Background/Purpose: In 2018, according to the National Institute of Health, opioid misuse and addiction is a major public health issue. Approximately 70% of individuals who use opioids on a long-term basis have musculoskeletal disorders, such as low back pain, spondylosis and osteoarthritis. Additionally, one-third of patients with Rheumatoid Arthritis are prescribed an opioid to treat their condition, while one in ten use opioids chronically during their disease course. Over the last 25 years, there has been an increase in physicians prescribing opioids for chronic pain, while there is limited availability of alternatives for identifying, managing, and treating pain. To address this epidemic, Hospital for Special Surgery (HSS) implemented a Pain and Stress Management (PSM) program to improve knowledge and implementation of complementary practices as alternatives to medications.

Methods: In 2017, the PSM program was piloted to patients at the HSS Ambulatory Care Center (ACC), a low income, diverse community living with chronic musculoskeletal conditions. Reaching 122 participants, this included weekly meditation conference calls and monthly workshops with a social work-led debrief session. Participants engaged in mindful breathing techniques and meditation practices to cope with chronic pain and stress. Knowledge, self-management and program acceptability were evaluated using post surveys. As a follow-up to the survey, qualitative data was collected to obtain additional information on program effectiveness (i.e., how often participants use the learned techniques and how the techniques have helped participants cope with their pain and stress).

Results: The program was highly rated by 98% of participants. Most participants showed increase in knowledge of complementary alternative treatments (95%) and ability to apply the techniques learned to manage their pain and stress (95%). One out of three participants reported using the mindful breathing techniques 5 or more times a week in place of medication. Debrief sessions revealed that after using the techniques, participants experienced improved daily function, calmness, improved self-efficacy and state of mind, reduced pain and stress, and were less reliant on pain medication to manage their condition.

Conclusion: Results indicate that alternative approaches are effective in reducing pain and stress, and improving self-management and general well-being. Based on the success of the PSM program in the orthopedic clinic, we are expanding the program to patients of the HSS rheumatology clinic, who also rely on opioid use to cope with chronic pain, to help this population increase their knowledge and awareness of alternative approaches to manage their debilitating condition.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/complementary-practices-as-alternatives-to-pain-effectiveness-of-a-pain-management-program-for-patients-in-an-orthopedic-clinic/