Pain Management for Veterans Filing Compensation Claims

Inclusion Criteria:

- Veteran of OEF/OIF/OND

- Scheduled exam for back, neck, knee, or shoulder. These four body parts were selected
because they are classified as MSD by the VBA and are common causes of chronic
non-cancer pain. Including other conditions (e.g. osteomyelitis, muscle injuries)
would introduce more heterogeneity in illness course.

- Able to participate psychologically and physically, able to provide informed consent,
complete assessments, and participate in study procedures.

- Self-reports peak pain of at least 2 on a numeric pain rating scale (0 "no pain" to 10
"worst pain imaginable" in the last 28 days in the joint that is the focus of the
claim. This broad pain inclusion criterion may be narrowed after the Counseling
Refinement Stage. Some Veterans apply for service connection for injuries that are not
currently symptomatic, in case the injury recurs. This criterion will exclude these
asymptomatic Veterans

- Risky substance use within the last 28 days, defined as one of the following:

1. Risky alcohol use: i.e. >14 drinks/week or>4 drinks/occasion for men 65 or
younger; >7 drinks/week or >3 drinks/occasion for women. A standard drink will be
14 grams of absolute alcohol, equivalent to 12 oz of beer, 5 oz of wine, or 1.5
oz of 80-proof liquor

2. Self-reported use of an illicit drug in the preceding 28 days. Use of opioids or
sedative hypnotics not prescribed to the Veteran will be considered illicit drug
use.Medical marijuana is legal in Connecticut but is illegal federally. Use of
medical marijuana puts someone at some risk for future misuse of cannabis or
other drugs and therefore will be treated as an illicit drug.

3. Misuse of prescribed opioid medications in the preceding 28 days. Two questions
adapted from the CIDI for use in a NIDA Clinical Trials Network study, were
modified to describe misuse of prescribed opioid medications: "How often have you
taken your pain medications in larger amounts than prescribed or for a longer
period than prescribed?" and "How often have you used your pain medicines to get
high, to relax, or to make you feel more alert?"

Exclusion Criteria:

- Will not be able to attend the follow-up appointments.

- Attended VA or non-VA substance abuse treatment during the three months prior to
randomization. Veterans who are receiving mental health treatment but indicate it is
not addressing substance use will be enrolled.

- Physiological dependence on alcohol, illicit drugs, or non-prescribed opioids. People
with more severe dependence have not benefited from SBIRT in prior studies.