Age differences in demographic and clinical characteristics among Veterans with chronic low back pain: A cross-sectional study of baseline findings from the Veteran Response to Dosage in Chiropractic Therapy (VERDICT) trial

Abstract: Background: Veteran Response to Dosage in Chiropractic Therapy (VERDICT) was a pragmatic randomized trial testing chiropractic dosage effects in 766 veterans with chronic low back pain (CLBP) of ≥ 3 months. This cross-sectional analysis compares baseline characteristics of younger (18-to-64 years) and older veterans (≥ 65 years). Methods: Data were collected from February 22, 2021 to May 21, 2025 via electronic health records and REDCap questionnaires. Descriptive statistics and tests of group differences were performed using SAS. Results: VERDICT enrolled 188 older veterans (25%; mean 72 years) and 578 younger veterans (75%; mean 44 years). More female (24.7% vs. 10.6%, p<.001), Black (18.9% vs. 12.2%), and Hispanic (11.8% vs. 3.7%, p=.001) veterans comprised the younger cohort. Employment differed (p<.001) with older veterans retired (78.2% vs. 14.2%) and younger veterans employed (59% vs. 16.5%). About 14% lived rurally and period of military service was similar. Pain profiles were similar between younger and older veterans for >5 years duration (78.4% vs. 73.4%), high-impact chronic pain (64.5% vs. 62.2%), mean pain interference [63.8(4.8) vs. 63.2(5.0)], and mean back-related disability (primary outcome) [11.9(5.2) vs. 13.3(4.9)]. Younger veterans scored significantly higher than older veterans for depression (44.8% vs. 31.4%, p=.001), anxiety (41.5% vs. 20.7%, p<.001), post-traumatic stress (38.4% vs. 17.6%, p<.001), sleep disturbance (57.1% vs. 34.6%, p<.001), and high-risk alcohol use (25.4% vs. 18.1%, p=.05). Previous chiropractic use was similar (younger 75.4% vs. older 80.3%). Medications in past 3 months differed with younger veterans reporting cannabis (25.8% vs. 12.8%, p<.001) and muscle relaxants (31.7% vs. 17.6%, p<.001) and more older veterans reporting acetaminophen (63.3% vs. 49.3%, p<.001) and gabapentin (34% vs. 20.1%, p<.001). NSAIDs use was highest among both younger (62.8%) and older (56.9%) veterans. While two-thirds had tried exercise in the past 3 months, only 16% reported exercising for their pain condition, with older veterans more likely to report providers encouraging physical activity. Conclusions: Similar pain profiles were reported among older and younger veterans seeking chiropractic care for CLBP within a clinical trial. However, potentially important age differences were noted in demographics, mental health and substance use, and CLBP treatments. Trial registration: ClinicalTrials.gov: NCT04087291. Date of Registration: 9/12/2019. Enrollment Duration: 2/22/2021 (first participant enrolled) through 5/10/2024 (last participant enrolled).