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

Abstract

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.