title: Integration of Complementary and Alternative Medicine Therapies into Primary-Care Pain Management for Opiate Reduction in a Rural Setting.
abstract: BACKGROUND
  Opiates are no longer considered the best strategy for the long-term management of chronic pain. Yet, physicians have made many patients dependent on them, and these patients still request treatment. Complementary and alternative medicine (CAM) therapies have been shown to be effective, but are not widely available and are not often covered by insurance or available to the medically underserved.
  
  
  METHODS
  Group medical visits (GMVs) provided education about non-pharmacological methods for pain management and taught mindfulness techniques, movement, guided imagery, relaxation training, yoga, qigong, and t'ai chi. Forty-two patients attending GMVs for at least six months were matched prospectively with patients receiving conventional care.
  
  
  RESULTS
  No one increased their dose of opiates. Seventeen people reduced their dose, and seven people stopped opiates. On a 10-point scale of pain intensity, reductions in pain ratings achieved statistical significance (p = 0.001). The average reduction was 0.19 (95% confidence interval [CI] 0.12-0.60; p = 0.01). The primary symptom improved on average by -0.42 (95% CI -0.31 to -0.93; p = 0.02) on the My Medical Outcome Profile, 2nd version. Improvement in the quality-of-life rating was statistically significant (p = 0.007) with a change of -1.42 (95% CI = -0.59 to -1.62). In conventional care, no patients reduced their opiate use, and 48.5% increased their dose over the two years of the project.
  
  
  CONCLUSIONS
  GMVs that incorporated CAM therapies helped patients reduce opiate use. While some patients found other physicians to give them the opiates they desired, those who persisted in an environment of respect and acceptance significantly reduced opiate consumption compared with patients in conventional care. While resistant to CAM therapies initially, the majority of patients came to accept and to appreciate their usefulness. GMVs were useful for incorporating non-reimbursed CAM therapies into primary medical care.
authors.affiliation: 1 Department of Research, Coyote Institute , Orono, ME.|2 Family Medicine Residency, Eastern Maine Medical Center , Bangor, ME.|3 Department of Family Medicine, University of New England College of Osteopathic Medicine , Bangor Clinical Campus, ME.|4 Department of Psychiatry, Acadia Hospital , Bangor, ME.
authors.forename: Lewis
authors.initials: L
authors.lastname: Mehl-Madrona
authors.affiliation: 5 Department of Creative Arts Therapy, Coyote Institute , Orono, ME.
authors.forename: Barbara
authors.initials: B
authors.lastname: Mainguy
authors.affiliation: 6 Department of Psychiatry, Dartmouth University School of Medicine , Hanover, NH.
authors.forename: Julie
authors.initials: J
authors.lastname: Plummer
mesh_terms: D000328:Adult; D000529:Complementary Therapies; D005260:Female; D006801:Humans; D055048:Integrative Medicine; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000628:therapy*; D019035:Rural Health Services