Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4082 — Use of Non-Pharmacological Pain Treatment Modalities among Veterans with Chronic Pain

Lead/Presenter: Sara Edmond, COIN - West Haven
All Authors: Edmond SN (HSR&D Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, West Haven, CT and Yale School of Medicine) Becker WC (PRIME and Yale School of Medicine) Driscoll MA (PRIME and Yale School of Medicine) Decker SE (VA Connecticut Healthcare System, and Yale School of Medicine) Higgins DM (VA Boston Healthcare System and Boston University School of Medicine) Bastian LA (PRIME and Yale School of Medicine) Kerns RD (Yale School of Medicine) Haskell SG (PRIME and Yale School of Medicine)

Objectives:
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.

Methods:
Using survey data from the Women Veterans Cohort Study from Veterans endorsing pain lasting > = 3 months (n = 460), we examined demographic and clinical correlates of past year NPM use. We classified NPM use as follows: psychological/behavioral therapies, exercise/movement therapies, and manual therapies. We calculated descriptive statistics and examined bivariate associations before examining multivariable associations using logistic regression.

Results:
Veterans were 33.8 years old (SD = 10.7), 56.3% female, and 80.2% White. Regarding NPM use, 22.6% used psychological/behavioral, 50.9% exercise/movement, and 51.7% used manual therapies. More educated Veterans (OR = 2.47; 95% CI: 1.44, 4.24; p = 0.001) and those with greater mental health symptom severity (OR = 2.77; 95% CI: 2.02, 3.81; p < 0.001) were more likely to use psychological/behavioral therapies. Females (OR = 0.61; 95% CI: 0.41, 0.90; p = 0.014), Veterans using over-the-counter pain medication (OR = 1.78; 95% CI: 1.14, 2.76; p = 0.01), and Veterans using potentially harmful pain management strategies (e.g., using alcohol to manage pain) (OR = 1.56; 95% CI: 1.01, 2.43; p = 0.047) were more likely to use exercise/movement therapies. Non-White Veterans (OR = 0.59; 95% CI: 0.36, 0.96, p = 0.033), Veterans with more education (OR = 2.12; 95% CI: 1.42, 3.17; p < 0.001), and Veterans using over-the-counter pain medications (OR = 1.98; 95% CI: 1.27, 3.09; p = 0.002) were more likely to use manual therapies.

Implications:
Consistent with prior research, females may find exercise/movement therapies more acceptable. Similarly, racial differences in pain screening rates have been previously documented in VA and may relate to racial differences in NPM use, due to differences in referral rates or treatment preferences. Prior experience with mental health treatment (i.e., for those with greater mental health symptoms) may influence the likelihood of referral to or willingness to engage in psychological/behavioral pain treatments.

Impacts:
Results suggest demographic and clinical characteristics are related to differences in NPM use, which may indicate differences in Veteran treatment preference or provider referral patterns. As differences emerge, further study of provider referral patterns and Veteran treatment preferences is needed to inform interventions to increase NPM utilization.