927 - Chronic Pain Treatment Utilization in Rural vs Urban/Suburban Inhabitants Following Traumatic Brain Injury

Objectives: To determine the differences in healthcare utilization for chronic pain among rural and urban/suburban civilians and Military Veterans after a moderate-severe TBI.

Design: Setting: Eighteen Traumatic Brain Injury Model Systems (TBIMS) Centers. Participants: A total of 1,741 TBIMS participants 1 to 30 years post-injury reporting chronic pain at their most recent follow-up interview. Primary Measures: Sociodemographic, injury, functional outcome, pain, and pain treatment characteristics.

Results: Participants were mostly male (72.9%), White (75.2%), civilian (83.8%), 46 years old on average, and had greater than high school education (59.9%). 32% of participants resided in rural areas and 67% in suburban/urban areas. No significant difference in healthcare utilization for chronic pain was observed between rural and suburban/urban civilians after adjustment for relevant covariates. However, rural Veterans enrolled with the Veterans Health Administration (VHA) healthcare system had odds ratios >3 for each major treatment category including medical services (OR=3.56), exercise therapies (OR=5.23), psychological services (OR=4.43), complementary and alternative therapies (OR=3.23), and pain rehabilitation program (OR=4.16) compared to rural civilians. Being married vs single, Bachelor/graduate education vs high school or less, and employed vs unemployed all had odds ratios >1 for exercise therapies, psychological services, complementary and alternative therapies, and pain rehab program.

Conclusions: Contrary to initial hypotheses, there were no significant differences in healthcare utilization for chronic pain treatment comparing those in rural vs suburban/urban areas. However, differences found between rural Veterans and civilians suggest there may be differences in healthcare access related to coverage for healthcare services.  The improved access to social and financial services afforded by VHA programs to Veterans may serve as a model for improving healthcare utilization in similar civilian populations. Further research is needed to determine whether those with TBI and chronic pain are receiving the care needed to improve their quality of life and function.