Latent Patterns of Complementary and Integrative Health Therapy Utilization Among VHA Patients on Long-Term Opioid Therapy

Abstract Background Complementary and integrative health (CIH) therapies offer safe and effective alternatives for pain management, and use of these therapies by Veteran Health Administration (VHA) patients with pain warrants examination. Objective This study examines the patterns of CIH therapy utilization among VHA patients in a Long-Term Opioid Therapy (LTOT) cohort, identifying distinct subgroups of patients based on their CIH therapy use patterns and exploring how demographic and clinical characteristics are associated with membership in each subgroup. Methods From a national retrospective cohort of VHA patients with a documented history of LTOT between 2017 and 2021, we analyzed electronic health record data of 17,079 VHA patients who used any CIH therapy during a 12-month period (October 2021 to September 2022). We assessed patterns of any use of nine CIH therapies through latent class regression analysis and assessed covariates of latent class membership. Results A four-class solution was identified. The largest class was Chiropractic Care (32.3%), followed by Acupuncture (29.7%), Mind-Body therapies (28.0%), and Manual Therapy (10.0%). The chiropractic care class comprised those who utilized chiropractic care with some acupuncture co-use; Acupuncture class comprised patients using almost exclusively acupuncture; Mind-Body therapies class was defined by predominant use of meditation, yoga, and tai chi; and Manual Therapy class comprised patients who used massage, acupuncture, and chiropractic care. Significant demographic and clinical differences were observed between classes. Conclusion These findings highlight distinct CIH therapy utilization patterns among VHA patients on LTOT associated with patients’ demographic and clinical features. Quantifying patterns of CIH therapy use provides an effective framework for comparing pain and opioid-related outcomes across different groups. These findings suggest the need for investigating pathways to CIH that result in differences in use patterns.