National Center for Complementary and Alternative Medicine (NCCAM)

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Integrative Approaches to Managing Pain and Co-Morbid Conditions in U.S. Military Personnel, Veterans, and Their Families

Project Concept Review

Council Date: June 1, 2012

Program Officer: Kristen Huntley, Ph.D.

Background

With U.S. military forces serving in Iraq and Afghanistan, there have been approximately 2 million troops deployed and approximately 3 million deployments. As a result of these military operations, 202,281 cases of traumatic brain injury (TBI) have been recorded between 2000–2010 [455KB PDF]; rates of post-traumatic stress disorder (PTSD) vary, typically ranging from 5% to 20% among previously deployed personnel not seeking treatment with prevalence estimates higher in those seeking treatment (Ramchand, 2010); and high co-morbidity rates are reported among the following psychiatric conditions: PTSD, TBI, substance use disorder (SUD), and Depression (Seal, et. al., 2011). Furthermore, studies show nearly 50% of veterans report that they experience pain on regular basis (Otis, et. al., 2009; Kerns, et. al., 2003) and there is significant overlap between chronic pain, PTSD, and persistent post-concussive symptoms (Lew, et. al., 2009).

The Office of The Army Surgeon General’s Pain Management Task Force released their Final Report in May 2010, “Providing a Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors and their Families”, and have launched a Comprehensive Pain Management Campaign Plan. One of the objectives specified in the final report is to incorporate complementary and integrative therapeutic modalities into patient centered plans of care [3.66KB PDF].

In a separate but related effort, the Institute of Medicine (IOM) released a Consensus Report on Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. The IOM report encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. The report also notes that ideally, most patients with severe persistent pain would obtain pain care from an interdisciplinary team using an integrated approach that would target multiple dimensions of the chronic pain experience - including disease management, reduction in pain severity, improved functioning, and emotional well-being and health-related quality of life.

The current health care needs of military personnel and veterans and the substantial interest by veteran and military entities in incorporating complementary approaches to pain and symptom management is an opportunity to study utilization, mechanisms, efficacy, and effectiveness of promising integrative approaches.

Purpose of Proposed Initiative

NCCAM would like to leverage the substantial interest in the implementation of complementary approaches in VA and DoD health care settings. These FOAs would encourage data collection and research focused on complementary approaches for pain and symptom management among U.S. military personnel, Veterans and their families. NCCAM would like to stimulate research on complementary approaches to pain and symptom management in VA or DoD settings using a phased approach:

  1. A Program Announcement was published on 4/11/12, soliciting administrative supplements to NCCAM grants to foster collaborations with VA/DoD researchers or clinicians in order to expand/plan for expansion of the NCCAM funded research. This program seeks to support collaborative interactions that will encourage future research on the use of complementary approaches for symptom management in military or veteran health care settings or populations. It is anticipated that these administrative supplements will be successful in generating pilot data for new joint investigator-initiated R21, R01 or P01 grant submissions to the NIH.
  2. Publish an RFA/Program Announcement soliciting competitive revisions to NCCAM grants to expand funded research on the use of complementary approaches for pain and symptom management in military or veteran health care settings or populations.
  3. Publish an RFA seeking applications proposing research on complementary approaches for the management of pain and associated problems (e.g., post-traumatic stress disorder (PTSD), traumatic brain injury (TBI), depression, anxiety, sleep disturbances, substance abuse) among U.S. military personnel, Veterans and their families. The RFA would be specific to research related to individuals who are serving or have served in Operation Enduring Freedom (Afghanistan) and/or Operation Iraqi Freedom (Iraq) (OEF/OIF). Research related to all branches of the military (e.g., Army, Navy, Marines, Air Force, Coast Guard, U.S. Military Reserves, National Guard) and Veterans are of interest.

Objectives

The objectives of the RFA concept and the phased approach to stimulating research are to:

  1. Encourage collaborations between researchers with expertise in complementary or integrative approaches to health and researchers or clinicians in military or VA health care settings
  2. Expand NCCAM’s portfolio of currently funded research on pain and symptom management
  3. Increase applications and funded projects proposing research studying complementary approaches to pain management. For the RFA, applications in the following areas would be encouraged:
    1. Secondary data analysis
    2. Research on efficacy, effectiveness, or the implementation of complementary approaches to pain management in military populations
    3. Research to understand and to identify the biological mechanisms by which complementary approaches exert beneficial effects (biological mechanisms, biomarkers)