VA’s holistic approach for chronic pain beats CBT, study finds

An approach to chronic pain management implemented by the U.S. Department of Veterans Affairs that focuses on personal health goals, nonpharmaceutical therapies, and wellness coaching improved how much pain disrupts patients’ lives better than cognitive behavioral therapy, according to a study published in JAMA in April 2026.

“The whole health team approach suggests a small improvement in how much pain limits life activities compared with both cognitive behavioral therapy and usual care in veterans with chronic pain. These findings may support including the whole health approach as an option,” researchers wrote.

The VA’s Whole Health program emphasizes personal health planning with care provided by transdisciplinary teams, or a group of providers who work from a shared framework. For veterans with chronic pain, the approach includes conventional medicine but with a focus toward health, well-being and self-care. It includes mindfulness, yoga and tai chi, acupuncture and massage, and nutritional counseling and weight management. The also program includes a free app that provides resources, including podcasts on mindfulness and pain management techniques, and it helps patients set goals and track progress.

The Whole Health approach was congressionally mandated in 2016 for patients with chronic pain as part of the Comprehensive Addiction and Recovery Act. A 2022 study of 4,869 veterans showed that the Whole Health program reduced opioid doses by 8.5% when combined with complementary and integrative health therapies.

In the JAMA study, researchers wanted to assess whether the Whole Health program could reduce chronic pain’s interference with daily life. They compared the Whole Health program with cognitive behavioral therapy, which aims to help patients reduce pain by changing thoughts and emotions to reduce symptoms.

The study randomized 764 adults with chronic pain receiving care through six VA health systems from Sept. 18, 2020, and Jan. 19, 2024. Of these, 632 patients completed the 12-month follow-up. Patients were randomized to either the Whole Health program, cognitive behavioral therapy or usual care. Whole health included individualized, interdisciplinary care focused on personal health goals, nonpharmaceutical therapies, and wellness coaching. The whole health team included a primary physician or nurse practitioner, a second clinician providing nonpharmacological or integrative pain care, and a coach. Cognitive behavioral therapy included seven group sessions focused on pain management skills. Usual care included standard VA pain management.

Researchers found that the Whole Health group showed greater improvement in pain interference at 12 months compared with cognitive behavioral therapy and usual care.

Suicidal ideation was the most common adverse event, which occurred in 13.7% of patients in the whole health team, 15.9% in the cognitive behavioral therapy group, and 13.4% in the usual care group.