BACKGROUND/RATIONALE:
Opioids misuse, abuse, addiction, and overdose have become serious public health worldwide. They are also a leading cause of death in the USA. Complementary and integrative health (CIH) interventions may help prevent or reduce opioid related harms. However, an April 2016 QUERI ESP report stated that "the evidence base regarding the effectiveness of select CIH interventions for reducing opioid use is extremely limited." Strategies to identify CIH use and its effects are needed. The impact of CIH on opioid use, co-prescriptions, pain and related outcomes in VA is poorly understood. Because Veterans with PTSD are at higher risk for opioid related harms, and because of the potential mutual reinforcement of PTSD and pain symptoms, CIH may have substantial impact on decreasing rates of opioid initiation and harms. We will examine CIH use and non-use among Veterans with musculoskeletal disorders (MSD) and compare opioid and pain outcomes by PTSD status.

OBJECTIVE(S):
Our aims are to assess the impact of CIH on opioid initiation among Veterans with MSD, estimate whether the effect varies by Veterans demographic and clinical characteristics, with particular attention to Veterans with PTSD status, and to examine potential harms of CIH use.

METHODS:
We will use algorithms from the Musculoskeletal Disorders cohort study (CRE12-012) to identify Veterans with MSD, and identify CIH use via structured data (e.g. procedure and ICD codes) and informatics tools on unstructured data (e.g. clinical notes). We will examine acupuncture, massage, meditation/mindfulness and yoga as they are currently or likely to be integrated into routine VA care. Using structured data only, we identified 7,621 CIH users among MSD cohort entrants in FY11-FY13 (n= 309,277); of which, 21% had a PTSD diagnosis. Opioid and other medications will be identified from pharmacy data.

FINDINGS/RESULTS:
None to date

IMPACT:
None to date

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External Links for this Project

NIH Reporter

Grant Number: I01HX002308-01A1
Link: https://reporter.nih.gov/project-details/9393072

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PUBLICATIONS:

Journal Articles

1. Coleman BC, Lisi AJ, Abel EA, Runels T, Goulet JL. Association between early nonpharmacological management and follow-up for low back pain in the veterans health administration. North American Spine Society journal. 2023 Jun 1; 14:100233. [view]
2. Kessler RC, Bauer MS, Bishop TM, Bossarte RM, Castro VM, Demler OV, Gildea SM, Goulet JL, King AJ, Kennedy CJ, Landes SJ, Liu H, Luedtke A, Mair P, Marx BP, Nock MK, Petukhova MV, Pigeon WR, Sampson NA, Smoller JW, Miller A, Haas G, Benware J, Bradley J, Owen RR, House S, Urosevic S, Weinstock LM. Evaluation of a Model to Target High-risk Psychiatric Inpatients for an Intensive Postdischarge Suicide Prevention Intervention. JAMA psychiatry. 2023 Mar 1; 80(3):230-240. [view]
3. Wang KH, McAvay G, Warren A, Miller ML, Pho A, Blosnich JR, Brandt CA, Goulet JL. Examining Health Care Mobility of Transgender Veterans Across the Veterans Health Administration. LGBT health. 2021 Feb 1; 8(2):143-151. [view]
4. Taub C, Gordon KS, Goulet J, Lee A, Mayhew M, Von Korff M, DeBar L, Kerns RD. Graded chronic pain scale revised: validation in a Veteran sample. Pain medicine (Malden, Mass.). 2023 Oct 3; 24(10):1169-1175. [view]
5. Coleman BC, Goulet JL, Higgins DM, Bathulapalli H, Kawecki T, Ruser CB, Bastian LA, Martino S, Piette JD, Edmond SN, Heapy AA. ICD-10 Coding of Musculoskeletal Conditions in the Veterans Health Administration. Pain medicine (Malden, Mass.). 2021 Nov 26; 22(11):2597-2603. [view]
6. Cavanagh CE, Rosman L, Chui PW, DeRycke E, Bathulapalli H, Gandhi P, Bastian LA, Burg MM, Brandt C, Goulet JL. Pain intensity and pain medication prescription patterns in Veterans with heart failure and back pain. Heart & lung : the journal of critical care. 2021 Nov 1; 50(6):770-774. [view]

DRA: Mental, Cognitive and Behavioral Disorders, Musculoskeletal Disorders
DRE: Epidemiology, Treatment - Observational, TRL - Applied/Translational
Keywords: Pain, Substance Use and Abuse, Surveillance, Technology Development, Utilization
MeSH Terms: none