# ASSOCIATION OF COMPLEMENTARY AND INTEGRATIVE HEALTH (CIH)INTERVENTIONS WITH OPIOID USE AND RELATED RISKS AMONG VETERANS WITH MUSCULOSKELETAL DISORDERS (MSD) AND PTSD

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2020 · —

## Abstract

Opioids misuse, abuse, addiction, and overdose are a serious public health crisis, and a leading cause of
death in the USA. Complementary and integrative health (CIH) approaches to pain may help reduce opioid
related harms. However, a 2016 VA QUERI ESP report stated that “the evidence base regarding the
effectiveness of select CIH interventions for reducing opioid use is extremely limited.” In addition, the
Comprehensive Addiction and Recovery Act (CARA; PL 114-198) signed by Congress in to law on 7/22/2016
explicitly calls for “expansion of research and education on and delivery of complementary and integrative
health to veterans.” (Title IX, Subtitle C, Sec. 931).
The impact of CIH on opioid use and pain-related outcomes in VA is poorly understood. Musculoskeletal
disorders (MSD) and PTSD are two of the most prevalent disorders among Veterans in VA care, and their
comorbidity is high: both are increasing, especially among women. Veterans with PTSD are at high risk for
opioid related harms. Veterans with pain and PTSD are more likely to be prescribed opioids and
benzodiazepines, and experience adverse outcomes. Because of the potential mutual reinforcement of PTSD
and pain symptoms, CIH may help reduce opioid initiation and harms for many Veterans with PTSD. VA/DOD
guidelines suggest a role for select CIH for both pain and for PTSD. The CDC Guideline for Opioid Therapy for
Chronic Pain promotes non-pharmacologic treatments, making it likely that the demand for CIH will increase.
However, the extent of CIH use among Veterans in VA care is not well-known, in part because most CIH data
are contained in unstructured electronic health record (EHR) fields that defy ready quantification. We will
examine CIH use and non-use among Veterans with MSD and compare opioid and pain outcomes by PTSD
status. This is an opportunity to anticipate future needs for CIH and to examine patterns of benefit and harms.
We will use algorithms from the Musculoskeletal Disorders cohort study (CRE12-012) to identify Veterans with
MSD, and identify CIH use via structured data (e.g. CPT and ICD codes) and informatics tools on unstructured
data (e.g. clinical notes). We will examine acupuncture, massage, meditation/mindfulness and yoga as they
are currently or likely to be integrated into routine VA care. Using structured data only, we identified 7,621 CIH
users among MSD cohort entrants in FY11-FY13 (n= 309,277); of which, 21% had a PTSD diagnosis. Opioid
and other medications will be identified from pharmacy data. Based on clinical observations, the benefit of CIH
is not uniform. Some patients experience dramatic and long term pain relief, while others do not. Some benefit
from one specific CIH modality versus another. To support personalized treatment and optimize future
outcomes, we will also compare responses among pre-defined demographic and clinical sub-groups.
Our specific aims are to assess the impact of CIH on opioid initiation among Veterans with MSD, estimate
whethe...

## Key facts

- **NIH application ID:** 9729450
- **Project number:** 5I01HX002308-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Joseph Lucien Goulet
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-05-01 → 2022-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9729450

## Citation

> US National Institutes of Health, RePORTER application 9729450, ASSOCIATION OF COMPLEMENTARY AND INTEGRATIVE HEALTH (CIH)INTERVENTIONS WITH OPIOID USE AND RELATED RISKS AMONG VETERANS WITH MUSCULOSKELETAL DISORDERS (MSD) AND PTSD (5I01HX002308-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/9729450. Licensed CC0.

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