A new study of treatment options for military veterans with chronic pain has determined that care practices at Veterans Health Administration (VHA) facilities vary widely and could contribute to a veteran's likelihood of using opioids.
A recently published article in the Journal of General Internal Medicine surveyed care provided to 1.1 million veterans at 176 VHA medical centers between 2010 and 2015.
At some centers, as many as one-third of the veterans seeking care for chronic pain began long-term opioid therapy, compared with only 5 percent at other centers.
"We found that there were not consistent practices between VHA facilities," said senior author Joseph Frank, MD, MPH. "While there is a consensus that multiple approaches to care are important, there is a wide variation in availability of those options at some centers."
Frank, who is an assistant professor of medicine at the CU School of Medicine and an investigator for the VA Eastern Colorado Health Care System's Center of Innovation for Veteran-Centered and Value Driven Care, and his fellow investigators reviewed 10 pain-related treatment options, including physical and occupational therapy, and non-opioid pain-relief medications.
They found that when a facility had a wider range of treatment options to provide, veterans were less likely to begin long-term opioid therapy. They also found that sites that offered more non-opioid medications ultimately had higher rates opioid use by veterans.
The results of the study are important because of efforts to reduce the use of opioids due to the rising numbers of addiction and overdoses of the drugs. In 2017, the U.S. Departments of Veterans Affairs and Defense issued guidelines on opioid therapy for chronic pain that strongly recommend non-pharmacologic treatments and non-opioid medications.
"This study is a first step in understanding the institutional cultures that may contribute to the use of opioids to treat chronic pain," said Frank. "We need to continue our work to understand better ways to provide non-opioid treatments across diverse, real-world clinical settings."
"We'll need the help of healthcare leaders and investments by healthcare systems to gather evidence on non-medication treatments. We'll measure success in quality of life and prevention of opioid-related harms," said Frank.
Facility-level utilization patterns of non-pharmacologic, non-opioid, and opioid treatments for chronic pain are associated with subsequent patient-level initiation of LTOT among veterans with incident chronic pain.
Further studies should seek to understand facility-level variation in chronic pain care and to identify facility-level utilization patterns that are associated with improved patient outcomes.