Longitudinal Utilization of Invasive Pain Treatment Procedures Among Veterans with Chronic Pain Following Use of Whole Health Services and Complementary and Integrative Health Therapies.

Zeliadt SB, DeFaccio R, Carey EP, Etingen B, Rosser EW, Suri P, Chen JA, Bokhour BG, Coggeshall S. Longitudinal Utilization of Invasive Pain Treatment Procedures Among Veterans with Chronic Pain Following Use of Whole Health Services and Complementary and Integrative Health Therapies. Journal of pain research. 2025 Feb 11; 18:647-661, DOI: 10.2147/JPR.S480718.

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Abstract:

OBJECTIVE: To assess whether Whole Health, a system of care that emphasizes non-pharmacological approaches for chronic pain management, is associated with changes in downstream utilization of invasive pain treatment procedures. METHODS: Longitudinal retrospective cohort analysis of VHA administrative data. A total of 53,412 Veterans with chronic pain were identified between April and September 2018, with 584 initiating Whole Health and 3794 initiating a complementary and integrative health (CIH) therapy independent of Whole Health (CIH-only). Whole Health included use of coaching, personal health planning, and other services including CIH referral. CIH therapies included chiropractic care, acupuncture, massage therapy, yoga, Tai Chi/Qigong, and meditation. Propensity score matching was used to estimate expected rates of invasive pain treatment procedures 0-3, 4-12, and 13-18 months after initiating Whole Health or CIH-only compared to similar Veterans who had not engaged in either. RESULTS: Overall, 14% of the population were female, 11% had received prior spine injections, 3.3% had received surgery, and 0.4% had an implantable spinal stimulator. Whole Health use was associated with 42% (-61% to -17%) lower utilization of invasive pain procedures at three months compared to matched patients who did not use Whole Health. This reduction was attenuated at 18 months: 22% (-39% to -5%). CIH-only was associated with 18% (-29% to -4%) lower utilization at three months compared with matched patients, but differences were minimal at 18 months: 1% (-9% to 9%). DISCUSSION: Whole Health care, including CIH therapies, may help patients interrupt patterns of escalating and invasive pain care.