NMM/OMTOriginal Article

Perceptions of nonopioid treatment for pain in a homeless population

Kristina A. Fraser, OMS IV; Harvard Nguyen, OMS IV; Suhhyun Kim, OMS III; Flora Park, OMS III; Joshua Bernal, OMS IV; Alexa D. Westberg, OMS IV; and Alan Podawiltz, DO
Notes and Affiliations
Notes and Affiliations

Received: September 5, 2020

Accepted: February 8, 2021

Published: April 2, 2021

  • Kristina A. Fraser, OMS IV, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Harvard Nguyen, OMS IV, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Suhhyun Kim, OMS III, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Flora Park, OMS III, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Joshua Bernal, OMS IV, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Alexa D. Westberg, OMS IV, 

    Texas College of Osteopathic Medicine, University of North Texas, Health Science Center, Fort Worth, USA

  • Alan Podawiltz, DO, 

    Department of Psychiatry, University of North Texas, Health Science Center, Fort Worth, USA

Abstract

Background: Opioid abuse has developed into a public health emergency within the last decade because opioid medications, while addictive, are effective and commonly used for pain management. In 2016, over 42,000 deaths were attributed to opioids. Chronic pain affects about 50% of people experiencing homelessness in the US, and they have a higher overall rate of chronic pain than the general population; opioids are among the methods they might use to manage that pain. Complementary and alternative therapies for pain management have largely gone unexplored in the homeless population.

Objectives: To determine, among people experiencing homelessness, the willingness to use and current use of complementary and alternative treatments (physical and massage therapy, chiropractic treatments). A secondary objective was to investigate awareness and perception of osteopathic manipulative treatment (OMT) as a complementary treatment for chronic pain among the homeless population.

Methods: A 32 question survey was administered verbally to guests of True Worth Place Homeless Shelter in Fort Worth, Texas in three 4 hour sessions from February 2019 to April 2019. If participants gave verbal consent, a researcher read the questionnaire, one question at a time, and recorded the participant’s responses. The survey included queries for opioid and nonopioid treatment modalities (physical and massage therapy, chiropractic, and OMT) to assess the perception of and current use of each among the population. Appropriate nonparametric statistical analysis was conducted to assess significance and correlations among the treatment groups.

Results: Of the 200 survey participants, 126 (91.3%) reported a history of opiate use for pain, but 136 (68.0%) believed that a nondrug pain intervention could better treat their pain. Additionally, 150 participants (75.0%) believed that regular manipulation, including OMT, would decrease their need for pain medications. Participants with a history of opioid use for pain were more likely to believe that the availability of regular manipulation, including OMT, at True Worth Place could decrease their need for pain medication (odds ratio=3.7143; 95% confidence interval=1.6122–8.5572; p=0.0009). Moreover, some participants (141; 70.5%) were already pursuing nondrug pain management modalities such as PT, massage therapy, and chiropractic care. The greatest barriers to receiving OMT were transportation and cost.

Conclusions: This survey study was conducted to determine whether a homeless population would be willing to use nonopioid treatment, particularly OMT, for chronic pain management. Results revealed both a willingness to use and a previous use of nonopioid treatments for pain, along with a high prevalence of opiate use. Despite limited exposure to OMT, this population reported being potentially willing to pursue manipulation, including OMT, as a complementary treatment for pain relief alongside opioids if readily available.

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