Correlates of Use and Perceived Effectiveness of Non-pharmacologic Strategies for Chronic Pain Among Patients Prescribed Long-term Opioid Therapy

  • Crystal C. Lozier
  • Shannon M. Nugent
  • Ning X. Smith
  • Bobbi Jo Yarborough
  • Steven K. Dobscha
  • Richard A. Deyo
  • Benjamin J. Morasco
Original Research



Non-pharmacologic treatments (NPTs) are recommended for chronic pain. Information is limited on patient use or perceptions of NPTs. We examined the frequency and correlates of use and self-rated helpfulness of NPTs for chronic pain among patients who are prescribed long-term opioid therapy (LTOT).


Participants (n = 517) with musculoskeletal pain who were prescribed LTOT were recruited from two integrated health systems. They rated the frequency and utility of six clinician-directed and five self-directed NPTs for chronic pain. We categorized NPT use at four levels based on number of interventions used and frequency of use (none, low, moderate, high). Analyses examined clinical and demographic factors that differed among groups for both clinician-directed and self-directed NPTs.


Seventy-one percent of participants reported use of any NPT for pain within the prior 6 months. NPTs were rated as being helpful by more than 50% of users for all treatments assessed (range 51–79%). High users of clinician-directed NPTs were younger than non-users or low-frequency users and had the most depressive symptoms. In both clinician-directed and self-directed categories, high NPT users had significantly higher pain disability compared to non-NPT users. No significant group differences were detected on other demographic or clinical variables. In multivariable analyses, clinician-directed NPT use was modestly associated with younger age (OR = 0.97, 95% CI = 0.96–0.98) and higher pain disability (OR = 1.01, 95% CI = 1.00–1.02). Variables associated with greater self-directed NPT use were some college education (OR = 1.80, 95% CI = 1.13–2.84), college graduate or more (OR = 2.02, 95% CI = 1.20–3.40), and higher pain disability (OR = 1.01, 95% CI = 1.01–1.02).


NPT use was associated with higher pain disability and younger age for both clinician-directed and self-directed NPTs and higher education for self-directed NPTs. These strategies were rated as helpful by those that used them. These results can inform intervention implementation and be used to increase engagement in NPTs for chronic pain.


chronic pain non-pharmacologic pain management long-term opioid therapy 


Compliance with Ethical Standards

Study procedures were reviewed, approved, and monitored by Institutional Review Boards at both study settings. All participants provided written informed consent to participate.

Conflict of Interest

Research reported in this manuscript was supported by grant 034083 from the National Institute on Drug Abuse of the National Institutes of Health. Dr. Lozier was funded in part by Mental Illness Research, Education and Clinical Center at the VA Portland Health Care System. The work was also supported by resources from the VA Health Services Research and Development-funded Center to Improve Veteran Involvement in Care at the VA Portland Health Care System (CIN 13-404). Dr. Yarborough has received grant support from Purdue Pharma LP, and the Industry PMR Consortium, a consortium of 10 companies working together to conduct FDA-required post-marketing studies that assess known risks related to extended-release, long-acting opioid analgesics. Dr. Deyo receives royalties from UpToDate for authoring topics on low back pain. He received a financial award from NuVasive, as part of a lifetime achievement award from the International Society for Study of the Lumbar Spine. No other author reports having any potential conflict of interest with this study. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of the Department of Veterans Affairs or the National Institute on Drug Abuse.


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Copyright information

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

Authors and Affiliations

  • Crystal C. Lozier
    • 1
    • 2
  • Shannon M. Nugent
    • 1
    • 2
  • Ning X. Smith
    • 3
  • Bobbi Jo Yarborough
    • 3
  • Steven K. Dobscha
    • 1
    • 2
  • Richard A. Deyo
    • 2
    • 3
  • Benjamin J. Morasco
    • 1
    • 2
  1. 1.VA Portland Health Care SystemPortlandUSA
  2. 2.Oregon Health & Science UniversityPortlandUSA
  3. 3.Kaiser Permanente Northwest Center for Health ResearchPortlandUSA

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