Black Vets Prefer Nonpharmacologic Pain Treatments

Black veterans with chronic pain favor nonpharmacologic therapies to achieve better physical function and reengage in “meaningful life activities,” according to an online study available in The Journal of Pain.

The study (J Pain 2024: S1526-5900[24]00368-7) included 106 participants from the intervention arm of the randomized controlled trial COOPERATE (Communication and Activation in Pain to Enhance Relationships and Treat Pain with Equity). Recruited from primary care clinics at a large midwestern Veterans Affairs (VA) medical center, participants averaged nearly 62 years of age, with 85% male and most (74.6%) having some post-secondary education, according to the study. The Brief Pain Inventory was administered to measure pain intensity and interference.

Results showed that 61% of participants ranked improved physical functioning as a top treatment goal, followed by 45% who wanted increased engagement in valued activities and 37% who desired a reduction in pain intensity. Most patients (73%) preferred nonpharmacologic treatments such as physical therapy, exercise, acupuncture and yoga, according to the study. It was also found that 17% preferred medication treatment and 42% and 22% opted out of pharmacologic and surgical treatments, respectively.

“Treatments such as exercise, physical therapy and psychotherapy have been demonstrated to be quite effective in improving pain severity and reducing interference. Within VA, there have been many initiatives focused on non-medication treatments to improve the whole health of veterans with chronic pain. These services are readily available and have shown great success in improving the care we provide,” said lead author Mackenzie Shanahan, PhD, an advanced postdoctoral fellow at the Center for Innovations in Quality Effectiveness and Safety in the VA Medical Center in Houston.

“Among the patients I treat, everybody wants to be more active,” said Scott Kreiner, MD, first vice president of the North American Spine Society. “They all want to be able to exercise and don’t want to be on drugs. They’d rather find other ways to manage pain. I’m not surprised patients within the Black community feel the same way.”

The study cites limitations, including a focus on “a predominantly male sample of Black veterans with musculoskeletal pain” and a cross-sectional analysis that hinders determination of causation. “Future research should investigate whether treatment goals and preferences differ in Black women and Black non-veterans with chronic pain,” the authors stated.

“It’s primarily a male population. They’re all veterans. They didn’t do any comparison between them and non-Black males,” Kreiner said.

Shanahan acknowledged that “our results might not be as relevant to other groups. We also did not try to determine whether participants could access treatments they preferred. Although we know from other research that Black patients with pain often encounter barriers in obtaining certain pain treatments, we know little about whether this is true for non-medication treatments, such as the ones discussed in this paper .”

She added: “It’s essential to ask Black patients about their goals, treatment preferences and what is most important to them and to recognize goals, values and preferences can be different for each individual patient. Taking a little time to understand each patient’s values and preferences will go a long way to help patients find pain treatments that fit best with what they find.”

“The general takeaway is these patients, and probably most patients, prefer nonpharmacologic management of pain to improve function and regain the ability to do tasks they like,” Kreiner said. “Those goals are demonstrated in this group of patients.”

—Sherree Geyer