Vulnerable Patients' Psychosocial Experiences in a Group-Based, Integrative Pain Management Program

Abstract

Objectives: To use a psychosocial framework to examine the pain experiences of low-income, ethnically diverse patients before and after an Integrative Pain Management Program (IPMP).Design and methods: IPMP is a 12-week, multimodal pain group incorporating mindfulness, acupuncture, massage, education, movement, and health coaching. The authors conducted semistructured interviews at the beginning, end, and 3 months following completion of IPMP. Interviews were digitally recorded and transcribed and analyzed using inductive coding methods.Setting: A primary care clinic in San Francisco, CA, serving low-income, ethnically diverse patients, many of whom are marginally housed and living with disabilities.Subjects: Forty-one patients with a diagnosis of chronic pain, currently receiving prescription opioids and referred by their primary care provider, who participated in IPMP.Results: Authors thematically analyzed 104 individual interviews with 41 IPMP participants, including 41 baseline, 35 three-month follow-up, and 28 six-month follow-up. Before IPMP, participants described a psychologic ''vicious cycle'' of pain symptoms that worsened with movement and anxiety, while increasing their sense of disempowerment and social isolation. Following IPMP, patients reported using new strategies to manage pain, including lowering medication use, resulting in an emerging sense of psychologic resilience, and more social connections.Conclusions: IPMP offers an accessible model for addressing psychosocial aspects of chronic pain. Vulnerable patients engaged with integrative medicine groups and developed new perspectives and tools for managing their pain; they emerged feeling hopeful and resilient. These results support the use of integrative medicine groups for targeting psychosocial aspects of chronic pain within primary care.

Power over pain – An interprofessional approach to chronic pain: Program feedback from a medically underserved community

“…This transformation was mainly due to a better understanding of chronic pain that made cognitive reframing and de‐stigmatization possible. Our findings confirm results from a study by Bruns et al that group‐based, integrative pain management resulted in an increased sense of self‐efficacy, allowing participants to better manage and cope with pain 20 . In addition, pain education has been shown in several studies to reduce pain catastrophizing by helping patients reframe their thinking using improved understanding of pain neuroscience 35 .…”

“…This study focuses on the perspectives of black medically underserved patients with concomitant social and psychological stressors. It is well known that patients of low socioeconomic status are at higher risk of developing chronic pain and are less likely to have access to adequate treatment 1,19‐22 . Racial disparities are well documented in the healthcare system in general 19,22 and specifically in the management of chronic pain 21,23,24 .…”

“…Racial disparities are well documented in the healthcare system in general 19,22 and specifically in the management of chronic pain 21,23,24 . Social and psychological comorbidities are linked to a higher vulnerability of developing chronic pain, a more severe pain experience, and worse outcomes 1,5,6,18,20 . Although several studies have explored patients' perceptions of interprofessional chronic pain treatment programs, few have focused on perspectives of patients at an intersection of racial, economic, and psychosocial vulnerabilities 20 .…”

“…Social and psychological comorbidities are linked to a higher vulnerability of developing chronic pain, a more severe pain experience, and worse outcomes 1,5,6,18,20 . Although several studies have explored patients' perceptions of interprofessional chronic pain treatment programs, few have focused on perspectives of patients at an intersection of racial, economic, and psychosocial vulnerabilities 20 . The purpose of this article is to present the perceptions of medically underserved black patients with concomitant psychosocial stressors of an interprofessional pain management program, Power over Pain (PoP).…”

“Chasing the pain relief, not the high”: Experiences managing pain after opioid reductions among patients with HIV and a history of substance use

“…While evidence about the effectiveness of these modalities is limited compared to opioid pharmacotherapy, a systematic review of noninvasive nonpharmacological treatments for chronic pain suggests that exercise, multidisciplinary rehabilitation, acupuncture, cognitive behavioral therapy, and mind-body practices were associated with improvements in pain and function among patients with selected chronic pain conditions [9]. Nonetheless, there remain a multitude of barriers to accessing these therapies, such as insufficient insurance coverage, limited referral options, and logistical challenges [10][11][12][13]. Moreover, the CDC guidelines are focused on opioid-naïve patients and authors recently clarified that the dose limitations and related recommendations were never intended to apply to patients already maintained on long-term OPRs [14].…”