Optimizing the Impact of Pragmatic Clinical Trials for Veteran and Military Populations: Lessons From the Pain Management Collaboratory

Author:

Ali Joseph1,Antonelli Margaret23,Bastian Lori23,Becker William23,Brandt Cynthia A23,Burgess Diana J45,Burns Amy23,Cohen Steven P6,Davis Alison F3,Dearth Christopher L78,Dziura Jim3,Edwards Rob9,Erdos Joe23,Farrokhi Shawn10,Fritz Julie11,Geda Mary3,George Steven Z12,Goertz Christine13,Goodie Jeffrey14,Hastings Susan N1516,Heapy Alicia23,Ilfeld Brian M17,Katsovich Lily3,Kerns Robert D23ORCID,Kyriakides Tassos C23,Lee Allison23,Long Cynthia R18,Luther Stephen L1920,Martino Steve23,Matheny Michael E2122,McGeary Don23,Midboe Amanda24,Pasquina Paul2526,Peduzzi Peter3,Raffanello Michael2,Rhon Daniel27,Rosen Marc23,Esposito Elizabeth Russell28,Scarton Dylan29,Hastings Susan N3031,Seal Karen3233,Silliker Norman3,Taylor Sakasha2,Taylor Stephanie L3435,Tsui Megan29,Wright Fred S2,Zeliadt Steven2836

Affiliation:

1. Johns Hopkins Berman Institute of Bioethics and Bloomberg School of Public Health, Baltimore, MD 21205, USA

2. VA Connecticut Healthcare System, West Haven, CT 06516, USA

3. Yale University School of Medicine, New Haven, CT 06520, USA

4. Minneapolis VA Health Care System, Minneapolis, MN 55417, USA

5. University of Minnesota Medical School, Minneapolis, MN 55455, USA

6. Johns Hopkins Medical Institutions, Clarksville, MD 21029, USA0

7. DoD-VA Extremity Trauma and Amputation Center of Excellence, Bethesda, MD 20814, USA

8. Department of Surgery, Uniformed Services University of the Health Sciences and Walter Reed National Military Medical Center, Bethesda, MD 20814, USA

9. Department of Anesthesiology, Harvard Medical School, Brigham and Women’s Hospital, Chestnut Hill, MA 02467, USA

10. Naval Medical Center San Diego, Department of Physical Therapy, San Diego, CA 92134, USA

11. University of Utah, College of Health, Salt Lake City, UT 84108, USA

12. Duke Clinical Research Institute and Department of Orthopaedic Surgery, Duke University, Durham, NC 27715, USA

13. Spine IQ, Oskaloosa, IA 52577, USA

14. School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

15. Duke University School of Medicine, Durham, NC 27710, USA

16. Durham VA Health Care System, Durham, NC 27705, USA

17. Department of Anesthesiology, University of California San Diego School of Medicine, LaJolla, CA 92093, USA

18. Palmer Center for Chiropractic Research, Davenport, IA 52803, USA

19. James A. Haley Veterans Hospital, Tampa, FL 33612, USA

20. University of South Florida College of Public Health, Tampa, FL 33612, USA

21. Tennessee Valley Healthcare System, Nashville, TN 37212, USA

22. Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN 37212, USA

23. Department of Psychiatry & Behavioral Sciences, University of Texas Health Science Center, San Antonio, TX 78229, USA

24. VA Palo Alto Health Care System, Palo Alto, CA 94304, USA

25. Department of Physical Medicine & Rehabilitation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

26. Department of Rehabilitation, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA

27. Brooke Army Medical Center, JBSA Fort Sam Houston, TX 78234, USA

28. VA Puget Sound Health Care System, Seattle, WA 98108, USA

29. Henry Jackson Foundation, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA

30. Durham VA Medical Center, Durham, NC 27701, USA

31. Department of Medicine, Duke University, Durham, NC 27708, USA

32. University of California San Francisco, School of Medicine, San Francisco, CA 94143, USA

33. San Francisco VA Medical Center, San Francisco, CA 94121, USA

34. VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA

35. University of California Los Angeles Department of Medicine and Department of Health Policy and Management, Los Angeles, CA 90095, USA

36. University of Washington, School of Public Health, Seattle, WA 98195, USA

Abstract

ABSTRACT Pragmatic clinical trials (PCTs) are well-suited to address unmet healthcare needs, such as those arising from the dual public health crises of chronic pain and opioid misuse, recently exacerbated by the COVID-19 pandemic. These overlapping epidemics have complex, multifactorial etiologies, and PCTs can be used to investigate the effectiveness of integrated therapies that are currently available but underused. Yet individual pragmatic studies can be limited in their reach because of existing structural and cultural barriers to dissemination and implementation. The National Institutes of Health, Department of Defense, and Department of Veterans Affairs formed an interagency research partnership, the Pain Management Collaboratory. The partnership combines pragmatic trial design with collaborative tools and relationship building within a large network to advance the science and impact of nonpharmacological approaches and integrated models of care for the management of pain and common co-occurring conditions. The Pain Management Collaboratory team supports 11 large-scale, multisite PCTs in veteran and military health systems with a focus on team science with the shared aim that the “whole is greater than the sum of the parts.” Herein, we describe this integrated approach and lessons learned, including incentivizing all parties; proactively offering frequent opportunities for problem-solving; engaging stakeholders during all stages of research; and navigating competing research priorities. We also articulate several specific strategies and their practical implications for advancing pain management in active clinical, “real-world,” settings.

Funder

National Center for Complementary and Integrative Health

Social Sciences Researc

NCCIH, OBSSR, and the National Institutes of Health

Publisher

Oxford University Press (OUP)

Subject

Public Health, Environmental and Occupational Health,General Medicine

Reference20 articles.

1. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research;Institute of Medicine,2011

2. Pain and the global burden of disease;Rice;Pain,2016

3. Prevalence of chronic pain and high-impact chronic pain among adults—United States, 2016;Dahlhamer;MMWR Morb Mortal Wkly Rep,2018

4. Chronic pain and opioid use in U.S. soldiers after combat deployment;Toblin;JAMA Intern Med,2014

5. National Pain Strategy: a comprehensive population health-level strategy for pain;Department of Health and Human Services,2016

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