Acupuncture for Chronic Pain

Chronic pain is a significant public health problem, associated with impairments of physical
and psychological functioning. While a third or more of the general population may suffer
from chronic pain, it is often under recognized and under treated in health care settings.
Low income and minority samples experience disparities in the prevalence of chronic pain, in
perceived access to effective pain treatment, and in consultations for pain. A great deal of
literature suggests that acupuncture offers potential benefit in the management of chronic
pain, but it is rarely available to low income patients. The Acupuncture to Decrease
Disparities in Outcomes of Pain Treatment (ADDOPT) project will introduce and evaluate the
addition of acupuncture to the management of chronic pain for ethnically diverse, low-income
primary care patients. The project represents a collaboration between the New York City
Research and Improvement Networking Group (NYC RING), a practice-based research network
dedicated to decreasing health disparities through primary care research, the Continuum
Center for Health and Healing,The Swedish Institute School of Acupuncture, and Pacific
College of Oriental Medicine. Our intervention will involve addition of weekly acupuncture
sessions at 3 urban primary care practices. During training sessions at each practice,
primary care providers will become familiar with acupuncture and indications for referral.
Patients will be eligible if they experience chronic pain due to neck pain, back pain, or
osteoarthritis. Our process evaluation, guided by Glasgow's REAIM framework, will assess
barriers to implementation and adoption of the intervention in busy urban practices and
acceptability to patients and providers. The investigators will employ a quasiexperimental
design to assess primary outcomes (pain and quality of life) and obtain preliminary
estimates of secondary outcomes (health care utilization and costs) of the intervention at
each health center. This design will permit comparison across sites to discern practice
level differences in uptake and outcomes.