The BraveNet prospective observational study on integrative medicine treatment approaches for pain

Abstract

BackgroundChronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures.MethodsOur prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks.ResultsOf 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12.ConclusionsAmong participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures.Trial RegistrationClinicalTrials.gov, NCT01186341

A closer look: Alternative pain management practices by heart failure patients with chronic pain

“…People with chronic pain who have been referred to integrative medicine and/or palliative care report significant reductions in pain intensity and interference with function, depressive symptoms, stress, and fatigue, and significant improvement in quality of sleep. 26 Initiation of treatments to reduce burdensome symptoms might assist people with chronic HF to improve their overall self-management, reduce symptom exacerbations, reduce re-hospitalizations, and improve their quality of life.…”

“…Pain relieving effects of analgesics and/or co-analgesics are generally enhanced when evidence-based alternative pain treatments are included in the pain treatment regimen. 26 People with HF and chronic pain frequently experience additional burdensome symptoms that include depressive symptoms, 10 anxiety, 27 and fatigue. 10 The unique contribution of pain to depressive symptoms, anxiety, and fatigue in people with HF is unclear, but pain reduction is likely to reduce overall symptom burden for people with HF and might also reduce co-morbid symptoms.…”

Complementary medicine and chronic pain management

“…Ainsi, les médecines complémentaires ne prendraient pas leur place dans une médecine intégrative de façon aléatoire ou fonction de preuves d'efficacité sur tel ou tel symptôme comme il est proposé dans la littérature [35][36][37] mais dans un cadre thérapeutique permettant au patient de recontextualiser les ressentis sensitivo-émotionnels de façon positive à l'aide d'un programme thérapeutique centré sur le patient, où sans doute l'éducation thérapeutique (ETP) à un rôle majeur à jouer comme élément déclen-cheur pour l'implication du patient dans la prise en main de sa santé. Ce n'est sans doute pas un hasard si les méde-cines complémentaires utilisées dans les structures douleur sont souvent celles que le patient peut se réapproprier.…”

Integrative Medicine Patients Have High Stress, Pain, and Psychological Symptoms

“…We know that chronic-pain patients seeking IM in these same clinics have averaged 4.7 on the same scale prior to treatment. 25 For sleep quality, there is a single study available to compare with our sample. Chinese patients, older than 90 years and without dementia, averaged 5.2 on a similar scale (SD ¼ 2.…”

“…[22][23][24] BraveNet, the first IM PBRN, has conducted two studies to better understand patients seeking and receiving IM. In one study, 25 mean pain-severity scores for 252 IM chronic-pain patients decreased 23% from moderate to mild, and pain interference scores dropped 28% over six months of IM care. Also, IM treatment positively impacted other psychological outcomes.…”