Objective: In this cross-sectional study, we examined correlates of manual therapy (spinal manipulation, massage therapy) and/or acupuncture use in a population engaging in conventional pain care in West Virginia.

Methods: Participants were patients (aged 18+ years) from 4 Appalachian pain and rheumatology clinics. Of those eligible (N = 343), 88% completed an anonymous survey including questions regarding health history, pain distress (Short Form Global Pain Scale), prescription medications, and current use of complementary health approaches for pain management. We used age-adjusted logistic regression to assess the relation of sociodemographic, lifestyle, and health-related factors to use of manual therapies and/or acupuncture for pain (complete-case N = 253).

Results: The majority of participants were white (92%), female (56%), and middle aged (mean age, 54.8 ± 13.4 years). Nearly all reported current chronic pain (94%), and 56% reported ≥5 comorbidities (mean, 5.6 ± 3.1). Manual therapy and/or acupuncture was used by 26% of participants for pain management (n = 66). Current or prior opioid use was reported by 37% of those using manual therapies. Manual therapy and/or acupuncture use was significantly elevated in those using other complementary health approaches (adjusted odds ratio, 3.0; 95% confidence interval, 1.5-5.8). Overall Short Form Global Pain Scale scores were not significantly associated with use of manual therapies and/or acupuncture after adjustment (adjusted odds ratio per 1-point increase, 1.01; 95% confidence interval, 1.00-1.03).

Conclusion: We found no evidence for an association of pain-related distress and use of manual therapies and/or acupuncture, but identified a strong association with use of dietary supplements and mind-body therapies. Larger studies are needed to further examine these connections in the context of clinical outcomes and cost-effectiveness in rural adults given their high pain burden and unique challenges in access to care.

Author keywords: Manipulation, Chiropractic; Manipulation, Orthopedic; Acupuncture Therapy; Massage; Epidemiology; Rural Health; Chronic Pain; Pain Clinics

Author affiliations: TMF, BC, AL, CB: VA Healthcare Connecticut Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, Connecticut; Yale University School of Medicine Center for Medical Informatics, New Haven, Connecticut. KEI: Department of Epidemiology, West Virginia University School of Public Health, Morgantown, West Virginia. RDK: VA Healthcare Connecticut Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, West Haven, Connecticut; Departments of Psychiatry, Neurology and Psychology, Yale University, New Haven, Connecticut. BJ: Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland; University of Maryland Orthopaedic Associates, Baltimore, Maryland. NM: VA Healthcare Connecticut, Newington, Connecticut
Corresponding author: TMF—termeh.feinberg@yale.edu

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