Integrative Pain Management Centers in the Military: The Challenges.

Objectives: Biomedicine and complementary and alternative medicine are forming new relationships, under the rubric of integrative medicine. Recently, the military has adopted integrative medicine as the model for pain management. An evaluation was conducted on an integrative model for pain management at a major Army medical center to determine the distinct challenges that were encountered during the early stages of this integrative program. Methods: The design is a case study evaluation. Qualitative data were analyzed to determine whether the outcomes in terms of processes were in harmony with the program's mission. Study participants were patients (34), referring providers (25), program staff (20), administrators (18), and related medical center leadership (6). Results: The study uncovered the following challenges: misaligned culture and mission, resources, the valuing of services (relative value units), systemic transition, patient throughput, and stigma associated with the focus and location of the program in a psychology department. Conclusions: These challenges prevented the program from fully achieving its mission and potential. Although integrative medicine might be the appropriate model for pain management in the military, the structural and process elements to bring it about are not yet in place or fully understood.