Adding Self-Care Complementary and Integrative Health Therapies to Care for Chronic Pain: The Assessing Pain, Patient Reported Outcomes and Complementary Health (APPROACH) Study.

IF 1.9 2区医学 Q1 HEALTH CARE SCIENCES & SERVICES

Medical Care Pub Date : 2026-05-01 Epub Date: 2026-03-02 DOI:10.1097/MLR.0000000000002295

Steven B Zeliadt, Scott S Coggeshall, Barbara Bokhour, A Rani Elwy, Benjamin Kligler, Claudia Der-Martirosian, Ethan W Rosser, Marlena Shin, Joy Toyama, Michelle L Upham, Xiaoyi Zhang, Stephanie L Taylor

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引用次数: 0

Abstract

Background: Health care systems and insurers are expanding coverage for practitioner-delivered and self-care complementary and integrative health (CIH) therapies for chronic pain.

Objectives: To determine if combining practitioner-delivered and self-care CIH therapies (PD/SC-CIH) improves pain outcomes more than practitioner-delivered CIH (PD-CIH) therapies alone.

Research design: Pragmatic nonrandomized trial. Structural nudges and the availability of CIH therapies were used as a surrogate to randomization.

Subjects: Of 3306 veterans with chronic musculoskeletal pain at 18 medical centers in the Veterans Health Administration between March 2021 and March 2023.

Measures: PD-CIH therapies included acupuncture, chiropractic care, or massage therapy. Participants in the PD/SC-CIH arm also received yoga, mindfulness/meditation, and/or Tai Chi/Qigong. The primary outcome was the change in pain-related functional interference at 6 months.

Results: Pain interference improved in both arms (-0.62 and -0.70), with 39.5% and 41.1%, respectively, achieving clinically meaningful improvement with no difference between arms in improvement in pain interference: -0.12 (-0.28 to 0.05). At 6 months, more participants in the PD/SC-CIH arm reported their use of CIH therapies specifically led to perceived improvements across 4 global patient-centered measures: pain (11%; 5%-18%); fatigue (28%; 17%-40%); mental health (24%; 14%-35%); and overall well-being (27%; 18%-35%).

Conclusions: Both approaches to offering CIH therapies were equally associated with improvements in pain interference among this large cohort with real-world CIH therapy engagement. More patients in the PD/SC-CIH arm perceived that their use of CIH therapies improved multiple health dimensions. Patients with chronic musculoskeletal pain should be encouraged to add self-care CIH therapies and health care systems should expand their availability.

Study registration: ClinicalTrials.gov Identifier: NCT05097521.

查看原文本刊更多论文

在慢性疼痛护理中加入自我护理补充和综合健康（CIH）疗法——评估疼痛、患者报告的结果和补充健康（APPROACH）研究

背景：卫生保健系统和保险公司正在扩大覆盖范围的医生提供和自我保健补充和综合健康（CIH）治疗慢性疼痛。目的：确定联合医生提供和自我护理CIH治疗（PD/SC-CIH）是否比单独医生提供的CIH （PD-CIH）治疗更能改善疼痛结局。研究设计：实用的非随机试验。结构性推动和CIH疗法的可用性被用作随机化的替代。受试者：在2021年3月至2023年3月期间，在退伍军人健康管理局的18个医疗中心，有3306名患有慢性肌肉骨骼疼痛的退伍军人。措施：PD-CIH治疗包括针灸、捏脊护理或按摩治疗。PD/SC-CIH组的参与者还接受了瑜伽、正念/冥想和/或太极/气功。主要结局是6个月时疼痛相关功能干扰的改变。结果：两组患者的疼痛干扰均有改善（-0.62和-0.70），分别为39.5%和41.1%，达到有临床意义的改善，两组患者的疼痛干扰改善无差异：-0.12（-0.28 ~ 0.05）。在6个月时，PD/SC-CIH组中更多的参与者报告说，他们使用CIH疗法在4项全球以患者为中心的测量指标上明显改善：疼痛（11%;5%-18%）；疲劳（28%;17%-40%）；心理健康（24%;14%-35%）；整体幸福感（27%;18%-35%）。结论：在参与真实世界CIH治疗的大队列中，两种提供CIH治疗的方法均与疼痛干扰的改善相关。PD/SC-CIH组中更多的患者认为他们使用CIH疗法改善了多个健康维度。应鼓励慢性肌肉骨骼疼痛患者增加自我保健CIH疗法，卫生保健系统应扩大其可用性。研究注册：ClinicalTrials.gov标识符：NCT05097521。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Care 医学-公共卫生、环境卫生与职业卫生

CiteScore

5.20

自引率

3.30%

发文量

228

审稿时长

3-8 weeks

期刊介绍： Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, provision, and evaluation of health services.