# Age differences in demographic and clinical characteristics among veterans with chronic low back pain: a cross-sectional study of baseline findings from the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) trial

## TL;DR

This study compares younger and older veterans with chronic low back pain, finding differences in demographics, mental health, and medication use.

## Contribution

The study identifies age-related differences in mental health, substance use, and treatment patterns among veterans with chronic low back pain.

## Key findings

- Younger veterans had higher rates of depression, anxiety, PTSD, and sleep disturbance compared to older veterans.
- Medication use differed by age, with younger veterans using more cannabis and muscle relaxants, while older veterans used more acetaminophen and gabapentin.
- Despite similar pain profiles, significant demographic and treatment differences were observed between younger and older veterans.

## Abstract

Veteran Response to Dosage in Chiropractic Therapy (VERDICT) was a pragmatic randomized trial testing chiropractic dosage effects in 766 veterans with chronic low back pain (CLBP) of ≥ 3 months. This cross-sectional analysis compares baseline characteristics of younger (18-to-64 years) and older veterans (≥ 65 years).

Data were collected from February 22, 2021 to May 21, 2025 via electronic health records and REDCap questionnaires. Descriptive statistics and tests of group differences were performed using SAS.

VERDICT enrolled 188 older veterans (25%; mean 72 years) and 578 younger veterans (75%; mean 44 years). More female (24.7% vs. 10.6%, p < .001), Black (18.9% vs. 12.2%), and Hispanic (11.8% vs. 3.7%, p = .001) veterans comprised the younger cohort. Employment differed (p < .001) with older veterans retired (78.2% vs. 14.2%) and younger veterans employed (59% vs. 16.5%). About 14% lived rurally and period of military service was similar. Pain profiles were similar between younger and older veterans for > 5 years duration (78.4% vs. 73.4%), high-impact chronic pain (64.5% vs. 62.2%), mean pain interference [63.8(4.8) vs. 63.2(5.0)], and mean back-related disability (primary outcome) [11.9(5.2) vs. 13.3(4.9)]. Younger veterans scored significantly higher than older veterans for depression (44.8% vs. 31.4%, p = .001), anxiety (41.5% vs. 20.7%, p < .001), post-traumatic stress (38.4% vs. 17.6%, p < .001), sleep disturbance (57.1% vs. 34.6%, p < .001), and high-risk alcohol use (25.4% vs. 18.1%, p = .05). Previous chiropractic use was similar (younger 75.4% vs. older 80.3%). Medications in past 3 months differed with younger veterans reporting cannabis (25.8% vs. 12.8%, p < .001) and muscle relaxants (31.7% vs. 17.6%, p < .001) and more older veterans reporting acetaminophen (63.3% vs. 49.3%, p < .001) and gabapentin (34% vs. 20.1%, p < .001). NSAIDs use was highest among both younger (62.8%) and older (56.9%) veterans. While two-thirds had tried exercise in the past 3 months, only 16% reported exercising for their pain condition, with older veterans more likely to report providers encouraging physical activity.

Similar pain profiles were reported among older and younger veterans seeking chiropractic care for CLBP within a clinical trial. However, potentially important age differences were noted in demographics, mental health and substance use, and CLBP treatments.

ClinicalTrials.gov: NCT04087291. Date of Registration: 9/12/2019. Enrollment Duration: 2/22/2021 (first participant enrolled) through 5/10/2024 (last participant enrolled).

The online version contains supplementary material available at 10.1186/s12998-025-00613-z.