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2023 HSR&D/QUERI National Conference Abstract

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1186 — Exploring Pain Experience and Pain Management Strategies for Pregnant and Postpartum Veterans with Chronic Pain

Lead/Presenter: Aimee Kroll-Desrosiers,  VA Central Western Massachusetts Healthcare System
All Authors: Kroll-Desrosiers A (VA Central Western Massachusetts Healthcare System), Marteeny V (VA Central Western Massachusetts Healthcare System), Higgins D (VA Boston Healthcare System), Martino S (VA Connecticut Healthcare System), Mattocks K (VA Central Western Massachusetts Healthcare System)

Objectives:
Understanding how pregnant and postpartum Veterans manage chronic pain remains unknown. To begin to document how Veterans experience and treat pain during the perinatal period, we conducted a qualitative study to explore pain management and related VA care provided to pregnant and postpartum Veterans.

Methods:
We identified potential participants from Veterans receiving care at one of 15 VA facilities across the U.S. and who were enrolled in an ongoing cohort study (Center for Maternal and Infant Outcomes and Research in Translation [COMFORT]). All participants had delivered a newborn prior to June 1, 2021 and met the following inclusion criteria: 1) had 2 or more visits for a pain-related musculoskeletal condition in the 365 days prior to pregnancy AND 2) had presence of chronic pain of at least moderate severity with 30 days between occurrences in the 365 days prior to pregnancy, measured by two or more numeric rating scale pain scores of ?4. We completed interviews with 30 Veterans between November 2021 and January 2022. We utilized a rapid approach to our qualitative analysis which was conducted in ATLAS.ti.

Results:
Veterans in our sample were 31 years of age on average. The majority were married (80%); 47% were White and 37% were Black. The most common type of pain diagnoses were dorsalgia (93%), joint disorders (73%), and/or soft tissue disorders (50%). Three major themes were identified from our interviews: 1) Veterans had a challenging time discontinuing pain medications during pregnancy; 2) there were numerous barriers to receiving recommended pain treatments during pregnancy; and 3) providers were often unwilling to let Veterans immediately return to their prepregnancy treatment regimen following delivery and/or breastfeeding. Veterans suggested several ways the VA could improve pain care during the perinatal period: more acupuncture, massage, and chiropractic coverage; physical therapy with providers knowledgeable about pregnancy/postpartum needs (e.g., pelvic floor conditions); having pregnancy specific devices available (e.g., back braces for pregnant persons); and training providers on supportive care when wanting to continue breastfeeding and waiting to go back on pain medications.

Implications:
Understanding the unique needs of Veterans with chronic pain is important to provide quality care during the perinatal period. Veterans highlighted several areas where the VA could improve pain management during pregnancy and postpartum, including increasing benefits for complementary therapies by offering a greater number of covered visits and receiving care from VA providers knowledgeable about pain management during the perinatal period.

Impacts:
VA should consider additional benefits for complementary therapies for pregnant and postpartum Veterans and offering training or additional guidelines for providers on best practices for managing chronic pain during the perinatal period.