Women veterans are doing yoga. Why aren't men?

Kaylah Jackson
October 03, 2018 - 2:03 pm

(Specialist 1st Class Elizabeth Merriam/Released)

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While the VA conducts more research on what some might call non-traditional therapies for aches and pains, male and female veterans gravitate towards these alternative therapies differently based on gender and ethnicity. It’s not exactly clear why, but Dr. Elizabeth Evans, who studies opioids and substance abuse, particularly in women is hoping to find the answer. 

Connecting Vets (CV): Opioids have been deemed both a health crisis and epidemic but along with an increase in prescription opioid use is also increased interest in finding other ways of treating pain. How did the idea for this study come about?

Dr. Elizabeth Evans (EE): My year there at the VA really peaked my interest in looking more closely at addiction among veterans especially heroin and opioids and how we can better serve veterans so that they could recover from any opioid problems that they could be facing.

CV: The title of the study is "Gender Differences in Use of Complementary and Integrative Health by U.S. Military Veterans with Chronic Musculoskeletal Pain." Those are some pretty heavy medical terms. Could you explain what this type of pain and therapy looks like for a veteran?

EE: So, it's trying to differentiate say pain due to cancer and other pain. Like joint pain, aches, and pains, back pain...it’s not about cancer-related pain. It's aches, and pains you have because of overuse of joints. And it's things like medication, yoga, acupuncture, movement-related therapy so Tai Chi is included in there. Those are the most commonly-used type of complementary and integrative health therapies. Others include chiropractic care, even massage, hypnosis but those are less frequently used.

(U.S. Army photo by Sgt. Paige Behringer)

CV: The study highlights more woman participants than men used yoga for the pain they were feeling. Do women veterans on average experience more chronic musculoskeletal pain, than male veterans?

EE: I think that’s something we’re trying to understand. So, they do report different types of pain. Whether it’s more severe or greater pain, in other literature, women, in general, are more likely to report their pain conditions and also mental health symptoms than men and one complication is it that we don’t know if women experience greater pain or more of them have mental health conditions or they’re just more likely to talk about it and report it.

CV: While fewer women used massage, Tai Chi, and meditation as an alternative therapy, the study showed even more variations based on ethnicity. Particularly, black women veterans are least likely among the veteran population to use CIH (Complementary and integrated health) therapies. Did you ever look into possible reasons for that behavior?

EE: I, myself, was kind of surprised and interested especially the finding around black women no matter their age are the least likely to use this type of care given the bigger context of maybe black women and men may be underdiagnosed for their pain…A lot of it is related to racism and discrimination in health care delivery meaning their pain symptoms are more likely to be underdiagnosed and go untreated.

It is important to talk with these groups to understand ‘why is it that you’re not using this? Is it because it’s not available or you don’t feel welcome there or you’re just not aware that it’s something you could use?’

CV: Aside from reasons such as health care discrimination, could reasons be culturally-based as well?

EE: Maybe one way to do that is to look at well, 'why is it that Hispanics are more likely to use it, is it a cultural aspect?' There’s some research to support Hispanic individuals come from cultures that support an alternative to traditional medicine and so they may be more comfortable using what’s thought to be “out of the box” type of health care and therefore they’re more likely to use CIH therapies.

CV: A lot of the results of this study make me wonder if VA clinicians are more sensitive to their veterans depending on their gender or ethnicity. How can those conversations start happening when a doctor says, ‘in addition to maybe this medication, there’s also this alternative?

EE: Well, first, I should just say I’m not a clinician and every patient should be talking to their clinician directly but it does seem like maybe this should be the first option that’s offered. So, to put it out there as the first treatment plan or on equal footing as prescribing medication. It seems like it’s in our own best interests and the patient’s best interest to offer a non-pharmaceutical type option when it would lead to the same or maybe better outcomes as pharmaceutical type options.

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