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Center for Chronic Disease Outcomes Research

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Chronic Pain

Background:
Chronic pain is a major public health problem affecting more than 100 million adults in the United
States and resulting in at least $560–$635 billion in health care costs and lost productivity each year. Further, opioid prescribing for chronic pain has grown exponentially over the past two decades, resulting in an epidemic of prescription drug abuse and overdose.

Highlights:
• Dr. Krebs launched the EPOCH study, an HSR&D-funded prospective cohort study examining patient-centered outcomes of opioid prescribing changes among Veterans treated with long-term opioids for chronic pain. The project will survey a nationally-representative sample of VA primary care patients receiving long-term opioid therapy at baseline. Longitudinal patient-reported pain outcomes data will be merged with administrative and pharmacy data to examine relationships of changes in pain treatment with changes in patient-reported pain and quality of life outcomes.

• Drs. Polusny and Krebs launched a National Center for Complementary and Integrative Health (NCCIH) R01-funded longitudinal study of chronic pain and complementary medicine use in a National Guard Veteran cohort.

• Dr. Burgess began recruitment for the qualitative portion of the ACTION study, a trial that will test a proactively delivered telephone-counseling program to promote walking and decrease pain in Black Veterans with musculoskeletal diagnoses.

• Drs. Polusny and Krebs worked with Dr. Erin Koffel to complete a secondary data analysis examining the bidirectional relationship of sleep and pain. They analyzed data from a 12-month randomized controlled trial that tested the effectiveness of a collaborative care intervention for Veterans with chronic musculoskeletal pain. Participants were 250 Veterans from 5 primary care clinics in a Veteran Affairs (VA) medical center. Early improvements in sleep predicted improvements in pain over the course of a year; conversely, worsening sleep predicted worsening pain over time. To a lesser extent, changes in pain predicted changes in sleep. This work helps to further disentangle the complex relationship between pain and sleep and suggests that it will be important to continue investigating targeted sleep treatments for improving pain functioning.

• CCDOR investigators published 9 peer-reviewed publications in the area of chronic pain management.

•Dr. Krebs participated in developing educational and advocacy materials to reduce harms of opioid prescribing as the invited American College of Physicians clinical representative to the American
Medical Association (AMA) Task Force to Reduce Opioid Abuse and to the Pain Management Expert Panel for the AMA Prescriber Clinical Support System for Opioid Therapies (PCSS-O) series.

• Dr. Krebs participated in guideline development and dissemination activities as an Opioid
Prescribing Guidelines for Chronic Pain Core Expert Group member for the Centers for Disease Control and Prevention (CDC).

• Dr. Krebs served as a Technical Advisory Group member for the VHA Pain Management Survey, which was published by the VHA Office of the Assistant Deputy Under-Secretary for Health for Policy and Planning in November 2014.