A study by VA researchers and colleagues found that non-drug therapies given to service members with chronic pain may reduce the risk later in life of adverse outcomes like substance use disorders and suicide attempts.

Dr. Esther Meerwijk with the VA Palo Alto Health Care System was the lead author. Her team reviewed the VA health records of more than 140,000 former Army soldiers. All had reported chronic pain after deployment to Iraq or Afghanistan.

“Chronic pain is associated with adverse outcomes, such as substance use and suicidal thoughts and behavior,” Meerwijk says. “It made sense that if non-drug treatments are good at managing pain, their effect would go beyond only pain relief.”

Controlling for variables

The researchers controlled for several variables. Among them were length of care in VA, whether the Veteran had been exposed to non-drug therapies in VA, and the number of days a VA patient received opioids. They also tested to see if those who received non-drug treatments were healthier to begin with.

It’s possible, says Meerwijk, that soldiers who received non-drug therapies didn’t have to rely as much on opioids. “We may also be seeing a genuine effect of non-drug therapies that occurs regardless of whether soldiers use opioids or not. 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 to turn to drugs.”

“It made sense that if non-drug treatments are good at managing pain, their effect would go beyond only pain relief.”

Chronic pain is often managed with opioids. Especially at higher doses and longer duration, the drugs have been linked to higher risk of substance use disorder and self-inflicted injuries, such as opioid overdose and suicide attempts.

Study didn’t consider treatments individually

Examples of the non-drug therapies Veterans had received in the service include acupuncture, biofeedback, chiropractic care, massage, and exercise therapy.

Because the study was based only on past treatment data and didn’t include a randomized clinical trial, it doesn’t show cause and effect—only an association. Another limitation: The researchers didn’t look at specific non-drug therapies to gauge the extent to which they may have contributed—or not—to the overall finding.

“We didn’t look at effects of individual non-drug therapies. We treated them as one,” says Meerwijk. “Most likely, only some of the therapies that we included are responsible for the effect that we reported, whereas others may have had no effect at all, assuming there’s no other variable that explains our findings.”

In the photo above, Capt. Israel Orengo is evaluated by physical therapist Tyler Snow at Madigan Army Medical Center in 2015.

Read more about the study on the VA Research website.