{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:49:34Z","timestamp":1779194974606,"version":"3.51.4"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>Objective.\u2002Chronic pain management is a growing focus of attention, in part because of concern over excessive use of opioids for treatment of chronic noncancer pain. In the Veterans Health Administration (VHA), pain specialty clinics have been established to address the needs of patients with challenging pain issues. The current study identified characteristics of such patients in a national sample of VHA service users in fiscal year 2012.<\/jats:p>\n               <jats:p>Design.\u2002Bivariate analyses compared patients diagnosed with pain who visited a pain specialty clinic with those who did not on sociodemographic characteristics, medical, pain, and psychiatric diagnoses, health service use, and opioid and psychotropic drug use. Logistic regression identified variables that independently differentiated pain clinic users from nonusers.<\/jats:p>\n               <jats:p>Results.\u2002Altogether, 122,240 of 2,025,765 patients with pain diagnoses (5.79%) attended pain specialty clinics. Pain clinic users had higher rates of muscle spasms, neuralgia, neuritis, radiculitis, and fibromyalgia, as well as major depression and personality disorders. Further, a fibromyalgia diagnosis was the strongest independent correlate of pain clinic attendance, along with the number of medical-surgical clinic visits. Veterans attending a pain clinic also received more opioids than those not attending (10.4 vs 6.7 prescriptions, respectively), but there were no substantial differences in other factors.<\/jats:p>\n               <jats:p>Conclusions.\u2002Patients attending pain specialty clinics have more difficult-to-treat pain conditions and comorbid psychiatric disorders that are independent of major medical diagnoses, use more outpatient services, and receive a greater number of opioid prescriptions. These data support the inclusion of mental health care in the specialized treatment of chronic pain.<\/jats:p>","DOI":"10.1093\/pm\/pnw206","type":"journal-article","created":{"date-parts":[[2017,1,12]],"date-time":"2017-01-12T21:00:44Z","timestamp":1484254844000},"page":"702-710","source":"Crossref","is-referenced-by-count":13,"title":["Rates and Correlates of Pain Specialty Clinic Use Nationally in the Veterans Health Administration"],"prefix":"10.1093","volume":"18","author":[{"given":"Caroline A.","family":"Arout","sequence":"first","affiliation":[{"name":"*Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mehmet","family":"Sofuoglu","sequence":"additional","affiliation":[{"name":"*Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut"},{"name":"\u2020Veterans Health Administration Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert A.","family":"Rosenheck","sequence":"additional","affiliation":[{"name":"*Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut"},{"name":"\u2020Veterans Health Administration Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2017,4,24]]},"reference":[{"key":"2025090806015181100_pnw206-B1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1016\/j.jpain.2012.03.009","article-title":"The economic costs of pain in the United States","volume":"13","author":"Gaskin","year":"2012","journal-title":"J Pain"},{"key":"2025090806015181100_pnw206-B2","doi-asserted-by":"crossref","first-page":"295","DOI":"10.7326\/M14-2775","article-title":"National Institutes of Health Pathways to Prevention Workshop: The role of opioids in the treatment of chronic pain","volume":"162","author":"Reuben","year":"2015","journal-title":"Ann Intern Med"},{"key":"2025090806015181100_pnw206-B3","doi-asserted-by":"crossref","first-page":"697","DOI":"10.1682\/JRRD.2009.01.0006","article-title":"Prevalence of chronic pain, posttraumatic stress disorder, and persistent postconcussive symptoms in OIF\/OEF veterans: Polytrauma clinical triad","volume":"46","author":"Lew","year":"2009","journal-title":"J Rehabil Res Dev"},{"key":"2025090806015181100_pnw206-B4","article-title":"Pain as the 5th vital sign toolkit","author":"Affairs","journal-title":"Geriatrics and Extended Care Strategic Healthcare Group"},{"key":"2025090806015181100_pnw206-B5","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1001\/jama.284.4.423b","article-title":"JCAHO pain management standards are unveiled. Joint Commission on Accreditation of Healthcare Organizations","volume":"284","author":"Phillips","year":"2000","journal-title":"JAMA"},{"key":"2025090806015181100_pnw206-B6","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1682\/JRRD.2003.09.0397","article-title":"An examination of the relationship between chronic pain and post-traumatic stress disorder","volume":"40","author":"Otis","year":"2003","journal-title":"J Rehab Res Devel"},{"key":"2025090806015181100_pnw206-B7","doi-asserted-by":"crossref","first-page":"371","DOI":"10.1682\/JRRD.2003.09.0371","article-title":"Veterans' reports of pain and associations with ratings of health, health-risk behaviors, affective distress, and use of the healthcare system","volume":"40","author":"Kerns","year":"2003","journal-title":"J Rehabil Res Dev"},{"key":"2025090806015181100_pnw206-B8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/j.jpain.2008.10.008","article-title":"Clinical guidelines for the use of chronic opioid therapy in chronic noncancer pain","volume":"10","author":"Chou","year":"2009","journal-title":"J Pain"},{"key":"2025090806015181100_pnw206-B9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.mcna.2015.08.006","article-title":"An overview of pharmacologic management of chronic pain","volume":"100","author":"Beal","year":"2016","journal-title":"Med Clin North Am"},{"key":"2025090806015181100_pnw206-B10","first-page":"101","article-title":"Management of chronic musculoskeletal pain","volume":"22","author":"Uhl","year":"2014","journal-title":"J Am Acad Orthop Surg"},{"key":"2025090806015181100_pnw206-B11","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1358\/dot.2014.50.6.2127023","article-title":"Current status of atypical antipsychotics for the treatment of fibromyalgia","volume":"50","author":"Rico-Villademoros","year":"2014","journal-title":"Drugs Today (Barc)"},{"key":"2025090806015181100_pnw206-B12","doi-asserted-by":"crossref","first-page":"135","DOI":"10.2165\/11597130-000000000-00000","article-title":"The role of antipsychotics in the management of fibromyalgia","volume":"26","author":"Calandre","year":"2012","journal-title":"CNS Drugs"},{"key":"2025090806015181100_pnw206-B13","first-page":"CD004844","article-title":"Antipsychotics for acute and chronic pain in adults","volume":"8","author":"Seidel","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090806015181100_pnw206-B14","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1155\/2014\/754693","article-title":"Pharmacological management of chronic neuropathic pain: Revised consensus statement from the Canadian Pain Society","volume":"19","author":"Moulin","year":"2014","journal-title":"Pain Res Manag"},{"key":"2025090806015181100_pnw206-B15","volume-title":"VHA national pain management strategy","author":"Administration","year":"1998"},{"key":"2025090806015181100_pnw206-B16","doi-asserted-by":"crossref","first-page":"2046","DOI":"10.1111\/pme.12554","article-title":"Integrating interdisciplinary pain management into primary care: Development and implementation of a novel clinical program","volume":"15","author":"Dorflinger","year":"2014","journal-title":"Pain Med"},{"key":"2025090806015181100_pnw206-B17","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1016\/S1090-3801(02)00042-3","article-title":"Satisfaction with treatment for chronic pain in a specialty service: Preliminary prospective results","volume":"6","author":"McCracken","year":"2002","journal-title":"Eur J Pain"},{"key":"2025090806015181100_pnw206-B18","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.sjpain.2012.05.073","article-title":"Multidisciplinary pain treatment\u2013Which patients do benefit?","volume":"3","author":"Heiskanen","year":"2012","journal-title":"Scand J Pain"},{"key":"2025090806015181100_pnw206-B19","doi-asserted-by":"crossref","first-page":"1399","DOI":"10.1016\/0895-4356(92)90202-X","article-title":"A profile of users of specialty pain clinic services: Predictors of use and cost estimates","volume":"45","author":"Weir","year":"1992","journal-title":"J Clin Epidemiol"},{"key":"2025090806015181100_pnw206-B20","first-page":"451","article-title":"Epidemiologic comparison of persistent pain sufferers in a specialty pain clinic and in the community","volume":"67","author":"Crook","year":"1986","journal-title":"Arch Phys Med Rehab"},{"key":"2025090806015181100_pnw206-B21","volume-title":"Statistical Power Analysis for the Behavioral Sciences","author":"Cohen","year":"1988"},{"key":"2025090806015181100_pnw206-B22","doi-asserted-by":"crossref","first-page":"778","DOI":"10.1111\/papr.12253","article-title":"Treatment considerations for cancer pain: A global perspective","volume":"15","author":"Pergolizzi","year":"2015","journal-title":"Pain Pract"},{"key":"2025090806015181100_pnw206-B23","doi-asserted-by":"crossref","first-page":"2236","DOI":"10.1016\/S0140-6736(11)60236-5","article-title":"Treatment of cancer pain","volume":"377","author":"Portenoy","year":"2011","journal-title":"Lancet"},{"key":"2025090806015181100_pnw206-B24","doi-asserted-by":"crossref","first-page":"4149","DOI":"10.1200\/JCO.2014.56.0383","article-title":"Quality of cancer pain management: An update of a systematic review of undertreatment of patients with cancer","volume":"32","author":"Greco","year":"2014","journal-title":"J Clin Oncol"},{"issue":"12","key":"2025090806015181100_pnw206-B25","doi-asserted-by":"crossref","DOI":"10.1093\/annonc\/mdn419","article-title":"Prevalence of undertreatment in cancer pain. A review of published literature","volume":"19","author":"Deandrea","year":"2008","journal-title":"Ann Oncol"},{"key":"2025090806015181100_pnw206-B26","first-page":"349","article-title":"Early integration of palliative care services with standard oncology care for patients with advanced cancer","volume":"63","author":"Greer","year":"2013","journal-title":"CA Cancer J Clin"},{"key":"2025090806015181100_pnw206-B27","doi-asserted-by":"crossref","first-page":"1547","DOI":"10.1001\/jama.2014.3266","article-title":"Fibromyalgia: A clinical review","volume":"311","author":"Clauw","year":"2014","journal-title":"JAMA"},{"key":"2025090806015181100_pnw206-B28","doi-asserted-by":"crossref","first-page":"1379","DOI":"10.1089\/jwh.2007.0656","article-title":"Fibromyalgia: Diagnosis and management for the primary healthcare provider","volume":"17","author":"Huynh","year":"2008","journal-title":"J Womens Health (Larchmt)"},{"key":"2025090806015181100_pnw206-B29","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1001\/jama.2008.944","article-title":"Treatment of fibromyalgia syndrome with antidepressants: A meta-analysis","volume":"301","author":"H\u00e4user","year":"2009","journal-title":"JAMA"},{"key":"2025090806015181100_pnw206-B30","doi-asserted-by":"crossref","DOI":"10.1002\/14651858.CD010782","article-title":"Anticonvulsants for fibromyalgia","volume":"10","author":"\u00dc\u00e7eyler","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"2025090806015181100_pnw206-B31","doi-asserted-by":"crossref","first-page":"1347","DOI":"10.1517\/14656566.2015.1047343","article-title":"An update on pharmacotherapy for the treatment of fibromyalgia","volume":"16","author":"Calandre","year":"2015","journal-title":"Expert Opin Pharmacother"},{"key":"2025090806015181100_pnw206-B32","doi-asserted-by":"crossref","first-page":"358","DOI":"10.1007\/s11916-013-0358-3","article-title":"Fibromyalgia comorbid with anxiety disorders and depression: Combined medical and psychological treatment","volume":"17","author":"Bernik","year":"2013","journal-title":"Curr Pain Headache Rep"},{"key":"2025090806015181100_pnw206-B33","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1146\/annurev-clinpsy-090310-120430","article-title":"Psychological treatment of chronic pain","volume":"7","author":"Kerns","year":"2011","journal-title":"Annu Rev Clin Psychol"},{"key":"2025090806015181100_pnw206-B34","doi-asserted-by":"crossref","first-page":"635","DOI":"10.1007\/s13142-011-0094-3","article-title":"Implementation of the Veterans Health Administration national pain management strategy","volume":"1","author":"Kerns","year":"2011","journal-title":"Transl Behav Med"}],"container-title":["Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/18\/4\/702\/64219690\/painmedicine_18_4_702.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/painmedicine\/article-pdf\/18\/4\/702\/64219690\/painmedicine_18_4_702.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,8]],"date-time":"2025-09-08T10:02:07Z","timestamp":1757325727000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/painmedicine\/article\/18\/4\/702\/2898099"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,4,1]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2017,4,24]]},"published-print":{"date-parts":[[2017,4,1]]}},"URL":"https:\/\/doi.org\/10.1093\/pm\/pnw206","relation":{},"ISSN":["1526-2375","1526-4637"],"issn-type":[{"value":"1526-2375","type":"print"},{"value":"1526-4637","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,4]]},"published":{"date-parts":[[2017,4,1]]}}}