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. 2020 Mar;35(3):775-783.
doi: 10.1007/s11606-019-05450-4. Epub 2019 Oct 28.

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

Esther L Meerwijk  1 , Mary Jo Larson  2 , Eric M Schmidt  3 , Rachel Sayko Adams  2 , Mark R Bauer  2 , Grant A Ritter  2 , Chester Buckenmaier 3rd  4 , Alex H S Harris  5   6
Affiliations

Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration

Esther L Meerwijk et al. J Gen Intern Med. 2020 Mar.

Abstract

Background: Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.

Objective: To compare active duty U.S. Army service members with chronic pain who did/did not receive NPT in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA).

Design and participants: A longitudinal cohort study of active duty Army service members whose MHS healthcare records indicated presence of chronic pain after an index deployment to Iraq or Afghanistan in the years 2008-2014 (N = 142,539). Propensity score-weighted multivariable Cox proportional hazard models tested for differences in adverse outcomes between the NPT group and No-NPT group.

Exposures: NPT received in the MHS included acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports.

Main measures: Primary outcomes were propensity score-weighted proportional hazards for the following adverse outcomes: (a) diagnoses of alcohol and/or drug disorders; (b) poisoning with opioids, related narcotics, barbiturates, or sedatives; (c) suicide ideation; and (d) self-inflicted injuries including suicide attempts. Outcomes were determined based on ICD-9 and ICD-10 diagnoses recorded in VHA healthcare records from the start of utilization until fiscal year 2018.

Key results: The propensity score-weighted proportional hazards for the NPT group compared to the No-NPT group were 0.92 (95% CI 0.90-0.94, P < 0.001) for alcohol and/or drug use disorders; 0.65 (95% CI 0.51-0.83, P < 0.001) for accidental poisoning with opioids, related narcotics, barbiturates, or sedatives; 0.88 (95% CI 0.84-0.91, P < 0.001) for suicide ideation; and 0.83 (95% CI 0.77-0.90, P < 0.001) for self-inflicted injuries including suicide attempts.

Conclusions: NPT provided in the MHS to service members with chronic pain may reduce risk of long-term adverse outcomes.

Keywords: adverse outcomes; chronic pain; nonpharmacological treatment; opioids; veterans.

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Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Timeline of important events in our study. Solid arrows indicate fixed study start and end points. The solid double-headed arrow indicates the time period during which an end of index deployment qualifies an individual as member of our cohort. Fading bars indicate events that vary between service members. NPT exposure and chronic pain were determined between the end of the index deployment and VHA enrollment or the end of the MHS window, whichever came first.
Figure 2
Figure 2
Flowchart showing inclusion/exclusion of active duty U.S. Army service members from the SUPIC cohort. Note that chronic pain categories are not mutually exclusive. Superscript letter “a”: qualified MHS utilization refers to any data that we used to determine diagnoses, procedures, medication use, pain ratings, hospitalizations, etc.
See this image and copyright information in PMC

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