{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T07:12:32Z","timestamp":1778051552417,"version":"3.51.4"},"reference-count":32,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T00:00:00Z","timestamp":1773619200000},"content-version":"vor","delay-in-days":74,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,1,1]],"date-time":"2026-01-01T00:00:00Z","timestamp":1767225600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010binomial regression. Models were adjusted for demographics and comorbidities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      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%\u00a0vs. 74.8%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 0.001) and less likely to have a specialty care visit coded for a COPC (31.8%\u00a0vs. 37.8%;\n                      <jats:italic>p<\/jats:italic>\n                      &lt; 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\u20130.92). Further, Veterans receiving care at urban clinics (RR = 0.81, 95% CI: 0.80\u20130.81) and rural clinics (RR = 0.66, 95% CI: 0.64\u20130.67) 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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Rural Veterans with COPCs may benefit from increased access to specialty pain care, which may also reduce burden on rural primary care providers.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70132","type":"journal-article","created":{"date-parts":[[2026,3,17]],"date-time":"2026-03-17T03:50:45Z","timestamp":1773719445000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Rural specialty care for Veterans with the chronic overlapping pain conditions: Fibromyalgia, migraine, or irritable bowel syndrome"],"prefix":"10.1111","volume":"42","author":[{"given":"Katherine","family":"Hadlandsmyth","sequence":"first","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"College of Nursing University of Iowa  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mary A.","family":"Driscoll","sequence":"additional","affiliation":[{"name":"Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System  West Haven Connecticut USA"},{"name":"Department of Psychiatry Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jenna L.","family":"Adamowicz","sequence":"additional","affiliation":[{"name":"Pain Research, Informatics, Multimorbidities, and Education (PRIME) Center, VA Connecticut Healthcare System  West Haven Connecticut USA"},{"name":"Department of Psychiatry Yale School of Medicine  New Haven Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lauren","family":"Garvin","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of Iowa Carver College of Medicine  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brian C.","family":"Lund","sequence":"additional","affiliation":[{"name":"VA Office of Rural Health (ORH), Veterans Rural Health Resource Center\u2010Iowa City (VRHRC\u2010IC), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Center for Access &amp; Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System  Iowa City Iowa USA"},{"name":"Department of Epidemiology University of Iowa College of Public Health  Iowa City Iowa USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2026,3,16]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2016.10.021"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/j.pain.0000000000000567"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-018-3108-8"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/milmed\/usz104"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.70014"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.genhosppsych.2021.12.002"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00392-5"},{"key":"e_1_2_7_9_1","unstructured":"IASP.Definitions of chronic pain syndromes.2024. 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