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Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome
Journal article   Open access   Peer reviewed

Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome

Katherine Hadlandsmyth, Mary A Driscoll, Jenna L Adamowicz, Lauren Garvin and Brian C Lund
The Journal of rural health, Vol.42(1), e70132
01/2026
DOI: 10.1111/jrh.70132
PMCID: PMC12992181
PMID: 41839795
url
https://doi.org/10.1111/jrh.70132View
Published (Version of record) Open Access

Abstract

This study examines primary and specialty health care among rural and urban Veterans with three common chronic overlapping pain conditions (COPCs): fibromyalgia, migraine, and irritable bowel syndrome (IBS) and the impact of both rural residence and rural primary care site on access to specialty care. The cohort included all Veterans treated for fibromyalgia, migraine, and/or IBS in the VA in 2022. The frequency of outpatient primary care and specialty care encounters for these COPCs in the following year was contrasted by residence (urban/rural) and primary care site (medical center, urban clinic, or rural clinic) using multivariate log-binomial regression. Models were adjusted for demographics and comorbidities. 250,533 Veterans were treated in the VA for the COPCs fibromyalgia, migraine, and/or IBS in 2022; 30.5% were rural residing. Relative to urban Veterans, rural Veterans were significantly more likely to have a primary care visit coded for a COPC (79.5% vs. 74.8%; p < 0.001) and less likely to have a specialty care visit coded for a COPC (31.8% vs. 37.8%; p < 0.001). After adjustment, rural residents were somewhat less likely to receive specialty care for their COPC, relative to urban residing Veterans (RR = 0.91, 95% CI: 0.90-0.92). Further, Veterans receiving care at urban clinics (RR = 0.81, 95% CI: 0.80-0.81) and rural clinics (RR = 0.66, 95% CI: 0.64-0.67) were substantially less likely to have a specialty care visit coded for a COPC, relative to larger VA medical centers. Rural/urban differences are also presented for a referent cohort of musculoskeletal pain conditions. Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.
 United States Adult Aged Chronic Pain - therapy Cohort Studies Female Fibromyalgia - complications Fibromyalgia - epidemiology Fibromyalgia - therapy Health Services Accessibility - standards Health Services Accessibility - statistics & numerical data Humans Irritable Bowel Syndrome - complications Irritable Bowel Syndrome - epidemiology Irritable Bowel Syndrome - therapy Male Middle Aged Migraine Disorders - complications Migraine Disorders - epidemiology Migraine Disorders - therapy Primary Health Care - statistics & numerical data Rural Health Services - statistics & numerical data Rural Population - statistics & numerical data United States Department of Veterans Affairs - organization & administration United States Department of Veterans Affairs - statistics & numerical data Veterans - statistics & numerical data

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