Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome
J Rural Health. 2026 Jan;42(1):e70132. doi: 10.1111/jrh.70132.
ABSTRACT
PURPOSE: 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.
METHODS: 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.
FINDINGS: 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.
CONCLUSIONS: Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.
PMID:41839795 | DOI:10.1111/jrh.70132