Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain: Results from a Cross-Sectional Survey

  • Sara N. Edmond
  • William C. Becker
  • Mary A. Driscoll
  • Suzanne E. Decker
  • Diana M. Higgins
  • Kristin M. Mattocks
  • Robert D. Kerns
  • Sally G. Haskell
Original Research



Despite strong evidence for the effectiveness of non-pharmacological pain treatment modalities (NPMs), little is known about the prevalence or correlates of NPM use.


This study examined rates and correlates of NPM use in a sample of veterans who served during recent conflicts.


We examined rates and demographic and clinical correlates of self-reported NPM use (operationalized as psychological/behavioral therapies, exercise/movement therapies, and manual therapies). We calculated descriptive statistics and examined bivariate associations and multivariable associations using logistic regression.


Participants were 460 veterans endorsing pain lasting ≥ 3 months who completed the baseline survey of the Women Veterans Cohort Study (response rate 7.7%.

Main measures

Outcome was self-reported use of NPMs in the past 12 months.

Key results

Veterans were 33.76 years old (SD = 10.72), 56.3% female, and 80.2% White. Regarding NPM use, 22.6% reported using psychological/behavioral, 50.9% used exercise/movement and 51.7% used manual therapies. Veterans with a college degree (vs. no degree; OR = 2.51, 95% CI = 1.46, 4.30, p = 0.001) or those with worse mental health symptoms (OR = 2.88, 95% CI = 2.11, 3.93, p < 0.001) were more likely to use psychological/behavioral therapies. Veterans who were female (OR = 0.63, 95% CI = 0.43, 0.93, p = 0.02) or who used non-opioid pain medications (OR = 1.82, 95% CI = 1.146, 2.84, p = 0.009) were more likely to use exercise/movement therapies. Veterans who were non-White (OR = 0.57, 95% CI = 0.5, 0.94, p = 0.03), with greater educational attainment (OR = 2.11, 95% CI = 1.42, 3.15, p < 0.001), or who used non-opioid pain medication (OR = 1.71, 95% CI = 1.09, 2.68, p = 0.02) were more likely to use manual therapies.


Results identified demographic and clinical characteristics among different NPMs, which may indicate differences in veteran treatment preferences or provider referral patterns. Further study of provider referral patterns and veteran treatment preferences is needed to inform interventions to increase NPM utilization. Research is also need to identify demographic and clinical correlates of clinical outcomes related to NPM use.



The authors wish to thank Erin Krebs, M.D. for her important intellectual contributions to this research, specifically her role in the development of the survey, and her contribution as a site principal investigator.

Funding Information

This research was supported by VA Health Services Research and Development awards (#DHI07–065 and #IIR-12-118) and the VA Health Services Research and Development Service Center of Innovation (CIN 13-407).

Compliance with Ethical Standards



Prior Presentations


Conflict of Interest

The authors declare that they do not have a conflict of interest.


The views expressed in this article are those of the authors and do not necessarily represent the position or policy of the Department of Veterans Affairs or the United States government.


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Copyright information

© Society of General Internal Medicine (outside the USA) 2018

Authors and Affiliations

  • Sara N. Edmond
    • 1
    • 2
  • William C. Becker
    • 1
    • 3
  • Mary A. Driscoll
    • 1
    • 2
  • Suzanne E. Decker
    • 2
    • 4
  • Diana M. Higgins
    • 5
    • 6
  • Kristin M. Mattocks
    • 7
    • 8
  • Robert D. Kerns
    • 1
    • 2
    • 9
  • Sally G. Haskell
    • 1
    • 3
  1. 1.Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center/11ACSLGVA Connecticut Healthcare SystemWest HavenUSA
  2. 2.Department of PsychiatryYale School of MedicineNew HavenUSA
  3. 3.Department of Internal MedicineYale University School of MedicineNew HavenUSA
  4. 4.New England Mental Illness Research Education and Clinical CenterVA Connecticut Healthcare SystemWest HavenUSA
  5. 5.Anesthesiology, Critical Care, and Pain Medicine ServiceVA Boston Healthcare SystemJamaica PlainUSA
  6. 6.Department of PsychiatryBoston University School of MedicineBostonUSA
  7. 7.VA Central Western Massachusetts Healthcare SystemLeedsUSA
  8. 8.Quantitative Health Sciences and PsychiatryUniversity of Massachusetts Medical SchoolWorcesterUSA
  9. 9.Departments of Neurology and PsychologyYale UniversityNew HavenUSA

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