Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

• DOI: 10.1371/journal.pone.0225540
• Publication Date: 2019-12-18T13:26:40Z
• Authors: Paula Gardiner; Man Luo; Salvatore D’Amico; Katherine Gergen-...; Laura F. White; Robert Saper; Suzanne Mitchell; Jane M. Liebschutz
• Keywords: Quality of life; Adult; Male; Patients; Office Visits; Science; 150; Psychiatry and Psychology; Therapeutics; Patient Health Questionnaire; Severity of Illness Index; 796; 03 medical and health sciences; Alternative and Complementary Medicine; Signs and Symptoms; 0302 clinical medicine; Humans; Pathological Conditions; Single-Blind Method; Aged; Pain Measurement; Aged, 80 and over; Academic Medical Centers; Integrative Medicine; Primary Health Care; Movement and Mind-Body Therapies; Depression; Mental Disorders; Critical care and emergency medicine; Q; R; Community Health Centers; Middle Aged; Primary care; Pain management; 3. Good health; Opioids; Randomized controlled trials; Medicine; Female; Chronic Pain; Mindfulness; Safety-net Providers; Research Article

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.Determine the effectiveness of IMGV compared to a Primary Care Provider (PCP) visit in patients with chronic pain and depression.9-week single-blind randomized control trial with a 12-week maintenance phase (intervention-medical groups; control-primary care provider visit).Academic tertiary safety-net hospital and 2 affiliated federally-qualified community health centers.159 predominantly low income racially diverse adults with nonspecific chronic pain and depressive symptoms.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.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.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.Absence of treatment assignment concealment for patients and disproportionate group attendance in IMGV.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.clinicaltrials.gov NCT02262377.