The Veteran Affairs’ Approach for Chronic Pain Management

To the Editor Chronic pain trials increasingly enroll populations with substantial psychiatric symptoms, yet suicidality is often treated as a safety observation rather than a clinically meaningful outcome. The Whole Health Options and Pain Education (wHOPE) trial illustrates this tension. Despite exclusion of patients with active suicidality at baseline, suicidal ideation was the most common adverse event, occurring in 13.7% of the whole health group, 15.9% of the cognitive behavior therapy gro...