Use of Complementary and Integrative Health Therapies and Chiropractic Care Among Patients Receiving Long-Term Opioid Therapy in the Department of Veterans Affairs.

BACKGROUND

Use of complementary and integrative health (CIH) therapies has increased over the past two decades. Accumulating evidence supports the effectiveness of CIH therapies for a range of health outcomes and an association between CIH therapy use and reduced use of opioid therapy.

OBJECTIVE

To describe differences in the use of evidence-based CIH therapies among individuals with chronic pain on long-term opioid therapy (LTOT) by sociodemographic and clinical characteristics.

DESIGN

This was an observational study using a national retrospective cohort of patients developed from Veterans Affairs (VA) electronic health record data.

SAMPLE: The sample comprised 281,903 patients receiving LTOT upon cohort entry between July 1, 2017, and December 31, 2021, with a health care encounter in one of 54 VA medical centers.

MAIN MEASURES: CIH therapy use was defined as chart-documented use of any of eight priority CIH therapies or chiropractic care in the year prior to cohort entry. LTOT was defined as having a prescribed opioid analgesic for ≥90 consecutive days, allowing ≤30 days between fills. Sociodemographic and clinical characteristic variables were assessed as covariates of CIH therapy use.

KEY

RESULTS

Among the full cohort, the CIH therapy use rate was 9.5%. Use increased with each cohort entry year relative to 2017. In a multivariable model, variables associated with greater odds of CIH therapy use included being female, having a musculoskeletal pain condition, obesity, opioid use disorder, anxiety, depression, post-traumatic stress disorder, and receiving services in a flagship site. Lower odds of use were associated with being older, unmarried, prescribed higher opioid doses, smoking, and rural residence.

CONCLUSIONS

CIH therapy use has increased over time, consistent with national trends; however, differential patterns of exposure suggest the need to explore pathways to use. These may elucidate opportunities to broaden access to these evidence-based therapies for patients with chronic pain.