HRONIC NONCANCER PAIN IS associated with considerable physical and psychosocial impairment, distress, comorbid depression, and increased health care use and costs. [1][2][3][4] Many primary care patients report chronic pain, 2,5,6 most commonly musculoskeletal pain. 2,7 Guidelines for chronic pain treatment have been developed. 8,9 However, implementation has been problematic, especially in busy primary care practices in which access to recommended treatment components may be limited.Multifaceted, collaborative interventions can promote guideline-concordant care and improve outcomes for chronic conditions in primary care. 10,11 These interventions, based on the chronic care model, 10 attempt to optimize patient and clinician interactions via education and activation while providing system support, including care management and clinician feedback. Several investigators have demonstrated improvements in pain intensity and pain-related function in studies of interventions using collaborative approaches. 12-14 However, one of these studies used a pre-post design, 14 and the

High clinician confidence and interest in treating chronic pain concurrent with low satisfaction with ability to provide optimal treatment suggests a need for more system support. VA primary care clinicians are frequently influenced by fears of contributing to dependence or addiction. The relationships among panel size, job satisfaction, and opioid prescribing rates merit additional investigation.

Abstract-We describe prior use and willingness to try complementary and alternative medicine (CAM) among 401 veterans experiencing chronic noncancer pain and explore differences between CAM users and nonusers. Participants in a randomized controlled trial of a collaborative intervention for chronic pain from five Department of Veterans Affairs (VA) primary care clinics self-reported prior use and willingness to try chiropractic care, massage therapy, herbal medicines, and acupuncture. Prior CAM users were compared with nonusers on demographic characteristics, pain-related clinical characteristics, disease burden, and treatment satisfaction. A majority of veterans (n = 327, 82%) reported prior use of at least one CAM modality, and nearly all (n = 399, 99%) were willing to try CAM treatment for pain. Chiropractic care was the least preferred option, whereas massage therapy was the most preferred (75% and 96%, respectively). CAM users were less likely to have service-connection disabilities (54% vs 68%; chi square = 4.64, p = 0.03) and reported having spent a larger percentage of their lives in pain (26% vs 20%; Z = 1.40, p = 0.04) than nonusers. We detected few differences between veterans who had tried CAM and those who had not, suggesting that CAM may have broad appeal among veterans with chronic pain. Implications for VA policy and practice and for clinicians treating veterans with chronic pain are discussed.Clinical Trial Registration: ClinicalTrials.gov. NCT00129480, "Improving the Treatment of Chronic Pain in Primary Care"; http://www.clinicaltrials.gov.

Decision support improved processes of care but not depression outcomes. More intensive care management or specialty treatment may be needed to improve depression outcomes.