Department of Veterans Affairs Office of Research and Development's pain portfolio.

Abstract

It is an exciting time for pain research at the Department of Veterans Affairs (VA). In the seven years that I have been a Scientific Program Manager in the Rehabilitation Research and Development Service in the Office of Research and Development (ORD), I have witnessed an increase in the number of projects and funded investigators within VA's pain portfolio. In 2009, there were approximately 57 projects on pain research. In July 2015, the number of projects was 109, and importantly, the investment in pain research almost tripled within this time span. This change can be attributed to the increased interest in pain research within VA's scientific and clinical communities brought about by the unique chronic pain management needs of Veterans returning from Iraq and Afghanistan and the collaborative effort between VA's pain research community and ORD to spotlight pain research. Pain research in ORD appropriately spans the translational research spectrum and includes basic/foundational research mainly in animal models, epidemiology to determine the distribution of various painful conditions in the VA, pain diagnosis, management and treatment of pain, underlying causes of chronic pain including the transition from the acute to chronic state, adverse events associated with pain management, and health services-level research. This editorial covers a fraction of the innovative and unique areas of pain research being conducted at the VA and the important role VA researchers play in the pain community, as evidenced by VA participation in the Interagency Pain Research Coordinating Committee (IPRCC) National Pain Strategy (NPS). * Pain management: The challenge of treating Veterans with chronic pain and coexisting conditions has sparked an interest in how to care for these individuals effectively. Team-based integrative approaches play up to VA's strengths as a healthcare system and include the clinicians who see Veterans in the clinic, who also conduct basic up to health services research. This is reflected in the high number of treatment-related projects (n = 46) examining the effectiveness of exercise and activity; complementary approaches, including electroceuticals (e.g., transcranial magnetic stimulation) and yoga; and testing different formulations of drug therapies focused not only on pain but also on coexisting conditions, including posttraumatic stress disorder (PTSD), depression, sleep, and substance use disorders. The emphasis of treatment includes reduced dependence on opioids as "go to" drugs and examining alternate forms of pain management, putting the Veteran in the driver's seat in managing the painful condition. * Comparative-effectiveness research: Comparative-effectiveness studies emphasize the importance of "evidence-based practice" and "practice-based evidence" results and are reality checks as to what treatments should be effective and what treatments actually are effective. These types of studies are unique to healthcare systems and aim to improve the delivery of care and maximize patient satisfaction while being cost-effective. It is an area of research well-suited to the VA and an area in which the VA Health Services researchers are leaders in the field. Results from these studies change the way care is delivered at the VA. An example of evidence-based practice research is the adoption of acupuncture for chronic low back pain at the VA, while an example of practice-based evidence research is the ongoing assessment of the Stepped Care Model for pain management. In this case, results recommend the rearrangement of "steps" to make the process more efficient and effective, including rotating the clinicians versus having the patient rotate through the "steps." Comparative-effectiveness studies are an ideal way to determine best practices that benefit the Veteran. * Precision medicine: Everyone is talking about precision medicine, but VA pain researchers and clinicians are actually "walking the walk. …