Introduction: Chronic low back pain (cLBP) is the most prevalent chronic pain condition among veterans, contributing to disability, reduced quality of life, and opioid dependence. Complementary and integrative health (CIH) approaches offer evidence-based, non-pharmacological alternatives that may improve pain management, enhance patient satisfaction, lower healthcare costs, and reduce opioid dependence.
Materials and methods: The objective of the study was to synthesize current evidence on CIH approaches for veterans with cLBP, evaluate their impact on pain, function, and well-being, and identify implications for policy, health system implementation, and future research. The key questions of the study included: what is the effectiveness of CIH modalities in reducing cLBP intensity among veterans, what are their broader effects on health outcomes, opioid use, and quality of life, what barriers exist to implementation within the VA, and what research and policy priorities are needed to optimize veteran-centered CIH care? A narrative synthesis of peer-reviewed literature published between 2010 and 2025 was conducted, prioritizing studies specific to veterans and incorporating systematic reviews, randomized controlled trials, observational studies, and evidence maps. A patient-centered, biopsychosocial, and whole-health framework guided the analysis.
Results: Evidence for CIH in veterans remains limited compared to that in civilian populations, but it demonstrates promise. Battlefield acupuncture demonstrated clinically meaningful reductions in pain, although yoga, Tai Chi, Qigong, and mindfulness offered modest improvements in pain and functional outcomes. Cognitive-behavioral therapy, Chiropractic care, and massage showed mixed results, with low to moderate certainty and limited durability. Multimodal approaches integrating CIH with conventional care have demonstrated the strongest outcomes, including reduced opioid prescriptions, improved coping, and potential cost savings. Barriers to care include provider shortages, administrative challenges, and uneven access across facilities.
Conclusions: CIH approaches represent patient-centered and holistic strategies with the potential to reduce pain, enhance function, and mitigate opioid reliance among veterans with cLBP. Broader, standardized implementation and veteran-specific trials are necessary to strengthen the evidence base and guide the sustainable integration of this approach into the VA health system.
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