Veterans With Chronic Pain Value Discussions With Health Care Providers About Natural Products

Veterans value discussions with health care providers about natural products (NPs); however, the perception among some veterans that providers are biased against these products negatively affects patient-provider relationships, according to a new study by researchers from the San Francisco VA Health Care System and other collaborating institutions, published in the Journal of General Internal Medicine. The findings of this study, which was funded by a collaborative agreement through the National Institutes of Health’s National Center for Complementary and Integrative Health and the Office of Dietary Supplements, indicate that providers engaging in conversations about NPs with curiosity and respect can reinforce patient-provider relationships.

Previous research has shown that natural product use is high among veterans with chronic pain, and an estimated 50 to 60 percent of veterans have chronic pain. Yet, few studies have examined veterans’ attitudes toward NPs or their discussions with health care providers around NPs. This study aimed to shed light on these topics.

The study was designed as a qualitative substudy of a larger pragmatic randomized controlled trial for chronic pain management in veterans with at least 6 months of documented moderate-to-severe chronic pain. After completing a survey about natural product use, 20 veterans—10 men and 10 women of different ethnicities and varying ages—who had endorsed natural product use were recruited for qualitative interviews. 

The research team used an original semistructured guide that they had developed and piloted to interview the study participants about how they access NPs and decide which ones to take, barriers to use, beliefs about the safety and efficacy of NPs, and experiences discussing NPs with health care providers. Participants answered questions such as, “Do you think that NPs are generally safe?” and “Do you think it is important for your healthcare provider to talk with you about NP use?” Interviewers then used open-ended questions to probe for additional information to better understand participant perspectives. The interviews were conducted by phone and audio recorded.

The researchers used a template-based rapid analysis technique to analyze the veterans’ responses. After summarizing the responses and transcribing relevant quotes for each domain, they integrated the content into a master matrix, organized by domain, which they used to identify and describe themes. To ensure consistency in the analysis and proportionally appropriate inclusion of the full range of veteran perspectives, investigators double-analyzed a random subset of interviews, discussed and reached consensus on differences in interpretations, and assessed level of saturation in the themes.

The analysis revealed that while the veterans in the study use and are interested in learning more about NPs, which they perceive as safe and convenient alternatives to pharmaceutical products, they want to talk with their health care providers to learn more about product options, safety, potential interactions, and efficacy for specific conditions and purposes. Some viewed NPs as safe because they perceived them as adequately “regulated” and “sourced naturally.”

The study authors noted that veterans are dissatisfied with their providers’ willingness and ability to communicate with them about NP options, which may represent a disconnect between the provider and the patient. The analysis found that veterans’ perception of provider biases against natural products negatively affected patient-provider relationships between the veterans in the study and their health care providers. In contrast, veterans reported having positive experiences with providers who validated patient experiences, demonstrated knowledge about NPs, and connected them to helpful resources. 

The findings of this study suggest that the patient-provider relationship is reinforced when providers engage in open, transparent conversations about NPs with their patients. The investigators who conducted the study said that more work is needed to understand provider barriers to discussing NPs with patients, and they suggested exploring the use of nonjudgmental communication techniques to facilitate meaningful discussions about NPs.