Date of Conferral



Doctor of Nursing Practice (DNP)




Patrick Palmieri


Chronic pain affects approximately 100 million adults in the United States annually, and costs exceeding $635 billion. Pain is the most common complaint in primary care, and chronic pain accounts for up to 16% of emergency room visits. Additionally, chronic pain accounts for 25% of missed workdays annually. Veterans are particularly vulnerable to chronic pain and have an increased incidence of chronic non-cancer pain. Chronic pain for veterans cost the Veterans Administration (VA) about $385 billion each year. This project evaluated the Patient Aligned Care Team (PACT) model to manage chronic lower back pain (CLBP) at a VA primary care center. The framework that guided the project was the theory of planned change and the chronic care model. A retrospective electronic chart review of demographic and pain management data was collected from a convenience sample of veterans (20 women, 20 men) with a history of CLBP managed by the primary care center for at least 1 year prior to and one year after the PACT model was implemented. Overall, the paired-samples t-test to was not statistically significant for improvements in veteran reported pain scores over time. However, there was a significant interaction between time and gender that indicates changes over time significantly differed because of gender. In addition, descriptively the mean pain levels were initially higher for men as compared to women, and these levels increased sharply for females over time while the men decreased. This project contributes positively to social change for veterans as the findings indicate an important gender difference in patient reported pain scores over time. There needs to be additional investigation to understand the etiology of the gender difference in the pain outcomes for CLBP.