Many military personnel and veterans experience chronic pain, a condition that can be debilitating and often difficult to treat. Service members may have other co-morbid conditions that are also challenging to treat including, post-traumatic stress disorder (PTSD), anxiety, depression, insomnia, and substance use disorder. Opioid medications are often prescribed for chronic pain conditions, but opioid use and misuse has been associated with an increase in hospitalizations and death. A study published in the journal JAMA Internal Medicine examined the prevalence of chronic pain and opioid use among U.S. soldiers following deployment. The researchers found that of the more than 2,500 participants surveyed, 44 percent had chronic pain and 15 percent regularly used opioids—rates much higher than the general population. An analysis of the National Health Interview Survey published in 2016 found that American veterans experience higher prevalence of pain and more severe pain than nonveterans, with young and middle-aged veterans suffering the most.
Many military personnel, veterans, and their families turn to complementary and integrative health approaches such as mindfulness meditation and other practices in an effort to increase their options for the management of pain and associated problems. This issue of the digest provides a summary of available evidence on complementary health approaches for health conditions of special concern to military, veterans, and their families.
Modality and Summary of Current Evidence
Research on complementary health approaches for chronic pain in military populations is currently being conducted, but very little data about the efficacy of these approaches specifically for chronic pain in military populations exists. However, there is published efficacy data on complementary health approaches for chronic pain in the general population.
The scientific evidence suggests that some complementary health approaches may provide modest effects that may help individuals in the general population manage the day-to-day variations in their chronic pain symptoms. While some complementary approaches do show modest benefit depending on the approach and pain condition, in most instances, though, there have been only a few studies conducted.
Clinical practice guidelines on the management of PTSD issued in 2010 by the Department of Veterans Affairs and the Department of Defense indicate that relaxation techniques be considered as a component of treatment approaches for acute stress disorder or PTSD in alleviating symptoms associated with physiological hyper-reactivity.
The guidelines also state that complementary health approaches that facilitate a relaxation response (e.g., mindfulness, yoga, acupuncture, massage, and others) may be considered for adjunctive treatment of hyperarousal symptoms, although there is no evidence that these are more effective than standard stress inoculation techniques.
There is some limited evidence that some mind and body approaches may have the potential for modest beneficial effects on stress and anxiety in military populations. However, many of the studies have small sample sizes.
There is some evidence to suggest that relaxation techniques, along with behavioral therapies, can be helpful components of a successful strategy to improve sleep, but there have only been a few small studies conducted in military populations. There is also some limited evidence that imagery rehearsal therapy may improve insomnia in nonveteran populations, but only a few small studies have examined imagery rehearsal therapy in combat veterans or active duty military personnel.