Effects of Race on Chronic Pain in a Randomized Clinical Trial of Integrative Medical Group Visits for Chronic Pain and Depression

Abstract

Chronic pain is one of the most common reasons adults seek medical care in the US, with estimates of prevalence ranging from 11% to 40% and relatively higher rates in diverse populations. Mindfulness meditation has been associated with significant improvements in pain, depression, physical and mental health, sleep, and overall quality of life. Group medical visits are increasingly common and are effective at treating myriad illnesses including chronic pain. Integrative Medical Group Visits (IMGV) combine mindfulness techniques, evidence based integrative medicine, and medical group visits and can be used as adjuncts to medications, particularly in diverse underserved populations with limited access to non-pharmacological therapies. The objective of the present study was to assess the effects of race on the primary pain outcomes and evaluate potential relationships between race and additional patient characteristics in data from a randomized clinical trial of IMGV in socially diverse, marginalized patients suffering from chronic pain and depression. It was hypothesized that there would be racial differences in the effects of IMGV on pain outcomes. Our analyses identified significant racial differences in the response to IMGV. Black subjects had increased pain severity throughout the duration of the 21-week study but were less likely to respond to the pain intervention compared to White subjects. These results may be related to differential comorbidity rates, catastrophizing, and digital health literacy among these participant groups. To improve patient outcomes in similar studies, interactions between pain outcomes and these factors require further investigation to affect levels and trajectory of pain severity and enhance the response to complimentary interventions.

Competing Interest Statement

The authors have declared no competing interest.

Clinical Trial

NCT02262377

Funding Statement

NCT from clinicaltrials.gov: 02262377 This research was funded through a Patient-Centered Outcomes Research Institute (PCORI) Award AD- 1304-6218.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The study was approved by the Boston University Medical Campus Institutional Review Board (IRB) and the community health centers (CHC) research committees (IRB Approval Number: H33096). We registered this randomized controlled trial (RCT) in the international trial register [ClinicalTrials.gov: Identifier NCT02262377].

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

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Data Availability

Correspondence concerning this article should be directed to Paula Gardiner.

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