Chronic Pain Treatment Utilization in Rural Versus Urban/Suburban Inhabitants Following Traumatic Brain Injury.

OBJECTIVE

To determine whether there are differences in healthcare utilization for chronic pain based on location (rural vs urban/suburban) or healthcare system (civilians vs Military Service Members and Veterans [SMVs]) after moderate-severe TBI.

SETTING

Eighteen Traumatic Brain Injury Model Systems (TBIMS) Centers.

PARTICIPANTS

A total of 1,741 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview.

PRIMARY MEASURES: Sociodemographic, injury, function outcome, pain, and pain treatment characteristics.

RESULTS

Participants were mostly male (72.9%), White (75.2%), civilian (76.9%), 46 years old on average, and had greater than high school education (59.9%). 32% of participants resided in rural areas and 67% in urban/suburban areas. No significant difference in healthcare utilization for chronic pain was observed between individuals living in rural versus urban/suburban locations after adjustment for relevant covariates. However, rural SMVs had odds ratios >3 for each major treatment category including medical services (OR = 3.56), exercise therapies (OR = 5.23), psychological services (OR = 4.43), complementary and alternative therapies (OR = 3.23), and pain rehabilitation program (OR = 4.16) compared to rural civilians. This same pattern of findings was seen SMVs in urban/suburban settings as well. Being married versus single, bachelor/graduate education versus high school or less, and employed versus unemployed all had odds ratios >1 for exercise therapies, psychological services, complementary and alternative therapies, and pain rehab program.

CONCLUSION

Contrary to initial hypotheses, there were no significant differences in healthcare utilization for chronic pain treatment comparing those in rural versus urban/suburban areas. However, differences were found between SMVs and civilians across both rural and urban/suburban locations suggesting that SMVs have more access to chronic pain treatment. The improved access to social and financial services afforded by VHA programs to SMVs may serve as a model for improving healthcare utilization in similar civilian populations.