Focused on improving pain management and avoiding substance use disorder (SUD), the National Capital Region (NCR) Pain Initiative at Walter Reed National Military Medical Center recently hosted the 2026 Combined Pain Care Skills Training and SUD Symposium.

The four-day event annually brings together virtually and in person, physicians, researchers and other subject-matter experts in pain management and SUD to share discoveries, treatments and innovations enhancing care and readiness of Military Health System (MHS) beneficiaries.

Dr. Christopher Spevak, Pain Management Fellowship program director, NCR’s Opioid Safety Program director, and deputy director of the NCR’s Pain Initiative and Wounded Warrior Pain Care Initiative, explained the purpose of the event. In its 16th year, the training and symposium champion the MHS’s pillars of “supporting the warfighter; sustaining the medical skills in times of peace; strengthening medical readiness and the health care chain; and preparing for the future battlefield.”

Spevak added that effective pain care is directly tied to readiness, recovery and quality of life—not only for recovering active-duty service members to return to duty, but also for veterans and civilian patients who look to Walter Reed and the MHS for world-class care. Integrating effective pain care and SUD prevention continues Walter Reed’s legacy of modeling a standard of care that not only serves MHS beneficiaries and enhances readiness but also influences best practices across health systems, he shared.

The event kicked off Aug. 11-12 with plenaries and workshops highlighted by the Dr. Anita Hickey Memorial Lecture provided this year by Dr. George Koob, director of the National Institute on Alcohol Abuse and Alcoholism. Hickey was a decorated U.S. Navy captain and pain medicine physician who dedicated nearly three decades to military service, helping to pioneer integrative, holistic pain management for active-duty service members and veterans.

Koob discussed the “Intersection of Hyperalgesia and Hyperkatifeia as a Driving Force for Negative Reinforcement in Addiction.” He explained that hyperalgesia is an abnormally high sensitivity to pain, and hyperkatifeia, a term he helped coin, as “the increased intensity of negative emotional/motivational symptoms and signs observed during withdrawal from drugs of addiction.”

“Withdrawal from drugs of addiction causes pain (hyperalgesia) and emotional pain (hyperkatifeia) during acute and protracted withdrawal,” Koob said. “A focus on brain circuits responsible for hyperalgesia and hyperkatifeia provide a rich substrate for novel approaches for diagnosis, treatment and prevention of addiction.”

Dr. Abigail Brooks, a clinical pharmacist practitioner at the West Palm Beach VA Healthcare System, discussed drug interactions and cardiovascular complications in pain management. “Medication reconciliation prior to initiation of pharmacotherapy for pain, or any other indication, is important to mitigate potential drug-drug interactions,” she shared. “If opioids are concomitantly prescribed with other [central nervous system] depressant medications, naloxone kit and education should be offered [and] provided.”

Dr. Mark Lumley, a clinical psychologist at Wayne State University in Detroit, Michigan, focused on neuroplastic recovery therapies for chronic pain, explaining that these aim to help patients “unlearn” persistent pain, teaching the brain to re-interpret safe body signals as non-threatening to break the cycle of chronic discomfort. He also explained the benefits of Emotional Awareness and Expression Therapy (EAET) as psychological treatment focused on reducing chronic pain and physical symptoms by helping people face, process, and express hidden or avoided emotions, trauma, and stress.

U.S. Army Lt. Col. (Dr.) Connie Thomas, associate director of the Center for Military Psychiatry and Neuroscience (CMPN) at the Walter Reed Army Institute of Research (WRAIR), provided the Dr. Richard Niemtzow Memorial Lecture, focusing on sleep in the military. Niemtzow was a retired U.S. Air Force colonel and pioneering physician widely known as the “father of battlefield acupuncture.” He was also noted as the first full-time physician acupuncturist in the U.S. military and a leader in integrating Eastern healing principles into military medicine. Thomas explained that many people who have pain issues often experience sleep challenges.

“Sleep loss is prevalent in the military due to unique occupational factors, such as operating tempo, deployments, work-life balance and mission creep [gradual, unplanned expansion of a military operation or goal beyond its original scope],” Thomas stated. “Sleep loss is a threat to military readiness and has been associated with risk of disease, injury, and risky behavior.”

Walter Reed’s Sleep Clinic tackles sleep issues for MHS beneficiaries, and Thomas added that the CPMN also “seeks to develop targeted strategies and technologies for monitoring, preventing, and/or reversing decrementing effects of sleep loss to enhance warfighter operational performance and potentially minimize the long-term effects of sleep loss on health.”

Dr. Diana Martinez, a psychiatrist from Columbia University in New York, explained that many people turn to alcohol to cope with pain. She discussed Alcohol Use Disorder (AUD) and its treatment with chronic pain with transcranial magnetic stimulation (TMS) therapy. TMS) is a non-invasive procedure that uses focused magnetic fields to stimulate nerve cells in specific areas of the brain. It is primarily used to treat depressive disorder and obsessive-compulsive disorder (OCD) and is currently in use at Walter Reed.

Martinez explained that chronic pain and AUD frequently co-occur and fuel one another. Long-term alcohol use can alter pain thresholds, while individuals with chronic pain often turn to alcohol for self-medication, raising the risk of severe dependence. “[It’s] important to treat both disorders at the same time,” she stated.

In discussing opioid metabolism pathways, Dr. Stephanie Weiss of the National Institutes of Health (NIH) explained how the body breaks down and eliminates opioid drugs. She shared that metabolism determines how a given dose of a drug is going to affect the body, and that it’s critical for doctors to understand metabolism since not all patients react the same way to a dose of opioids. She added that this is why it’s important for patients to be direct and honest with a medical professional who is considering prescribing opioids, so they know the correct type and dose of opioid that will work best for the patient.

Dr. Arwen Podesta, a New Orleans-based physician boarded in psychiatry, addiction medicine, forensic psychiatry and holistic and integrative medicine, cautioned in the use of “gas station and corner store drugs,” explaining many are unregulated and unapproved. They often are marketed as dietary supplements or herbal products and fall into regulatory loopholes. They include Kratom, Tianeptine and other emerging substances, often sold at counters in gas stations and corner stores marketed as “quick, over-the-counter solutions for pain relief, mood elevation, weight loss, energy, and male enhancement and packaged as ‘natural’ or ‘herbal’ supplements, which can pose several health risks and concerns.” These include unpredictable potency, psychoactive and habit-forming addiction, and overdose.

For more information about Walter Reed’s Pain Management Clinic talk to your primary care provider, or call: (New/Initial Appointments) 855-227-6331; (Appointments for Established Patients) 301-295-4435.