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Pain Care on a New Track: Complementary Therapies in the Safety Net

Emily Hurstak and Margot Kushel, UCSF and the Zuckerberg San Francisco General Hospital

As an alternative to opioids, community clinics are treating chronic pain with multidisciplinary care, including complementary and alternative medicine.

A tramway junction set in cobblestones.

This paper presents strategies that community health centers can use to provide multidisciplinary treatment for chronic pain. As an alternative to treatment with opioids, such programs combine medical therapy, behavioral therapy, physical reconditioning, complementary and alternative medicine, and self-management education in a comprehensive approach.

Funding and resource limitations have made multidisciplinary treatment difficult to access in safety-net settings. This paper reviews strategies some community health centers are using to overcome these challenges:

  • Shared medical appointments (also called group medical visits) allow providers to deliver multidisciplinary pain treatment while emphasizing community building and self-management skills.
  • Team-based models integrate medical care, mental health, and substance use treatment services for chronic pain.
  • Integrative medicine services, which can include acupuncture, massage therapy, and physical movement classes, offer patients nonopioid options to manage chronic pain.
  • Buprenorphine, available for both addiction treatment and chronic pain, is a safer alternative than opioids for patients at risk of negative outcomes from high-dose, long-term opioid use.

Evaluation data, though limited, suggest that such multidisciplinary pain management strategies may not only improve treatment of pain but also reduce opioid reliance in safety-net clinical settings. This paper examines a variety of care and payment models used in community health centers.

The full report is available as a Document Download.

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