Chronic pain management is a significant health issue for many Americans. According to the Veterans Affairs Office of Research and Development, unrelieved and persistent chronic pain is associated with numerous negative effects including loss of function, depression, anxiety, poor sleep patterns, decreased quality of life, chronic opioids usage and is a risk factor for suicide. Often pain management involves prescription opioids. However, a recent study analyzing outcomes of nonpharmacologic treatment for active-duty service members with chronic pain has found that “especially at higher dosages and/or longer duration of usage, opioids are associated with increased risk for substance use disorders, opioid-related overdose, self-inflicted injuries, and suicide attempts.” As a result, there is considerable research being conducted to determine the safest and most efficient treatments for those living with chronic pain.
While people from all walks of life experience chronic pain, those in the military who have deployed have a high rate of chronic pain. The same study revealed that as many as 29-44% of active-duty service members have reported chronic pain after being deployed to conflict zones in Iraq or Afghanistan. Additionally, 48-60% of veterans who receive primary care through the Veterans Health Administration report chronic pain. The three most common chronic pain categories among these soldiers were, nontraumatic joint disorders, back and neck disorders, and other musculoskeletal disorders.
The study, sought to “compare active-duty U.S. Army service members with chronic pain who did or did not receive nonpharmacological treatments (NPT) in the Military Health System (MHS) and describe the association between receiving NPT and adverse outcomes after transitioning to the Veterans Health Administration (VHA).” They hypothesized that the use of NPT while still in active-duty status would be associated with lower adverse outcomes after the soldiers’ transition to the VHA. In support of this, they reference a research analysis published a few years prior to their work which found that soldiers who received NPT within the initial 30 days of an episode of low back pain had “modest improvements” on important military readiness outcomes including “healthcare utilization, long-term opioid use, and ability to carry out military duties” compared to their peers who did not receive NPT. Additionally, opioid usage was lower in the group who had received NPT.
For the purpose of the chronic pain study, NPT included: acupuncture/dry needling, biofeedback, chiropractic care, massage, exercise therapy, cold laser therapy, osteopathic spinal manipulation, transcutaneous electrical nerve stimulation (TENS) and other electrical manipulation, ultrasonography, superficial heat treatment, traction, other physical therapy, and lumbar supports – many of which are offered in chiropractic clinics. Health service records for over 275,000 Army service members were identified with chronic pain, of whom over 142,000 received care in the VHA.
They divided the records into four groups:
- Received NPT and enrolled in VHA;
- Did not receive NPT and enrolled in VHA;
- Received NPT and did not enroll in VHA; and
- Did not receive NPT and did not enroll in VHA.
Of those who received NPT, the most common modalities utilized were exercise therapy, other physical therapy, chiropractic care, TENS & other electrical modulation, massage, Spinal manipulation and acupuncture or dry needling. The most frequent adverse outcome was alcohol and/or drug use disorders, followed by suicide ideation, self-inflicted injuries (including suicide attempts) and lastly poisoning with opioids, related narcotics, barbiturates, or sedatives.
Analysis of the records revealed that soldiers who were treated with NPT for chronic pain while in MHS had “significantly lower risk in the VHA for new-onset alcohol and/or drug use disorder, poisoning with opioids, related narcotics, barbiturates, or sedatives, suicide ideation, and self-inflicted injuries including suicide attempts.”
They do note that all NPT modalities were lumped in together for this analysis, so some may be more effective than others. Additionally, the dosage could be a major factor and it is possible that NPT is more effective for certain types of chronic pain than others.
Researchers concluded that, “Given known associations of these adverse outcomes with morbidity and mortality, providing NPT to service members with chronic pain could potentially save lives. Our results provide further support for the role of NPT as a risk mitigation strategy when long-term opioid therapy is initiated, which is only briefly mentioned in the VA/DoD Clinical Practice Guideline for Opioid Therapy for Chronic Pain.”
In an interview, lead author, Dr. Esther Meerwijk, a statistician and suicide researcher at the VA Palo Alto Health Care System in California, stated: ““Chronic pain is associated with adverse outcomes, such as substance use and suicidal thoughts and behavior . . . It made sense that if non-drug treatments are good at managing pain, their effect would go beyond only pain relief. However, I was surprised that the results of our analyses held, despite our attempts to prove them wrong.” She said that those who received NPT may not have needed to rely on opioids for their chronic pain, leading to a lower risk for adverse outcomes. She continued: “We may also be seeing a genuine effect of non-drug therapies that occurs regardless of whether soldiers use opioids or not…If non-drug treatments make chronic pain more bearable, people may be more likely to have positive experiences in life. That makes them less likely to have thoughts of suicide or to turn to drugs.”
While this study addressed chronic pain among military personnel and veterans specifically, these insights add to the total volume of understanding of the treatment of chronic pain. A recent report stated that the most common types of chronic pain in the general population include regional pain, back pain, leg & foot pain, arm & hand pain, and headache. With the overlap of musculoskeletal pain between the general population and this military study, it is not a stretch to think that the same NPTs might offer relief for some civilian chronic pain patients.
Doctors of Chiropractic receive a minimum of 7 years of higher level education and are trained to prevent and manage many types of musculoskeletal pain using a safe, effective and nonpharmacological approach. In addition to spinal manipulation, many chiropractors offer modalities such as acupuncture/dry needling, exercise therapy, cold laser therapy, transcutaneous electrical nerve stimulation (TENS) and other electrical manipulation, ultrasonography, superficial heat treatment, traction, and lumbar supports. They are also trained to provide education on exercise therapy and functional movement such as proper lifting techniques. When needed, your chiropractor can also work with other health professionals to coordinate care, giving the opportunity to utilize NPT to reduce or eliminate the need for pain medications.
If you or a loved one are experiencing musculoskeletal pain, talk to your doctor about how nonpharmacological treatments, such as those provided by a chiropractor, can help you manage pain and maintain function. If you do not have a chiropractor, you can find a TCA member doctor near you at tnchiro.com/find-a-doctor.
Richman, Mike. Study supports long-term benefits of non-drug therapies for pain. VA Research Communications. December 10, 2019. Accessed 9/20/2023
Meerwijk EL, Larson MJ, Schmidt EM, Adams RS, Bauer MR, Ritter GA, Buckenmaier C 3rd, Harris AHS. Nonpharmacological Treatment of Army Service Members with Chronic Pain Is Associated with Fewer Adverse Outcomes After Transition to the Veterans Health Administration. J Gen Intern Med. 2020 Mar;35(3):775-783. doi: 10.1007/s11606-019-05450-4. Epub 2019 Oct 28. PMID: 31659663; PMCID: PMC7080907.
Larson MJ, Adams RS, Ritter GA, Linton A, Williams TV, Saadoun M, Bauer MR. Associations of Early Treatments for Low-Back Pain with Military Readiness Outcomes. J Altern Complement Med. 2018 Jul;24(7):666-676. doi: 10.1089/acm.2017.0290. Epub 2018 Mar 28. PMID: 29589956; PMCID: PMC6065526.
Dydyk AM, Conermann T. Chronic Pain. [Updated 2023 Jul 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553030/