Cover: Improving Pain Care for Service Members

Improving Pain Care for Service Members

Administrator, Provider, and Patient Perspectives on Treatment, Policies, and Opportunities for Change

Published Jul 26, 2023

by Kimberly A. Hepner, Jessica L. Sousa, Carol P. Roth, Shreya S. Huilgol, Chester Jean, Lucy B. Schulson, Priya Gandhi, Nipher Malika, Charles C. Engel

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Research Questions

  1. What are the real-world implications of MHS practices and policies for delivering pain care from the perspectives of administrators, providers, and patients?
  2. How can the MHS apply this information to improve pain care for service members?

Acute and chronic pain are common among service members, with musculoskeletal pain and injuries being the leading cause of nondeployability among active-duty service members. Given the significant implications for individual health and force readiness, providing high-quality pain care to service members is a priority of the Military Health System (MHS). Prior RAND research used administrative data to assess the quality and safety of pain care and opioid prescribing in the MHS, generated a set of quality measures that the MHS could adopt going forward, and identified strengths and opportunities for improvement in care provided to service members with pain conditions. In this report, authors document findings from interviews with MHS administrators, providers, and patients, providing valuable detail and context for those findings, along with on-the-ground perspectives on MHS pain care policies and guidance in practice. Staff and patients recommended prioritizing increases in treatment access and availability to improve pain care, and patients emphasized effective treatment and patient-centered care as the most important facilitators of high-quality pain care.

Key Findings

  • Nearly all providers reported assessing the severity of pain symptoms, but only approximately half said they used a structured method to assess pain severity and the impact of pain on patient functioning. Structured approaches that make use of existing MHS tools can help ensure that decisions about treatment adjustments are based on data collected in consistent ways over time.
  • Nearly all providers endorsed a shared decisionmaking approach to developing a pain treatment plan. Most patients cited positive experiences with shared decisionmaking, noting that they were offered a choice of treatment options, felt that providers explained benefits and risks, or believed their providers listened to their preferences. However, most patients reported that communication between their providers was less than adequate, and nearly one-quarter felt they had been treated differently because of some aspect of their background.
  • Consistent with the stepped-care model, most prescribers shared that they were reluctant to treat chronic pain with opioids and preferred nonopioid medications (e.g., oral nonsteroidal anti-inflammatory drugs) or nonpharmacologic treatment (NPT).
  • Despite the availability of physical therapy and the high level of support for NPT among providers, more than three-quarters of staff reported that patients faced barriers to accessing NPT.
  • Staff reported training and treatment access as the most important facilitators of high-quality pain care, whereas patients found effective treatment and patient-centered care most important.
  • Staff and patients recommended prioritizing increases in treatment access and availability to improve pain care.

Recommendations

  • Increase integration of effective NPT. This includes increasing access to effective NPT and monitoring access to NPT as part of a comprehensive strategy to improve the quality of pain care.
  • Identify barriers to broader use of the Defense and Veterans Pain Rating Scale, the standard pain scale to be used by all military providers to screen and assess for pain during each visit.
  • Expand provider education on effective treatment options and appropriate opioid prescribing.
  • Explore the feasibility and impact of allowing extended visit length for primary care appointments for patients with complex pain needs.
  • Improve patient experience in receiving care for chronic pain, and ensure pain care is equitable.

This research was sponsored by the Office of the Assistant Secretary of Defense for Health Affairs and conducted within the Personnel, Readiness, and Health Program of the RAND National Security Research Division (NSRD).

This report is part of the RAND research report series. RAND reports present research findings and objective analysis that address the challenges facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity.

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