# Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome

## TL;DR

Rural Veterans with chronic pain conditions like fibromyalgia and IBS are less likely to access specialty care compared to urban Veterans, despite more frequent primary care visits.

## Contribution

The study reveals disparities in specialty care access for rural Veterans with chronic overlapping pain conditions.

## Key findings

- Rural Veterans were more likely to have primary care visits for COPCs but less likely to access specialty care.
- Veterans at urban and rural clinics were significantly less likely to receive specialty care compared to those at larger VA medical centers.
- Rural/urban differences in care access were also observed for musculoskeletal pain conditions.

## Abstract

This study examines primary and specialty health care among rural and urban Veterans with three common chronic overlapping pain conditions (COPCs): fibromyalgia, migraine, and irritable bowel syndrome (IBS) and the impact of both rural residence and rural primary care site on access to specialty care.

The cohort included all Veterans treated for fibromyalgia, migraine, and/or IBS in the VA in 2022. The frequency of outpatient primary care and specialty care encounters for these COPCs in the following year was contrasted by residence (urban/rural) and primary care site (medical center, urban clinic, or rural clinic) using multivariate log‐binomial regression. Models were adjusted for demographics and comorbidities.

250,533 Veterans were treated in the VA for the COPCs fibromyalgia, migraine, and/or IBS in 2022; 30.5% were rural residing. Relative to urban Veterans, rural Veterans were significantly more likely to have a primary care visit coded for a COPC (79.5% vs. 74.8%; p < 0.001) and less likely to have a specialty care visit coded for a COPC (31.8% vs. 37.8%; p < 0.001). After adjustment, rural residents were somewhat less likely to receive specialty care for their COPC, relative to urban residing Veterans (RR = 0.91, 95% CI: 0.90–0.92). Further, Veterans receiving care at urban clinics (RR = 0.81, 95% CI: 0.80–0.81) and rural clinics (RR = 0.66, 95% CI: 0.64–0.67) were substantially less likely to have a specialty care visit coded for a COPC, relative to larger VA medical centers. Rural/urban differences are also presented for a referent cohort of musculoskeletal pain conditions.

Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.