Veterans Health Administration

The opioid epidemic and limitations of current nonopioid analgesics have created a need for safer, effective pain therapies. Suzetrigine, a first-in-class selective NaV1.8 inhibitor, was approved by the Food and Drug Administration in 2025 for the treatment of moderate to severe acute pain. The purpose of this review is to discuss the mechanism and clinical efficacy of suzetrigine and its potential for addressing existing therapeutic gaps in pain management. Phase 3 trials have demonstrated that suzetrigine provides a statistically significant and clinically meaningful reduction in acute postoperative pain compared to placebo, with efficacy similar to hydrocodone/acetaminophen and a favorable safety profile. Mechanistic studies confirm selective peripheral NaV1.8 inhibition, minimizing central nervous system effects and abuse potential. Ongoing research is evaluating suzetrigine for chronic pain conditions including diabetic peripheral neuropathy and lumbosacral radiculopathy, though long-term efficacy and safety remain to be established. Suzetrigine represents a promising nonopioid alternative for acute pain and has the potential to fill a significant gap in pain management. While initial results are encouraging, future studies are needed to define its role in chronic pain and multimodal analgesia, and to establish long-term safety.

Cancer continues to be a major cause of death, with an anticipated 2,114,850 new cases and almost 626,140 deaths from the disease in 2026 [...].

The Veterans Health Administration is promoting patient-reported outcome measure (PROM) collection for measurement-based mental health care. Understanding veteran preferences about how and when to complete PROMs is critical to support their implementation. We examined veteran preferences for timing and use of different technology platforms to complete mental health-related PROMs. We invited a national sample of 1373 veterans to complete a survey; 858 (62.5%) responded. Surveys asked about veteran preferences for how and when to complete mental health-related PROMs. We characterized responses using descriptive statistics and estimated multiple logistic regression models to examine associations between veteran demographic and health characteristics and preferences for completing PROMs. Most veterans preferred completing PROMs between appointments (607/801, 75.8%) using features of a patient portal (410/801, 51.2%), during appointments (589/801, 73.5%) verbally (413/801, 51.6%), and while at the medical center (480/801, 59.9%) on paper (189/801, 23.6%) or a tablet computer (180/801, 22.5%). Hispanic (vs non-Hispanic) veterans had 3.32 (95% CI 1.04-10.58) times higher odds of preferring to complete PROMs at the medical center, and veterans with lower (vs higher) socioeconomic status had lower odds (odds ratio 0.61, 95% CI 0.40-0.93) of preferring to complete PROMs in between appointments but 1.97 (95% CI 1.23-3.16) times higher odds of preferring to complete PROMs during appointments. As the Veterans Health Administration and other health care systems seek to expand the integration of PROM data into health care services, adaptive and flexible approaches to PROM administration that align with patient preferences, including those that leverage technology platforms in the remote collection of these data, may bolster implementation. Our results indicate that such implementation efforts should consider patient ethnicity and socioeconomic status. Our findings further suggest that these efforts could benefit from incorporating PROM administration into online patient portals, developing mobile health apps that support PROM completion through patients' personal devices in between clinical encounters, and engaging care team members in PROM administration during appointments.

The expansion of treatment options for prostate cancer (PC) has improved disease-specific and overall survival outcomes but has also raised questions about the optimal level of treatment needed for patients based on their individual prognosis and accounting for potential toxicity, incorporating quality of life considerations. A panel of experts met to discuss current controversies in the care of patients with PC across the disease continuum. Multidisciplinary experts review advances and persistent uncertainties in biomarker-guided assessment, imaging, and systemic therapy for prostate cancer. The discussion outlines priority gaps in evidence that must be addressed to optimize individualized patient care. Workshop topics included use of genomic biomarkers and artificial intelligence-guided tools to identify and manage high-risk and very-high risk localized disease, management of biochemical recurrence, identification of patients with metastatic hormone-sensitive PC who warrant treatment escalation, radiopharmaceutical therapy for metastatic castration-resistant PC including optimal sequencing of approved therapies, role of imaging in identification and management of extraprostatic disease, and lifestyle interventions to optimize survivorship. Many questions remain about management of PC related to biomarker-based risk stratification to guide treatment selection, use of prostate-specific membrane antigen-positron emission tomography, and balancing the risk for PC-related death with risks for treatment-related toxicity. Ongoing research efforts are needed to optimize risk-based treatment, sequence of therapies throughout the disease continuum, and survivorship care.

A 50-year-old male with a history of pulmonary sarcoidosis presented to the DC Veterans Affairs Medical Center with acute appendicitis. Laparoscopic view of the liver and peritoneum revealed studding lesions with biopsy confirmation of non-necrotizing granulomas consistent with intra-abdominal sarcoidosis. Operative and postoperative hospital courses were uncomplicated. In our case, avoidance of peritoneal sarcoid disease segments during laparoscopic entry into the abdomen may have helped reduce the chances of postoperative complications such as surgical site infection, wound dehiscence, or development of ventral hernias. However, further research intolaparoscopic entry in peritoneal sarcoid patients is required to further elucidate the subject and to help guide management. Literature reviews on intra-abdominal and peritoneal sarcoids, as well as surgical implications for laparoscopic entry, were discussed.

In a well-designed clinical trial, time zero is when eligibility is determined, treatment is assigned, follow-up time begins, and each of these elements is aligned. Attaining this alignment can be challenging in observational studies, risking potential bias. We compared the impact of different time zero designations on the estimated effectiveness of nirmatrelvir-ritonavir for COVID-19. We identified US veterans who tested positive for SARS-CoV-2 from April 2022 to March 2023 and compared nirmatrelvir-ritonavir vs no treatment using 5 time zero approaches: (1a) test-date (treated) vs test-date (untreated) allowing treatment on days 0-5 with matching, (1b) day 0 only with matching, or (1c) days 0-5 with a clone-censor-weight method; (2) treatment date vs test-date with matching; or (3) treatment date vs matched index date. Thirty-day incidence of hospitalization or death was lower in the nirmatrelvir-ritonavir group than the no treatment group for all time zero approaches. Estimated risk differences (95% CI) were larger for approaches 1a (-2.10% [-2.35 to -1.86]), 1b (-2.03% [-2.40 to -1.84]), and 2 (-2.26% [-2.47 to -2.02]); -1.80% (-1.89 to -1.45) for approach 3; and lowest for approach 1c (-0.95% [-1.11 to -0.75]). Different time zero designations can influence effect estimates and should be carefully considered when designing pharmacoepidemiology studies.

Intervertebral disc degeneration (IVDD) initiates a cascade of structural and biological changes that compromise mechanical function, often leading to chronic pain. While small animal models have provided insight into inflammatory and nociceptive mechanisms of IVDD, translational studies require large animal models that more closely replicate human spine anatomy and physiology. This study induced cervical disc degeneration via intradiscal chondroitinase ABC (ChABC) injection in a large animal model and evaluated the associated disc pathology and neuroinflammatory responses across IVDs and within spinal cord and dorsal root ganglia (DRG) tissues. Results confirmed structural degeneration at ChABC-injected levels and revealed additional evidence of adjacent segment degeneration. Neuroinflammatory analyses revealed innervation, via deposition of PGP9.5 and NFH, throughout both ChABC-injected and adjacent IVDs. Monocyte markers were significantly increased in ChABC-degenerated IVDs. Across experimental groups, the level of monocyte (Ly6C) and macrophage (CD68) markers correlated with worsened histological scores and with reduced mechanical integrity. Similarly, increased production of the neuropeptide, Substance P, in IVDs was significantly positively correlated with compromised IVD mechanical function. Finally, we observed elevated production of the microglia marker, Iba1, and Substance P production in the spinal cord, with similar trends in DRGs, in degenerative spines. By establishing quantitative relationships between disc pathology, immune responses, and neural activation, this work established possible disease-contributing neuroinflammatory activation and further validated a clinically relevant model for preclinical evaluation of regenerative and therapeutic strategies.