CORE Posters Fall 2025

Perceptions of Non-Opioid Treatment for Pain in Individuals Facing Housing Insecurity: Preliminary Study for OMT Service at Fralin Free Clinic, Roanoke Virginia Bargota, A., Cesiro, C., Kochanska, N., Russell, J., Willis, O., MPH, Nicholson, J., MAT, Kadio, B., MD, PhD Edward Via College of Osteopathic Medicine (VCOM), Preventative Medicine, Blacksburg, VA

Group R

Co-authorship should be given to collaborators such as a Statistician, who have made intellectual contribution in terms of writing, research design, study implementation, and data analysis and interpretation.

Discussion & Conclusions

Abstract

Results

t

With the devastating impact of the opioid epidemic over the past few decades, many researchers have turned their attention to complementary and alternative medicine (CAM) as a means of reducing reliance on opioids for chronic pain management. Individuals experiencing housing insecurity face disproportionately high burdens of chronic musculoskeletal disorders and stress, yet they often have limited access to non-opioid treatment options. Fraser et al. conducted one of the first studies in the United States to highlight this gap, reporting low awareness of osteopathic manipulation treatments (OMT) and other CAMs but positive perceptions and strong interest within this population. A similar survey was developed for use at the Fralin Free Clinic in Southwestern Virginia. This survey was adapted from a validated survey in Chin et al. on perceptions on osteopathic physicians within Chinese communities in New York City. The revised survey will be administered verbally to patients at the Fralin Free Clinic in Southwestern Virginia. The target sample will include approximately 200 participants, drawn from a demographic population comparable to that of the original Texas study. Inclusion and exclusion criteria will mirror those described by Fraser et al. to ensure methodological consistency and comparability. This approach will enable examination of regional differences in participant needs between Southwestern Virginia and Texas, thereby contributing to a broader understanding of potential geographic variation in healthcare needs within the United States. We anticipate to find similar findings to the Fraser at al. Paper with participants reporting low familiarity with OMT but expressing favorable perceptions and a strong willingness to pursue osteopathic manipulations. Limited studies exist on the potential benefit of osteopathic manipulative medicine and complementary medicine in individuals experiencing housing insecurity. One study based in Switzerland reported that while only 30% of participants had received complementary medicine treatment in the past 60 months, there was a 61.5% reported interest in osteopathy (Grazioli et al.). Review of the literature found a single study in the United States that examined perceptions and the benefit of nonopioid pain modalities in a population experiencing housing insecurity. Fraser et al. utilized a 32-question survey that was administered to guests at a homeless shelter in Fort Worth Texas from February 2019 to April 2019. The non-validated survey included three demographic questions and 22 binary questions on use of opioid and nonopioid pain treatment modalities, including massage therapy, chiropractic treatments, and OMT. The Fraser study used a Cochran’s Q test for the binary response questions to assess significance among treatment modalities and absolute differences to test for pairwise proportional differences. The study found that 91.3% of participants reported taking opiate medication for pain, emphasizing the need for more accessible alternative forms of treatment for individuals experiencing homelessness. 77.3% of participants reported that access to regular manipulation would decrease their need for opiate pain medication even though only 15.6% of participants reported prior awareness of OMT. Introduction & Methods

Limitations  Data on OMT demand and utilization among adults with housing insecurity in the U.S. are scarce.  Comparative effectiveness studies in this population are limited, and little implementation science exists to guide the scale-up of OMT in street medicine or shelter-based programs. Future Directions  Phase 1 (Preliminary): Survey that has been developed would be distributed to patients in the Fralin Free Clinic to assess awareness, perception, and willingness to receive OMT for chronic pain.  Phase 2: Implementation of OMT for the housing insecure population utilizing the Fralin Free Clinic with assessment of perceived outcomes and demand for integration of osteopathic manipulation into chronic pain management services. Implications  Embedding such treatment into homeless health services through free clinics, shelters, and mobile units; bundling osteopathic manipulation with physical therapy, behavioral health, and case management to improve uptake  Offering flexible access models such as drop-in blocks or walk-in appointments to lower barriers  Increasing awareness with plain-language education and tracking outcomes, both patient-reported measures and utilization metrics will also be key to building an evidence base that can guide future treatment of nonopioid alternatives in adults of housing insecurity  Explore differences in willingness, attitudes, and the prevalence of chronic disability between participants in the Fraser et al. study conducted in the Southwestern U.S. and those in our Southeastern U.S. population.

Figure 1: Prior exposure of guests at True Worth Place homeless shelter to OMT. Of 100respondents to the relevant questions, 15.6% (n=31) had heard of OMT, and 7% (n=14)had previously received OMT (Fraser et al.)

Key Findings from Fraser et al. study:

 Interest & Acceptability ○ Only 15.6% of participants reported prior awareness of OMT ○ 77.3% of participants reported that access to regular manipulations would decrease the need for opiate pain medications  Delivery Models ○ Free and student-run clinics, mobile outreach, and integration of comprehensive PT/OMT clinics have been successful in providing accessible OMT to underserved populations.  Clinical Rationale ○ OMT has evidence supporting its use in the treatment of chronic pain and stress/anxiety - conditions prevalent in housing-insecure populations  Barriers ○ Limited awareness of OMT, transportation, cost, and appointment availability  Facilitators ○ Free accessible clinics and integration with primary care and behavioral health

References

1.Chin J, Li S, Yim G, Zhou YA, Wan PJ, Dube ER, Volokitin M, Sahni S, Terrell MA, Lomiguen CM. Perceptions of the osteopathic profession in New York City's Chinese Communities. Fam Med Community Health. 2020 Feb 28;8(1):e000248. doi: 10.1136/fmch-2019-000248. PMID: 32201549; PMCID: PMC7069261. 2.Fraser KA, Kara A, Reitzel LR, Kendzor DE, Hébert ET. Perceptions of nonopioid treatment for pain management among adults experiencing homelessness. J Health Care Poor Underserved. 2019;30(3):1004-1018. 3.Grazioli VS, Hangartner E, Bodenmann P, Schaad L, Grosjean L, Nikles J, Campbell DJT, Hyvert L, Varela TA, Collins SE, Leblanc C, Loignon C, Berna C. Complementary medicine among individuals experiencing homelessness in Switzerland: a quantitative and qualitative descriptive study. BMC Complement Med Ther. 2025 May 6;25(1):166. doi: 10.1186/s12906-024-04727-4. PMID: 40329247; PMCID: PMC12057206.

Acknowledgements

Keywords: OMT, osteopathic, manipulation, pain, chronic pain, homeless, unhoused, housing insecurity.

We would like to thank the Fralin Free Clinic for their collaboration, as well as Dr. Bernard Kadio and Jessica Nicholson for their support and guidance. We would like to also acknowledge the help of the IRB as we await approval.

Figure 2: Fralin Free Clinic Patient Research Survey