Complementary and Integrative Health Therapies and Pain: Delivery Through Veterans Affairs and Community Care

Complementary and Integrative Health (CIH) services are a national priority for the Department of Veterans Affairs (VA) healthcare system and can be effective in reducing chronic pain. Eligible VA patients can receive their CIH care through a VA clinic, or through community care (CC) funded by the VA. The present study compares the effectiveness of 3 CIH services (acupuncture, chiropractic, and medical massage therapy) delivered in direct care by VA vs CC providers at improving veterans' chronic pain.

Data were analyzed from the Complementary and Integrative Health Therapy Patient Experience Survey, a longitudinal, self-administered survey of CIH use and health outcomes. Mixed models were used to evaluate the relationship of higher CIH therapy visits delivered by the VA vs CC with pain interference and pain severity, using both raw counts of visits and clinically meaningful groupings of visits.

Among veterans with chronic pain who engaged in CIH services, more CIH visits were associated with lower levels of pain severity and pain interference. VA acupuncture and chiropractic had a stronger beneficial relationship with pain than CC acupuncture and chiropractic, while CC medical massage therapy had a stronger beneficial relationship than VA medical massage.

CIH therapies delivered through the VA and through CC both offer potentially effective means of reducing chronic pain. Some therapies may be more effective when delivered through the VA vs CC, or may indicate lack of full implementation, but the limitations of observational data preclude any causal statements.