Skip to main content
Patient-Centered Outcomes Research Institute
Patient-Centered Outcomes Research Institute
  • Blog
  • Newsroom
  • Find It Fast
  • Help Center
  • Subscribe
  • Careers
  • Contact Us

PCORI

Patient-Centered Outcomes Research Institute

Search form

  • About Us
    Close mega-menu

    About Us

    • Our Programs
    • Governance
    • Financials and Reports
    • Procurement Opportunities
    • Our Staff
    • Our Vision & Mission
    • Contact Us

    Fact Sheets: Learn More About PCORI

    Download fact sheets about out work, the research we fund, and our programs and initiatives.

    Find It Fast

    Browse through an alphabetical list of frequently accessed and searched terms for information and resources.

    Subscribe to PCORI Email Alerts

    Sign up for weekly emails to stay current on the latest results of our funded projects, and more.

  • Research & Results
    Close mega-menu

    Research & Results

    • Explore Our Portfolio
    • Research Fundamentals
    • Research Results Highlights
    • Putting Evidence to Work
    • Peer Review
    • Evidence Synthesis
    • About Our Research

    Evidence Updates from PCORI-Funded Studies

    These updates capture highlights of findings from systematic reviews and our funded research studies.

    Journal Articles About Our Funded Research

    Browse through a collection of journal publications that provides insights into PCORI-funded work.

    Explore Our Portfolio of Funded Projects

    Find out about projects based on the health conditions they focus on, the state they are in, and if they have results.

  • Topics
    Close mega-menu

    Topics

    • Addressing Disparities
    • Arthritis
    • Asthma
    • Cancer
    • Cardiovascular Disease
    • Children's Health
    • Community Health Workers
    • COVID-19
    • Dementia and Cognitive Impairment
    • Diabetes
    • Kidney Disease
    • Medicaid
    • Men's Health
    • Mental and Behavioral Health
    • Minority Mental Health
    • Multiple Chronic Conditions
    • Multiple Sclerosis
    • Obesity
    • Older Adults' Health
    • Pain Care and Opioids
    • Rare Diseases
    • Rural Health
    • Shared Decision Making
    • Telehealth
    • Transitional Care
    • Veterans Health
    • Women's Health

    Featured Topic: Women's Health

    Learn more about the projects we support on conditions that specifically or more often affect women.

  • Engagement
    Close mega-menu

    Engagement

    • The Value of Engagement
    • Engagement in Health Research Literature Explorer
    • Influencing the Culture of Research
    • Engagement Awards
    • Engagement Resources
    • Engage with Us

    Engagement Tools and Resources for Research

    This searchable peer-to-peer repository includes resources that can inform future work in patient-centered outcomes research.

    Explore Engagement in Health Literature

    This tool enables searching for published articles about engagement in health research.

    Research Fundamentals: A New On-Demand Training

    It enables those new to health research or patient-centered research to learn more about the research process.

  • Funding Opportunities
    Close mega-menu

    Funding Opportunities

    • What & Who We Fund
    • What You Need to Know to Apply
    • Applicant Training
    • Merit Review
    • Awardee Resources
    • Help Center

    PCORI Funding Opportunities

    View and learn about the newly opened funding announcements and the upcoming PFAs in 2021.

    Tips for Submitting a Responsive LOI

    Find out what PCORI looks for in a letter of intent (LOI) along with other helpful tips.

    PCORI Awardee Resources

    These resources can help awardees in complying with the terms and conditions of their contract.

  • Meetings & Events
    Close mega-menu

    Meetings & Events

    • Upcoming
    • Past Events

    January 2021 Board of Governors Meeting

    The Board approved funding for a new research study relating to kidney health and a new funding allocation for PCORnet. Learn more

    Confronting COVID-19: A Webinar Series

    Learn more about the series and access recordings and summary reports of all six sessions.

    2020 PCORI Annual Meeting

    Watch recordings of all sessions, and view titles and descriptions of the posters presented at the virtual meeting.

You are here

  • Research & Results
  • Explore Our Portfolio
  • Do Group Medical Visits with a Focus ...

This project has results

Do Group Medical Visits with a Focus on Mind and Body Help Patients with Chronic Pain and Symptoms of Depression?

Sign Up for Updates to This Study  

Results Summary and Professional Abstract

Results Summary

Results Summary

Download Summary Español (pdf) Audio Recording (mp3)

What was the research about?

Chronic pain lasts for months or years. People who have chronic pain often also have depression. Usual care for chronic pain and depression is mainly using medicines to treat symptoms.

In this study, the research team wanted to know if a group medical visit program with a focus on mind and body care would help patients with chronic pain and depression symptoms. During nine weekly group visits with a doctor, patients in the program learned about their health issues and ways to calm their minds and bodies using mindfulness and meditation. Patients in the program also received a computer tablet with lessons and an interactive feature to use at home. Patients who took part in the program continued to receive usual care from their primary care doctors, including treatment with medicines if needed.

The research team compared patients in the group medical visit program with patients who had usual care only.

What were the results?

During the course of the study, patients in the program and patients who had usual care only didn’t differ in their responses to surveys about their

  • Pain symptoms
  • Symptoms of depression
  • Stress levels
  • Sleep quality
  • Misuse of pain medicines

Compared with patients who had usual care only, patients in the program

  • Were less likely to use any pain medicines, including opioids
  • Had better quality of life related to mental health
  • Had worse quality of life related to physical health, but this difference may be explained by the number of patients in the program who had low back pain

At the time the group visits ended, patients in the program had fewer visits to the emergency room, or ER, compared with patients who had usual care only, but the two groups didn’t differ by the end of the study.

Who was in the study?

The study included 159 patients with chronic pain and depression symptoms. Patients received care at three health clinics serving low-income neighborhoods in Boston, Massachusetts. Of these patients, 56 percent were black, 30 percent were unknown race, 19 percent were white, and 6 percent were multiple races; 14 percent were Hispanic. The average age was 51, and 86 percent were women. In addition, 63 percent had a yearly income of less than $30,000.

What did the research team do?

The research team assigned patients, by chance, to be in the group medical visit program or to receive usual care only. The group medical visits were in person and lasted for two and a half hours.

Patients completed surveys when the study began and then again 9 weeks and 21 weeks later. The research team also looked at patients’ health records.

A group of patients gave input throughout the study.

What were the limits of the study?

Not everyone in the group medical visit program went to all of the visits. The results may have differed if more patients went to all of the visits. This study included patients in only one city. Results may differ in other locations or settings.

How can people use the results?

Health centers can use the results when considering how to help patients with chronic pain and depression reduce their use of pain medicines and ER visits.

Professional Abstract

Professional Abstract

Objective

To compare the effectiveness of an integrative medical group visit (IMGV) intervention with a control group in reducing pain and depressive symptoms for patients with chronic pain who live in low-income neighborhoods

Study Design

Design Element Description
Design Randomized controlled trial
Population 159 patients with chronic pain and depressive symptoms who live in low-income neighborhoods
Interventions/
Comparators
  • IMGV intervention, which included group medical visits incorporating evidence-based integrative medicine and training in mindfulness techniques
  • Usual care only, in which researchers asked patients to have at least one individual office visit with a primary care clinician during the study period to receive usual care for chronic pain and depressive symptoms
Outcomes

Primary: pain, depressive symptoms

Secondary: pain medication use, mental and physical health–related quality of life, ED visits, pain self-efficacy, patient-perceived stress, sleep quality, risk of opioid misuse, patient activation

Timeframe 21-week follow-up for primary outcomes

This single-blind randomized controlled trial compared an IMGV intervention with usual primary care for patients with chronic pain who live in low-income neighborhoods to reduce pain and depressive symptoms and to increase their ability to manage pain.

Researchers randomly assigned patients to the IMGV group or to usual care only. The IMGV intervention included nine weekly, 2.5-hour, in-person group sessions with a physician facilitator that covered topics such as chronic pain, stress, insomnia, depression, and nutrition. Participants practiced mindfulness techniques, including meditation and chair yoga. They also received a computer tablet that had an e-health platform with an interactive component to support continued learning. Patients in both groups continued to receive usual care for chronic pain and depression, including pain medication if prescribed.

The study included 159 patients with self-reported chronic pain and depressive symptoms receiving care from two federally qualified health centers and one ambulatory clinic in an urban Boston, Massachusetts hospital. Of these, 56% were black, 30% were unknown race, 19% were white, and 6% were multiple races; 14% were Hispanic. The average age was 51, 86% were female, and 63% reported an annual income under $30,000.

Participants completed a survey at baseline, at 9 weeks when the group visits ended, and at 21 weeks when the maintenance phase ended. Researchers also reviewed medical records for emergency department (ED) visits.

A patient advisory group provided feedback throughout the study.

Results

In the quantitative analyses of survey results, the IMGV group and the control group did not show significantly different changes in self-reports of average pain in the past seven days or depressive symptoms.

Compared with the control group, the IMGV group

  • Was less likely to use pain medication at the end of the study (odds ratio=0.42; 95% confidence interval [CI]: 0.18, 0.98)
  • Showed a greater increase in mental health–related quality of life at the end of the study (relative risk [RR]=1.07; 95% CI: 1.01, 1.12)
  • Had a greater decrease in physical health–related quality of life at the end of the study (RR=0.85; 95% CI: 0.77, 0.97), but this difference was no longer significant after controlling for low back pain
  • Had a greater decrease in ED visits when weekly group visits ended (RR=0.31; 95% CI: 0.12, 0.83) but not at the end of the study

The two groups did not differ significantly on survey measures of pain self-efficacy, perceived stress, sleep quality, risk of opioid misuse, or patient activation.

Limitations

Some participants in the IMGV group did not attend all group sessions, which may have affected the effectiveness of the intervention. The study included patients from three health clinics in one city, limiting the generalizability of findings to other settings and locations.

Conclusions and Relevance

The IMGV intervention was not more effective than usual care at reducing pain and depressive symptoms for patients with chronic pain. It did provide some benefits, however, including greater reductions in pain medication use and ED visits.

Future Research Needs

Future studies could find ways to encourage attendance at all group sessions or could examine other ways to reduce pain and depression for patients with chronic pain.

Final Research Report

View this project's final research report.

Journal Articles

Results of This Project

PLoS One

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

Related Articles

Explore: The Journal of Science & Healing

Lessons Learned and Strategies for Recruitment of Diverse, Low-income Patients into an Integrative Medical Group Visit Clinical Trial

Complementary Therapies in Medicine

Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies

Journal of Alternative and Complementary Medicine

The Latino Integrative Medical Group Visit as a Model for Pain Reduction in Underserved Spanish Speakers

Contemporary Clinical Trials

Design of the integrative medical group visits randomized control trial for underserved patients with chronic pain and depression

More on this Project  

Videos

Chronic Pain Treatment without Opioids
This research project explores nonpharmacological alternatives for managing pain to help patients in low-income areas.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented, and the researchers made changes or provided responses. The comments and responses included the following:

  • The reviewers said that the report was unclear on whether the per-protocol analyses were preplanned, and what reported analyses were exploratory. This affected the reviewers’ comfort with the study’s original conclusions regarding the success of the integrated medical group visits (IMGV) compared to standard primary care visits. The researchers revised their analyses descriptions to specify what was pre-planned and what was exploratory. The researchers noted that they conducted much of the exploratory analyses based on the advice of patient and scientific advisors. The researchers also tempered their conclusions regarding the success of the IMGV since there was no significant difference in primary outcomes between the two treatment arms.
  • Reviewers commented that it was unclear whether different components of the IMGV intervention, including mindfulness techniques and group visits, were meant to work independently, additively, or synergistically. The researchers replied that Figure 2 demonstrates the proposed mechanism of how different aspects of the intervention work, but the study was not designed to assess how well individual components work or whether they work in synergy.
  • Reviewers noted that the study provided no information on the range of treatmentsthe usual care participants received and suggested that without better-defined mechanisms for treatment components, any differences observed could be due to the amount of attention participants received in the study. The researchers agreed that they did not collect important information on the control group, such as time spent with clinicians. They expanded on this in the limitations section.
  • Reviewers noted that the researchers collected several measures of intervention uptake for the IMGV group, as well as measures on use of non-pharmacological treatments in the usual care group but did not use these data in analyses to help identify reasons for the null study findings. The researchers explained that they did not factor in non-pharmacological treatment changes because so many participants in the usual care group were already using non-pharmacological treatments when they started the study.

Conflict of Interest Disclosures

View the COI disclosure form.

Project Details

Principal Investigator
Paula Gardiner, MD, MPH
Project Status
Completed; PCORI Public and Professional Abstracts, and Final Research Report Posted
Project Title
Integrative Medicine Group Visits: A Patient-Centered Approach to Reducing Chronic Pain and Depression in a Disparate Urban Population
Board Approval Date
September 2013
Project End Date
March 2019
Organization
Boston Medical Center
Year Awarded
2013
State
Massachusetts
Year Completed
2019
Project Type
Research Project
Health Conditions  
Mental/Behavioral Health
Depression
Neurological Disorders
Chronic Pain
Intervention Strategies
Complementary and Alternative Medicine
Other Clinical Interventions
Other Health Services Interventions
Technology Interventions
Training and Education Interventions
Populations
Individuals with Multiple Chronic/co-morbid Conditions
Low Health Literacy/Numeracy
Low Income
Racial/Ethnic Minorities
Urban
Women
Funding Announcement
Addressing Disparities
Project Budget
$1,929,563
DOI - Digital Object Identifier
10.25302/04.2020.AD.13046218
Study Registration Information
HSRP20143375
NCT02262377
Page Last Updated: 
May 12, 2020

About Us

  • Our Programs
  • Governance
  • Financials and Reports
  • Procurement Opportunities
  • Our Staff
  • Our Vision & Mission
  • Contact Us

Research & Results

  • Explore Our Portfolio
  • Research Fundamentals
  • Research Results Highlights
  • Putting Evidence to Work
  • Peer Review
  • Evidence Synthesis
  • About Our Research

Engagement

  • The Value of Engagement
  • Engagement in Health Research Literature Explorer
  • Influencing the Culture of Research
  • Engagement Awards
  • Engagement Resources
  • Engage with Us

Funding Opportunities

  • What & Who We Fund
  • What You Need to Know to Apply
  • Applicant Training
  • Merit Review
  • Awardee Resources
  • Help Center

Meetings & Events

January 21
Cycle 1 2021 Broad PFA Applicant Town Hall
February 2
PCORI 2021 and Beyond: Opportunities for Funding and Involvement in Patient-Centered Research
February 9
Board of Governors Meeting: February 9, 2021

PCORI

Footer contact address

Patient-Centered Outcomes
Research Institute

1828 L Street, NW, Suite 900
Washington, DC 20036
Phone: (202) 827-7700 | Fax: (202) 355-9558
[email protected]

Subscribe to Newsletter

Twitter Facebook LinkedIn Vimeo

© 2011-2021 Patient-Centered Outcomes Research Institute. All Rights Reserved.

Privacy Policy | Terms of Use | Trademark Usage Guidelines | Credits | Help Center