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Pain and Spine Medicine

An Interdisciplinary Functional Integrative Restoration Group Program for Chronic Pain

Friday, October 24, 2025
12:00 PM - 1:30 PM MT
Location: Original Research Theater

    Poster Presenter(s)

  • Dylan B. Combs, MD

    Resident Physician
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Charlestown, Massachusetts

    • Co-Author(s)

  • JK

    Jennifer Kurz, MD

    Assistant Professor
    Spaulding Rehabilitation Hospital
    Natick, Massachusetts

  • ZI

    Zacharia Isaac, MD

    Division Chief, Spine Care and Pain Management
    Spaulding Rehabilitation
    Boston, Massachusetts

  • AG

    Ashley Gureck, MD

    Resident Physician
    Spaulding Rehabilitation Hospital/Harvard Medical School PM&R Program
    Boston, Massachusetts

  • Alejandra Cardenas Rojas, MD

    PM&R Resident PGY3
    Johns Hopkins University PM&R Program
    Baltimore, Maryland

  • CJ

    Carolina Jaramillo, MD

    Resident
    MassGeneral Brigham/Spaulding Rehabilitation/Harvard Medical School PM&R Program
    Boston, Massachusetts

  • DB

    Daniel S. Barron, MD, PhD

    Director Pain Intervention & Digital Research
    MassGeneralBrigham
    Lincoln, Massachusetts

  • DS

    Danielle L. Sarno, MD

    Assistant Professor of Physical Medicine & Rehabilitation
    Harvard Medical School
    Sharon, Massachusetts

Disclosure(s):
Dylan B. Combs, MD: No financial relationships to disclose
Alejandra Cardenas Rojas, MD: No financial relationships to disclose
Background and/or Objectives: Chronic pain is a leading cause of disability worldwide and often requires a multimodal approach. Evidence supports interdisciplinary programs targeting the biopsychosocial contributors to pain. The Functional Integrative Restoration (FINER) program is an 8-week group program based at a large academic institution, led by physiatrists specializing in pain care, in collaboration with physical therapists, lifestyle, integrative, and mind-body medicine specialists. The program initially comprised of virtual seminars integrating pain neuroscience, lifestyle medicine, and pain psychology. Given the promising results upon program initiation in 2020, a hybrid in-person/virtual format was trialed since 2023 to evaluate improvement of functional outcomes due to the hypothesized benefits of increased social connectivity and patient engagement.

Design: Cohort Study

Setting : Outpatient clinics

Participants : 22 patients (6M, 16F; median age 54.5, 28-76 years) with chronic back pain.

Interventions: Program Participation

Main Outcome Measures: Patient reported functional outcomes, including Pain Catastrophizing Scale (PCS), Tampa Kinesiophobia Scale (TSK), Patient-Reported Outcomes Measurement Information System-29 (PROMIS-29), Numeric Rating Scale (NRS).

Results: Mean BMI was 26.4 ± 5.86. 27% of patients had prior spine surgery, 54.5% had prior axial injections (epidural, medial branch block, RFA). 82.0% had pain >5 years. Paired t-tests/Wilcoxon-signed rank tests compared pre- and post-FINER outcomes. There were significant improvements in PCS, (MD 8.18, p=0.006), TSK (MD 7.5, p=0.001), average pain (MD 2.00, p=0.001), and the physical function (MD=2.75, p=0.026), depression (MD=4.20, p=0.028), fatigue (MD=5.94, p< 0.001), sleep disturbance (MD=4.38, p=0.01), and pain interference (MD=6.90, p=0.002) subscales of PROMIS-29. Cohen’s d was 0.658 for PCS, 0.970 for TSK, 1.160 for fatigue, and 0.827 for pain, indicating moderate, large, large, and large effects, respectively.

Conclusions: The FINER program resulted in meaningful improvement in functional outcomes and NRS, indicating efficacy of the updated format. Future directions include expansion of the study population, and use of active (patient-reported outcomes) and passive (mobility and sociability) digital measures to further characterize functional outcomes.