Author: Steven B Zeliadt1,2, Rian DeFaccio1, Evan P Carey3, Bella Etingen4,5, Ethan W Rosser1, Pradeep Suri6, Jessica A Chen1, Barbara G Bokhour7,8, Scott Coggeshall1
Affiliation:
1 VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, VA Puget Sound Healthcare System, Seattle, WA, USA.
2 Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, USA.
3 VA Center of Innovation (COIN) for Veteran-Centered and Value-Driven Care, Eastern Colorado Healthcare System, Denver, CO, USA.
4 Research and Development Service, Dallas VA Medical Center, Dallas, TX, USA.
5 Department of Public Health, Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, TX, USA.
6 Seattle Epidemiologic Research and Information Center (ERIC), VA Puget Sound Healthcare System, Seattle, WA, USA.
7 Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.
8 Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, MA, USA.
Conference/Journal: J Pain Res
Date published: 2025 Feb 11
Other:
Volume ID: 18 , Pages: 647-661 , Special Notes: doi: 10.2147/JPR.S480718. , Word Count: 253
Objective:
To assess whether Whole Health, a system of care that emphasizes non-pharmacological approaches for chronic pain management, is associated with changes in downstream utilization of invasive pain treatment procedures.
Methods:
Longitudinal retrospective cohort analysis of VHA administrative data. A total of 53,412 Veterans with chronic pain were identified between April and September 2018, with 584 initiating Whole Health and 3794 initiating a complementary and integrative health (CIH) therapy independent of Whole Health (CIH-only). Whole Health included use of coaching, personal health planning, and other services including CIH referral. CIH therapies included chiropractic care, acupuncture, massage therapy, yoga, Tai Chi/Qigong, and meditation. Propensity score matching was used to estimate expected rates of invasive pain treatment procedures 0-3, 4-12, and 13-18 months after initiating Whole Health or CIH-only compared to similar Veterans who had not engaged in either.
Results:
Overall, 14% of the population were female, 11% had received prior spine injections, 3.3% had received surgery, and 0.4% had an implantable spinal stimulator. Whole Health use was associated with 42% (-61% to -17%) lower utilization of invasive pain procedures at three months compared to matched patients who did not use Whole Health. This reduction was attenuated at 18 months: 22% (-39% to -5%). CIH-only was associated with 18% (-29% to -4%) lower utilization at three months compared with matched patients, but differences were minimal at 18 months: 1% (-9% to 9%).
Discussion:
Whole Health care, including CIH therapies, may help patients interrupt patterns of escalating and invasive pain care.
Keywords: chronic pain; complementary and integrative health; invasive spine procedures; veterans; whole health.
PMID: 39958580 PMCID: PMC11829604 DOI: 10.2147/JPR.S480718
