SRFP021: Characteristics of Patients with Non-Cancer Pain Who Use Alternative Pain Therapies

Anika Mahavni; Joanne Salas, MPH; Lisa Miller-Matero, PhD; Jeffrey Scherrer, PhD

Abstract

Context: Chronic pain is among the most common conditions managed in primary care. Understanding factors associated with the use of non-opioid treatments may help clinicians reduce long-term opioid prescribing. While characteristics of patients with non-cancer pain who use physical therapy have been described, less is known about factors associated with the use of alternative therapies like cannabidiol (CBD) and chiropractic care. Objective: To determine whether demographics, pain measures, psychosocial factors, and prescription opioid use differ between patients in four alternative treatment groups: 1) CBD, 2) CBD and chiropractic/physical therapy, 3) chiropractic/physical therapy and 4) no alternative therapy. Study Design: Baseline survey data from a longitudinal cohort study of patients with non-cancer pain. Setting or Dataset: Patients who met eligibility criteria based on screening questions and electronic health record data at Saint Louis University School of Medicine and Henry Ford Health System. Population Studied: Patients 18-70 years of age with non-cancer pain who had a new period of prescription opioid use lasting 30-90 days. Outcome Measures: Type of alternative pain treatment (CBD, CBD and chiropractic/physical therapy, chiropractic/physical therapy, and no alternative therapy). Results: Older age was significantly associated with chiropractic/physical therapy use without CBD. Female gender was most prevalent in the CBD and chiropractic/physical therapy group. African American race was most common among those with no alternative therapies; white race was most common in the CBD and chiropractic/physical therapy group. Patients with more pain sites were more likely to be in the CBD and chiropractic/physical therapy group. Those with a history of depression were most prevalent in the CBD and chiropractic/physical therapy group. A positive VE score was associated with CBD and chiropractic/physical therapy. Sleep impairment was more common among those in the CBD and chiropractic/physical therapy group. Those with CBD use had the lowest prevalence of high emotional support. Expected Outcomes: Younger age, female gender, white race, more pain sites, depression, VE, sleep impairment, and low emotional support characterize patients who use non-opioid treatments. Pain interference and severity are not associated with the type or number of alternative therapies. Evidence of racial disparity in the use of non-opioid treatment suggests barriers to care.
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Jack Westfall
jwestfall@aafp.org 11/21/2021

Great to see students presenting at NAPCRG. Welcome to the best research family around. Terrific poster and presentation. Thanks for your work.

William R. Phillips
wphllps@uw.edu 11/22/2021

Great work. Lots of useful data on an important patient care problem. The literature on alternative and integrative medicine approaches to chronic pain is huge and somewhat chaotic. Patterns of use may have important regional differences. Impact of accident liability and disability cases should always be considered, as well. Does our concern for equity suggest we should call for equal access to unproven therapies? I hope you continue to pursue this important and challenging line of inquiry. Thanks for sharing your work here at NAPCRG. - Bill Phillips

Diane Harper
harperdi@med.umich.edu 11/22/2021

what are your next steps? Present your results in Phoenix next year! Thank you for sharing your work with NAPCRG!

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Interesting way to look at this topic. Great work

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