Returning military personnel suffering from chronic pain experience a lower risk of adverse post-treatment outcomes after receiving non-drug therapy, a new study reveals.

The most common option for treating chronic pain is to prescribe an opioid painkiller, but potential negative health outcomes associated with these drugs often prove to be more complicated than the original condition of chronic pain. Furthermore, the long-term effects of opioid dependence and misuse are often deadly.

Such outcomes are what prompted researchers to embark on discovering how non-drug treatments compare to prescription medication in terms of effectiveness. These outcomes may include:

• Post-treatment alcohol or drug use disorder
• Accidental poisoning with narcotics, opioids, sedatives or barbiturates
• Depression
• Suicidal thoughts
• Self-harm, including suicidal ideation
• Any combination of the above

The National Institute on Drug Abuse, the National Center for Complementary and Integrative Health and the National Institute on Drug Abuse funded this new research.

The study, published in the Journal of General Internal Medicine, found that opting for non-drug therapies over prescription drugs for chronic pain yielded more positive health outcomes for vets over the long-term.

According to lead researcher Dr. Esther Meerwijk, Ph.D. from the VA Palo Alto Health Care System in California, "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 turn to drugs."

Study on Non-Drug Treatments

Meerwijk and colleagues analyzed health records for over 142,00 veterans who reported chronic pain after deployment to Afghanistan or Iraq from 2008-2014. The study included data from as recent as 2015, with the median age of military personnel being 26 and the average tour of duty being just over 1 year. Health issues most frequently reported were chronic pain involving the back and neck, joints, bone or muscles.

Scientists tracked the following variables relating to participants in the study:

• Drug or non-drug treatments received
• Number of days, if any, a participant had taken opioids
• Length of each veteran's care

Prior to transitioning to care with the Veterans Health Administration (VHA) after leaving service, 29-44% of active military personnel reported having chronic pain to the Military Health System (MHS), with 48-60% reporting chronic pain when they went on to receive treatment from the VHA, according to Medical News Today.

Findings

Health outcomes for vets receiving non-pharmacological therapies (NPTs) included not only less pain but also better mental health outcomes. Addressing the pain without the use of prescription drugs helped vets to more successfully avoid drug and alcohol abuse, suicidal ideation and self-harm, all of which can be due to long-term coping with chronic pain, long-term use of opioids, or both.

Although results were encouraging, researchers point out that the nature of the study made it difficult to develop a clear cause and effect chain. However, the research team is hopeful that findings will encourage medical professionals to consider alternative therapies for patients with chronic pain. NPTs offered by the MHS and used in the study included:

• Acupuncture
• Transcutaneous electrical nerve stimulation
• Superficial heat treatment
• Osteopathic spinal manipulation
• Ultrasonography
• Biofeedback
• Chiropractic care
• Traction
• Exercise therapy
• Dry needling
• Lumbar supports
• Massage
• Cold laser therapy

92.2% of participants in the NPT group received exercise therapy, with the following non-drug treatments being less common.

• Other physical therapy 32.4%
• Chiropractic care: 23.5%
• Electrical stimulation: 20.3%
• Massage: 17.6%
• Spinal manipulation: 12.0%
• Acupuncture or dry needling: 10.2%
• Remaining NPTs: Less than 10% each

Research Limitations

Due to the relatively small scope of the study, researchers acknowledge that "The potential long-term protective effect of NPT against adverse outcomes has not been examined." Still, the authors' analysis showed a reduction in adverse health outcomes among participants receiving NPT, with the most significant effect being a 35% decline in the risk of accidental poisoning from opioids, related narcotics, barbiturates or sedatives. Additionally, researchers observed that the NPT group were:

• 17% less likely to sustain self-inflicted injuries, including those from suicide attempts
• 12% less likely to experience thoughts of suicide
• 8% less likely to experience drug or alcohol use disorders

According to Meerwijk, "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."

Due to piqued interest in the study from the VA, Meerwijk hopes that military medical authorities will more readily consider non-drug solutions for veterans coping with chronic pain.