Clinical research as a foundation for Veterans Health Administration Pain Management Strategy.

Early this year, the Editor of Journal of the American Medical Association (JAMA) put out a call for “Pain Management” papers to be published in a special thematic issue in November 2003 [1]. Specifically, she wrote “The management of pain is a continuing public health problem. Pain of all descriptions is one of the most frequently encountered complaints in physicians’ offices, hospitals, chronic care facilities, and nursing homes. Virtually all health care professionals encounter patients with pain, whether it is acute or chronic; is due to trauma, surgery, arthritis, cancer, or other illnesses; or occurs as part of daily life or at the end of life.” Researchers involved with the VHA have longed worked on pain and pain management issues, and we feel the readership of the Journal of Rehabilitation Research and Development (JRRD) would be greatly interested in understanding the current approaches and programs now in use and being developed that address these issues for veterans. Therefore, we have put together this special section to highlight the research and development of pain management within the Department of Veterans Affairs (VA) as a complement to the very exciting JAMA thematic issue. In late 1998, the Veterans Health Administration (VHA) launched a National Pain Management Strategy designed “to develop a comprehensive, multicultural, integrated, systemwide approach to pain management that reduces pain and suffering for veterans experiencing acute and chronic pain associated with a wide range of illnesses, including terminal illness” [2,3]. Early in the implementation of the Strategy, a multidisciplinary VHA National Pain Management Strategy Coordinating Committee (NPMCC) was organized to oversee the development and implementation of the Strategy. Supporting the NPMCC are 21 regional or Veterans Integrated Service Networks (VISNs) points of contact, VISN pain management committees, and local facility pain management oversight committees, in addition to dedicated providers and administrators throughout the VHA. Over the past 5 years, the NPMCC and many collaborating VHA and non-VHA experts have been responsible for numerous efforts targeting several more specific goals of the Strategy. These goals include the development of a single systemwide standard of care that reduces suffering from pain, development of standards and methods for routine pain assessment of all veterans receiving care in VHA facilities, development and implementation of empirically supported and expert guidelines for promoting state-of-the-art pain care, provision of opportunities for patient and family as well as provider education regarding pain management, development of Robert D. Kerns, PhD VA Connecticut Healthcare System and Yale University, Clinical Research, as a foundation for the Veterans Health Administration (VHA) Pain Management Strategy