VA Medical Centers are Using Lessons from Research to Guide Care

The opioid epidemic has impacted individuals and families across the country, but the veteran population has been especially hard hit. Veterans are twice as likely as civilians to die from an accidental opioid overdose, and according to Rachel Ramoni, chief research and development officer at the Department of Veterans Affairs (VA), six veterans die every day due to opioids.

Furthermore, according to a 2016 study, 9% of male veterans and 11% of female veterans report severe pain. And chronic pain, coupled with anxiety and depression, is a major issue for many veterans. For these individuals, the management of this pain can be difficult, and careful and consistent follow up is necessary.

Considering these staggering data, and the unique patient population that they treat, VA Medical Centers are on the front lines of researching topics like pain management and treatment for substance use disorder. They are also training the next generation of researchers to combat this epidemic in the years to come.

A May 2018 congressional briefing, hosted by the Friends of VA Medical Care and Health Research (FOVA), highlighted examples of innovative research being conducted by the VA to combat the opioid epidemic. Speakers included Erin E. Krebs, MD, MPH, core investigator, Center for Chronic Disease Outcomes Research and associate professor of medicine at the Minneapolis VA and University of Minnesota; Matthew Bair, MD, core investigator, Center for Health Information and Communication and associate professor of medicine at the Roudebush VA and University of Indiana; and Sulayman Dib-Hajj, PhD, senior research scientist in neurology and associate director of the Center for Restoration of Nervous System Function at the West Haven VA and Yale University.

The VA system promotes a streamlined coordination of care, making it an ideal research environment. In addition, because of the high rate of veterans affected by chronic pain, the VA has a well-established research program that has been supporting research in this field for many years.

Both Krebs and Bair noted that their visits with patients help inform their work in the laboratory. “I have learned the most from hearing veterans talk about how they’re suffering from chronic pain,” said Bair.

“I have learned the most from hearing veterans talk about how they’re suffering from chronic pain.”

Matthew Bair, MD

In a recent research trial, Krebs and her team found that opioid therapy was not superior to nonopioid medication therapy over 12 months. This finding was consistent with those of previous short-term trials — opioids have modest benefits and were not superior to other pain killers over time. This data provided VA researchers with evidence that opioids do not need to be a physician’s primary response to a veteran’s chronic pain.

“It’s not that opioids have no value or no place in medicine. [However,] we now recommend against the initiation of long-term opioid therapy for chronic pain."

Erin Krebs, MD, MPH

“It’s not that opioids have no value or no place in medicine,” Krebs explained. However, “we now recommend against the initiation of long-term opioid therapy for chronic pain.”

All the speakers highlighted the need for more federal funding for pain research and implementation, and Bair noted that in order “to have greater impact, we need more multisite trials.” Furthermore, each speaker agreed that providers should look to personalized care management as a primary intervention and consider alternative treatments to pain management like yoga and massage. 

Instead of continuing to use opioids as a primary intervention, “we can use existing drugs in a more effective manner,” said Dib-Hajj, whose research into sodium channel-blocking drugs could lead to new, nonopioid pain management therapies in the future. “We all know the problems with the current options. We have an unmet medical need for novel, safer, nonaddictive pain medications, but the take-home message is one of hope.”