New Survey Shows U.S. Veterans’ Use of Natural Products for Chronic Pain

A new survey of United States military veterans with chronic pain shows prevalent use of multiple natural products with, or in some cases, as substitutes for, prescribed pain medications. Although natural products, including dietary supplements, are commonly used, there is little information about their use for chronic pain. While many of the survey participants expressed concerns about safety, a significant proportion had not discussed their natural product use with their health care providers. Many, however, expressed their desire to have more informed conversations about natural product use with their providers.

The survey, which was piloted with 52 participants in the U.S. Department of Veterans Affairs (VA) Whole Health Options and Pain Education (wHOPE) pragmatic trial, was developed by researchers from the Pain Management Collaboratory to gain information about natural product use for chronic pain. The survey was co-sponsored by the National Institutes of Health (led by the National Center for Complementary and Integrative Health), the Department of Defense, and the VA. Findings were published in the journal Global Advances in Integrative Medicine and Health.

Among the findings from the survey: 

• All of the respondents had chronic pain, with 80 percent reporting disabling pain every day. 
• Sixty-seven percent of respondents were prescribed non-opioid pain medication, 15 percent were prescribed opioids, and 17 percent reported not using any pain medication. 
• The most frequently used natural products were vitamins/minerals (94 percent), followed by herbals/botanicals (60 percent) and cannabis (40 percent). 
• One-third of respondents reported substituting natural products for pain medications.
• Approximately half of the survey participants expressed concerns about interactions of natural products with either pain medications (55 percent) or other natural products (52 percent).
• Nearly all participants (98 percent) believed providers should discuss natural product use with their patients to help prevent potential harm; however, only 52 percent said they had disclosed natural product use to their health care providers. 

According to 2010-2014 data from the National Health Interview Survey, U.S. military veterans experienced pain and severe pain more often than nonveterans did, with 65.5 percent of veterans reporting pain in the prior 3 months. Additionally, a disproportionate number of mental health problems in veterans with chronic pain has been associated with an increase in prescription opioid use and negative outcomes. 

Many health care systems, including the VA, recommend nonpharmacologic therapies, such as cognitive behavioral therapy, exercise, and complementary and integrative health approaches, as first-line treatments for chronic pain. Natural products are the most frequently used complementary health approach in the United States and are often used alone or in combination with medications for chronic pain. 

The study authors said the survey was shown to be acceptable and feasible in the small but diverse sample of veterans with chronic pain and that the study produced descriptive information about natural products for pain, helping fill a knowledge gap. They noted that although some natural products are generally considered safe, many may be mislabeled, contain adulterants, have side effects, or interact with other products or medications, especially in people with more than one health condition who are taking multiple medications. 

The authors noted that although many clinicians lack knowledge and up-to-date information about natural products, there are several online evidence-based natural product databases that clinicians can access. This may encourage clinician communication with patients and informed shared decision making, possibly leading to improved safety and pain-related outcomes in patients.