The Pain/Opioid CORE's current research priorities are informed by two recent VA Health Services Research (HSR) State of the Art (SOTA) Conferences focused on nondrug therapies for chronic musculoskeletal pain management and opioid safety. Many unanswered scientific questions exist related to the broad areas of pain, opioid prescribing, and opioid use disorder. The Pain/Opioid CORE is currently engaged in a multi-year process to update pain/opioid research priorities.

The Pain/Opioid CORE research priorities are summarized below. For more information, see summaries and detailed reports from the HSR SOTA Conferences.

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Cross-cutting issues in nondrug management of chronic pain

  • Approaches to enhance patient activation, engagement, and adherence to active evidence-based therapies 
  • Comparisons of treatment delivery strategies for evidence-based therapies (e.g., telehealth vs. in-person, group vs. individual, and brief vs. standard course)
  • Outcomes of combining or sequencing nondrug therapy interventions
  • Treatment "dosing and maintenance strategies for evidence-based non-drug therapies
  • Evaluation of implementation strategies to increase uptake of effective treatments

Psychological and behavioral therapies for chronic pain

  • Effectiveness of meditation, biofeedback, hypnosis, and relaxation therapies
  • Approaches to address clinician and health system barriers to use of evidence-based therapies including Cognitive Behavioral Therapy (CBT), Acceptance and Commitment Therapy (ACT), and Mindfulness Based Stress Reduction (MBSR)

Exercise and movement therapies for chronic pain

  • Effectiveness of aquatic vs. land-based therapies for back pain and fibromyalgia
  • Approaches to improve availability and reach of evidence-based therapies including exercise therapies (e.g., strengthening, aerobic) and movement-based mind-body therapies (e.g., yoga, tai chi)

Manual therapies for chronic pain

  • Effectiveness of manipulation, acupuncture, and massage for specific conditions with insufficient evidence
  • Approaches to improve availability and reach of evidence-based approaches including manipulation, massage, and acupuncture for low back and neck pain

Chronic pain care delivery models

  • Effectiveness of novel care delivery approaches such as peer-delivered care and prognostic/risk stratification
  • Multisite effectiveness-implementation research on evidence-based collaborative care and stepped care models

Management of opioid use disorder (OUD)

  • Approaches to address clinician and health system barriers to broad implementation of medication treatment for OUD (MOUD)
  • Interventions to improve retention of patients in treatment and reduce inappropriate discontinuation of MOUD by providers
  • Effectiveness of various OUD treatment adherence monitoring strategies
  • Effectiveness of psychosocial treatments and community/peer/family support strategies in patients with OUD
  • Approaches to implementing chronic disease management model for MOUD
  • Approaches to link patients with nonfatal overdose to MOUD treatment

Long-term opioid therapy (LTOT) for pain

  • Benefits and harms of opioid dose reduction and discontinuation in LTOT
  • Effectiveness of approaches to support opioid tapering (e.g., collaborative care, tapering protocols, nondrug therapies, clinician training, patient education, interventions to enhance engagement, technology-based interventions)
  • Effectiveness of buprenorphine for opioid risk reduction and opioid dose reduction/discontinuation in LTOT for chronic pain
  • Clinical diagnostic and management strategies for patients with opioid dependence/LTOT who do not have opioid use disorder
  • Effectiveness of 1) continuing vs. discontinuing low-dose intermittent opioids among patients on established LTOT and 2) initiating low-dose intermittent opioid medications vs. non-opioid medications for older adults with chronic pain

Co-occurring pain and substance use disorders (SUD)

  • Approaches to implementing and integrating behavioral and exercise/movement therapies for patients with co-occurring pain and SUD
  • Approaches to enhance patient activation, engagement, and adherence to behavioral and movement therapies among patients with pain and SUD
  • Effectiveness of buprenorphine for chronic pain among patients with comorbid chronic pain and SUD
  • Effectiveness of approaches to manage perioperative pain among patients on MOUD (medication treatment for opioid use disorder)