Interdisciplinary Whole Health Teams Improve Chronic Pain Function Over Standard Care

Redefining Interdisciplinary Management for Chronic Pain

Chronic pain remains a leading cause of long-term disability, prompting clinical guidelines to prioritize nonpharmacological interventions over opioid therapy [1, 2]. While cognitive behavioral therapy is frequently utilized as a standard psychological approach, its efficacy in reducing pain severity is often modest, leading researchers to investigate alternative strategies [3]. Current guidelines emphasize biopsychosocial self-management and the integration of behavioral health into primary care settings to improve patient function [4]. However, the optimal structure for delivering these interdisciplinary services remains a subject of ongoing clinical debate [5]. To address this gap, a new randomized clinical trial examines the effectiveness of a comprehensive team-based model that aligns clinical care with the personal values and health goals of the patient.

The Whole Health Team Intervention Model

The United States Department of Veterans Affairs (VA) Whole Health approach was congressionally mandated in 2016 for patients with chronic pain receiving care in VA hospitals. This mandate aimed to shift the clinical focus from a disease-oriented model to one centered on patient-defined well-being. Despite its broad implementation across the veteran healthcare system, no randomized clinical trials had previously tested the benefits of this approach. This lack of high-level evidence necessitated a rigorous evaluation to determine if the model provides superior outcomes compared with standard psychological interventions or routine primary care. The study utilized a specific interdisciplinary structure to deliver care over a 12-month intervention and follow-up period. Each whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. This triad worked collaboratively to move beyond symptom management, providing interdisciplinary, individualized care consistent with the VA Whole Health model. The primary objective of this team-based structure was to help patients attain personal health goals aligned with their individual values and life goals, rather than focusing solely on pain intensity scores. By integrating a health coach and an integrative medicine provider directly into the clinical workflow, the intervention sought to address the biopsychosocial complexities of chronic pain. The researchers designed the 12-month protocol to ensure that clinical decisions were driven by what matters most to the patient, a process known as value-aligned care (a framework where medical decisions are based directly on a patient's specific life goals rather than standardized clinical metrics). This approach allowed the team to tailor nonpharmacological treatments and behavioral changes to the specific functional needs of each veteran, providing a structured alternative to traditional group-based cognitive behavioral therapy or standard primary care models. For practicing physicians, this model offers a blueprint for restructuring chronic pain management around functional restoration rather than simple analgesia.

Trial Design and Participant Demographics

This multicenter randomized clinical trial was conducted across 6 VA health systems in the United States to evaluate the effectiveness of a whole health team intervention compared with both cognitive behavioral therapy and usual care for patients with chronic pain. The researchers also sought to determine the effectiveness of cognitive behavioral therapy specifically against usual care in reducing long-term pain interference. The study enrolled participants between September 18, 2020, and January 19, 2024, with the final follow-up occurring on January 27, 2025. Following the data collection phase, statistical analyses took place between April 1, 2025, and February 3, 2026. All participants were patients with chronic pain who were actively receiving primary care services within the Veterans Affairs system. The trial utilized an 11:11:2 randomization ratio to assign patients to one of three distinct study arms. This strategy resulted in 343 patients receiving the whole health team intervention, 339 patients receiving cognitive behavioral therapy for chronic pain delivered in group sessions, and 82 patients receiving usual care. In total, the study randomized 764 patients with a mean age of 60.5 years (standard deviation of 12.3 years). Within this cohort, 66.5% of the participants were men. The study maintained high longitudinal engagement, as 632 patients (82.7%) completed the 12-month follow-up period, providing a robust dataset for the primary outcome analysis of pain interference.

Comparative Reductions in Pain Interference

The researchers evaluated the efficacy of the interventions using the Brief Pain Inventory interference (BPI-I) subscale score as the primary outcome at 12 months. This clinical tool measures the degree to which pain limits daily activities on a scale of 0 to 10, where higher scores represent greater functional impairment. For clinicians interpreting these findings, the minimal clinically important difference (the smallest change in a treatment outcome that a patient would identify as meaningful) is 1.0 point. At the start of the trial, baseline interference levels were comparable across the three cohorts, with the whole health group starting at 6.6, the cognitive behavioral therapy group at 6.4, and the usual care group at 6.4. At the 12-month follow-up, the whole health group demonstrated a reduction in pain interference scores from 6.6 to 4.9, a change that exceeded the threshold for clinical importance. During the same period, the cognitive behavioral therapy group pain interference scores changed from 6.4 to 5.5, and the usual care group scores changed from 6.4 to 5.7. Statistical analysis revealed that the whole health group achieved significantly improved pain interference compared with cognitive behavioral therapy, with a mean difference of -0.58 (97% CI, -1.11 to -0.05; P = .02). Furthermore, the whole health group showed significantly improved pain interference compared with usual care, resulting in a mean difference of -0.77 (99% CI, -1.40 to -0.15; P = .002). In contrast, the study found that cognitive behavioral therapy did not improve pain interference scores significantly more than usual care at 12 months. The mean difference between these two arms was -0.19 (99% CI, -0.89 to 0.50; P = .46), which failed to reach statistical significance. While the whole health team approach yielded a statistically significant benefit over both standard care and group-based psychological therapy, the authors characterized the overall improvement as small. For practicing physicians, these data suggest that an interdisciplinary team model focused on personal health goals may offer superior functional outcomes for veterans with chronic pain compared with standard psychological referrals.

Safety Profile and Adverse Events

In evaluating the safety of the three treatment arms, the researchers monitored for adverse events throughout the 12-month study period. The most common adverse event across all cohorts was suicidal ideation, a finding that underscores the high psychiatric complexity often present in veteran populations with chronic pain. The incidence of suicidal ideation was relatively consistent across the different management strategies, suggesting that the risk may be more closely associated with the underlying patient condition than with the specific interdisciplinary or behavioral interventions provided. When comparing the three study arms, suicidal ideation occurred in 15.9% of patients in the cognitive behavioral therapy group, 13.7% in the whole health team group, and 13.4% in the usual care group. These data indicate that the whole health team approach, despite its more intensive interdisciplinary structure, did not result in a higher rate of serious psychiatric adverse events compared with standard care. For clinicians, these results provide reassurance regarding the safety profile of the whole health model, while highlighting the ongoing necessity for vigilant mental health screening and support for all patients undergoing treatment for chronic pain.

References

1. Dowell D, Haegerich TM, Chou R. CDC Guideline for Prescribing Opioids for Chronic Pain — United States, 2016. MMWR Recommendations and Reports. 2016. doi:10.15585/mmwr.rr6501e1

2. Dowell D, Ragan K, Jones CM, Baldwin G, Chou R. CDC Clinical Practice Guideline for Prescribing Opioids for Pain—United States, 2022. MMWR Recommendations and Reports. 2022. doi:10.15585/mmwr.rr7103a1

3. Yarns BC, Jackson NJ, Alas A, Melrose RJ, Lumley MA, Sultzer DL. Emotional Awareness and Expression Therapy vs Cognitive Behavioral Therapy for Chronic Pain in Older Veterans: A Randomized Clinical Trial.. JAMA network open. 2024. doi:10.1001/jamanetworkopen.2024.15842

4. Conrad M, Kimber JM, Moskal D, et al. Patient and provider perspectives of Brief Cognitive Behavioral Therapy for Chronic Pain: a qualitative analysis of a pilot randomized controlled trial.. Translational behavioral medicine. 2026. doi:10.1093/tbm/ibag011

5. Herbert M, Tynan M, Lang A, et al. An integrated mindfulness meditation and acceptance and commitment therapy intervention for chronic pain: Rationale, design, and methodology of a pilot randomized controlled trial of Acting with Mindfulness for Pain (AMP).. Contemporary Clinical Trials. 2022. doi:10.2139/ssrn.4057808