Investigating the effect of integrating complementary medicine therapies including acupuncture, naturopathy, yoga and massage therapy for military veterans with chronic pain.

In addition to the standard care described in the control, participants in the intervention arm will also receive referrals to complementary medicine (CM) therapists that have a demonstrable evidence base for pain or musculo-skeletal conditions in general or military or veteran populations. CM practices in this study include acupuncture/Chinese medicine, massage therapy, naturopathic medicine, or yoga. As in the control group, specific referrals for each individual will be determined by the General Practitioner, in collaboration with the other health professionals where appropriate, based on the identified need of the patient. The process of referral will mirror the GP Management Plan (GPMP) processes and policies. To ensure referrals are evidence-based, decision-making tools will be provided by the research team to the clinic which will summarise the level of evidence for the included CM in the treatment of health conditions relevant to the project. All practitioners will need to be eligible for private health insurance rebates under current rules. The acupuncturist, massage therapist and naturopath will provide services at the same clinical location as the GP while the yoga classes will be delivered in a nearby community centre. The overall duration for each CM therapy interventions is 26 weeks. Following recruitment into the intervention group, participants will be provided an opportunity to book consultations with each CM therapy for an initial consultation. There is no specified maximum amount of consultations or consultation frequency specified for each intervention. Frequency and number of consultations will be dictated by the individual practitioner. The only exception is yoga which will be conducted as a weekly group session. Apart from yoga utilising a session register, monitoring adherence to consultations will be achieved through GO2 Health SMS and phone reminders. Profession-specific criteria include: Acupuncture/Chinese medicine - The acupuncturist will be registered with the Chinese Medicine Board of Australia (Australian Health Practitioner Regulation Agency). A typical acupuncture appointment will include formal diagnosis according to Chinese Medicine principles. Treatment will then involve acupuncture, cupping, moxibustion and some Tui Na style massage. Oral herbal or nutritional supplements may be prescribed. Massage therapy - The massage therapist will be certified with a recognised professional association. A typical massage appointment will provide a 30-60 minutes of tailored remedial manual therapy. Massage therapists at G2H are Diploma or Bachelor of Musculoskeletal Therapy qualified. Naturopathy: Although the recent NHMRC review noted evidence for naturopathy in the treatment of musculo-skeletal conditions, it noted that due to the unregistered nature of the profession in Australia this was limited to naturopaths with degree training. As such, the naturopath will be a graduate of a four-year Australian naturopathic degree and registered with the Australian Register of Naturopaths and Herbalists. The naturopath may prescribe a range of treatments, most often focusing on nutritional, lifestyle, physical medicine and herbal prescriptions. Examples may include a tailored dietary plan, oral herbal and nutritional supplements, physical exercise program or fact sheets related to sleep, dietary fibre (as examples). Yoga - The yoga practitioner will be certified with the International Association of Yoga Therapists and will deliver group classes of Hatha yoga. The yoga exercises will be adjusted to the participants’ capabilities, and specific needs, and led by practitioners with substantial experience in the work with ex-military personnel. The yoga intervention will be delivered through a weekly 1 hour session (no maximum number of participants) which is voluntary for all participants in the intervention group. While participants will be encouraged to practice skills and exercises at home, there will be no dictated frequency or duration. It will focus on physical postures, breathing techniques and meditation. A session attendance sheet will be utilised to monitor adherence.