Whole Health Use and Interest Across Veterans With Co-Occurring Chronic Pain and PTSD: An Examination of the 18 VA Medical Center Flagship Sites

David E Reed 2nd; Barbara G Bokhour; Lauren Gaj; Anna M Barker; Jamie H Douglas; Rian DeFaccio; Rhonda M Williams; Charles C Engel; Steven B Zeliadt

doi:10.1177/21649561211065374

Whole Health Use and Interest Across Veterans With Co-Occurring Chronic Pain and PTSD: An Examination of the 18 VA Medical Center Flagship Sites

Glob Adv Health Med. 2022 Feb 11:11:21649561211065374. doi: 10.1177/21649561211065374. eCollection 2022.

Authors

David E Reed 2nd^{1

2}, Barbara G Bokhour^{3

4}, Lauren Gaj³, Anna M Barker³, Jamie H Douglas¹, Rian DeFaccio¹, Rhonda M Williams^{1

5}, Charles C Engel^{1

6}, Steven B Zeliadt^{1

2}

Affiliations

¹ Center of Innovation for Veteran-Centered and Value-Driven Care, Seattle, WA, United States.
² Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, WA, United States.
³ Center for Healthcare Organization and Implementation Research, Bedford, MA, United States.
⁴ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Boston, MA, United States.
⁵ Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States.
⁶ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States.

Abstract

Objective: Veterans Healthcare Administration (VHA) conducted a large demonstration project of a holistic Whole Health approach to care in 18 medical centers, which included making complementary and integrative health (CIH) therapies more widely available. This evaluation examines patterns of service use among Veterans with chronic pain, comparing those with and without PTSD.

Methods: We assessed the use of Whole Health services in a cohort of Veterans with co-occurring chronic pain and PTSD (n = 1698; 28.9%), comparing them to Veterans with chronic musculoskeletal pain only (n = 4170; 71.1%). Data was gathered from VA electronic medical records and survey self-report. Whole Health services were divided into Core Whole Health services (e.g., Whole Health coaching) and CIH services (e.g., yoga). Logistic regression was used to determine whether Veterans with co-occurring chronic pain and PTSD utilized more Whole Health services compared to Veterans with chronic pain but without PTSD.

Results: A total of 40.1% of Veterans with chronic pain and PTSD utilized Core Whole Health services and 53.2% utilized CIH therapies, compared to 28.3% and 40.0%, respectively, for Veterans with only chronic pain. Adjusting for demographics and additional comorbidities, Veterans with comorbid chronic pain and PTSD were 1.24 (95% CI: 1.12, 1.35, P ≤ .001) times more likely than Veterans with chronic pain only to use Core Whole Health services, and 1.23 (95% CI: 1.14, 1.31, P ≤ .001) times more likely to use CIH therapies. Survey results also showed high interest levels in Core Whole Health services and CIH therapies among Veterans who were not already using these services.

Conclusion: Early implementation efforts in VHA led to high rates of use of Core Whole Health and CIH therapy use among Veterans with co-occurring chronic pain and PTSD. Future assessments should examine how well these additional services are meeting the needs of Veterans in both groups.

Keywords: chronic pain; complimentary and integrative health; posttraumatic stress disorder; whole health.