The Pain Management Collaboratory Coordinating Center, a Yale-based research center that supports 16 large-scale pragmatic clinical trials of non-drug approaches to manage pain, has been awarded a funding extension to continue its work for six years.
The Pain Management Collaboratory (PMC), including the Coordinating Center, was established in 2017 to develop, implement, and test methods of treating pain and related conditions in veterans and active-duty military members without medication. Funding was provided by three federal agencies, including the National Center for Complementary and Integrative Health at the National Institutes of Health, and the Departments of Defense (DOD) and Veterans Affairs (VA).
Teams of researchers, many affiliated with the Yale School of Medicine, initially launched 11 large-scale, multi-site pragmatic clinical trials to study nonpharmacological approaches for pain management and common co-occurring conditions such as depression, post-traumatic stress disorder, and substance use disorders. The trials investigate approaches such as chiropractic care, mindfulness, physical therapy and other rehabilitation approaches, and psychological approaches when delivered in real-world clinical settings, as well as integrative models of care that incorporate these approaches.
Studies target patients receiving care in veteran and military health systems and include projects focusing on acute, surgical pain, and chronic pain conditions such as low back pain.
The originally funded research projects are nearing completion, and the researchers are preparing to present their early findings, lessons learned, and future directions and opportunities for research. Five additional projects are now underway.
“The principal aim of the PMC is to close the gap between existing evidence of the effectiveness of these nonpharmacological approaches and their limited uptake in routine clinical care,” said Robert D. Kerns, PhD, professor emeritus and senior research scientist of psychiatry.
Kerns directs the PMC Coordinating Center with Cynthia Brandt, MD, professor of biomedical informatics and data science, and Peter Peduzzi, PhD, professor emeritus and senior research scientist in biostatistics.
Kerns added, “The PMC is generating evidence that implementation of these approaches is feasible and effective in veteran and military health systems, offering encouragement for their adoption nationally, promoting access to high quality pain care for military service members and veterans.”
Kerns, Brandt, Peduzzi, and their Yale colleagues have been assisted by faculty and staff from other universities and the DOD and VA. The Coordinating Center established work groups led by Yale faculty and other experts to partner with the trial research teams to provide technical, design, and other support to develop and successfully implement the clinical trials.
“By harmonizing the work of the separate projects, the PMC3 results in aggregated products and shared processes so the product of the research is greater than the sum of its parts,” said Marc Rosen, PhD, professor of psychiatry and a PI on one of the trials.
Researcher Alicia Heapy, PhD, associate professor of psychiatry, is a PI on a trial that is researching two ways to deliver cognitive behavioral therapy for chronic pain. Specifically, they are working to take a technology-based intervention called Cooperative Pain Education and Self-Management (COPES) from the research realm to clinical care in 2025.
“Through our PMC trial we learned that direct-to-patient outreach about the program created a ‘self-serve lane’ that enabled veterans to easily refer themselves to COPES and increased engagement in the program relative to relying on primary care provider referral alone,” Heapy said. “Centralized delivery of COPES from a single location allowed us to offer the program widely without the need for a specially trained COPES coach at every facility, which improved access to care overall but particularly in under resourced facilities.”
Programs like the Yale Veteran and Military Affairs Center are central to developing and enhancing veteran-friendly, and military-connected communities at universities across the country, said Adam Anicich, chair of the Patient Resource Group for PMC3.
“Veterans and service members are welcomed as partners in their educational and research journeys and provided valuable esprit de corps that carries on as they progress in their careers,” Anicich said. “Veteran alumni often advance to successful leadership roles after graduation that allow them to continue service to others, including industry, healthcare, science, and public administration.”
Kerns said over 11,000 veterans, military service members, and their dependents have been engaged in the studies. “These people were advantaged by their ability to have access (to care) and to become engaged in these state-of-the-art clinical trials,” he said.
Many others who live outside the VA sphere do not have access to quality pain care. Estimates are that chronic pain affects 20 million Americans, and PMC researchers hope their study results can be incorporated into care for all populations, from children to adults.
For now, the focus is on veterans and military service members and pain care provided in health settings that target these groups. “They are the target population,” Kerns said. “They are known to be a population that has higher rates of chronic pain and co-occurring disorders. Demonstrating effectiveness of these approaches in this population will encourage broader use in other settings.”
Other Yale Researchers in the PMC
- Alicia Heapy, PhD, associate professor of psychiatry – PI on PMC Trial
- Marc Rosen, MD, professor of psychiatry – PI on 2 PMC Trials
- Steve Martino, PhD, professor of psychiatry – PI on 2 PMC Trials
- William Becker, MD, professor of general medicine – PI on 2 PMC Trials
- Sara Edmond, PhD, assistant professor of general medicine – PI on PMC Trial
- James Dziura, PhD, professor, emergency medicine, biostatistics, medicine (endocrinology) – co-chair of Work Group
- Tassos Kyriakides, PhD, assistant professor of biostatistics – co-chair of Work Group
- Lori Bastian, MD, professor of general medicine – co-chair of Work Group
For more information about the Pain Management Collaboratory, visit www.painmanagementcollaboratory.org.