Department of Family Medicine and Community Health; Center for Integrated Primary Care
Alternative and Complementary Medicine | Integrative Medicine | Mental Disorders | Movement and Mind-Body Therapies | Pain Management | Pathological Conditions, Signs and Symptoms | Psychiatry and Psychology | Therapeutics
BACKGROUND: Current treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies.
OBJECTIVE: Determine the effectiveness of IMGV compared to a Primary Care Provider (PCP) visit in patients with chronic pain and depression.
DESIGN: 9-week single-blind randomized control trial with a 12-week maintenance phase (intervention-medical groups; control-primary care provider visit).
SETTING: Academic tertiary safety-net hospital and 2 affiliated federally-qualified community health centers.
PARTICIPANTS: 159 predominantly low income racially diverse adults with nonspecific chronic pain and depressive symptoms.
INTERVENTIONS: IMGV intervention- 9 weekly 2.5 hour in person IMGV sessions, 12 weeks on-line platform access followed by a final IMGV at 21 weeks.
MEASUREMENTS: Data collected at baseline, 9, and 21 weeks included primary outcomes depressive symptoms (Patient Health Questionnaire 9), pain (Brief Pain Inventory). Secondary outcomes included pain medication use and utilization.
RESULTS: There were no differences in pain or depression at any time point. At 9 weeks, the IMGV group had fewer emergency department visits (RR 0.32, 95% CI: 0.12, 0.83) compared to controls. At 21 weeks, the IMGV group reported reduction in pain medication use (Odds Ratio: 0.42, CI: 0.18-0.98) compared to controls.
LIMITATIONS: Absence of treatment assignment concealment for patients and disproportionate group attendance in IMGV.
CONCLUSION: Results demonstrate that low-income racially diverse patients will attend medical group visits that focus on non-pharmacological techniques, however, in the attention to treat analysis there was no difference in average pain levels between the intervention and the control group.
TRIAL REGISTRATION: clinicaltrials.gov NCT02262377.
Pain management, Opioids, Patients, Depression, Critical care and emergency medicine, Primary care, Quality of life, Randomized controlled trials
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Copyright: © 2019 Gardiner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
DOI of Published Version
PLoS One. 2019 Dec 18;14(12):e0225540. doi: 10.1371/journal.pone.0225540. eCollection 2019. Link to article on publisher's site
Gardiner P, Luo M, D'Amico S, Gergen-Barnett K, White LF, Saper R, Mitchell S, Liebschutz JM. (2019). Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial. Open Access Articles. https://doi.org/10.1371/journal.pone.0225540. Retrieved from https://escholarship.umassmed.edu/oapubs/4102
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This work is licensed under a Creative Commons Attribution 4.0 License.
Alternative and Complementary Medicine Commons, Integrative Medicine Commons, Mental Disorders Commons, Movement and Mind-Body Therapies Commons, Pain Management Commons, Pathological Conditions, Signs and Symptoms Commons, Therapeutics Commons