BRIEF REPORT
E. Marshall Brooks, PhD; Ashley Johnson, MPH; Karissa Tu, BS; Wu-Hsun Tom Yang, ND, LAc; Sebastian T. Tong, MD, MPH
Corresponding Author: Ashley Johnson, MPH; University of Washington, Department of Family Medicine
Email: ashleyj5@uw.edu
DOI: 10.3122/jabfm.2024.240181R2
Keywords: Alaska, Chronic Pain, Community Health Services, Complementary Therapies, Idaho, Integrative Medicine, Montana, Pain Management, Practice-Based Research Networks, Primary Health Care, Public Health, Qualitative Research, Washington, Wyoming
Dates: Submitted: 05-02-2024; Revised: 09-20-2024; Accepted: 10-21-2024
Status: In production for ahead of print.
BACKGROUND: Mounting evidence supports the use of integrative pain management (IPM) in primary care settings. There is limited understanding of primary care clinicians’ experiences, recommendations, and strategies for integrating IPM into clinical care.
METHODS: In-depth interviews were conducted with clinicians who had an interest in IPM throughout 2023. Clinicians were identified through the Washington, Wyoming, Alaska, Montana, and Idaho (WWAMI) region Practice and Research Network, a practice-based research network with over 120 practices. Interviews addressed knowledge of and approaches to IPM, barriers and facilitators integrating IPM into clinical care, and recommendations for future program design. Interviews were then transcribed and subjected to thematic analysis.
RESULTS: Interviews were completed with a total of 14 clinicians, including 11 MDs, 1 PA, 1 LCSW, and 1 PharmD. Domains reported include strategies and perspectives on integrating IPM, system level improvements needed to increase access, clinical barriers to addressing chronic pain, and perceived patient level challenges. Key findings within these domains include the need for a paradigm shift in the approach to treating chronic pain, the importance of adaptability and flexibility, and challenges related to time, payment, and resource availability.
DISCUSSION: As a specialty that focuses on whole-person, comprehensive care, family medicine is uniquely situated to integrate IPM into routine practice. However, challenges related to knowledge, comfort, payment, and resource availability must first be overcome. This requires improving education on pain management in medical school and residency, increasing access to community referral networks with specialized knowledge in chronic pain, and expanding payments for non-pharmacologic and team-based care.