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The musculoskeletal diagnosis cohort: examining pain and pain care among veterans

Goulet, Joseph L.; Kerns, Robert D.; Bair, Matthew; Becker, William C.; Brennan, Penny; Burgess, Diana J.; Carroll, Constance M.; Dobscha, Steven; Driscoll, Mary A.; Fenton, Brenda T.; Fraenkel, Liana; Haskell, Sally G.; Heapy, Alicia A.; Higgins, Diana M.; Hoff, Rani A.; Hwang, Ula; Justice, Amy C.; Piette, John D.; Sinnott, Patsi; Wandner, Laura; Womack, Julie A.; Brandt, Cynthia A.

doi: 10.1097/j.pain.0000000000000567
Research Paper
Editor's Choice
Global Year 2016

Musculoskeletal disorders (MSDs) are highly prevalent, painful, and costly disorders. The MSD Cohort was created to characterize variation in pain, comorbidities, treatment, and outcomes among patients with MSD receiving Veterans Health Administration care across demographic groups, geographic regions, and facilities. We searched electronic health records to identify patients treated in Veterans Health Administration who had ICD-9-CM codes for diagnoses including, but not limited to, joint, back, and neck disorders, and osteoarthritis. Cohort inclusion criteria were 2 or more outpatient visits occurring within 18 months of one another or one inpatient visit with an MSD diagnosis between 2000 and 2011. The first diagnosis is the index date. Pain intensity numeric rating scale (NRS) scores, comorbid medical and mental health diagnoses, pain-related treatments, and other characteristics were collected retrospectively and prospectively. The cohort included 5,237,763 patients; their mean age was 59, 6% were women, 15% identified as black, and 18% reported severe pain (NRS ≥ 7) on the index date. Nontraumatic joint disorder (27%), back disorder (25%), and osteoarthritis (21%) were the most common MSD diagnoses. Patients entering the cohort in recent years had more concurrent MSD diagnoses and higher NRS scores. The MSD Cohort is a rich resource for collaborative pain-relevant health service research.

Supplemental Digital Content is Available in the Text.The Musculoskeletal Disorder Cohort is a rich resource of information about pain and pain care and may serve as a platform for collaborative pain-relevant research.

aPain Research, Informatics, Multi-morbidities, and Education Center (PRIME), VA Connecticut Healthcare System, West Haven, CT, USA

bVA Center of Health Information and Communication, Richard L. Roudebush VAMC, Indianapolis, IN, USA

cHSR&D Center of Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, CA, USA

dCenter for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Healthcare System, Minneapolis, MN, USA

eCenter to Improve Veteran Involvement in Care (CIVIC), VA Portland Health care System, Portland, OR, USA

fAnesthesiology, Critical Care, and Pain Medicine Service/Research Service, VA Boston Healthcare System, Boston, MA, USA

gGeriatrics Research, Education and Clinical Center, James J. Peters VAMC, Bronx, NY, USA

hVA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann arbor, MI, USA

iHealth Economics Resource Center, VA Palo Alto Health Care System, Menlo Park, CA, USA

Corresponding author. Address: VA Connecticut Healthcare System, 950 Campbell Ave, 35a, West Haven, CT 06516. Tel.: 203.932.5711, ext. 5325; fax: 203.937.4926. E-mail: (J.L. Goulet).

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

Received November 05, 2015

Received in revised form February 12, 2016

Accepted March 18, 2016

© 2016 International Association for the Study of Pain
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