Background Complementary and integrative health (CIH) therapies offer safe and effective alternatives for pain management, and use of these therapies by Veterans Health Administration (VHA) patients with pain warrants examination.Objective This study examines the patterns of CIH therapy utilization among VHA patients in a Long-Term Opioid Therapy (LTOT) cohort, identifying distinct subgroups of patients based on their CIH therapy use patterns and exploring how demographic and clinical characteristics are associated with membership in each subgroup.Methods From a national retrospective cohort of VHA patients with a documented history of LTOT between 2017 and 2021, we analyzed electronic health record data of 17 079 VHA patients who used any CIH therapy during a 12-month period (October 2021-September 2022). We assessed patterns of any use of 9 CIH therapies through latent class regression analysis and assessed covariates of latent class membership.Results A 4-class solution was identified. The largest class was Chiropractic Care (32.3%), followed by Acupuncture (29.7%), Mind-Body therapies (28.0%), and Manual Therapy (10.0%). The chiropractic care class comprised those who utilized chiropractic care with some acupuncture co-use; Acupuncture class comprised patients using almost exclusively acupuncture; Mind-Body therapies class was defined by predominant use of meditation, yoga, and tai chi; and Manual Therapy class comprised patients who used massage, acupuncture, and chiropractic care. Significant demographic and clinical differences were observed between classes.Conclusion These findings highlight distinct CIH therapy utilization patterns among VHA patients on LTOT associated with patients' demographic and clinical features. Quantifying patterns of CIH therapy use provides an effective framework for comparing pain and opioid-related outcomes across different groups. These findings suggest the need for investigating pathways to CIH that result in differences in use patterns.
Abstract Objective Despite not being recommended in treatment algorithms, people often take acetaminophen for pain relief in neuropathic pain. As there is no randomized clinical trial on oral acetaminophen in neuropathic pain, this study aims to evaluate the efficacy of oral therapeutic-dose acetaminophen compared to placebo in patients with peripheral neuropathic pain. Design This is a randomized, placebo-controlled, crossover, double-blind clinical study. The protocol and informed consent form were approved by the French Research Ethics Committee and National Drug Agency (trial number: NCT03559985). Setting It took place in University Hospital, Clermont-Fd, France. Subjects Thirty patients with chronic post-surgery neuropathic pain were randomised. Methods Acetaminophen or placebo was taken for 7 days with a wash-out period of 7 days and treatments were compared. Outcomes were 7-day mean pain intensity (numerical rating scale) after treatment, Neuropathic Pain Symptom Inventory (NPSI), Patient Global Impression of Change (PGIC), Hospital Anxiety and Depression Scale (HAD), Pittsburgh Sleep Quality Index (PSQI), and adverse events. Results Acetaminophen presents no statistical difference with the placebo for pain report (effect-size [95%CI]: -0.09 [-0.45; 0.26], P = 0.607) and for all secondary outcomes. Conclusions This study demonstrates no clinically meaningful analgesic benefit of short-term, 3g/day oral acetaminophen as add-on therapy in chronic post-surgical peripheral neuropathic pain, and no adverse events. Although findings should not be generalized, patients with neuropathic pain using self-medicated acetaminophen should always be informed about the risks of long-term use of acetaminophen to avoid unnecessary intake and potential long term adverse events.
