Supporting Research in Pain Management for Veterans and Military Service Members
Supporting Research in Pain Management for Veterans and Military Service Members

Age Differences in Demographic and Clinical Characteristics among Veterans with Chronic Low Back Pain

A Cross-Sectional Study of Baseline Findings from the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) Trial

Stacie A. Salsbury, Cynthia R. Long, Jacob McCarey, Anthony J. Lisi, Anna Steward, Robert B. Wallace and Christine M. Goertz

Chiropractic & Manual Therapies

 https://doi.org/10.1186/s12998-025-00613-z

Background

Chiropractic care is an important component of the evidenced-based care recommendations within the VA/DOD Clinical Practice Guidelines for the Diagnosis and Treatment of Low Back Pain (LBP).  Yet, utilization rates for VA chiropractic care is relatively low even though data shows that patients who receive chiropractic care are less likely to need escalations in care than those receiving analgesic pharmacological care, and are also less likely to fill opioid prescriptions. The barriers to utilization include: limited access to care, lack of awareness and misconceptions about chiropractic care.

Primary PMC Study

The VERDICT trial evaluated the effectiveness of varied doses of chiropractic care for the management of chronic low back pain (CLBP) in veterans. By design, the trial aimed to gather a large sample size that included varied key demographics (age, sex, race, and ethnicity). The trial was conducted within VA Healthcare Systems in the following locations: Iowa City, Iowa; Greater Los Angeles, California; Minneapolis, Minnesota; and West Haven, Connecticut.
More About the VERDICT Trial
Participants:
  • Male and Female Veterans aged 18 years or older from diverse backgrounds.
  • Self-reported CLBP
  • Low back pain (LBP) intensity equal to or greater than 2 on at baseline on Pain, Enjoyment, and General Activity (PEG) instrument
  • LBP disability score equal to or greater than 4 on the Roland Morris Disability Questionnaire
  • Able to understand study without a proxy
  • Diagnosis confirming neuromusculoskeletal LBP
  • Willing to attend chiropractic visits for up to one year

Findings

This study provides a secondary analysis of baseline data from VERDICT, with a focus on the impact of age on experience of pain intensity, functional status, mental and physical health, and ability to manage pain. Findings indicate that younger veterans and older veterans’ experiences of pain and pain management differ, likely influenced by different rates of mental health and substance use challenges, as well as disparate lifestyle factors.

Key Commonalities

  • Older and younger veterans reported moderate physical disability and pain interference.
  • Substantial tobacco use, cannabis use, and high-risk alcohol use was common across all ages; however younger veterans reported more use than older veterans.
  • Substance use increased over earlier studies from 2017.
  • Use of non-steroidal anti-inflammatory drugs was common.
  • 45-49% in both age cohorts lived in areas with higher deprivation index score, suggesting veterans may have less access to health-promoting resources.

Key Differences

Younger veterans…

…reported higher levels of service-connected disability than older veterans.

Older veterans…

…reported a slightly higher LBP disability at baseline than younger veterans.

Younger veterans…

…reported more sleep disturbance than older veterans.

Older veterans…

…experienced less sleep disturbance and fatigue and better global physical and mental health.

Younger veterans…

…experienced more employment challenges and were less likely to have a partnered relationship status.

Older veterans…

…reported higher satisfaction with social roles and activities, but PROMIS scores continued to be in the moderate to severe range.

Younger veterans…

…were more likely to have higher levels of depression, anxiety and post-traumatic stress disorders.

Older veterans…

…reported less problems with mental health, substance use, and fatigue than younger veterans.

Younger and older veterans…

…reported substantial substance use including tobacco, cannabis, and high-risk alcohol use.

Access Full Publication Here

Clinical Practice Takeaways

FINDING

Veterans with CLBP screened highly for depression, anxiety, past-traumatic stress disorder, and substance use.

Takeaway

Veterans’ mental health needs and substance use may impact treatment outcomes or require referral.

FINDING

Few veterans reported exercising as a pain management strategy. Many veteran report sleep disturbances.

Takeaway

Chiropractors may help veterans to prioritize activity and rest as part of their self-management goals.

More Information