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


Autoři: Paula Gardiner aff001;  Man Luo aff002;  Salvatore D’Amico aff002;  Katherine Gergen-Barnett aff002;  Laura F. White aff003;  Robert Saper aff002;  Suzanne Mitchell aff002;  Jane M. Liebschutz aff004
Působiště autorů: Department of Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, United States of America aff001;  Department of Family Medicine, Boston University School of Medicine and Boston Medical Center, Boston, Massachusetts, United States of America aff002;  Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, United States of America aff003;  Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, United States of America aff004
Vyšlo v časopise: PLoS ONE 14(12)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225540

Souhrn

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.

Klíčová slova:

Critical care and emergency medicine – Depression – Opioids – Pain management – Patients – Primary care – Quality of life – Randomized controlled trials


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2019 Číslo 12