# Use of Nonpharmacologic Interventions by Adults With High-Impact Chronic Pain in the United States: A Cross-Sectional Analysis

## TL;DR

This study finds that most U.S. adults with high-impact chronic pain use non-drug treatments, with usage varying based on the location of their pain.

## Contribution

The study compares nonpharmacologic intervention use between high- and low-impact chronic pain groups and links pain location to intervention use.

## Key findings

- 69.7% of high-impact chronic pain patients used at least one nonpharmacologic intervention in the past 3 months.
- Physical therapy was the most common nonpharmacologic intervention used, while peer support groups were the least used.
- Back and upper extremity pain were associated with higher odds of using nonpharmacologic interventions.

## Abstract

Introduction: Few studies compare differences in the use of nonpharmacologic interventions (NPIs) between those with high-impact chronic pain (HICP) and low-impact chronic pain (LICP) or describe differences in the use of NPIs by locations of bothersome pain.

Objectives: To describe the use of NPIs in HICP and LICP subgroups and to examine the association between locations of bothersome pain and use of NPIs among those with HICP.

Methods: We used data from the 2019 National Health Interview Survey. After identifying respondents who reported having chronic pain, we then created high and low pain impact subgroups. Additional variables in our analyses included sociodemographic data, health characteristics, and pain management characteristics. Our analysis included descriptive statistics, Chi-squared tests, and adjusted survey-weighted logistic regression models.

Results: The estimated prevalence of chronic pain in US adults was 19.9% (95% CI: 19.5–20.0), with 36.4% (95% CI: 35.1–38.0) of that group having HICP. Of those with HICP, 69.7% (95% CI: 67.6–71.9) reported using ≥ 1 NPIs in the past 3 months, compared to 62.9% (95% CI: 61.1–64.6) with LICP. The most frequently used NPI was physical, rehabilitative, or occupational therapy (25.9%, 95% CI: 24.0–27.9), and the least used was a peer support group (2.7%, 95% CI: 2.0–3.6). Among those with HICP, bothersome back pain (OR = 1.52, 95% CI: 1.19–1.95) and upper extremity pain (OR = 1.26, 95% CI: 1.003–1.59) are associated with the greater use of any NPIs compared to those without bothersome pain at these sites, respectively.

Conclusion: Our findings highlight that most US adults with HICP have recently used NPIs to manage their pain, but the use of specific NPIs varied considerably. The odds of using NPIs were different depending on the locations of bothersome pain. Future work should examine barriers for access to specific NPIs or the use of NPIs by locations of bothersome pain.