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• Nearly 80 percent of service members with acute low back pain received treatment consistent with "stepped care," a model that recommends less-intensive treatments prior to prescribing opioids.
• Service members with chronic pain are a large population with complex health care needs, with nearly 100,000 service members experiencing chronic pain in a given year.
• More than 80 percent of service members with chronic pain received at least some nonpharmacologic therapy, but few received some recommended types.
• Opioid prescribing was largely consistent with recommended guidance.
• Rates of naloxone dispensing for service members on higher-risk daily opioid dosages were low.
• Few service members with opioid use disorder received recommended medication treatment.
• Providers at military treatment facilities were more likely than TRICARE-contracted private-sector providers to adhere to opioid-prescribing recommendations after dental and ambulatory procedures.

Pain conditions are the leading cause of disability among active-duty service members. Given the significant implications for force readiness and service member well-being, the Military Health System (MHS) has made it a strategic priority to provide service members with the highest-quality treatment for pain conditions.

RAND researchers assessed MHS outpatient care for acute and chronic pain, including opioid prescribing. The assessment involved developing a set of 14 quality measures designed to assess aspects of outpatient care for pain, including care associated with dental and ambulatory procedures, acute low back pain, chronic pain, opioid prescribing, and medication treatment for opioid use disorder. This report offers the most comprehensive examination to date of the quality and safety of pain care in the MHS and its alignment with evidence-based clinical practice guidelines. It identifies several areas of strength in pain care delivery, along with some areas for improvement, and provides recommendations to support the MHS in continuing to improve pain care for service members.

• Chapter One

  Introduction

• Chapter Two

  Developing a Pain Care Measure Set

• Chapter Three

  Analytic Methods

• Chapter Four

  Acute Pain Related to Procedures

• Chapter Five

  Acute Low Back Pain

• Chapter Six

  Chronic Pain

• Chapter Seven

  Opioid Prescribing

• Chapter Eight

  Medication for Opioid Use Disorder

• Chapter Nine

  Findings and Recommendations

• Appendix A

  Technical Specifications for Quality Measures

• Appendix B

  Key Cross–Measure Domain Definitions

• Appendix C

  Comorbidity and Health Care Utilization Among Service Members with Chronic Pain, by Pain Condition

• Appendix D

  Opioid Prescribing

• Appendix E

  Assessing Pain During Clinical Care