Non-pharmacological interventions for veterans living with chronic pain: a scoping review and intervention map

PURPOSE: To describe the content of studied intervention programs, the rationale/mechanism and outcomes from these studies and the limitations and gaps within the existing literature. METHODS: CINAHL, EMBASE, PubMed, Cochrane Reviews, and Google Scholar were searched for studies. Three authors screened studies against predefined inclusion criteria. Data were analyzed through qualitative synthesis. Articles were included if they addressed a rehabilitation intervention that focused on chronic pain management in a population of military veterans. RESULTS: A total of 31 articles were included, 25 being randomized trials. Interventions varied in design components, sessions, and delivery mode (58% in-person, 25% remote, 17% mixed). Adherence and fidelity were reported by 78% of studies. Only 4/31 studies reported the use of veteran engagement during development of the intervention. A conceptual map summarizing the intervention components (5 main categories) expected mechanisms and outcomes (process, health and patient specific) from the primary interventions was created. CONCLUSIONS: Poor reporting of content, rationale, and frameworks of non-pharmacological interventions for military veterans may explain why systematic reviews have not found support for their value. Future trials must improve rigor in design and reporting to be explicit and responsive to the needs of the veteran population facing chronic pain.