Personalizing pain management: impact of participant characteristics on the effectiveness of complementary and integrative health versus standard rehabilitation in chronic pain treatment among active-duty service members.

IMPORTANCE

By identifying which factors impact the physical function outcomes of pain therapies, health care providers can more effectively match therapies to individuals. This approach will ultimately improve the overall quality of pain management for diverse patient populations.

OBJECTIVE

The objective of this study was to test the following research question: Does the effectiveness of complementary and integrative health (CIH) versus standard rehabilitative care (SRC) in improving physical function differ on the basis of participant characteristics?

DESIGN

The study design was a moderator analysis of data collected during a pragmatic clinical trial using a sequential multiple assignment randomized trial design.

SETTING

The setting was the Interdisciplinary Pain Management Center at Madigan Army Medical Center.

PARTICIPANTS

The participants were a complete case sample of 249 active-duty service members with chronic pain.

INTERVENTIONS: The interventions included a 3-week program of CIH therapies, consisting of twice-weekly chiropractic, acupuncture, yoga, and massage therapies, as well as a 3-week program of SRC, consisting of twice-weekly physical and occupational therapies.

MAIN OUTCOMES AND MEASURES: Functional measure t scores were calculated from a treadmill, lift, and carry battery.

RESULTS

Multiple linear regression models showed that the effect of CIH versus SRC on the functional performance measure was moderated by race, pain impact, pain catastrophizing, and satisfaction with social roles.

CONCLUSIONS

CIH interventions may be most effective for individuals who are non-Hispanic White, and SRC interventions may be more effective for individuals who are non-Hispanic Black. Psychosocial factors that may improve intervention effectiveness include lower baseline pain impact and pain catastrophizing and higher satisfaction with social roles.

RELEVANCE: This research underscores the importance of tailoring interventions to the individual. By considering individuals' demographics as well as their psychological and social factors, health care providers can more effectively match individuals with the most appropriate treatment approach, ultimately improving outcomes across multiple dimensions of physical function.