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Question

How do the DoD and VHA treat pain?

HPRC's Answer

The DoD and the VHA use a Stepped Careapproach to pain. That is, different treatments may be offered to you based on the type, length, and cause of pain. How your pain is treated is also affected by possible side effects and cost of treatments. The treatment/management of your pain will be specific to you, and it may involve more than one kind of treatment from more than one healthcare provider. These documents from the DoD’s Pain Management Task Force and VHA Directive 2009-053 provide additional information.

Below is a brief model of the Stepped Care approach to pain:

Step 1: Primary Care Team

Types of pain: Acute

Treatments: low-risk medication, physical/occupational therapies, self-care and mind-body techniques

Step 2: Pain Specialists

Types of Pain: Long-term acute, potentially chronic

Treatments: Step 1 treatments, plus injections, medication, minor surgeries

Step 3: Integrated Pain Team

Types of Pain: Chronic

Treatments: Steps 1 and 2 treatments, plus major surgeries, mental health care, medications