Abstract
Trends and drivers of Complementary and Alternative Medicine (CAM) use among adults with chronic noncancer pain in the United States
APHA 2022 Annual Meeting and Expo
Background: Chronic noncancer pain (CNCP), defined as persistent pain not due to a malignancy lasting more than three months, affects one in five American adults annually. Complementary and Alternative Medicine (CAM), or nonpharmacologic treatment, has been recommended to mitigate CNCP by the Centers for Disease Control and Prevention, in the effort to reduce the nation’s reliance on pharmaceuticals to treat pain. However, limited data exist on how and who are using CAM for CNCP. This study assessed (1) trends in CAM use for noncancer pain and (2) variations in CAM use among adults with CNCP between 2010 and 2017 by race/ethnicity and insurance type.
Methods: The retrospective time-series study used data from Panels 15 (2010-2011) to 21 (2016-2017) from the Medical Expenditure Panel Survey (MEPS). International Classification of Diseases (ICD) and Clinical Classification codes were used to identify patients with CNCP. We used office-based and outpatient visit files linking to medical condition data to identify visit-level pain diagnosis. The primary outcome – dichotomous pain-associated CAM use – was defined as having had at least one visit to chiropractors, acupuncturists, massage therapists, homeopathic/naturopathic/herbalists, and other alternative/complementary care providers. Chi-Square tests and a survey-weighted generalized logistic regression model were used to examine the trends of and factors for CAM use.
Results: A total of 35,104 adult respondents with CNCP (corresponding to weighted population of 110,252,40) were identified (Hispanic: 11.5%, non-Hispanic Black: 10.4%, non-Hispanic Asian:3.9%; non-Hispanic White: 71.4%). CAM use increased from 14.2% in 2010-2011 to 18.3% in 2016-2017, with substantial variations by race/ethnicity and insurance type. From 2010-2011 to 2016-2017, non-Hispanic White (from 16.2% to 21.1%) and Asian adults (16.4%-17.7%) were consistently more likely to have CAM visits for their pain-related conditions across all race/ethnicity groups (Black adults: 4.8%-7.1%; Hispanic adults: 9.1%-12.3%). Adults with any private insurance had the highest rate of CAM use (21.9% in 2016-2017), compared to those with only public insurance or no insurance (both 10.3%). Female, individuals living in the West vs. Northeast, higher educational levels, and those aged between 25 and 44 vs. 18-25 years old were more likely to use CAM for their pain conditions than their counterparts.
Conclusions: American adults with CNCP increasingly used CAM for their pain conditions during 2010-2017. Differences in CAM use by race/ethnicity and insurance type persisted, highlighting inequitable access to CAM care for the populations most in need, especially racial minorities, patients insured by Medicare, Medicaid, and those without insurance.