For Providers - Team-Based Pain Care
Providing excellent whole person pain care requires a team approach. While the components of the treatment team will vary based on the setting, certain elements of integrated care form the basis for an effective team approach: communication, mutual respect, proactive preparation, and common therapeutic goals. The Biopsychosocial model and the VA Stepped Care Model for Pain Care provide a framework for effective integrated team-based pain care.
Learn about the Biopsychosocial Model of Pain Care
Psychological or social factors influence pain. Such influences are known as the biopsychosocial model of pain. This model is used to interpret pain, the severity of pain is determined not only by physical problems, but also by personal factors and aspects of the environment.
||The Chronic Pain for Education for Veterans on-line questionnaire assesses these factors and provides customized content based on a Veterans experiences and beliefs about pain and its treatment. This assessment will identify physical causes of pain, but also identify other factors that may affect the severity of pain. The factors that determine the degree of pain come from different areas of medicine, which may require treatment by various medical disciplines (neurology, orthopedics, psychology, psychiatry and rehabilitation).
After completing, a personal feedback report is provided with suggestions for steps the Veterans can take for better pain management and topics which should discussed with health care providers. This information can be used when designing pain management treatment. Link to the Chronic Pain Education for Veterans - questionaire.
VA PACT Pain Champions
The VA PACT Pain Champions Initiative is a program designed to improve pain care options in primary care. The VA Stepped Care Model for pain care recognizes that many positive approaches to pain can be utilized in the primary care setting to improve medication safety and offer many safe and effective options for pain related to self-care, pain education, cognitive behavioral approaches to pain, physical therapy and movement options as well as whole health approaches that incorporate a biospsychosocial approach to pain that also includes complementary integrative approaches such as mindfulness, yoga and auricular acupuncture.
Since its inception in 2008 as the primary care pain task force the group has now evolved into the pact pain champions that includes a representative from every facility as well as a representative from every VISN. Each group meets monthly and there is also a monthly community of practice call to share ideas and innovations. Some innovations that have come from this program include primary care based pain teams, involvement in the VA SCOUTT program that improves access to Medication Assisted Treatment for Opioid Use Disorder in primary care and other non SUD settings, primary care based pain schools, the PACT Pain roadmap that outlines approaches to pain in primary care, and improved access to opioid overdose education and naloxone to name.
VA Stepped Care Model of Pain Care
VHA Directive 2009-053, Pain Management - Veterans Affairs - VHA employs a stepped-care model of pain care that provides for management of most pain conditions in the primary care setting.
VHA has taken a lead in improving chronic pain care with the Stepped Model of Pain Care. The Stepped Care Model provides a roadmap to providing appropriate level and intensity of pain management and effective treatment to patients with acute and chronic pain. The VA Stepped Care Model of Pain Care is key to providing the right care for the right patient in the right setting.
|Abbreviations: CARF=Commission on Accreditation of Rehabilitation Facilities, SUD=Substance Use Disorder, MH-PC=Mental Health-Primary Care, OEF/OIF=U.S.-led conflicts in Afghanistan and Iraq. Specifically, OEF means "Operation Enduring Freedom" (the war in Afghanistan), while OIF stands for "Operation Iraqi Freedom," or the Iraq War, COT=chronic opioid.
PACT Roadmap for Managing Pain
||The VA Office of Primary Care, in collaboration with other pain care team members and stakeholders, has created this PACT Roadmap for Managing Pain (Pain Roadmap-PDF), to assist PACTs in establishing the processes and relationships needed to provide safe and effective team-based, stepped pain care.
This video provides an explanation of the "Stepped Care Model for Pain Management" and its use in the VHA and DoD. Click here to access the video
Journal of Rehabilitation Research & Development (JRRD)
"Stepped care model for pain management and quality of pain care in long-term opioid therapy."
Abstract — This study examined the utility of the Pain Care Quality (PCQ) extraction tool in evaluating implementation of the Stepped Care Model for Pain Management at one Veterans Health Administration (VHA) healthcare system over 4 yr and in a non-VHA Federally qualified health center (FQHC) over 2 yr. Read more: https://www.rehab.research.va.gov/jour/2016/531/jrrd-2014-10-0254.html
Providers Pain Management - Resource Topics
Literature Alerts for VA Staff
The VA Library Network will provide VA staff an index of recent articles related to opioids and many other areas of interest right to your work mailbox. If you are interested in subscribing to this alert click here.
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