VA Pain Care Transformation: Implementation of the Six Essential Elements
of Good Pain Care
Presenter: Stephen Hunt, MD, MPH
Presenter: Lucile Burgo-Black, MD, ABIHM
Presenter: Ilene Robeck, MD
Presenter: Stephen Eraker, MD, MPH, FACP
There are currently few clinical challenges more prominent on the national health care landscape than
those associated with chronic pain management. Beneath the escalating morbidity and mortality
associated with steady increases in opioid use over the past two decades, a deeper and more fundamental
problem has been identified: we have lacked a strong conceptual model for what good pain care is and
how it can be delivered across the health care system. In VA, it has also been the case that the need for
changes in opioid prescribing has driven efforts to affect broader transformations in pain care
conceptualization and delivery. This transformation has been structured around the notion of six essential
elements that comprise good pain care: education of Veterans/family members, education of clinical
teams, orienting toward self-care/self-management and non-pharmacological interventions, using safe
prescribing practices whenever opioids are used, leveraging such modalities as e -consultation, SCAN
EHCO, tele-health and consultation lines to bring expertise to the Veteran’s team and developing and
using metrics to measure and monitor pain care.
This session will begin by describing the pain care needs of Veterans in general, highlighting the unique
considerations that must be taken into account when providing pain care for individuals who have been
deployed to combat theaters. The integrated matrix of initiatives, tools and resources necessary to
implement each of the essential elements in any VA care setting and to support a stepped care model of
delivery will be presented. Various examples of such settings, from large urban VA Medical Centers to
remote Community Based Outpatient Clinics (CBOCs) will be described.
Data demonstrating progress in this pain care transformation process will be presented. Potential
applications of lessons learned from VA pain care transformation to other clinical settings will be
discussed.
Learning Objectives
1. Describe the six essential elements for pain care transformation
2. Be familiar with the pain care needs of military service members and Veterans
3. Recognize how point of care data can drive safe opioid prescribing
Describe approaches to systematically educate teams to transform pain care practices