TBI Disability, Health Beliefs, and Workforce Capacity Are Top Barriers to Chronic Pain Guideline-Based...

To examine determinants of evidence-based, nonpharmacologic treatments for chronic pain among patients with traumatic brain injury (TBI) using an access to care lens.

Convenience sample of respondents to an online survey directed to rehabilitation professionals.

Civilian and VA-based centers with TBI providers.

US based providers (N=145) (63% civilian; 34% VA, 3% DOD).

Not applicable.

A 10-item survey examining barriers to nonpharmacologic evidence-based therapies, informed by the robust Levesque Access to Care framework, which includes supply and demand characteristics. Six of the items described patient and community abilities to access care and 4 focused on health care system or infrastructure critical in access. On the basis of their professional experience, participants were asked to separately rate the frequency of the 10 barriers for each of the 3 specific guideline-endorsed interventions for chronic pain: behavioral health therapies, comprehensive chronic pain programs, and substance use disorder treatment.

Across all 3 interventions, morbidity associated with TBI (ie, cognitive, physical disabilities), patient lack of understanding, trust, or beliefs about efficacy of intervention, and lack of qualified providers who can deliver the intervention were the most frequently endorsed barriers to delivering NP-EBTs for chronic pain. Subgroup analyses found higher frequency of barriers in civilian versus VA settings particularly related to patient ability to afford (58%-70% difference) and insurance coverage (54%-61%) of interventions.

Findings have implication for policy and practice to address health care inequities that persons with TBI-related disability experience in accessing high-quality, evidence-based treatments.