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The implementation of a pain navigator program in the department of Veterans Affairs' (VA) health care systems: a cluster randomized pragmatic clinical trial.

Pain medicine (Malden, Mass.)·November 2024·Courtni France, Chad E Cook, Cynthia J Coffman et al.
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Key Finding

A telehealth pain navigator program successfully implemented non-pharmacologic care access including acupuncture for veterans with low back pain at 9 of 10 VHA clinics, with approximately 50% of patients modifying their treatment choice during follow-up.

What This Means For You

Researchers at the Veterans Health Administration studied a new program called the Pain Navigator Pathway to help veterans with low back pain access non-drug treatment options. The study involved over 1,000 veterans across 10 VA clinics over three years. Pain navigators worked with veterans through telehealth (remote) visits to recommend and coordinate treatments like physical therapy, chiropractic care, acupuncture, and yoga or tai chi.

The program was successfully implemented at 9 out of 10 clinics. Acupuncture was among the most frequently recommended treatments for veterans with low back pain. Interestingly, about half of the veterans decided to try a different treatment option during their six-week follow-up visit than what was originally suggested, showing that patients often need flexibility in their care choices.

The study found notable differences between clinics in how quickly veterans could start treatment and how often they attended follow-up appointments. This variation highlights that while the navigator program concept works, each clinic may need to adapt it to their specific circumstances and patient population.

For patients with low back pain, this research suggests that having a dedicated navigator to help coordinate non-drug treatment options—including acupuncture—can make it easier to access these therapies. The telehealth delivery format also means patients can receive guidance remotely, which may be particularly helpful for those with mobility issues or transportation barriers. If you're considering acupuncture for back pain, seek a licensed acupuncturist or one certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).

Clinical Notes for Practitioners

This cluster-randomized pragmatic trial evaluated implementation of a telehealth-based Pain Navigator Pathway (PNP) across 10 VHA clinics, involving 19 pain navigators, over 200 primary care physicians, and more than 1,000 veterans with low back pain over three years. The PNP facilitated access to non-pharmacologic treatments including physical therapy, chiropractic care, acupuncture, and yoga/tai chi. Implementation succeeded at 9 of 10 sites, with data extracted from electronic health records. Approximately 50% of veterans changed their initial treatment selection during six-week follow-up, indicating the importance of flexible care pathways. Significant inter-clinic variation was observed in time-to-treatment initiation and follow-up adherence rates. Clinical takeaway: Telehealth-delivered navigation programs can effectively facilitate veteran access to evidence-based non-pharmacologic therapies for low back pain, with acupuncture being among the most frequently recommended modalities. Implementation success depends on adapting the model to local clinic contexts and maintaining flexibility in treatment options.

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