Integrative Pain Management in the Real World: Comparing Traditional and Alternative Approaches in a Diverse Chronic Pain Cohort

Background and/or Objectives: To evaluate how psychological distress, medication use, and access to non-pharmacologic therapies impact functional outcomes in chronic pain patients, with attention to insurance type, care barriers, and engagement with multidisciplinary pain management.

Design: Retrospective cohort study of patient-reported outcomes, psychological distress, and treatment patterns.

Setting : Outpatient pain and disability management clinic serving a diverse patient population, including workers’ compensation and traditional insurance claimants with chronic pain.

Participants : 110 adults (ages 20–70+), stratified by Workers’ Comp vs. non-Workers’ Comp insurance, representing diverse ethnicities, education, and employment, with pain lasting from under 6 months to over 3 years.

Interventions: Data included GAD-7, BDI, medication use, alternative therapy engagement, social support, and outcomes like distress, adherence, and pain management.

Main Outcome Measures: Primary outcomes included return-to-work status and time to return, serving as proxies for functional recovery. Secondary outcomes included opioid and controlled substance use, duration of pain, and reported systemic barriers to care (e.g., insurance denial, cost, provider access). Psychological burden was inferred indirectly through chronicity, opioid reliance, and work disability.

Results: Chronic pain >3 years affected 63.3% of patients. While 55.1% had prior opioid use, only a minority remained on controlled substances; 30.2% used none. Buprenorphine (8.3%), gabapentin (7.3%), and tramadol (4.2%) were the most common agents. Barriers to care were prevalent: 21% faced insurance denials, often alongside delays, costs, or provider shortages. Return-to-work rates were low—only 36.6% returned, and just 12.5% within a month. Workers’ compensation covered 56.9% of patients, underscoring the system-level obstacles and psychosocial complexity in this cohort.

Conclusions: Chronic pain care requires addressing both medical and systemic barriers. Insurance denials and administrative delays hinder timely, multimodal treatment. Functional recovery-particularly return to work—may be a more meaningful outcome than pain scores alone. Early, coordinated interventions and better navigation of insurance systems are essential. Findings support policy reforms to reduce chronicity and improve outcomes, especially in disability settings.