VA Pain Management

The VA's Whole Health system is a person-centered approach that combines conventional medicine with personalized health planning, complementary and integrative health (CIH), and self-care strategies. The VA describes itself as a leader in promoting individualized whole-person pain care.

The program uses a "Circle of Health" framework with eight self-care components: working the body, surroundings, personal development, food and drink, recharge (sleep), family/friends/coworkers, spirit and soul, and power of the mind.

How to Access Whole Health

• Talk to your VA provider about Whole Health services at your facility
• Contact your local VA and ask for the Whole Health Point of Contact
• Download the free Live Whole Health app (iOS/Android) for personal health inventories and goal-setting

The VA uses a stepped care approach that starts with the least intensive interventions and moves to more specialized care as needed:

Since launching the Opioid Safety Initiative in 2013, the VA has invested heavily in non-pharmaceutical pain management. A landmark VA study comparing opioid and non-opioid therapy found that opioids were not superior to non-opioid approaches in terms of effectiveness but were associated with significant side effects.

As a result, the VA now promotes team-based pain care that reduces reliance on opioids, emphasizes non-pharmacological treatments, and distributes naloxone (an opioid overdose reversal medication) through education programs. Veterans today have access to a wider range of pain management options than ever before.

Acupuncture involves inserting thin needles into specific points on the body to relieve pain and promote healing. It is available at many VA Medical Centers and some Community Based Outpatient Clinics.

Battlefield Acupuncture (BFA)

BFA is a specific protocol widely used throughout VA and DoD. It uses 5–10 small, semi-permanent needles placed at specific points on each ear. The tiny needles with golden studs remain in place for 3–5 days for continued treatment. Originally developed at Walter Reed Army Medical Center for wounded service members.

• Can reduce pain in minutes
• More than 75% of users report some immediate decrease in pain intensity
• On average, reduces pain levels by 2 points on the pain scale

How to Access

Requires a referral from your VA provider. Initial authorization is typically 60 days / 12 visits. Can be provided in individual or group settings. Covered by your VA medical benefits package when clinically necessary.

Chiropractic care involves hands-on manipulation of the body, primarily the spine, to restore proper alignment and mobility to joints. It can help with back pain, neck pain, headaches, and musculoskeletal conditions.

Since 2004, every VA medical center has provided access to chiropractic services — either on-station at VA facilities or through community care.

How to access: Request a referral from your VA provider or through MyHealtheVet Secure Messaging. Initial authorization is typically 90 days / 12 visits. No copay for service-connected conditions.

Medical massage therapy involves applying pressure and manipulation to muscles, tendons, and soft tissue to reduce pain, decrease muscle tension, and promote relaxation. It is covered by the VA medical benefits package when deemed clinically necessary.

How to access: Requires a referral from your VA provider. Initial authorization is typically 90 days / 12 visits. Available at some VA facilities; community care referral available where VA massage is not offered.

How to access: Contact your local VA's Whole Health Point of Contact or ask your VA provider about available programs. Both are typically offered as group classes through Whole Health.

CBT-CP is an evidence-based psychological treatment available throughout the VA. It teaches veterans an active, problem-solving approach to manage chronic pain by changing thoughts and behaviors related to pain.

What You Learn

• How to reshape expectations about pain
• Strategies to increase participation in meaningful activities
• Managing pain flare-ups more effectively
• Reducing worry about increased pain or injury
• Improving overall quality of life

How to access: Talk to your primary care provider, pain management provider, Primary Care Mental Health Integration (PCMHI) team member, or therapist. Available in individual or group settings. A shorter version (Brief CBT-CP) is available in primary care, and a specialized version (CBT-HA) addresses headache disorders.

Physical therapy is one of the most commonly prescribed pain management treatments at VA. VA's Physical Medicine and Rehabilitation Services offers:

• Manual therapy — hands-on techniques for joints and soft tissue
• Therapeutic exercise — stretching, strengthening, conditioning
• Cold and heat treatment
• Aqua therapy — water-based physical therapy in pools with trained therapists
• Therapeutic ultrasound — delivers deep heat to tissues to promote healing
• Electrical stimulation — TENS and other electrotherapy during sessions
• Traction — for spinal pain conditions
• Education — body mechanics, ergonomics, home exercise programs

How to access: Your primary care provider can refer you directly to physical therapy — no separate specialty referral is needed in most cases. Available at VA medical centers and many Community Based Outpatient Clinics.

The H-Wave is an FDA-cleared electrostimulation device designed for pain relief and tissue rehabilitation. Unlike standard TENS units, H-Wave uses a proprietary exponentially decaying waveform with a very long pulse duration (about 5,000 microseconds — roughly 100 times longer than a standard TENS unit).

Two Operating Modes

• Low-frequency mode (1–2 Hz): Produces gentle, non-fatiguing muscle contractions that increase blood flow and enhance lymphatic drainage — helping clear fluid buildup that contributes to pain and swelling.
• High-frequency mode (60 Hz): Creates a profound pain-blocking effect by affecting sodium channel pump function in the nerve, providing hours of significant pain relief after treatment.

H-Wave vs. TENS

Clinical Results

• 88% of patients increased function or decreased medication within 30 days
• 78% experienced significant pain reduction
• 65% reduced or eliminated pain medication needs

How to Get an H-Wave Through VA

The H-Wave is listed on the Federal Supply Schedule and available through VA channels:

1. Talk to your VA primary care or pain management provider about electrical stimulation therapy
2. If appropriate, your provider writes a prescription for the H-Wave device
3. The prescription goes through the VA Prosthetics and Sensory Aids Service (PSAS)
4. PSAS orders the device through the Federal Supply Schedule
5. The device comes with a carrying case, lead wires, battery recharger, electrodes, manual, and aloe gel
6. One-on-one instruction and follow-up support are included at no additional cost

TENS (Transcutaneous Electrical Nerve Stimulation) uses low-voltage electrical current delivered through electrode pads placed on the skin to provide pain relief. It works through multiple pathways, including the "gate control" theory (electrical signals reach the brain faster than pain signals) and endorphin release.

Common Uses

• Chronic back pain
• Arthritis
• Neuropathy
• Post-surgical pain
• Fibromyalgia
• Musculoskeletal pain

How to Get a TENS Unit Through VA

1. Talk to your VA Primary Care team about your pain and interest in electrotherapy
2. Your provider writes a consult to a Pain Management Clinic or Physical Therapy
3. Staff schedules you for an evaluation to develop a pain management plan
4. If appropriate, a TENS unit is prescribed for home use
5. The prescription is processed through VA Prosthetics and Sensory Aids Service — provided at no cost to the veteran

VA's Prosthetics and Sensory Aids Service (PSAS) is the largest and most comprehensive provider of prosthetic devices and sensory aids in the world. It provides equipment at no cost to enrolled veterans with a documented medical need.

Pain-Related Equipment Available

How to Request Equipment

1. Discuss your pain management needs and functional limitations with your VA provider
2. Your provider evaluates whether a device would benefit your treatment plan
3. Provider submits a referral to PSAS through a consult in the VA system
4. PSAS evaluates your needs, recommends appropriate devices, and coordinates fitting
5. Equipment is provided at no cost, including repair and maintenance

Tip: Be specific about how pain limits your daily activities. The more your provider understands your functional limitations, the better they can match you with appropriate equipment. VA has more than 70 locations where orthotics are custom-fabricated, plus over 600 contracts with community orthotic providers.

VA operates comprehensive chronic pain rehabilitation programs that combine multiple therapies in an intensive, interdisciplinary format.

Program Types

What's Included

• Movement-based therapies (physical therapy, tai chi, adaptive yoga)
• Behavioral strategies (pacing, mindfulness)
• Vocational rehabilitation and occupational therapy
• Pain neuroscience education
• Recreation therapy
• Cognitive-behavioral therapy
• Family involvement
• Self-management skills training

PEAK (Pain Empowerment Anywhere) is a fully virtual pain rehabilitation program launched in 2020. It follows the same treatment philosophy as in-person programs and is accessible to veterans regardless of location.

How to access: Must be enrolled in VA healthcare and formally referred by a VA or DoD provider. Notable facilities include VA Minneapolis, VA Tampa, and VA Oklahoma City.

If a specific pain management therapy is not available at your local VA, you may be eligible for community care. Eligibility criteria include:

• The therapy you need is not offered at your VA facility
• Drive time exceeds 30 minutes (primary care/mental health) or 60 minutes (specialty)
• Wait time exceeds 20 days (primary care/mental health) or 28 days (specialty)
• You and your provider agree community care is in your best medical interest

TelePain programs make pain management consultation more accessible, especially for veterans in rural areas. These virtual programs connect veterans with pain specialists regardless of location.

1. Contact your PACT — start with your VA primary care team
2. Describe your pain — be specific about location, severity, and how it affects daily life
3. Ask about options — inquire about specific treatments you've heard about
4. Get a referral — your provider submits a consult to the appropriate service
5. Follow up — if you don't hear back within 2 weeks, call your care team

Use MyHealtheVet Secure Messaging — often the easiest way to request referrals, ask about available services, follow up on pending consults, and communicate between appointments.

If Your Request Is Denied

• Ask your provider to document why a specific treatment would benefit you
• Request a second opinion from another VA provider
• Contact the Patient Advocate at your VA facility
• If the treatment is available through community care, discuss that option with your provider

• VA Pain Management — Official VA pain management resources and information
• VA Whole Health — The VA's comprehensive Whole Health program
• Prosthetics and Sensory Aids — Information on devices and equipment through PSAS
• MyHealtheVet — Secure Messaging and appointment scheduling
• Ask VA — General questions about VA services
• Veterans Crisis Line: 988 (press 1) — for immediate mental health support