Main Article Content

Kelsey Corcoran
Lori Bastian
Eric DeRycke
Cynthia Brandt
Sally Haskell
Anthony Lisi


Veterans' Health, Low Back Pain


OBJECTIVE: This study examines patient factors associated with the use of chiropractic services among Operations Enduring Freedom/Iraqi Freedom/New Dawn (OEF/OIF/OND) Veterans who sought primary care for low back pain (LBP).

METHODS: This was a cross-sectional analysis of cohort of OEF/OIF/OND Veterans with ≥1 primary care visit associated with an ICD-9 code for LBP from 10/01/11 to 09/30/14 at Veterans Health Administration (VHA) facilities that offered on-station chiropractic services. Chiropractic service use was defined as ≥1 chiropractic visit associated with a LBP diagnosis within a year after a primary care visit for LBP. Patient factors, such as demographics, clinical characteristics, and mental health co-morbidities for both recipients of chiropractic care and nonrecipients were collected. Multivariate logistic regression analyses were used to compare patient factors between recipients of chiropractic care and nonrecipients.

RESULTS: There were 72,810 OEF/OIF/OND Veterans with a primary care visit for LBP and 8.1% used chiropractic services. Compared to nonrecipients, Veterans who received chiropractic services were more likely to be female, white, under 35 years of age, and an officer during military service (p<.05). Chiropractic users were also more likely to have moderate to severe pain, a diagnosis of posttraumatic stress disorder, and a lower body mass index (p<.001).

CONCLUSIONS: This study outlines several patient factors associated with receiving VHA chiropractic services for LBP among Veterans of recent wars. These results provide context relevant for further research and operational planning to optimize the care of this Veteran cohort.


Download data is not yet available.
Abstract 125 | LOW BACK PAIN AND VETERANS Downloads 80


Katz JN. Lumbar disc disorders and low-back pain: socioeconomic factors and consequences. J Bone Joint Surg Am 2006;88 Suppl 2:21-24
2. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet 2016;388(10053):1545-1602
3. Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med 2017;166(7):514-530
4. Lisi AJ, Brandt CA. Trends in the use and characteristics of chiropractic services in the Department of Veterans Affairs. J Manipulative Physiol Ther 2016;39(5):381-386
5. Kligler B, Bair MJ, Banerjea R et al. Clinical policy recommendations from the VHA State-of-the-Art Conference on Non-Pharmacological Approaches to Chronic Musculoskeletal Pain. J Gen Intern Med 2018;33(Suppl 1):16-23
6. Phillips KM, Clark ME, Gironda RJ et al. Pain and psychiatric comorbidities among two groups of Iraq and Afghanistan era Veterans. J Rehabil Res Dev 2016;53(4):413-432
7. Driscoll MA, Higgins DM, Seng EK et al. Trauma, social support, family conflict, and chronic pain in recent service veterans: does gender matter? Pain Med 2015;16(6):1101-1111
8. Analysis of VHA Healthcare Utilization among US Global War on Terrorism (GWOT) Veterans. In: Hazards VOoPHaE, ed2009
9. Beliveau PJH, Wong JJ, Sutton DA et al. The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap. 2017;25:35
10. Elixhauser A, Steinder C, Palmer L. Clinical Classifications Software (CCS) for ICD-9-CM. 2008; Accessed December 5, 2017
11. McGinnis KA, Brandt CA, Skanderson M et al. Validating smoking data from the Veteran's Affairs Health Factors dataset, an electronic data source. Nicotine Tob Res 2011;13(12):1233-1239
12. Goulet JL, Brandt C, Crystal S et al. Agreement between electronic medical record-based and self-administered pain numeric rating scale: clinical and research implications. Med Care 2013;51(3):245-250
13. Han L, Goulet JL, Skanderson M et al. Evaluation of complementary and integrative health approaches among US veterans with musculoskeletal pain using propensity score methods. Pain Med 2019;20(1):90-102
14. VHA Chiropractic Services. On-station chiropractic patients and visits by facility with VAST type. 2021; Accessed May 17, 2021
15. US Department of Veterans Affairs. Veterans Health Administration. 2019;,Veterans%20enrolled%20in%20the%20VA. Accessed January 21, 2021
16. Evans EA, Herman PM, Washington DL et al. Gender differences in use of complementary and integrative health by U.S. military veterans with chronic musculoskeletal pain. Womens Health Issues 2018;28(5):379-386
17. Forte ML, Maiers M. Differences in function and comorbidities between older adult users and nonusers of chiropractic and osteopathic manipulation: a cross-sectional analysis of the 2012 National Health Interview Survey. J Manipulative Physiol Ther 2019;42(6):450-460
18. Coleman BC, Corcoran KL, DeRycke EC et al. Factors associated with posttraumatic stress disorder among veterans of recent wars receiving Veterans Affairs chiropractic care. J Manipulative Physiol Ther 2020;43(8):753-759
19. Outcalt SD, Ang DC, Wu J, Sargent C, Yu Z, Bair MJ. Pain experience of Iraq and Afghanistan veterans with comorbid chronic pain and posttraumatic stress. J Rehabil Res Dev 2014;51(4):559-570
20. Fishbain DA, Pulikal A, Lewis JE, Gao J. Chronic pain types differ in their reported prevalence of post -traumatic stress disorder (PTSD) and there is consistent evidence that chronic pain Is associated with PTSD: an evidence-based structured systematic Rreview. Pain Med 2017;18(4):711-735
21. Lang KP, Veazey-Morris K, Berlin KS, Andrasik F. Factors affecting health care utilization in OEF/OIF veterans: the impact of PTSD and pain. Mil Med. 2016;181(1):50-55
22. Outcalt SD, Yu Z, Hoen HM, Pennington TM, Krebs EE. Health care utilization among veterans with pain and posttraumatic stress symptoms. Pain Med 2014;15(11):1872-1879
23. Nalamachu S, Robinson RL, Viktrup L et al. Pain severity and healthcare resource utilization in patients with osteoarthritis in the United States. Postgrad Med.2021;133(1):10-19
24. Wei W, Gandhi K, Blauer-Peterson C, Johnson J. Impact of pain severity and opioid use on health care resource utilization and costs among patients with knee and hip osteoarthritis. J Manag Care Spec Pharm 2019;25(9):957-965
25. Witt EA, Kenworthy J, Isherwood G, Dunlop WC. Examining the association between pain severity and quality-of-life, work-productivity loss, and healthcare resource use among European adults diagnosed with pain. J Med Econ 2016;19(9):858-865
26. Volkman JE, DeRycke EC, Driscoll MA et al. Smoking status and pain intensity Among OEF/OIF/OND veterans. Pain Med 2015;16(9):1690-1696
27. Green KT, Wilson SM, Dennis PA et al. Cigarette Smoking and musculoskeletal pain severity among male and female Afghanistan/Iraq era veterans. Pain Med 2017;18(9):1795-1804
28. Higgins DM, Buta E, Dorflinger L et al. Prevalence and correlates of painful conditions and multimorbidity in national sample of overweight/obese Veterans. J Rehabil Res Dev 2016;53(1):71-82
29. Salsbury SA, Goertz CM, Vining RD et al. Interdisciplinary practice models for older adults with back pain: a qualitative evaluation. Gerontologist 2018;58(2):376-387
30. Weeks WB, Goertz CM, Meeker WC, Marchiori DM. Public perceptions of doctors of chiropractic: results of a national survey and examination of variation according to respondents' likelihood to use chiropractic, experience with chiropractic, and chiropractic supply in local health care markets. J Manipulative Physiol Ther 2015;38(8):533-544
31. Blanchette MA, Rivard M, Dionne CE, Cassidy JD. Chiropractors' characteristics associated with physician referrals: results from a survey of Canadian doctors of chiropractic. J Manipulative Physiol Ther 2015;38(6):395-406.
32. Stump JL, Redwood D. The use and role of sport chiropractors in the national football league: a short report. J Manipulative Physiol Ther 2002;25(3):E2
33. Grant ME, Steffen K, Palmer D. The usage of multidisciplinary physical therapies at the Rio de Janeiro 2016 Olympic Summer Games: an observational study. Braz J Phys Ther 2020
34. Okamoto CS, Dunn AS, Green BN, Formolo LR, Chicoine D. Correlation of body composition and low back pain severity in a cross-section of US veterans. J Manipulative Physiol Ther 2017;40(5):358-364
35. Globe G, Farabaugh RJ, Hawk C et al. Clinical practice guideline: chiropractic care for low back pain. J Manipulative Physiol Ther 2016;39(1):1-22
36. Ewald SC, Hurwitz EL, Kizhakkeveettil A. The effect of obesity on treatment outcomes for low back pain. Chiropr Man Therap 2016;24:48
37. Dowell D, Haegerich TM, Chou R. CDC guideline for prescribing opioids for chronic pain - United States, 2016. MMWR Recomm Rep 2016;65(1):1-49
38. Lisi AJ, Corcoran KL, DeRycke EC et al. Opioid use among veterans of recent wars receiving Veterans Affairs chiropractic care. Pain Med 2018;19(suppl_1):S54-S60
39. Dorflinger L, Moore B, Goulet J et al. A partnered approach to opioid management, guideline concordant care and the stepped care model of pain management. J Gen Intern Med 2014;29 Suppl 4:870-876
40. Corcoran KL, Bastian LA, Gunderson CG, Steffens C, Brackett A, Lisi AJ. Association between chiropractic use and opioid receipt among patients with spinal ain: a systematic review and meta-analysis. Pain Med 2020;21(2):e139-e145
41. Whedon JM, Toler AWJ, Goehl JM, Kazal LA. Association between utilization of chiropractic services for treatment of low-back pain and use of prescription opioids. J Altern Complement Med 2018;24(6):552-556
42. Allen H, Wright M, Craig T et al. Tracking low back problems in a major self-insured workforce: toward improvement in the patient's journey. J Occup Environ Med 2014;56(6):604-620
43. Vogt MT, Kwoh CK, Cope DK, Osial TA, Culyba M, Starz TW. Analgesic usage for low back pain: impact on health care costs and service use. Spine 2005;30(9):1075-1081
44. Rhee Y, Taitel MS, Walker DR, Lau DT. Narcotic drug use among patients with lower back pain in employer health plans: a retrospective analysis of risk factors and health care services. Clin Ther 2007;29 Suppl:2603-2612
45. Williams VF. Use of complementary health approaches at military treatment facilities, active component, U.S. Armed Forces, 2010-2015. MSMR (U.S. Army Center for Health Promotion and Preventive Medicine, Executive Communications Division).23(7):9-22