Treating chronic pain nonpharmacologically during active military duty reduces long-term risk

  • Meerwijk EL & al.
  • J Gen Intern Med
  • 28.10.2019

  • von Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • Active duty military service members who received nonpharmacological treatments (NPT) for chronic pain from the Military Health System (MHS) before transferring to the Veterans Health Administration had a significantly lower risk for long-term adverse outcomes than those who did not receive NPT while on active duty.

Why this matters

  • Those who received early NPT had lower risks for alcohol and/or drug use disorders; accidental poisoning with opioids, related narcotics, barbiturates, or sedatives; suicidal ideation; and self-inflicted injuries including suicide attempts.

Study design

  • 142,539 active duty Army service members (median age, 26 years) reported chronic pain after an index deployment to Iraq/Afghanistan.
  • NPT 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.
  • Funding: NIH.

Key results

  • Median total duration of deployments: 446 days.
  • Median duration of observation in the MHS after the index deployment: 1274 days.
  • Receipt of NPT was associated with lower risk for:
    • alcohol and/or drug use disorders (aHR, 0.90; P<.001>
    • poisoning with opioids/related narcotics/barbiturates/sedatives (accidental: aHR, 0.61 [P<.001 ahr>
    • suicidal ideation (aHR, 0.83; P<.001 and>
    • self-inflicted injuries including suicide attempts (aHR, 0.80; P<.001>

Limitations

  • Observational design.

Coauthored with Chitra Ravi, MPharm