Journal article
TBI Disability, Health Beliefs, and Workforce Capacity are Top Barriers to Chronic Pain Guideline-Based Non-Pharmacologic Interventions
Archives of physical medicine and rehabilitation
06/13/2025
PMID: 40518064
Metrics
7 Record Views
Abstract
•TBI disability is a barrier to receiving nonpharmacologic chronic pain treatment.•Patient lack of trust in non-pharmacologic evidence-based interventions is a barrier to accessing treatment.•Access barriers to evidence-based chronic pain treatments were more prevalent in civilian versus Veterans Affairs healthcare settings.
To examine determinants to evidence-based, non-pharmacologic treatments for chronic pain among persons with traumatic brain injury (TBI) utilizing an access-to-care lens. Chronic conditions such as TBI commonly co-occur with chronic pain which contributes to long-term health outcomes. Despite guideline endorsement of evidence-based non-pharmacologic treatments (NP-EBT) for long-term chronic pain management, persons with TBI report low rates of utilization.
Convenience sample of respondents to an online survey directed to rehabilitation professionals.
Civilian and VA-based centers with TBI providers.
145 US-based providers (63% civilian; 34% VA, 3% DOD).
NA
10-item survey examining barriers to non-pharmacologic evidence-based therapies informed by the robust Levesque access to care framework which includes supply and demand characteristics. Six of the items described patient and community abilities to access care and four focused on healthcare system or infrastructure critical in access. Based on their professional experience, participants were asked to separately rate the frequency of the ten barriers for each of the three specific guideline endorsed interventions for chronic pain: behavioral health therapies, comprehensive chronic pain programs, and substance use disorder treatment.
Across all three interventions, morbidity associated with TBI (i.e., cognitive, physical disabilities), patient lack of understanding, trust, or beliefs about efficacy of intervention, and lack of qualified providers who can deliver the intervention were the most frequently endorsed barriers to delivering NP-EBTs for chronic pain. Subgroup analyses found higher frequency of barriers in civilian vs VA settings particularly related to patient ability to afford [58-70% difference] and insurance coverage [54-61%] of interventions.
Findings have implication for policy and practice to address healthcare inequities that persons with TBI-related disability experience in accessing high-quality, evidence-based treatments.
[Display omitted]
Related links
Details
- Title
- TBI Disability, Health Beliefs, and Workforce Capacity are Top Barriers to Chronic Pain Guideline-Based Non-Pharmacologic Interventions
- Publication Details
- Archives of physical medicine and rehabilitation
- Resource Type
- Journal article
- Publisher
- Elsevier Inc
- Copyright
- © American Congress of Rehabilitation Medicine
- Identifiers
- 99381394684106600
- Academic Unit
- Usha Kundu, MD College of Health; Health Sciences and Administration
- Language
- English