Veterans Need Drug-Free Pain Care Strategy as Opioid Epidemic Grows

The results of the most recent peer-reviewed study of drug overdose deaths among United States veterans, while troubling, included a glimmer of hope. The drug overdose death rate among veterans grew by more than 53% from 2010-2019, according to the research, but that trajectory began to drop in 2017. Moreover, overdose deaths have been higher in nonveteran vs veteran men since 2014.¹

The caveat, however, is that despite the decrease from 2017-2019 in the overall overdose mortality rate, deaths involving synthetic opioids, such as fentanyl, continued to increase through 2019.

The positive trends are encouraging and no doubt because the US Department of Veterans Affairs’ (VA) Opioid Safety Initiative has reduced prescription opioid use by 64% from 2012-2020.² Yet it is clear more needs to be done to protect veterans from opioid overdoses and opioid use disorder (OUD). Reducing the number and length of prescriptions is an element of that prevention strategy, but rates of severe pain are greater in veterans than in nonveterans,³ a fact that cannot be ignored.

Therefore, a prevention strategy that includes expanded access and awareness around effective drug-free pain management methods, such as chiropractic care, is needed.

Chiropractic Care Is Effective and Endorsed

The VA began to include doctors of chiropractic (DCs) in its community care network in 2000 and on-station at VA facilities in 2004.⁴ From 2014-2019, utilization of chiropractic care increased 6-fold in the community care network, although only a small percentage of veterans overall received the services.⁴

Chiropractic care, however, has proven effective at reducing musculoskeletal pain and improving quality of life among veterans and active-duty personnel. For example, in a survey of more than 3000 veterans, 37% reported using chiropractic care among the 9 drug-free care methods included in the survey. Overall, 84% of veterans reported they were interested in trying or learning more about at least 1 drug-free care approach.⁵

Moreover, a study of veterans with chronic pain who served in Iraq and Afghanistan showed those who received nonpharmacologic pain management methods after their service, including chiropractic care, were less likely to suffer from alcohol and/or drug use disorders; have accidental poisoning with opioids, related narcotics, barbiturates, or sedatives; have suicidal ideation; or commit self-inflicted injuries including suicide attempts.⁶ Another similar study showed the percentage of veterans receiving opioid prescriptions was lower after they received chiropractic care compared to before.⁷

Quality of Life Improvement

Another study published in 2022 once again confirmed how chiropractic care reduces lower back pain while helping active-duty military personnel maintain or improve their quality of life.⁸ In a randomized clinical trial involving 750 military personnel with low back pain, approximately half of the study participants received usual medical care, which typically involved pain medication and, in some cases, referrals to a physical therapist and/or pain clinic. The other half of the study participants received the usual medical care plus chiropractic care.

Participants then filled out the Patient-Reported Outcome Measurement Information System-29 V1.0 questionnaire, where they assessed pain intensity using a single 0-10 numeric rating item and responded to questions concerning health domains (physical function, fatigue, pain interference, depression, anxiety, satisfaction with social role, and sleep disturbance).

The difference between the 2 groups was small, but noteworthy. Researchers found the chiropractic care group had statistically significant differences in questionnaire responses indicating greater improvement. Notably, among the chiropractic care group, 58% of individuals reported pain reduction after 12 weeks, compared to 42% of military personnel who received only usual medical care.

Nonpain-related scores also improved more significantly for the chiropractic group. For example, 28% of participants receiving chiropractic care reported decreased emotional distress, which is depression and anxiety combined, compared to only 18% of the usual medical care group. While 45% of the chiropractic care group reported an improvement in their ability to perform in social roles, such as work and family, only 33% of the usual medical care group reported an improvement.

The chiropractic care group also showed more improved mental health summary scores, less fatigue, and greater overall physical health. These results suggest chiropractic care impacts health-related quality of life beyond pain, and nonpharmacologic pain management methods are effective for this population suffering from a higher rate of neuromusculoskeletal disorders than nonveterans.⁹ Given opioid cravings among veterans were more closely associated with depression than physical pain,¹⁰ quality of life and mental health are significant factors in avoiding overdoses and OUD.

Battle Against Opioid Use Disorder

Rebecca “Becky” Halstead, a retired US Army Brigadier General and the first woman in US history to command in combat at the strategic level, recently spoke of the dangers of opioids and veterans during a recent podcast interview. Halstead retired from the military in 2008, in part due to chronic pain for which she received more than a dozen pharmaceutical drugs. Chiropractic care helped Halstead eliminate both the pain and drugs from her life, she stated.

“I always tell everybody that in the military I was physically fit—12-mile foot marches, jumping out of helicopters, carrying heavy rucksacks—but I wasn’t healthy,” Halstead said during the interview. “Now, I’m healthy, take no prescription medications, supplements and all those things. I get adjusted by a chiropractor, so I’m healthy, but I could be a little more physically fit.”¹¹

For many veterans, opioids prescribed for pain have become an enemy that has won the battle, so it is our duty to help them win the war. Expanding access to and spreading awareness of evidence-based drug-free pain management methods, such as chiropractic care, can continue the positive trends we are now witnessing around veterans and overdoses while relieving pain and improving their quality of life.

References:

1. Begley MR, Ravindran C, Peltzman T, et al. Veteran drug overdose mortality, 2010-2019. Drug Alcohol Depend. 2022;233:109296. doi:10.1016/j.drugalcdep.2022.109296
2. VA reduces prescription opioid use by 64% during past eight years. News release. US Department of Veterans Affairs; July 30, 2020. Accessed April 14, 2022. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5492
3. Nahin RL. Severe pain in veterans: The effect of age and sex, and comparisons with the general population. J Pain. 2017;18(3):247-254. doi:10.1016/j.jpain.2016.10.021
4. Burdick R, Corcoran KL, Zhao X, Lisi A. The rate of use of Veterans Affairs chiropractic care: A 5-year analysis. Chiropr Man Ther. 2022;30(4). doi:10.1186/s12998-022-00413-9
5. Taylor SL, Hoggatt KJ, Kligler B. Complementary and integrated health approaches: What do veterans use and want. J Gen Intern Med. 2019;34:1192-1199. doi:10.1007/s11606-019-04862-6
6. Meerwijk EL, Larson MJ, Schmidt EM, et al. Nonpharmacological treatment of Army service members with chronic pain is associated with fewer adverse outcomes after transition to the Veterans Health Administration. J Gen Intern Med. 2020;35:775-783. doi:10.1007/s11606-019-05450-4
7. Lisi AJ, Corcoran KL, DeRycke E, et al. Opioid use among veterans of recent wars receiving Veterans Affairs chiropractic care. Pain Med. 2018;19(supp 1):S54-S60. doi:10.1093/pm/pny114
8. Hays RD, Shannon ZK, Long CR, et al. Health-related quality of life among United States service members with low back pain receiving usual care plus chiropractic care plus usual care vs usual care alone: Secondary outcomes of a pragmatic clinical trial. Pain Med. 2022;pnac009. doi:10.1093/pm/pnac009
9. Hinojosa R, Hinojosa MS. Activity-limiting Musculoskeletal conditions in US veterans compared to non-veterans: Results from the 2013 National Health Interview Survey. PLoS One. 2016;11(12):e0167143. doi:10.1371/journal.pone.0167143
10. Toor T, Murphy E, Simmons AN, Palyo S, Librodo SC, Strigo IA. Craving of prescription opioids among veterans with chronic pain. Pain. Published online January 28, 2022. doi:10.1097/j.pain.0000000000002598
11. McAllister SD. The first person you must lead is you with retired brigadier general, Becky Halstead. Adjusted Reality. November 10, 2021. Accessed April 14, 2022. https://podcasts.apple.com/gr/podcast/adjusted-reality/id1541219104?i=1000541332772