# COVID-19 Impact on Pain management: Highlighting, Explaining, and Realigning services (CIPHER)

> **NIH VA I01** · RLR VA MEDICAL CENTER · 2024 · —

## Abstract

Background: The COVID-19 pandemic severely disrupted healthcare. These changes are likely to have
especially profound implications for Veterans obtaining regular care for chronic conditions, such as chronic
pain—particularly when Veterans are obtaining nonpharmacologic treatments, which often require regular, in-
person visits. Although virtual care delivery in VA increased dramatically in response to the pandemic and is
unlikely to diminish, it is unclear what services Veterans with pain have received via virtual delivery and how
Veterans have been affected by these shifts. The goal of this project is to understand changes in VA chronic
pain care after COVID-19 and their associated impacts—and use these data to develop strategies to optimize
delivery of VA pain services in a post-COVID-19 environment.
Significance: This project addresses priorities in HSR&D's Targeted Solicitation on Opioid Safety and Opioid
Use Disorder. Specifically, this project is responsive to priority area E, “examination of the impact of the
COVID-19 public health emergency on the effective treatment of chronic pain, including effects on access to
care, medication and treatment modalities, patient function and satisfaction.” Despite the clear impact on care
delivery exerted by the COVID-19 pandemic, little is known about how these changes and disruptions have
affected Veterans and their chronic pain care, including their ability to access care after the onset of the
pandemic. These concerns are reflected in our pilot data, which indicate that Veterans have felt the impact of
service disruptions on their pain management.
Innovation and Impact: The effects of the COVID-19 pandemic are not yet well-understood. This project takes
a mixed-methods approach to examine changes in chronic pain care since the onset of the pandemic, working
with an expert stakeholder panel at each stage of the research to ensure results and recommendations are
disseminated rapidly to maximize impact.
Specific Aims: Aim 1 (quantitative): Describe changes in pain management visits for Veterans with chronic low-
back pain (cLBP) following the onset of the COVID-19 pandemic. Aim 2 (qualitative): Explain differential
patterns of receipt of services identified in Aim 1 and perceived impacts. Aim 3: Share findings throughout the
project, including final, integrated findings from Aims 1 and 2, and develop short- and long-term strategies to
optimize delivery of pain care for Veterans in a post-COVID-19 environment.
Methodology: This study uses an embedded mixed-methods design. In Aim 1 a retrospective cohort of
Veterans receiving care for cLBP will be established. Receipt of guideline-recommended, nonpharmacological
pain management services, including changes in service receipt following the onset of COVID-19, will be
examined. Veteran and facility factors associated with differential changes will be tested. Once the first phase
of Aim 1 analyses is complete, qualitative sampling for Aim 2 will begin. Thus, ...

## Key facts

- **NIH application ID:** 10823217
- **Project number:** 5I01HX003401-03
- **Recipient organization:** RLR VA MEDICAL CENTER
- **Principal Investigator:** Marianne S Matthias
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-04-01 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10823217

## Citation

> US National Institutes of Health, RePORTER application 10823217, COVID-19 Impact on Pain management: Highlighting, Explaining, and Realigning services (CIPHER) (5I01HX003401-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10823217. Licensed CC0.

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