Guidance for simultaneous treatment of chronic pain and PTSD: a Delphi study

Despite the high co-prevalence of chronic pain and PTSD (CP + PTSD) among Veterans, there are no established guidelines for simultaneous treatment. This Delphi study provides guidance on simultaneous treatment for CP + PTSD. We used snowball sampling to recruit experts in CP + PTSD from nationwide VA facilities to participate in qualitative interviews and four rounds of a Delphi survey. The initial list of experts was compiled based on our previous work. Qualitative interviews were recorded, transcribed, and analyzed using the Framework Method. This approach identified Delphi survey items for quantitative rating. Individual items were rated using a Likert scale and items not reaching consensus were forwarded to subsequent rounds. A priori termination criteria determined the completion of Delphi survey rounds. Twenty-three experts from 13 VA facilities completed interviews and 15 (65%) completed four rounds of the Delphi survey. Interviews yielded 5 domains (61 items) for the first consensus-building survey round. Feedback from rounds 1 and 2 resulted in an additional 10 items. Of the 71 items, a priori group consensus for a final item list was reached on 48 items. Expert consensus identified guidance (Main Considerations, Key Intervention Components, Care Delivery Options, Facilitators, and Barriers) for the simultaneous treatment of CP + PTSD within the VA healthcare system. Future research that reports on the application of this guidance will facilitate improvements in healthcare and advance the field of integrative care for common comorbidities.