title: Rates and Correlates of Pain Specialty Clinic Use Nationally in the Veterans Health Administration.
abstract: Chronic 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.
  
  
  
  Bivariate 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.
  
  
  
  Altogether, 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.
  
  
  
  Patients 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.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA.
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Arout
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA.|Veterans Health Administration Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut, USA.
authors.forename: Mehmet
authors.initials: M
authors.lastname: Sofuoglu
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, VA Connecticut Healthcare System, West Haven, Connecticut, USA.|Veterans Health Administration Mental Illness Research, Education, and Clinical Center (MIRECC), West Haven, Connecticut, USA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use*; D059350:Chronic Pain / Q000453:epidemiology* / Q000517:prevention & control*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics / Q000706:statistics & numerical data*; D059408:Pain Management / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D013223:Statistics as Topic; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014600:Utilization Review; D014728:Veterans / Q000706:statistics & numerical data*
chemical_list: D000701:Analgesics, Opioid
keywords: Chronic Pain; Pain Clinic; Veterans Health Administration