Engagement in Integrative and Nonpharmacologic Pain Management Modalities Among Adults with Chronic Pain: Analysis of the 2019 National Health Interview Survey

Figures & data

Table 1 Socio-Demographic, Pain, and Mental Health Characteristics by IHM Engagement

Weighted Variable	All with Chronic Pain	IHM	No IHM	p Value
Total, n	49,695,212	17,610,400	32,084,812
Age in years, mean	55.4 (54.9–55.9)	51.8 (51.0–52.6)	57.3 (56.7–57.9)	<0.001^a
Sex, %				<0.001^b
Female	54.9 (53.5–56.3)	60.3 (57.9–62.6)	52.0 (50.2–53.7)
Male	45.1 (43.7–46.5)	39.7 (37.4–42.1)	48.0 (46.3–49.8)
Race/Ethnicity, %				0.005^b
NH White only	73.2 (71.9–74.5)	74.8 (72.7–76.8)	72.3 (70.6–73.9)
Hispanic	10.5 (9.59–11.5)	10.1 (8.79–11.6)	10.7 (9.52–12.0)
NH Black/African American only	11.0 (10.1–11.9)	9.0 (7.73–10.5)	12.1 (11.0–13.3)
Other single and multiple races	5.3 (4.66–6.03)	6.1 (5.01–7.33)	4.9 (4.11–5.81)
Education, %				<0.001^b
Less than high school	15.5 (14.4–16.7)	8.8 (7.45–10.4)	19.2 (17.7–20.7)
High school graduate/GED	30.4 (29.1–31.7)	25.2 (23.1–27.5)	33.2 (31.6–34.9)
Some college, no degree	19.1 (18.0–20.2)	21.3 (19.4–23.4)	17.8 (16.5–19.2)
Associate’s or bachelor’s degree	28.2 (27.0–29.4)	34.3 (32.2–36.6)	24.8 (23.4–26.3)
Master’s, doctoral, or professional degree	6.9 (6.31–7.53)	10.3 (9.11–11.6)	5.0 (4.42–5.71)
Family income in $1000s, mean	63.1 (61.6–64.6)	71.7 (69.0–74.3)	58.4 (56.7–60.2)	<0.001^a
Proximity to metro area, %				<0.001^b
Nonmetropolitan	19.9 (18.8–21.0)	16.1 (14.5–17.9)	22.0 (20.6–23.5)
Medium and small metro	33.9 (32.6–35.3)	33.1 (30.9–35.3)	34.4 (32.8–36.1)
Large fringe metro	21.7 (20.5–22.9)	23.6 (21.6–25.8)	20.6 (19.2–22.1)
Large central metro	24.4 (23.2–25.7)	27.2 (25.1–29.4)	22.9 (21.4–24.5)
Number of pain locations, mean	3.1 (3.1–3.1)	3.4 (3.3–3.4)	3.0 (2.9–3.0)	<0.001^a
Pain limiting life/work, %				<0.001^b
Never	28.2 (27.0–29.5)	22.9 (21.1–24.9)	31.1 (29.5–32.8)
Some days	35.6 (34.2–36.9)	38.6 (36.2–40.9)	33.9 (32.2–35.6)
Most days	15.4 (14.4–16.5)	17.1 (15.2–19.0)	14.5 (13.3–15.8)
Every day	20.8 (19.7–22.0)	21.5 (19.6–23.5)	20.5 (19.1–21.9)
Opioid use in past 3 months, %				0.026^b
Never	84.8 (83.7–85.8)	85.5 (83.7–87.2)	84.4 (83.1–85.7)
Some days	4.7 (4.12–5.38)	5.1 (3.97–6.45)	4.5 (3.86–5.27)
Most days	1.8 (1.47–2.19)	2.2 (1.63–2.91)	1.6 (1.20–2.09)
Every day	8.7 (7.91–9.53)	7.2 (6.12–8.49)	9.5 (8.47–10.6)
PHQ-8 total, mean	5.3 (5.1–5.4)	5.7 (5.4–6.0)	5.0 (4.8–5.2)	<0.001^a

Note: Values in parentheses represent 95% confidence intervals. ^aWilcoxon rank-sum test for complex survey samples. ^bChi-squared test with Rao & Scott’s second-order correction.

Abbreviations: CI, confidence interval; GED, general equivalency diploma; IHM, integrative health and medicine; metro, metropolitan; NH, Non-Hispanic; PHQ-8, Patient Health Questionnaire-8.

Figure 1 Adjusted Odds Ratios of Engaging in ≥1 IHM Modality for Pain.

Notes: Red dots represent point estimates for adjusted odds ratios, and error bars represent 95% confidence intervals. Education covariates are placed on a separate axis given their size to not obscure the other covariates.

Abbreviations: aOR, adjusted odds ratio; Assoc, associate’s; Bach, bachelor’s; fam, family; GED, general equivalency diploma; HS, high school; L, large; M, medium; metro, metropolitan; NH, Non-Hispanic; PHQ-8, Patient Health Questionnaire-8; S, small; v., versus; yrs, years.

Figure 2 Relative Change in Count of IHM Modalities Used for Pain.

Notes: Red dots represent point estimates for relative change in count, and error bars represent 95% confidence intervals. Education covariates are placed on a separate axis given their size to not obscure the other covariates.

Abbreviations: aOR, adjusted odds ratio; Assoc, associate’s; Bach, bachelor’s; fam, family; GED, general equivalency diploma; HS, high school; L, large; M, medium; metro, metropolitan; NH, Non-Hispanic; PHQ-8, Patient Health Questionnaire-8; S, small; v., versus; yrs, years.

Table 2 Socio-Demographic, Pain, and Mental Health Characteristics by Nonpharmacologic Modality Engagement

Weighted Variable	Combined Groups	Nonpharm Only	Opioids Only	p Value
Total, n	22,707,275	19,099,216	3,608,059
Age in years, mean	54.0 (53.2–54.7)	53.0 (52.2–53.8)	59.2 (57.6–60.8)	<0.001^a
Sex, %				0.797^b
Female	59.2 (57.1–61.3)	59.4 (57.1–61.6)	58.6 (53.0–63.9)
Male	40.8 (38.7–42.9)	40.6 (38.4–42.9)	41.4 (36.1–47.0)
Race/Ethnicity, %				0.221^b
NH White only	74.3 (72.4–76.1)	74.6 (72.6–76.6)	72.6 (67.2–77.3)
Hispanic	10.1 (8.91–11.5)	10.0 (8.73–11.5)	10.7 (7.59–14.8)
NH Black/African American only	9.8 (8.60–11.1)	9.2 (7.96–10.6)	12.8 (9.77–16.5)
Other single and multiple races	5.8 (4.82–6.92)	6.1 (5.11–7.31)	4.0 (1.84–8.57)
Education, %				<0.001^b
Less than high school	12.1 (10.7–13.7)	9.6 (8.25–11.2)	25.0 (20.3–30.2)
High school graduate/GED	26.7 (24.8–28.6)	25.4 (23.5–27.5)	33.4 (28.4–38.8)
Some college, no degree	20.4 (18.8–22.2)	20.6 (18.8–22.5)	19.4 (15.4–24.2)
Associate’s or bachelor’s degree	31.2 (29.4–33.1)	33.7 (31.6–35.8)	18.3 (14.8–22.4)
Master’s, doctoral, or professional degree	9.6 (8.54–10.7)	10.6 (9.47–11.9)	3.9 (2.47–6.07)
Family income in $1000s, mean	68.5 (66.2–70.8)	72.8 (70.3–75.4)	45.6 (41.6–49.6)	<0.001^a
Proximity to metro area, %				<0.001^b
Nonmetropolitan	18.0 (16.5–19.6)	16.5 (15.0–18.2)	25.9 (21.7–30.7)
Medium and small metro	33.0 (31.1–35.0)	32.8 (30.8–34.9)	33.9 (28.9–39.3)
Large fringe metro	22.1 (20.4–23.9)	23.3 (21.5–25.3)	15.7 (12.4–19.7)
Large central metro	26.8 (25.0–28.8)	27.3 (25.3–29.4)	24.5 (19.8–29.8)
Number of pain locations, mean	3.2 (3.2–3.3)	3.2 (3.1–3.3)	3.3 (3.2–3.5)	0.086^a
Pain limiting life/work, %				<0.001^b
Never	22.1 (20.5–23.8)	24.2 (22.4–26.1)	10.9 (8.13–14.5)
Some days	38.5 (36.4–40.6)	39.3 (37.1–41.5)	34.3 (29.1–39.9)
Most days	17.2 (15.8–18.8)	16.9 (15.3–18.7)	18.9 (15.3–23.1)
Every day	22.2 (20.5–24.0)	19.6 (17.9–21.5)	36.0 (30.9–41.3)
PHQ-8 total, mean	5.6 (5.3–5.8)	5.4 (5.1–5.6)	6.5 (5.9–7.2)	<0.001^a

Note: Values in parentheses represent 95% confidence intervals. ^aWilcoxon rank-sum test for complex survey samples. ^bChi-squared test with Rao & Scott’s second-order correction.

Abbreviations: CI, confidence interval; GED, general equivalency diploma; metro, metropolitan; NH, Non-Hispanic; Nonpharm, nonpharmacologic; PHQ-8, Patient Health Questionnaire-8.

Figure 3 Adjusted Odds Ratios of Using Nonpharmacologic Only vs Opioids Only.

Notes: Red dots represent point estimates for adjusted odds ratios, and error bars represent 95% confidence intervals. Education covariates are placed on a separate axis given their size to not obscure the other covariates.

Abbreviations: aOR, adjusted odds ratio; Assoc, associate’s; Bach, bachelor’s; fam, family; GED, general equivalency diploma; HS, high school; L, large; M, medium; metro, metropolitan; NH, Non-Hispanic; PHQ-8, Patient Health Questionnaire-8; S, small; v., versus; yrs, years.