Whole Health Team Improved Pain Interference In VA Trial
Key Takeaways
- The Whole Health arm was associated with greater improvement in 12-month pain interference than either comparator.
- Group cognitive behavioral therapy was not significantly different from usual care on the primary endpoint.
- Suicidal ideation was the most common adverse event and occurred at similar frequencies across groups.
The wHOPE randomized clinical trial was conducted across 6 VA health systems and enrolled patients with chronic pain receiving VA primary care. Investigators randomized 764 patients in an 11:11:2 ratio to a Whole Health team intervention, group cognitive behavioral therapy for chronic pain, or usual care over 12 months. The Whole Health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach, with care individualized around personal values and life goals. CBT was delivered in group sessions, and the primary endpoint was Brief Pain Inventory interference at 12 months.
Participants had a mean age of 60.5 years, and 66.5% were men. On the 0-to-10 Brief Pain Inventory interference scale, higher scores reflected worse interference, and the minimal clinically important difference was 1.0. Scores changed from 6.6 to 4.9 with Whole Health, from 6.4 to 5.5 with CBT, and from 6.4 to 5.7 with usual care. Between-group differences were -0.58 for Whole Health versus CBT (97% CI, -1.11 to -0.05; P=.02), -0.77 for Whole Health versus usual care (99% CI, -1.40 to -0.15; P=.002), and -0.19 for CBT versus usual care (99% CI, -0.89 to 0.50; P=.46).
Of the randomized cohort, 632 patients, or 82.7%, completed 12-month follow-up. Enrollment ran from September 18, 2020, to January 19, 2024, with final follow-up on January 27, 2025, and analyses conducted between April 1, 2025, and February 3, 2026. Suicidal ideation was the most common adverse event, occurring in 15.9% of the CBT group, 13.7% of the Whole Health group, and 13.4% of the usual care group.