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J Altern Complement Med. 2019 Jul;25(7):719-726. doi: 10.1089/acm.2019.0074.

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

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1Department of Psychiatry, University of California, San Francisco, San Francisco, CA.
2Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.
3San Francisco Department of Public Health, San Francisco, CA.
4Department of Family & Community Medicine and History, and Social Medicine, University of California, San Francisco, San Francisco, CA.
5Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA.
6Osher Center for Integrative Medicine, University of California, San Francisco, San Francisco, CA.
7Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA.


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.


biopsychosocial; chronic pain; integrative medicine; multidisciplinary pain management; primary care; underserved populations; vulnerable populations

[Available on 2020-07-01]

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