Group-based Integrative Pain Management: A multi-level approach to address intersectional stigma and social isolation in diverse primary care safety net patients with chronic pain

基于群体的综合疼痛管理：一种多层次的方法，用于解决患有慢性疼痛的不同初级保健安全网患者的交叉耻辱和社会隔离问题

• 批准号: 10539166
• 负责人: MARIA T CHAO
• 金额: $ 162.9万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-12 至 2024-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10539166
• 关键词: Acupuncture Therapy; Address; Behavioral; COVID-19 pandemic; Caring; Clinic; Clinical; Data; Discrimination; Education; Empathy; Feeling; Guidelines; High Prevalence; Individual; Integrative Medicine; Intervention; Intervention Studies; Knowledge; Length; Link; Loneliness; Low Income Population; Low income; Mediating; Mediator of activation protein; Medical; Meditation; Mental Depression; Methods; Mind-Body Intervention; Modeling; Neighborhoods; Nonpharmacologic Therapy; Outcome; Pain; Pain Measurement; Pain intensity; Pain interference; Pain management; Pain quality; Participant; Patients; Personal Communication; Persons; Phase; Physical Function; Preparation; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Public Health; Qualitative Methods; Quasi-experiment; Randomized; Reporting; Research; Research Personnel; Resource-limited setting; Resources; San Francisco; Self Efficacy; Social isolation; Social support; Standardization; Stigmatization; Structure; Testing; Time; Urban Health; Visit; Vulnerable Populations; Yoga; base; biopsychosocial; care seeking; chronic pain; chronic pain patient; clinical care; disadvantaged population; effective intervention; ethnic diversity; evidence base; experience; health equity; improved; individualized medicine; internalized stigma; intervention effect; member; multimodality; opioid mortality; opioid overuse; pain model; pain outcome; pain relief; post intervention; prescription opioid; primary care setting; primary outcome; programs; racial diversity; racism; recruit; safety net; secondary outcome; social; social factors; social health determinants; social stigma; socioeconomic disadvantage; socioeconomics; theories; treatment as usual

PROJECT ABSTRACT Background: The proposed study seeks to address chronic pain disparities in racially diverse, socioeconomically disadvantaged individuals by optimizing multimodal pain management provided in primary care safety net clinics. Multilevel barriers exist in primary care settings where socioeconomically disadvantaged patients are most often treated. Lack of access to multimodal and nonpharmacologic care at the organizational level, and provider bias and other forms of discrimination at the interpersonal level contribute to unequal assessment, treatment, and quality of pain care. Stigmatization cross-cuts all levels and is closely linked with social isolation common among individuals with chronic pain. Group-based models are a promising multilevel approach to increase access to non-pharmacologic therapies, address time constraints that contribute to disparities in pain care, improve interpersonal communication, and provide social support among safety net patients with chronic pain. Methods: This study uses mixed methods and a pragmatic 2x2 randomized factorial trial to test two group-based models: integrative group medical visits (IGMV) and group acupuncture. The study tests the hypotheses that compared with usual care, each study intervention improves pain interference and social isolation (primary outcomes), and that the two combined have synergistic effects mediated by increased social support and decreased impact of intersectional stigma among safety net patients with chronic pain. Study interventions include 12 weekly sessions based on existing protocols tested in primary care safety net settings. IGMV includes pain education, social and behavioral support, and mind-body approaches (meditation, yoga). Group acupuncture uses responsive manualization, allowing for a standardized yet individualized treatment. During the R61 phase, a panel of national experts and patient stakeholders will refine and optimize the structure, process, and content of IGMV aimed at reducing social isolation and intersectional stigma as part of pain management. Interventions will be piloted in 40 English or Spanish speaking patients with chronic pain at two primary care safety net clinics. Study procedures will be tested and adapted for a larger scale trial. In the R33 phase, 360 participants will be recruited from two safety net clinics and randomized to IGMV, group acupuncture, both, or neither. Aim 1 is to determine the effects of study interventions on pain-related outcomes (primary outcomes: pain interference and social isolation). Aim 2 tests social support and stigma as intervention mediators. Aim 3 examines patient experiences with pain management, patient-clinician relationships, and clinical care in primary care safety net settings using qualitative methods. Significance: Multilevel approaches are need to advance health equity in pain management. The proposed study will contribute to knowledge of group-based integrative pain management co-located in primary care to address disparities in pain care for socioeconomically vulnerable populations.

项目摘要 背景：拟议的研究旨在解决种族多种多样的慢性疼痛差异， 通过优化初级提供的多模式疼痛管理，社会经济处境不利的人 护理安全网诊所。多层次障碍存在于社会经济处境不利的初级保健环境中 患者经常接受治疗。在组织中无法获得多模式和非药物护理 级别，提供者的偏见和其他形式的人际关系级别的歧视有助于不平等 疼痛护理的评估，治疗和质量。污名交叉切割所有级别，并与 社会隔离在患有慢性疼痛的个体中常见。基于小组的模型是一个有前途的多层次 增加获得非药物疗法的方法的方法，解决有助于的时间限制 疼痛护理的差异，改善人际交往并在安全网中提供社会支持 慢性疼痛的患者。方法：本研究使用混合方法和务实的2x2随机 测试两个基于小组的模型的阶乘试验：集成小组医疗访问（IGMV）和组针灸。 该研究检验了与通常护理相比的假设，每种研究干预都会改善疼痛 干扰和社会隔离（主要结果），并且两个组合具有协同作用 由安全网患者中社会支持增加和交叉污名的影响减少所介导的 慢性疼痛。研究干预措施包括基于在初级测试的现有协议的每周课程 护理安全网设置。 IGMV包括疼痛教育，社会和行为支持以及心身 方法（冥想，瑜伽）。小组针灸使用响应式手动化，允许标准化 但是个性化的治疗。在R61阶段，由国家专家和患者利益相关者组成的小组 完善并优化IGMV的结构，过程和内容，旨在减少社会隔离和 交叉污名作为疼痛管理的一部分。干预措施将以40英语或西班牙语进行试验 在两个初级保健安全网诊所中慢性疼痛患者。研究程序将进行测试， 适用于大规模试验。在R33阶段，将从两个安全网诊所招募360名参与者 并随机分配给IgMV，组针灸，或两者都不是。目标1是确定研究的影响 与疼痛相关结果的干预措施（主要结果：疼痛干扰和社会隔离）。 AIM 2测试 社会支持和污名作为干预调解人。 AIM 3检查患者疼痛的经历 管理，患者 - 俗人的关系和初级保健安全网中的临床护理使用 定性方法。意义：多级方法需要提高痛苦健康公平 管理。拟议的研究将有助于基于群体的综合疼痛管理的知识 在初级保健中共同确定，以解决社会经济脆弱人群的疼痛护理差异。