A new study that was published in the Journal of General Internal Medicine based on Veterans Affairs health records shows that non-drug therapies that are given to military service members that have chronic pain may reduce the risk of long-term adverse outcomes, such as drug disorder, alcohol and self-induced injuries like suicide attempts.
Pushing for non-drug therapy
The researchers of the study concluded that service members that have chronic pain who got non-drug therapies while they were in the military, like acupuncture or massage, had shallow risk in VA of new-onset drug disorder or alcohol disorder, barbiturates, poisoning with opioids and related narcotics, sedatives and suicidal thoughts and attempts. The team did not study death by suicide.
A statistician and suicide researcher at the VA Palo Alto Health Care System in California, Dr. Esther Meerwijk, lead her team to review the VA health records of 140,000 Army soldiers who had chronic pain following their deployment to Afghanistan or Iraq from 2008 to 2014. The most common kind of chronic pain was back and neck issues, joint discomfort, and other issues that involved the bones or muscles.
Meerwijk stated that chronic pain is linked with adverse outcomes, like suicidal thoughts and behavior and substance use. It made sense that if non-drug treatments are good at managing the pain, the effect will go beyond only pain relief. But she said she was surprised at the results of their analysis, despite their attempts to prove them wrong. Often enough in research, significant results disappear once you start controlling for variables that can affect the outcome of the study.
The researchers controlled for length of a service member's care in VA, whether they had been exposed to non-drug therapies and the number of days they received opioids. They also checked to see if the veterans who received non-drug treatments were healthier, to begin with and if more of them who received non-drug therapies died before any of the adverse outcomes occurred.
Meerwijk explained that it is possible that the soldiers who received non-drug therapies did not have to rely on opioids as much for their chronic pain, and they are, therefore, at lower risk for adverse outcomes. She stated that they may also be seeing a genuine effect of non-drug therapies that happens regardless of whether soldiers use opioids or not. If non-drug treatments make chronic pain at least more bearable, people may be more likely to have positive experiences in life. That can make them less likely to have negative thoughts such as suicide or to turn to drugs.
Meerwijk's research is a part of the Substance Use and Psychological Injury Combat Study or SUPIC, which is the longest and largest observational study to date of behavioral health conditions and pain management in Army service members returning from Afghanistan and Iraq. VA has participated in the study, which is led by Dr. Mary Jo Larson of Brandeis University in Massachusetts.
Meerwijk added that when she joined the team of researchers, one of her goals was to study the long-term effects of non-drug treatments for chronic pain received in the military. Given that her research interests in suicide and suicide prevention, it was suggested that they look at suicidal thoughts and attempts as outcomes. Given SUPIC's interest in substance use, especially in opioids, they broadened the analysis to serious adverse events that are related to opioid use and chronic pain.
Managing chronic pain
Chronic pain is usually managed with prescription opioids. With higher doses and longer length of use, opioids have been linked to a greater risk of substance use disorder and self-inflicted injuries like opioid overdose and suicide attempts.
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