Facilitators and Barriers to Non-Pharmacologic Chronic Pain Treatment for Service Members and Veterans with Traumatic Brain Injury

Abstract

<h3>Research Objectives</h3> To identify treatments utilized by Service Members and Veterans (SMVs) with TBI and chronic pain and characterize access barriers and facilitators to non-pharmacologic treatments. <h3>Design</h3> A secondary data analysis of SMV with TBI interview data guided by a biopsychosocial model of pain management1-3 and framework for accessing healthcare services4. <h3>Setting</h3> Five geographically diverse VA Polytrauma Rehabilitation Centers (PRC) within the Department of Veterans Affairs. <h3>Participants</h3> The secondary data analysis includes a sample of 55 SMVs with chronic TBI (>2 years) who were enrolled in VA TBI Model Systems. Half the sample had severe TBI (56%) with a mean age of 43 at time of injury, were male (93%), and married (51%). <h3>Interventions</h3> N/A. <h3>Main Outcome Measures</h3> Facilitators and barriers to accessing non-pharmacologic chronic pain treatment. <h3>Results</h3> Thematic analysis revealed that chronic pain and/or headache was a common rehabilitation need. The use of polypharmacy (including opioid use) was a common theme for those reporting chronic pain concerns. Facilitators to accessing treatment (including non-pharmacological treatments) for chronic pain included the ability to use the VA Choice Program to access community care and family or other social support to advocate for treatment. The primary barriers to accessing care for chronic pain included having insufficient information about alternative treatment options. <h3>Conclusions</h3> Despite VA/DoD clinical practice guidelines advising against using opioids in persons with documented TBI, polypharmacy emerged as a theme in this study cohort. Findings highlight facilitators and barriers to alternative evidence-based treatments with implications for practice and policy. <h3>Author(s) Disclosures</h3> None.