We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration.
- Authors
Meerwijk, Esther L.; Larson, Mary Jo; Schmidt, Eric M.; Adams, Rachel Sayko; Bauer, Mark R.; Ritter, Grant A.; Buckenmaier III, Chester; Harris, Alex H. S.; Buckenmaier, Chester 3rd
- Abstract
<bold>Background: </bold>Potential protective effects of nonpharmacological treatments (NPT) against long-term pain-related adverse outcomes have not been examined.<bold>Objective: </bold>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).<bold>Design and Participants: </bold>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.<bold>Exposures: </bold>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.<bold>Main Measures: </bold>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.<bold>Key Results: </bold>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.<bold>Conclusions: </bold>NPT provided in the MHS to service members with chronic pain may reduce risk of long-term adverse outcomes.
- Subjects
AFGHANISTAN; UNITED States; HEALTH services administration; UNITED States. Veterans Health Administration; MILITARY personnel; TRANSCUTANEOUS electrical nerve stimulation; CHRONIC pain; VETERANS' health; OSTEOPATHIC physicians; UNITED States. Army; MILITARY Health System (U.S.); SUICIDE statistics; CHRONIC pain treatment; RESEARCH; RESEARCH methodology; SELF-evaluation; POST-traumatic stress disorder; MEDICAL cooperation; EVALUATION research; COMPARATIVE studies; RESEARCH funding; VETERANS; LONGITUDINAL method; HEALTH self-care
- Publication
JGIM: Journal of General Internal Medicine, 2020, Vol 35, Issue 3, p775
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05450-4