6 - (IOP 9) Beliefs About Non-pharmacological Treatment for Chronic Pain Among Non-treatment Seeking Veterans Who Are Prescribed Opioids

Chronic pain is highly prevalent in the US, particularly among Veterans. Despite the risks associated with long-term opioid use (e.g., dependence, overdose), non-pharmacological treatments such as Cognitive Behavioral Therapy (CBT) and physical therapy remain underutilized. Understanding Veterans' beliefs about these treatments is crucial for improving engagement.

This study aimed to identify and categorize beliefs about non-pharmacological pain treatments among Veterans receiving long-term opioid prescriptions. Data were derived from a randomized controlled trial evaluating the effectiveness of CBT for Treatment Seeking (CBT-TS) in facilitating non-pharmacological treatment initiation.

The sample included 131 Veterans (86.3% male, 58.9% white, age M= 62.9) who were prescribed at least a 90-day opioid supply with moderate to severe chronic pain and received CBT-TS. Frequencies of belief themes were examined to identify the commonly endorsed perceptions of non-pharmacological pain treatments. Chi-square analyses were conducted to determine if theme endorsement differed across racial identity and biological sex. Additionally, we explored differences between Veterans who initiated treatment (n=29) and those who did not (n=99) following CBT-TS.

A total of 329 distinct beliefs were identified and grouped into eight themes. The most common theme, ‘perceived ineffectiveness,’ was reported by 46.6% of participants, indicating skepticism about non-pharmacological treatments’ ability to alleviate pain. Other themes included ‘openness to [alternative] treatment’ (43.5%), ‘prior unsuccessful attempts’ reflecting the belief that they have exhausted all non-pharmacological options (20.6%), and the perception that their current pain treatment, including medication, is the best solution (20.6%). The ‘dislikes current medications’ theme included concerns about side effects and harm, and a desire to reduce medication use (n = 26, 19.8). Other themes included a perceived lack of need for alternative treatments (n = 18, 13.7%), practical barriers such as transportation difficulties (n = 16, 12.2%), and a self-reported lack of knowledge about non-pharmacological treatment options (n = 16, 12.2%).

The rate of practical barriers (χ2 = 8.68, p<.01) endorsed by females was higher (33.3%) than males (8.9%). There were no significant differences in treatment-related belief themes across racial groups or between those who did and did not initiate treatment following CBT-TS.

Findings highlight common beliefs about non-pharmacological pain treatment among Veterans. Addressing skepticism and reducing practical barriers may enhance openness to and utilization of non-pharmacological pain management.