1. 1.Veterans Health AdministrationWashingtonUSA
  2. 2.Icahn School of Medicine at Mount SinaiNew YorkUSA
  3. 3.Indiana University School of MedicineIndianapolisUSA
  4. 4.Kaiser Permanente Center for Health ResearchPortlandUSA
  5. 5.Oregon Health Sciences UniversityPortlandUSA
  6. 6.Yale University School of MedicineNew HavenUSA
  7. 7.Kaiser PermanenteWashington Health Research InstituteSeattleUSA

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