Natural Product Use for Chronic Pain: A New Survey of Patterns of Use, Beliefs, Concerns, and Disclosure to Providers.

Background: "Natural products" (NPs), including dietary supplements, are widely used, yet little is known about NP use for chronic pain and related conditions. Objective: To develop a new NP survey to better understand reasons for NP use, beliefs, concerns, medication substitution, and provider disclosure. Methods: Based on similar surveys and input from veteran focus groups and subject matter experts, a new brief NP survey was developed. The survey was piloted among 52 veterans with chronic pain enrolled in Veterans Health Administration (VA) primary care who endorsed NP use at baseline in a pragmatic trial comparing non-drug pain management approaches. Survey data was enriched with sociodemographic and clinical data from a parent trial. Descriptive frequencies and means were calculated. Results: Of 55 surveys, 52 were completed (response rate, 94.5%). Respondents' mean age was 57.6 (SD+/-12.5); 42% were women, 21% identified as Black/African American, and 10% Hispanic/Latinx ethnicity. All had chronic pain; 80% experienced disabling pain daily; 67% were prescribed non-opioid pain medication; 15% were prescribed opioids. In the prior 3 months, the mean number of NPs used was 4.6 (SD+/-3.2); 90% reported daily use. Most frequently used NPs were vitamins/minerals (94%), herbals/botanicals (60%); and cannabis (40%); one-third reported substituting NPs for pain medications. The majority endorsed safety concerns about interactions of NPs either with pain medications (55%) or other NPs (52%). Nearly all (98%) believed providers should discuss NP use with their patients, though only 52% had disclosed NP use to their providers. Conclusions: Among veterans with chronic pain in VA primary care enrolled in a pragmatic trial, a new NP survey revealed prevalent use of multiple NPs concurrently, and in some cases, as substitutes for prescribed medications. Most veterans expressed safety concerns, yet a significant proportion reported not discussing NP use with their providers.