Study shows holistic approach could help prevent drug-related deaths in vulnerable populations-ScienceDaily

The study, published on February 20, 2019 in the Journal of General Internal Medicine, tracked the impact of a program aimed at low-income and at-risk patients with chronic pain at the Tom Waddell Urban Health Clinic, in San Francisco's Tenderloin neighborhood, a public health facility where UCSF medical students are trained and supervised.

"Opioids are often prescribed to patients with moderate to severe pain resulting from chronic health problems or pain following an injury or surgery," said Maria T. Chao, first author of Dr. UCSF, Center for Medicine. integrative UCSF Osher. "Because of the potential dangers of opioid use, we wanted to know if a non-pharmacological multimodal program could reduce pain levels and stabilize the use of prescription opioids in vulnerable patients with high pain rates and barriers to care. "

The study compared 41 participants who took prescription medications such as hydrocodone, oxycodone and methadone for at least three months with 20 other potential participants having expressed interest in the program. The researchers found a 12% decrease in the intensity of pain in the study participants, compared to the lack of pain change in the comparison group.

Prescription opioids more deadly than heroin

The most notable improvement was a 22% increase in "self-efficacy pain," said Chao, who also works at the Zuckerberg San Francisco General Hospital and Trauma Center. This compares to a decline in the control group.

Once the three-month program was completed, patients still had access to weekly groups offering the same services. The use of opioid prescriptions remained constant over the course of the program and declined slightly three months later.

"We are not saying that the program is a panacea for the opioid crisis," said Chao. "We are trying to expand treatment options for secure pain management." Doctors, especially in primary care, are under tremendous pressure to reduce opioids, but they have a number limited options to relieve the pain of their patients. "

According to the Center for Disease Control and Prevention, the number of drug overdose deaths involving prescription opioids increased from 3,442 in 1999 to 17,029 in 2017. This compares with 15,482 overdose deaths in 2017 related to to heroin.

"The chronic pain treatment framework is a biopsychosocial model," said Barbara Wismer, senior author of the San Francisco Department of Public Health and the Department of Family and Community Medicine at UCSF. "There are physical factors that lead to chronic pain, such as tissue injury, but the psychosocial condition of the patient, such as his thoughts, emotions, and behavior greatly contributes to

The characteristics of the 41 participants included housing for the handicapped (76%), unstable, transitioning or rented room (46%) and post-traumatic stress disorder (37%). All 41 had an annual income of less than $ 35,000 and many reported risks of "problematic substance use" causing health, financial, legal or social problems.

"Treatments such as acupuncture and mbadage are not always available for people with fewer resources," said Chao. "We have found that this integrative approach can truly benefit patients with complex lives and limited income.We are very committed to expanding this type of treatment options for all."

Co-authors: Emily Hurstak, MD, MPH, MAS, UCSF; Kristina Leonoudakis-Watts, Frank Sidders and Joseph Pace, MD, San Francisco Department of Public Health; and Hali Hammer, MD, of UCSF and the San Francisco Department of Public Health.