A program providing group support, acupuncture, mindfulness, massage and gentle exercise may offer safe, extra relief to patients on prescription opioids, according to a study led by researchers at UC San Francisco.
The study, published Feb. 20, 2019, in the Journal of General Internal Medicine, tracked the impact of a program for low-income, at-risk patients with chronic pain at Tom Waddell Urban Health Clinic, a San Francisco Department of Public Health primary care clinic in San Francisco’s Tenderloin neighborhood. The clinic is the flagship health care site for the homeless population, and where UCSF medical students are trained and mentored.
“Opioids are often prescribed to patients with moderate-to-severe pain from chronic health conditions, or for pain following injury or surgery,” said first author Maria T. Chao, DrPH, MPA, of the UCSF Osher Center for Integrative Medicine. “Because of the potential dangers of opioid use, we wanted to see if a multimodal, non-pharmacological program could decrease pain levels and stabilize prescription opioid use in vulnerable patients with high rates of pain and barriers to care.”
The study compared 41 participants who had been on prescription drugs such as hydrocodone, oxycodone and methadone for at least three months with 20 other would-be participants who expressed interest in the program. The researchers found a 12 percent drop in pain intensity in the study participants, compared with no change in pain among the comparison group.
“In the context of the current opioid crisis, we are thrilled to be able to offer hope to those suffering from chronic pain that safer, evidence-based, effective therapies are available,” said co-author Joseph Pace, MD, Director of Primary Care Homeless Services and Medical Director of Tom Waddell Urban Health. “Chronic pain has a way of hijacking people’s lives. This study shows that even the most vulnerable can find ways to take charge of their chronic pain and have a better quality of life and that’s very exciting!”
Prescription Opioids More Lethal Than Heroin
The most notable improvement was a 22 percent boost in “pain self-efficacy,” a patient’s ability to manage and function in their daily life despite their pain, said Chao, who also works at Zuckerberg San Francisco General Hospital and Trauma Center. This compares with a decline among the control group.
After completion of the three-month program, patients continued to have access to weekly groups offering the same services. Opioid prescription use remained consistent during the program and dipped slightly three months later.
“We’re not claiming the program is a panacea to the opioid crisis,” said Chao. “We’re trying to broaden treatment options for safe pain management. Doctors, especially in primary care, are under tremendous pressure to taper opioids, but they have a limited toolbox of options to alleviate their patients’ pain.”
National drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017, according to the Centers for Disease Control and Prevention. This compares to 15,482 overdose deaths in 2017 involving heroin.
“The framework for treatment of chronic pain is a biopsychosocial model,” said senior author Barbara Wismer, MD, MPH, previously of the San Francisco Department of Public Health and the UCSF Department of Family and Community Medicine “This posits there are physical factors that lead to chronic pain, such as tissue injury, but the patient’s psychosocial state, such as thoughts, emotions and behavior contribute greatly.”
Characteristics of the 41 participants included disability (76 percent), unstable, transitional or room-rental accommodation (46 percent) and post-traumatic stress disorder (37 percent). All 41 had an annual income of less than $35,000 and many reported risks of “problematic substance use” that caused health, financial, legal or social problems.
“Treatments such as acupuncture and massage are not always available to those of lesser means,” said Chao. “We found that patients with complex lives and limited income can really benefit from this integrative approach. We are very committed to broadening these types of treatment options for all.”
Co-Authors: Emily Hurstak, MD, MPH, MAS, of UCSF; Kristina Leonoudakis-Watts, Frank Sidders and Joseph Pace, MD, of the San Francisco Department of Public Health; and Hali Hammer, MD, of UCSF and the San Francisco Department of Public Health.
Funding: Mount Zion Health Fund.
Disclosures: No conflicts of interest.
UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences; and a preeminent biomedical research enterprise. It also includes UCSF Health, which comprises three top-ranked hospitals – UCSF Medical Center and UCSF Benioff Children’s Hospitals in San Francisco and Oakland – as well as Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. UCSF faculty also provide all physician care at the public Zuckerberg San Francisco General Hospital and Trauma Center, and the SF VA Medical Center. The UCSF Fresno Medical Education Program is a major branch of the University of California, San Francisco’s School of Medicine.
About SF Department of Public Health: The mission of the San Francisco Department of Public Health (SFDPH) is to protect and promote health and wellbeing for all in San Francisco. SFDPH strives to achieve its mission through the work of two main divisions – the San Francisco Health Network and the Population Health Division. The San Francisco Health Network is a community of top-rated clinics, hospitals and programs that serves more than 100,000 people annually at sites such as Castro Mission, Chinatown, and Southeast health centers, Zuckerberg San Francisco General and Laguna Honda Hospital and Rehabilitation Center. With a broad community focus, the goal of the Population Health Division is to ensure that San Franciscans have optimal health and wellness at every stage of life. To achieve this, the Division is comprised of branches dedicated to core public health services, such as health protection and promotion, disease and injury prevention, disaster preparedness and response, and environmental health services.