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

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