Chronic Pain Rehabilitation Programs

History 

Interdisciplinary chronic pain services began at the James A. Haley Veterans’ Hospital in 1988 with the establishment of the chronic pain rehabilitation program (CPRP). The demand for CPRP services has grown significantly over the years and led to several expansions of the program.  The CPRP remains the only CARF (Commission on Accreditation of Rehabilitation Facilities) accredited, inpatient option for comprehensive chronic pain treatment in the VA system.  Referrals are received across the United States and within both the VA and DoD systems. 

During the pandemic, a fully virtual, 5-week, chronic pain rehabilitation program (PEAK Program), was developed to meet the pain care needs while the CPRP was shuttered. The PEAK Program’s success resulted in sustained funding support from VA Central Office to expand and continue to increase access to evidenced-based pain care. PEAK is also a national program that welcomes referrals from both Veterans and Active Duty service members.  Several years after its inception, the PEAK Program obtained CARF accreditation in May of 2023.   

Philosophy & Approach

CPRP and PEAK take an active rehabilitation, whole person, team-based approach to treating chronic pain. Our team of experts provides instruction in safe and indicated exercises, skills, and techniques to improve your management of pain and quality of life. 

Both programs entail a combination of individual and group-based interventions, including: movement-based therapies, behavioral strategies (e.g., pacing, mindfulness), pain neuroscience education, various rehabilitation therapies, medical consultation/management, and family involvement. 

The CPRP is 19 days in length and entails 6-7 hours of daily rehabilitation. Opioid and muscle relaxant medication are tapered as a part of the comprehensive treatment that is provided. PEAK is 5 weeks in length and involves approximately 8 hours of virtual programing per week. PEAK offers co-ed tracks, a women’s track, and a Polytrauma and Traumatic Brain Injury (TBI) track. 

Accomplishments  

• The CPRP was the first VA pain program to receive CARF accreditation in 1996. It continues to be the sole CARF-accredited inpatient chronic pain rehabilitation program within the VA.
• The CPRP has been designated a VA National Clinical Program of Excellence for pain treatment in 1999 and 2001 and Center of Excellence by the American Pain Society in 2007 and 2012.
• The CPRP was awarded the Secretary of Veterans Affairs Olin E. Teague Award in 2004 for sustained contributions to the care of war-injured veterans.
• The PEAK Program was the first known virtual pain program inside or outside the VA to receive CARF accreditation in 2023.   

Referral Information 

CPRP and PEAK accept referrals for Veterans and Active Duty service members with chronic pain from all 50 states and US territories.  See information below regarding the referral process.  For additional questions, you can contact us at: ext: 102104.

Information for Professionals

Long-distance 

A referral from a provider is needed for patients to be evaluated and considered for the CPRP or PEAK.  For long distance patients, the following information is needed: 

1. Name of Patient
2. Social Security Number
3. Date of Birth
4. Address
5. Phone Number
6. Email Address
7. Diagnosis
8. Urine Drug Screen (to be completed at the time the referral is placed – needs to include a buprenorphine level if the patient is prescribed this medication)
9. Completion of a Prescription Drug Monitoring Program Query

Referral information can be sent via email or fax.  If you are a VA provider, you can send an encrypted email to Dr. Christina Rowland and Shalah Thomas, DNP.  The referral can also be faxed to: with attention of Dr. Rowland or Mrs. Thomas. 

Local

If you are a provider at the Tampa VA, a consult must be placed for patients to be evaluated for the pain programs. The name of the consult is: PAIN (RMS/NEUROLOGY). Please click on the ‘interdisciplinary chronic pain rehab program’ box to specify that it is for evaluation for CPRP/PEAK. 

Training/Education/Consultation 

Team Training

The CPRP has been designated as a national training site for VA interdisciplinary pain teams by VA Central Office. Training is tailored to individual team and facility needs, and focuses on assisting with the development, expansion, or optimization of pain services at their home sites. Training length is negotiable but typically lasts 2 ½ days on-site at the Tampa VA. Of note, training does not entail basic pain assessment or treatment strategies. Participants should have basic knowledge and skills in these areas prior to requesting training. To schedule a training visit we will need the following information:

1. Number of attendees; 2) Discipline of each attendee; 3) Team and/or individual training objectives; and 4) Name of team leader.  

Contact Dr. Nicolle Angeli at Nicolle.Angeli@va.gov regarding inquiries about the team training or for additional information. 

Educational Opportunities   

The pain programs also offer several types of educational training experiences to VA clinical staff, medical fellows, and psychology interns/residents involved or interested in pain treatment. These experiences may include:

• Opportunity to observe the salient and rapid impact of intensive pain treatment programming with individuals with severe and longstanding disability.
• Close involvement with high‑functioning interdisciplinary teams,
• In depth exposure to two complementary, but far from identical medical approaches to the diagnosis and treatment of chronic pain through contact and consultation with the program's Neurology Pain Fellow and Physical Medicine & Rehabilitation Physiatrist.
• Experience in a program that uses a range of behavioral techniques (e.g., operant conditioning, cognitive‑behavioral therapy, reinforced practice, compliance monitoring, traditional therapy and assessment, etc.) to promote behavioral change. Familiarity with a wellness approach to the treatment of chronic medical problems that emphasizes patient responsibility for health and progress.

Consultation

Select pain program staff are also available to consult with VA providers from other facilities regarding program development or individual treatment issues. Other  services we provide include serving as speakers at professional conferences, community meetings or workshops, or acting as faculty for VA-sponsored 

Eligibility

To be eligible to participate in either the CPRP or PEAK, you must be a Veteran or Active Duty service member.  An evaluation process is required to determine appropriateness for programming.

Costs 

There may be some charges to you for our services. This will depend upon which eligibility category you are in. Check with your local VA eligibility office to determine if any charges will be incurred.

Referral Process 

If you are interested in being considered for the pain programs, you will need to be formally referred by a VA provider. Information regarding the referral process is available on the ‘For Professionals’ tab. 

To be eligible to participate in any of the following services, you must be a Veteran and receive services within our Tampa VA catchment area. 

Comprehensive Headache Management Program (CHAMP)

CHAMP is an outpatient, interdisciplinary headache program for Veterans suffering from chronic and significantly impairing headaches. Treatment entails behavioral interventions, focused medication management, and other recommendations to reduce the frequency and severity of headache-related pain. Patients undergo individual evaluation by pain psychology and neurology to determine if they would benefit from CHAMP.  CHAMP is only available to local Tampa VA patients. The program is 6-weeks in length and occurs once weekly (3 hours) either in-person or virtually. Following CHAMP, patients are offered aftercare programming and individual sessions as indicated.  For questions about CHAMP, you can contact Dr. Stanley Takagishi at: ext: 105663.

For general headache treatment, the Headache Center of Excellence (HCoE) at the James A. Haley Veterans’ Hospital offers both medical interventions with a headache specialist and non-medication treatments.  The HCoE also provides a twice weekly, virtual educational group regarding non-medication treatments. If interested in learning more about these options, you can ask one of your healthcare providers to place the following consult: Neurology Headache Intro Group.

Pain, Activation and Sleep Skills (PASS)

The PASS program helps Veterans develop skills for improving sleep quality and daytime fatigue in the context of chronic pain. Education is provided regarding the impact that pain has on daytime routines and how these changes contribute to the maintenance of sleep difficulties (e.g., insomnia).  Veterans are individually evaluated and offered participation in 8 virtual group meetings. More information regarding PASS can be obtained by contacting Dr. Aaron M. Martin at ext: 103419. 

Pain Psychology 

Outpatient pain psychology services offers effective treatments for reducing the negative impacts of chronic pain on Veterans’ lives and improving functioning. Psychoeducation and skills are provided to support better understanding and management of chronic pain.  Both individual and group-based options are available.  More information regarding outpatient pain psychology services can be obtained by contacting Dr. Peter Munro at or Dr. Jaclyn Fishalow at ext: 164198.                                                        

Psycho-Oncology

James A. Haley Veterans’ Hospital Cancer program helps Veterans diagnosed with cancer manage the physical and emotional impacts of cancer and its treatments. We offer time-limited, goal-oriented, and evidence-based psychotherapies to those with a new cancer diagnosis, going through treatment, or on surveillance.  Veterans can request a referral for psycho-oncology services from one of their providers. For additional information regarding psycho-oncology services, you can contact Dr. Jessica Choe at ext: 105440. 

Additional Chronic Pain & Oncology Resources

The following are helpful pain management and oncology resources for Veterans, their family members, and providers.

• Department of Veterans Affairs National Pain Management Website     
• The American Chronic Pain Association   
• US Pain Foundation   
• International Association for the Study of Pain   
• National Headache Foundation   
• American Headache Society   
• American Cancer Society
• National Cancer Institute
• CanCare

Accomplishments  

• The CPRP was the first VA pain program to receive CARF accreditation in 1996. It continues to be the sole CARF-accredited inpatient chronic pain rehabilitation program within the VA.
• The CPRP has been designated a VA National Clinical Program of Excellence for pain treatment in 1999 and 2001 and Center of Excellence by the American Pain Society in 2007 and 2012.
• The CPRP was awarded the Secretary of Veterans Affairs Olin E. Teague Award in 2004 for sustained contributions to the care of war-injured veterans.
• The PEAK Program was the first known virtual pain program inside or outside the VA to receive CARF accreditation in 2023.   

Positive Press

Veterans receive care through comprehensive pain program at local VA

By Mary O’Connell

November 11, 2021

TAMPA, Fla. — A unique program at the James A. Haley Veterans’ Hospital in Tampa is shining a light on the problem of pain and getting veterans and service members the help they need. 

Tuesday Kayongo knows what it means to serve her country. “I served in the United States Air Force for 23 years, five months, and six days, to be exact,” said Kayongo. Kayongo also knows what it’s like to live with pain. She was diagnosed with Multiple Sclerosis in 2016 while she was still on active duty.

“I also with that started to experience a lot of the neuropathic pain, a lot of the chronic pain that a lot of patients with Multiple Sclerosis suffer from, and I was at my wits’ end at that point,” said Kayongo. She said it was pain she wasn’t able to get rid of or mediate with any of the other therapies or medications she was on, so she turned to the PEAK program.

 “It is an all-virtual, interdisciplinary, whole person, active, and evidence-based pain rehabilitation program,” said Dr. Nicolle Angeli.

 PEAK, or Pain Empowerment Anywhere, is a program delivered virtually through the James A. Haley Veterans’ Hospital in Tampa. Dr. Angeli, a pain psychologist and the team lead for the PEAK Program, said the program opens up access to people who might not otherwise be able to come to the facility for care.

 “We focus on personalized rehabilitation, so the individual’s goals, and provide evidence-based exercises, skills, and techniques that people use together to improve their quality of life, decrease pain, and increase their activity level, their overall functioning, improve their sleep, improve their mood, engage in hobbies and recreation, and other meaningful activities,” said Angeli.

Over five weeks, participants get help with a wide range of skills and therapies, from mindful meditation, learning about the physical and emotional effects of pain, adaptive living skills, even movement-based therapies like Tai Chi and yoga. Participants are also offered ongoing programming when they graduate from PEAK.

Dr. Angeli highlighted some of the successes from the program, like participants who went from limited or sedentary lifestyles and end up working toward running a 10k. “Their life is opened up. Pain is a part of that, but it is not in the driver’s seat,” said Dr. Angeli. “It is not calling the shots. They are leading the way in terms of how their day goes, what they’re doing, how they’re doing that.”

The full article and accompanying video are available here: https://www.tampabay28.com/news/region-Hillsborough/veterans-receive-care-through-comprehensive-pain-program-at-local-va

Treating pain without opioids, Veterans improve their quality of life

September 10, 2015

 In recent years, there has been a drastic surge in opioid prescriptions to treat pain. While opioids can be helpful for some pain treatment, their use on a chronic basis is controversial due to a significant number of opioid-related overdoses, which highlights a compelling need for chronic pain treatment that does not focus solely on medication.

 Options available include programs that combine various health care disciplines and work together with the individual to offer comprehensive guidance on pain management.

“[Pain treatment programs] are much more limited in the private sector because unfortunately when you have the constraints of private insurance, it doesn’t necessarily mean you’re going to get the most effective care. In VA, we are able to provide these interdisciplinary programs, which is the best comprehensive way to treat pain,” said Jennifer Murphy Ph.D., Clinical Director of the Chronic Pain Rehabilitation Program (CPRP) at the Tampa, Florida VA Medical Center.

 Veterans undergo an intensive regimen of treatments and therapies but also are taught skills than what would not normally be prescribed in the private sector.

 “Instead of being dependent on pills and other passive treatment ‘fixes’ that too often fall short, our program and those like ours teach patients daily skills to take with them so that their pain does not feel so overwhelming,” said Murphy.

The full article is available here: https://news.va.gov/22718/treating-pain-without-opioids-veterans-improve-quality-life/