Adding Self-Care Complementary and Integrative Health (CIH) 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