Voices in Pain Medicine: Bridging the Gap – How PM&R Training at the Veterans Affairs Prepares Residents to Advance Multidisciplinary Pain Care
As a new PM&R resident, I recently completed a pain medicine rotation at the Veterans Affairs (VA) hospital. This clinical setting left a lasting impression on both my perspective as a physician and my clinical training. The VA is unlike any other healthcare environment I’ve experienced. Here, I appreciate the mission to serve those who have served our country, and the resources available for comprehensive, multidisciplinary care. In this post, I want to share how my PM&R training, combined with the unique opportunities at the VA, has given me a meaningful, well-rounded experience in pain medicine.
The Privilege of Caring for Veterans
Caring for veterans is a privilege that comes with a deep sense of responsibility. Many of my patients have endured injuries and traumas in service to our country, and their pain stories are often complex, layered with both physical and psychological challenges. What struck me most during my chronic pain medicine rotation was the trust veterans place in their care teams. The majority are open about their struggles, and they genuinely want to improve by not only managing pain, but also regaining function, independence, and quality of life.
One patient I worked with was a Vietnam veteran with a below-the-knee amputation and chronic low back pain. He had tried multiple medications and therapies in the past, but his pain persisted and limited his ability to use his prosthesis. Through the VA’s integrated system, we were able to coordinate a plan that included non-opioid medications, a referral to the amputee clinic for prosthetic adjustment, weekly acupuncture sessions, and regular follow-ups with a pain psychologist. Within several months, he reported not only less pain but also improved mobility, confidence in his daily activities, and the ability to interact with his grandkids. This kind of holistic, team-based care is what I appreciate about the field of physiatry and the clinical setting of the VA.
Fewer Administrative Barriers, More Focus on Patient Care
One of the most refreshing aspects of practicing at the VA is the reduced administrative and insurance-related barriers. Unlike private practice, where prior authorizations and insurance denials may delay or limit care, the VA model allows us to focus on what’s best for the patient. If a veteran needs a procedure, a brace, or a mental health referral, this care can typically be performed more quickly. This streamlined approach promotes more coordinated, timely, and patient-centered care.
For example, I saw a young veteran with PTSD and worsening lumbar disc herniation that he initially sustained while in the military. He was struggling with severe pain, anxiety, and difficulty returning to work. Since he just established care at the VA, we were able to arrange a multidisciplinary care plan that included a lumbar epidural steroid injection, physical therapy, monthly follow-ups with a pain pharmacist, and weekly sessions with a pain psychologist. The ability to coordinate these resources under one roof and without administrative delays made a tangible difference in his recovery.
The Power of Multidisciplinary Collaboration
The VA’s multidisciplinary environment is one of its greatest strengths. As a PM&R resident, I appreciate the interdisciplinary relationship between departments of pain medicine, rehabilitation, prosthetics, and mental health teams within the same hospital. The close communication between departments fostered a shared commitment to treating the whole person, not just the physical or emotional aspects of pain.
In our general PM&R clinic, we often co-manage patients with the pain medicine team, discussing cases in real time and adjusting treatment plans collaboratively. The proximity of the prosthetics and amputee clinics meant that if a patient needed a new brace or prosthetic adjustment, we could coordinate care immediately. The presence of pain psychologists and mental health professionals was invaluable, especially for veterans dealing with PTSD, depression, or substance use disorders alongside their pain.
PM&R Training: Building a Foundation for Pain Medicine
So far in my PM&R training, I have been striving to build a strong foundation in functional assessment, rehabilitation strategies, and procedural skills, all of which are essential for a career in pain medicine. At the VA, I assisted in performing fluoroscopy-guided epidural corticosteroid injections, nerve blocks, and other interventions, while also learning to integrate these procedures into broader rehabilitation plans.
I value that PM&R focuses on the continuum of care. We can see patients from the acute phase of injury through rehabilitation and long-term management. This perspective is especially valuable for veterans, whose pain often evolves over time and requires ongoing, adaptive care.
Personal Takeaways
This rotation has reinforced my belief that the best pain medicine care is collaborative, patient-centered, and rooted in a deep understanding of function and quality of life. The VA’s model, which may promote more integrated and coordinated care, allowed me to see what’s possible when resources, expertise, and collaboration come together for the benefit of those who have given so much.
I am grateful for the opportunity to learn from and care for veterans, and I am excited to carry these lessons forward as I continue my training in PM&R and pursue a future in pain medicine.
Eric Toan Phong Nguyen, DO
AAPM Resident Ambassador
Resident Physician, PGY-3
Physical Medicine & Rehabilitation, Charles R. Drew University of Medicine and Science
References
- Stanos, S. P., McLean, J., & Rader, L. (2007). Physical medicine rehabilitation approach to pain. The Medical clinics of North America, 91(1), 57–95. https://doi.org/10.1016/j.mcna.2006.10.014
- Malmut, L., Kline-Quiroz, C., & Cushman, D. M. (2022). Competency Assessment in Physical Medicine and Rehabilitation Resident Education: A Systematic Review. American journal of physical medicine & rehabilitation, 101(12), 1111–1116. https://doi.org/10.1097/PHM.0000000000001983
- Eshraghi, Y., Barad, M., Pritzlaff, S., Emerick, T., Wahezi, S., Anitescu, M., & Kohan, L. (2025). Enhancing early career development in pain medicine: the comprehensive role of mentorship. Pain medicine (Malden, Mass.), 26(3), 129–130. https://doi.org/10.1093/pm/pnae128
- Mattocks, K., Rosen, M. I., Sellinger, J., Ngo, T., Brummett, B., Higgins, D. M., Reznik, T. E., Holtzheimer, P., Semiatin, A. M., Stapley, T., & Martino, S. (2020). Pain Care in the Department of Veterans Affairs: Understanding How a Cultural Shift in Pain Care Impacts Provider Decisions and Collaboration. Pain medicine (Malden, Mass.), 21(5), 970–977. https://doi.org/10.1093/pm/pnz341
- Gauntlett-Gilbert, J., & Wilson, S. (2013). Veterans and chronic pain. British journal of pain, 7(2), 79–84. https://doi.org/10.1177/2049463713482082
As part of our commitment to advancing pain care across disciplines, AAPM periodically highlights significant work from across the field. Articles written by our guest blog authors are their own and do not necessarily reflect those of their institutions or the American Academy of Pain Medicine.