Related Experiment Video
Updated: Mar 18, 2026
Author Spotlight: Methodologies and Advancements of Chronic Pain Management Research
Published on: January 5, 2024
Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable
Katherine Hadlandsmyth1,2,3, Mary A Driscoll4,5, Jenna L Adamowicz4,5
1VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa, USA.
Purpose:
This study examines primary and specialty health care among rural and urban Veterans with three common chronic overlapping pain conditions (COPCs): fibromyalgia, migraine, and irritable bowel syndrome (IBS) and the impact of both rural residence and rural primary care site on access to specialty care.
Methods:
The cohort included all Veterans treated for fibromyalgia, migraine, and/or IBS in the VA in 2022. The frequency of outpatient primary care and specialty care encounters for these COPCs in the following year was contrasted by residence (urban/rural) and primary care site (medical center, urban clinic, or rural clinic) using multivariate log-binomial regression. Models were adjusted for demographics and comorbidities.
Findings:
250,533 Veterans were treated in the VA for the COPCs fibromyalgia, migraine, and/or IBS in 2022; 30.5% were rural residing. Relative to urban Veterans, rural Veterans were significantly more likely to have a primary care visit coded for a COPC (79.5% vs. 74.8%; p < 0.001) and less likely to have a specialty care visit coded for a COPC (31.8% vs. 37.8%; p < 0.001). After adjustment, rural residents were somewhat less likely to receive specialty care for their COPC, relative to urban residing Veterans (RR = 0.91, 95% CI: 0.90-0.92). Further, Veterans receiving care at urban clinics (RR = 0.81, 95% CI: 0.80-0.81) and rural clinics (RR = 0.66, 95% CI: 0.64-0.67) were substantially less likely to have a specialty care visit coded for a COPC, relative to larger VA medical centers. Rural/urban differences are also presented for a referent cohort of musculoskeletal pain conditions.
Conclusions:
Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.
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