Landmark clinical trial found that an interdisciplinary VA Whole Health Team approach significantly reduces chronic pain

The results of the wHOPE Randomized Clinical Trial (VA Whole Health Approach for Chronic Pain Management), which included 764 VA patients, provide the first rigorous test of the VA Whole Health model. 

The Whole Health Team approach, delivered by VA clinicians, brings together a primary care provider (physician or nurse practitioner), a clinician trained in non-pharmacologic or integrative pain care (for example, acupuncture, chiropractic, physical therapy), and a wellness coach. Together, they deliver personalized, whole-person pain care aligned with each patient’s goals and values. 

Key findings at 12 months:

• Participants receiving Whole Health care experience greater improvements in pain interference than those receiving CBT (-0.58 points) and usual care (-0.77 points)
• The Whole Health approach led to greater engagement in non-drug and complementary and integrative health therapies, including yoga, physical therapy, and acupuncture
• Patients in the Whole Health group reported a better overall perception of their pain over time, as measured by patient-reported global impression of change
• Most other secondary outcomes were similar across all groups

What makes this finding surprising?

Researchers noted that the most striking result was that the Whole Health Team out-performed CBT, a leading evidence-based treatment for chronic pain. Notably, CBT also did not significantly improve outcomes compared with usual care in this study.

"I am deeply grateful to the VA clinicians and the more than 750 Veterans nationwide who participated in the wHOPE trial—the first randomized trial of a VA Whole Health Team approach for chronic pain care,” said Dr. Karen Seal, Chief of Integrative Health Service at San Francisco VA Health Care System. 

“VA patients’ and staff’s commitment to the study made it possible to generate meaningful evidence supporting Whole Health as a mind and body, patient-centered approach to pain care that really works,” Dr. Seal added.

“We are so grateful for this rigorous evaluation, and the outcomes support further efforts in whole health implementation,” said Interim Director of VA’s Office of Patient Centered Care and Cultural Transformation (OPCC-CT), Dr. Kavitha P. Reddy. 

“The wHOPE trial represents a remarkable step forward in research related to delivery of the whole health approach which seeks to empower and equip Veterans to meet their health and well-being goals and live life to the fullest.”

The findings suggest that a Whole Health Team that integrates wellness coaching, personalized goal setting, and access to non-drug and complementary and integrative health therapies may be more effective than delivering a single evidence-based therapy alone, even one as well established as CBT.

With chronic pain affecting millions of Veterans, the wHOPE trial offers a compelling case for expanding interdisciplinary, whole-person care models across VA and other health systems. The approach addresses not just symptoms but the whole person- a patient’s life, values, and goals. 

About the study
This study was funded by the National Center for Complementary and Integrative Health and is a product of the NIH-DoD-VA Pain Management Collaboratory. Dr. Seal is a core investigator of the SFVA's Center of Innovation (COIN), the Center for Data to Discovery and Delivery Innovation (3DI).

The wHOPE trial was conducted at multiple VA sites across the United States. The findings are expected to inform future VA pain management guidelines and whole health implementation strategies.

San Francisco VA Health Care System is a leader in cutting-edge research and innovation aimed at advancing the field of Veteran health care. Our research programs span a wide range of areas, including cancer, cardiovascular disease, mental health, traumatic brain injury, and more. Through our partnerships with leading academic institutions and industry partners, we are dedicated to improving the lives of Veterans through the discovery of new treatments, therapies, and interventions.

For more information, please email V21SFCPublicAffairs@va.gov, call San Francisco VA Health Care System Public Affairs Office at or visit https://www.va.gov/san-francisco-health-care/.