Oral Presentation Session
Reviewed by: Society for Medical Anthropology
Of interest to: Practicing and Applied Anthropologists, Students
Primary Theme: Health
Secondary Theme: Policy
Chronic pain is the most commonly reported ailment among Americans, and almost half (40%) of the 9 million veterans enrolled in the Veterans Health Administration report chronic pain. Prescription opioids were one of the primary therapies used to treat chronic pain in the United States until, in recent years, overdose deaths associated with opioid use surpassed mortality rates for motor vehicle accidents and the “opioid crisis” was declared a national public health emergency by the US Department of Health and Human Services. In 2016, the Comprehensive Addiction & Recovery Act (CARA) mandated that the VA improve opioid safety measures & expand the availability of multi-modal approaches for chronic pain management that includes access to complementary integrative health (CIH) approaches. The opioid crisis and CARA have helped spur additional urgency and increased opportunities to test and implement non-pharmacological pain care for veterans at local, regional, and national levels. Consistent with the 2018 AAA Annual Meeting theme, “Change in the Anthropological Imagination,” this panel considers the changing landscape of “best practices” for biopsychosocial chronic illness through the lens of chronic pain management in VA—moving away from opioid management and toward more patient-driven and patient-centered models of chronic pain care.
This panel highlights VA-funded research on multi-modal approaches to chronic pain management for veterans. As social scientists in VA Health Services Research and Development, we study personal, social, cultural, structural, temporal, geographical, and financial factors that influence health and well-being. We employ patient-focused, mixed-methods approaches to identify gaps in health care needs and care quality to inform policy and practice to improve outcomes for veterans. In the first paper, Dr.Penney describes the implementation of the Empower Veterans Program (EVP), an interdisciplinary, "whole health" effort developed at the Atlanta VA that emphasizes patient “empowerment,” acceptance of their conditions, and active self-management for pain management. In paper two, Dr. Besterman-Dahan describes developing novel approaches to pain management among veterans using agriculture-based interventions as part of the GROW project. In paper three, Ms. Zamora outlines results from an evaluation of the expansion of the San Francisco VA’s Integrated Pain Team Clinic to include geographically diverse rural and urban clinic sites across Northern California. In paper four, Dr. Koenig examines how veteran and provider communication is influenced by both biographical lifecourse events and structural features of the clinical encounter, and outlines the development of a conceptual model for identifying processes that influence communication about complex chronic illnesses and delivery of patient-centered care. And in paper five, Dr. Hyde provides an overview of how the VA, the largest health care system in the U.S., is addressing high levels of opiate prescribing to veterans through a radical transformation in the way that health care is conceptualized and delivered throughout 18 VA Medical Centers across the nation. Our findings are derived from the lived experiences of patients, their caregivers, and clinicians, and it is their voices that we use to inform practice and, potentially, policy.