Group-Based Integrative Pain Management in Primary Care: A Study Protocol for Multilevel Interventions to Address Health Disparities


Author: Maria T Chao1,2, Ariana Thompson-Lastad1,3, Pamela Swedlow4, Sudha Prathikanti1,5, Wendy Hartogensis1, Folashade Wolfe-Modupe3, Jesse Wennik4

Affiliation: <sup>1</sup> Osher Center for Integrative Health, University of California, San Francisco (UCSF), San Francisco, CA, USA.

<sup>2</sup> Department of Medicine, UCSF, San Francisco, CA, USA.

<sup>3</sup> Department of Family and Community Medicine, UCSF, San Francisco, CA, USA.

<sup>4</sup> San Francisco Department of Public Health, San Francisco, CA, USA.

<sup>5</sup> Department of Psychiatry, UCSF, San Francisco, CA, USA.
Conference/Journal: Glob Adv Integr Med Health
Date published: 2024 Nov 19
Other:
 Volume ID: 13   ,  Pages: 27536130241302043   ,  Special Notes: doi: 10.1177/27536130241302043.   ,  Word Count: 284  
    Background:

Socioeconomically disadvantaged populations have a high prevalence of chronic pain, exacerbated by social isolation, intersectional stigma, and disparities in pain assessment and treatment. Effective interventions using a multilevel, biopsychosocial approach are needed to decrease the unequal burden of pain. Group-based integrative pain management in primary care safety net clinics is a promising model to improve pain care for racially and ethnically diverse low-income people.



Objective:

To describe a study protocol to test the impacts of 2 group-based models - group acupuncture and integrative group medical visits - on multilevel pain-related outcomes.



Methods:

The study uses a 2x2 factorial randomized clinical trial to test two 12 week group-based models: group acupuncture and integrative group medical visits (IGMV, with psychoeducation, mind-body approaches, and social support). English or Spanish-speaking adults with chronic pain for ≥3 months receiving care in San Francisco Department of Public Health primary care clinics are eligible for the trial. All participants will receive usual care and be randomized to group acupuncture, IGMV, both, or waitlist control. The primary outcomes are changes from baseline to 3 month follow-up in pain impact and in social support for chronic pain. Secondary outcomes include pain interference, pain intensity, depression, anxiety, quality of life, and social isolation. Data will include patient-reported outcomes, electronic health record data, and qualitative interviews, focus groups and observations to assess multilevel individual, interpersonal and organizational outcomes.



Discussion:

Multilevel approaches are needed to advance health equity in pain management. Our study contributes to knowledge of group-based integrative pain management in primary care safety net clinics to address multilevel barriers and disparities in pain care.



Keywords: acupuncture; biopsychosocial model; chronic pain; group medical visits; integrative health equity; multimodal pain management; pain disparities; primary care.



PMID: 39568795 PMCID: PMC11577469 DOI: 10.1177/27536130241302043