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

Meerwijk, Esther L.; Larson, Mary Jo; Schmidt, Eric; Adams, Rachel Sayko; Bauer, Mark; Ritter, Grant; Buckenmaier, Chester C.; Harris, Alex H. S.

doi:10.1007/s11606-019-05450-4

Cited by 33 publications

(31 citation statements)

References 34 publications

(37 reference statements)

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“…Study data were drawn from the Substance Use and Psychological Injury Combat Study, an observational, longitudinal study of Army soldiers returning from an index deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008-2014. The SUPIC study integrated data from the MHS and VHA to allow for investigation of postdeployment health, treatment and long-term outcomes across both systems of care [25,29,30]. Supported by multiple National Institute of Health grants, to our knowledge, SUPIC remains the only study that prospectively tracks postdeployment soldiers returning from Afghanistan/Iraq deployments as they transition out of the MHS and into VHA.…”

Section: Methodsmentioning

confidence: 99%

“…Chronic pain was defined as two or more diagnoses at least 90 days apart from the same pain category developed by the project (e.g., back and neck disorders; other musculoskeletal disorders; non-traumatic joint disorders), using International Classification of Disease diagnoses (ICD-9 and ICD-10) as described elsewhere [13]. Two additional non-diagnosis criteria were used to identify chronic pain, including: any 60-day supply of opioids (defined below) prescribed in a 3-month period, or 90day supply in a 12-month window [25,31].…”

Section: Chronic Pain Samplementioning

confidence: 99%

“…While chronic pain and pain management have been studied extensively in both the MHS and VHA since the Afghanistan/Iraq conflicts, there have been few studies of post-9/11 Veterans with chronic pain that have integrated data from both systems of care [25]. Veterans who deployed in OEF/OIF/OND are eligible for free health care at VHA for at least 5 years after separation from the military for reasons other than dishonorable [26].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

Adams

Meerwijk

Larson

et al. 2021

BMC Health Serv Res

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Background Chronic pain presents a significant burden for both federal health care systems designed to serve combat Veterans in the United States (i.e., the Military Health System [MHS] and Veterans Health Administration [VHA]), yet there have been few studies of Veterans with chronic pain that have integrated data from both systems of care. This study examined 1) health care utilization in VHA as an enrollee (i.e., linkage to VHA) after military separation among soldiers with postdeployment chronic pain identified in the MHS, and predictors of linkage, and 2) persistence of chronic pain among those utilizing the VHA. Methods Observational, longitudinal study of soldiers returning from a deployment in support of the Afghanistan/Iraq conflicts in fiscal years 2008–2014. The analytic sample included 138,206 active duty soldiers for whom linkage to VHA was determined through FY2019. A Cox proportional hazards model was estimated to examine the effects of demographic characteristics, military history, and MHS clinical characteristics on time to linkage to VHA after separation from the military. Among the subpopulation of soldiers who linked to VHA, we described whether they met criteria for chronic pain in the VHA and pain management treatments received during the first year in VHA. Results The majority (79%) of soldiers within the chronic pain cohort linked to VHA after military separation. Significant predictors of VHA linkage included: VHA utilization as a non-enrollee prior to military separation, separating for disability, mental health comorbidities, and being non-Hispanic Black or Hispanic. Soldiers that separated because of misconduct were less likely to link than other soldiers. Soldiers who received nonpharmacological treatments, opioids/tramadol, or mental health treatment in the MHS linked earlier to VHA than soldiers who did not receive these treatments. Among those who enrolled in VHA, during the first year after linking to the VHA, 49.7% of soldiers met criteria for persistent chronic pain in VHA. Conclusions The vast majority of soldiers identified with chronic pain in the MHS utilized care within VHA after military separation. Careful coordination of pain management approaches across the MHS and VHA is required to optimize care for soldiers with chronic pain.

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Section: Methodsmentioning

confidence: 99%

Section: Chronic Pain Samplementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

Adams

Meerwijk

Larson

et al. 2021

BMC Health Serv Res

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“… 47 Active military service members who accessed acupuncture for chronic pain had reduced risk of long-term adverse outcomes. 48 …”

Section: Background/literature Reviewmentioning

confidence: 99%

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot

Nielsen

Teets

Moonaz

et al. 2020

Glob Adv Health Med

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Chronic pain is prevalent in the United States, with impact on physical and psychological functioning as well as lost work productivity. Minority and lower socioeconomic populations have increased prevalence of chronic pain with less access to pain care, poorer outcomes, and higher risk of fatal opioid overdose. Acupuncture therapy is effective in treating chronic pain conditions including chronic low back pain, neck pain, shoulder pain, and knee pain from osteoarthritis. Acupuncture therapy, including group acupuncture, is feasible and effective, and specifically so for underserved and diverse populations at risk for health outcome disparities. Acupuncture therapy also encourages patient engagement and activation. As chronic pain improves, there is a natural progression to want and need to increase activity and movement recovery. Diverse movement approaches are important for improving range of motion, maintaining gains, strengthening, and promoting patient engagement and activation. Yoga therapy is an active therapy with proven benefit in musculoskeletal pain disorders and pain associated disability. The aim of this quasi-experimental pilot feasibility trial is to test the bundling of these 2 effective care options for chronic pain, to inform both the design for a larger randomized pragmatic effectiveness trial as well as implementation strategies across underserved settings.

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“…Josefowitz reported that 5 out 21 chiropractors had provided care to patients who died by suicide, and 13 of 21 chiropractors had provided care to a patient who had talked about suicide [ 47 ]. A longitudinal cohort study of active duty service members with chronic pain exposed to non-pharmacological interventions, including chiropractic care, were at lower risk of new-onset substance use disorder, opioid overdose, suicide ideation, and self-inflicted injuries, including suicide attempts, once enrolled in the Veterans Health Administration [ 48 ]. Clinically, patients already present to the chiropractor’s clinic with known risk factors for suicide, the same co-morbidities with relationship to spinal pain that includes, but not limited to, depression, anxiety, and PTSD [ 28 , 49 – 55 ].…”

Section: Introductionmentioning

confidence: 99%

Suicide prevention, public health, and the chiropractic profession: a call to action

et al. 2021

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Background Suicide is a major public health concern that has wide-reaching implications on individuals, families, and society. Efforts to respond to a public health concern as a portal-of-entry provider can reduce morbidity and mortality of patients. The objective of this commentary is a call to action to initiate dialogue regarding suicide prevention and the role the chiropractic profession may play. Discussion This public health burden requires doctors of chiropractic to realize current strengths and recognize contemporaneous deficiencies in clinical, research, and policy environments. With this better understanding, only then can the chiropractic profession strive to enhance knowledge and promote clinical acumen to target and mitigate suicide risk to better serve the public. Conclusion We implore the profession to transition from bystander to actively engaged in the culture of suicide prevention beholden to all aspects of the biopsychosocial healthcare model. The chiropractic profession’s participation in suicide prevention improves the health and wellness of one’s community while also impacting the broader public health arena.

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

Cited by 33 publications

References 34 publications

Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

Predictors of Veterans Health Administration utilization and pain persistence among soldiers treated for postdeployment chronic pain in the Military Health System

Group Acupuncture Therapy With Yoga Therapy for Chronic Neck, Low Back, and Osteoarthritis Pain in Safety Net Setting for an Underserved Population: Design and Rationale for a Feasibility Pilot

Suicide prevention, public health, and the chiropractic profession: a call to action

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