Results Summary

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.

Final Research Report

View this project's final research report.

Stories and Videos

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

Project Information

Paula Gardiner, MD, MPH
Boston Medical Center
$1,929,454 *
Integrative Medicine Group Visits: A Patient-Centered Approach to Reducing Chronic Pain and Depression in a Disparate Urban Population

Key Dates

September 2013
March 2019

Study Registration Information

Final Research Report

View this project's final research report.

Journal Articles


Has Results
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Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
Populations Populations PCORI is interested in research that seeks to better understand how different clinical and health system options work for different people. These populations are frequently studied in our portfolio or identified as being of interest by our stakeholders. View Glossary
Intervention Strategy Intervention Strategies PCORI funds comparative clinical effectiveness research (CER) studies that compare two or more options or approaches to health care, or that compare different ways of delivering or receiving care. View Glossary
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Last updated: October 18, 2023