A Research Agenda for Advancing Non-pharmacological Management of Chronic Musculoskeletal Pain: Findings from a VHA State-of-the-art Conference

  • William C. Becker
  • Lynn L. DeBar
  • Alicia A. Heapy
  • Diana Higgins
  • Sarah L. Krein
  • Anthony Lisi
  • Una E. Makris
  • Kelli D. Allen


Chronic pain is widely prevalent among Veterans and can have serious negative consequences for functional status and quality of life among other domains. The Veterans Health Administration (VHA) convened a state-of-the-art (SOTA) conference to develop research priorities for advancing the science and clinical practice of non-pharmacological management of chronic musculoskeletal pain. In this perspective article, we present the methods and consensus recommendations for research priorities emanating from the SOTA. In the months leading up to the SOTA, a core group of researchers defined four areas of focus: psychological/behavioral therapies; exercise/movement therapies; manual therapies; and models for delivering multi-modal pain care and divided into workgroups. Each workgroup, in their respective areas of focus, identified seminal studies capturing the state of the evidence. Herein, we present consensus recommendations ranging from efficacy to effectiveness to implementation/dissemination research depending on the state of the evidence as assessed by participants, including commentary on common elements across workgroups and future areas of innovation in study design, measurement, and outcome ascertainment.


chronic pain management non-pharmacologic treatments clinical research 



The authors wish to acknowledge the SOTA co-chairs and planning committee members who were not involved in writing the manuscript but whose process and products are described herein: Robert D. Kerns, PhD; Erin E. Krebs, MD, MPH; Benjamin Kligler, MD, MPH; Jennifer Murphy, PhD; Stephen Ezeji-Okoye, MD; Daniel Cherkin, PhD; Rollin “Mac” Gallagher, MD, MPH; and Matthew J. Bair, MD, MS.


The Department of Veterans Affairs, Health Services Research and Development provided funds for the SOTA described in this manuscript. Drs. Becker and Heapy receive funding from VA HSR&D/QUERI project 15-460. Dr. Makris was supported by the Center for Translational Medicine, NIH/NCATS Grants (KL2TR001103 and UL1TR001105), and she is currently supported by a VA HSR&D Career Development award (IK2HX001916). Dr. Krein is supported by a HSR&D Research Career Scientist Award (RCS 11-222). Dr. Allen is supported by the Center for Health Services Research in Primary Care at the Durham VA Healthcare System (CIN 13-410) and a National Institute of Arthritis and Musculoskeletal and Skin Diseases Multidisciplinary Clinical Research Center P60 AR062760.

Compliance with Ethical Standards

Conflict of Interest

Drs. Heapy and Higgins received consulting fees from Magellan Health for the development of a web-based CBT program for chronic pain. All other authors declare no conflicts of interest.


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • William C. Becker
    • 1
    • 2
  • Lynn L. DeBar
    • 3
  • Alicia A. Heapy
    • 1
    • 2
  • Diana Higgins
    • 4
    • 5
  • Sarah L. Krein
    • 6
    • 7
  • Anthony Lisi
    • 1
  • Una E. Makris
    • 8
    • 9
  • Kelli D. Allen
    • 10
    • 11
  1. 1.Pain Research, Informatics, Multimorbidities & Education Center of Innovation VA Connecticut Healthcare SystemWest HavenUSA
  2. 2.Yale School of MedicineNew HavenUSA
  3. 3.Kaiser Permanente Washington Health Research InstituteSeattleUSA
  4. 4.VA Boston Healthcare SystemBostonUSA
  5. 5.Boston University School of MedicineBostonUSA
  6. 6.Center for Clinical Management ResearchVA Ann Arbor Healthcare SystemAnn ArborUSA
  7. 7.Department of Internal MedicineUniversity of Michigan School of MedicineAnn ArborUSA
  8. 8.VA North Texas Health Care SystemDallasUSA
  9. 9.Department of Internal MedicineUT Southwestern Medical CenterDallasUSA
  10. 10.Center for Health Services Research in Primary CareDurham VA Healthcare SystemDurhamUSA
  11. 11.Department of Medicine & Thurston Arthritis Research CenterUniversity of North CarolinaChapel HillUSA

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