Barriers to Complementary and Integrative Health Use Among Veterans on Long-Term Opioid Therapy.

Authors

Maryam Kazemitabar, Robert D Kerns, William C Becker, Alicia A Heapy, Erica A Abel, Haseena Rajeevan, Jamie H Douglas, Steven B Zeliadt, Samara K Zuniga, Blair P Curtis, William C Westmoreland, Benjamen Kligler, Janet M Clark, Christina L Vair, Alison M Whithead, Julie L Olson, Anne C Black

Published in

Journal of integrative and complementary medicine. Pages 27683605261505152. Nov 11, 2026. Epub Nov 11, 2026.

Abstract

Complementary and integrative health (CIH) therapies are increasingly promoted within the Veterans Health Administration (VHA) as nonpharmacologic approaches and adjuncts to long-term opioid therapy (LTOT) for chronic pain. However, uptake remains modest, and barriers to initiation and continuation are poorly understood.
We conducted a cross-sectional survey of 126 Veterans with chronic pain on LTOT who had no CIH utilization documented in VHA electronic health records between July 1, 2017, and December 31, 2022. Participants were sampled from a national VHA cohort of over 280,000 Veterans. Respondents reported familiarity with nine CIH services-acupuncture, biofeedback, guided imagery, clinical hypnosis, therapeutic massage, meditation, tai chi/qi gong, yoga, and chiropractic care-as well as prior use and reasons for non-use or discontinuation. Barriers were summarized overall and stratified by age, sex, and race.
Fewer than 10% of Veterans reported regular use of most modalities, with chiropractic care as the exception (23% regular use). Common reasons for non-use included lack of knowledge about eligibility, uncertainty about how to begin, and skepticism about effectiveness. Discontinuation was most often attributed to perceived ineffectiveness, cost, and logistical challenges. Younger Veterans more frequently reported not knowing they were eligible or how to start, while White Veterans more often cited doubts about effectiveness, and Black Veterans reported discomfort with particular modalities. Self-practice therapies (yoga and meditation) were more commonly practiced at home; whereas hands-on therapies (acupuncture, chiropractic care, and massage) were largely accessed in community settings where cost and logistics were prominent barriers.
Substantial barriers remain to CIH service engagement among Veterans on LTOT, spanning awareness, logistics, and personal comfort. Targeted education, streamlined referrals, and strategies to manage early expectations may improve uptake and sustainment.

PMID:
43016000
Bibliographic data and abstract were imported from PubMed on 12 Nov 2026.

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