Use of Non-Pharmacological Pain Treatment Modalities Among Veterans with Chronic Pain: Results from a Cross-Sectional Survey
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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%.
Outcome was self-reported use of NPMs in the past 12 months.
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.
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
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.
- 1.Institute of Medicine. Relieving pain in America: a blueprint for transforming prevention, care, education, and research. Washington, DC; 2011.Google Scholar
- 9.The Management of Opioid Therapy for Chronic Pain Working Group. VA/DoD clinical practice guideline for opioid therapy for chronic pain. Department of Veterans Affairs / Department of Defense; 2017.Google Scholar
- 11.The Office of the Assistant Secretary for Health at the U.S. Department of Health and Human Services. National Pain Strategy; 2016.Google Scholar
- 12.SOTA Placeholder. SOTA Placeholder Reference. J Gen Intern Med. 2018.Google Scholar
- 14.Fransen M, McConnell S, Hernandez-Molina G, Reichenbach S. Exercise for osteoarthritis of the hip. Cochrane Database Syst Rev. 2014;(4):CD007912.Google Scholar
- 19.Chou R, Huffman LH, American Pain S, American College of P. Nonpharmacologic therapies for acute and chronic low back pain: a review of the evidence for an American Pain Society/American College of Physicians clinical practice guideline. Ann Intern Med. 2007;147(7):492–504.CrossRefPubMedGoogle Scholar
- 37.Cleeland CS, Ryan KM. Pain assessment: global use of the Brief Pain Inventory. Ann Acad Med. 1994;23(2):129–38.Google Scholar
- 40.Weathers F, Huska J, Keane T. The PTSD checklist military version (PCL-M). Boston, MA: National Center for PTSD. 1991;42.Google Scholar
- 41.Weathers F, Ford J. Psychometric review of PTSD Checklist (PCL-C, PCL-S, PCL-M, PCL-PR). Measurement of stress, trauma, and adaptation. 1996:250–1.Google Scholar