for people ages 18 years and up (full criteria)
at San Francisco, California
study started
estimated completion
Principal Investigator
by Maria Chao, DrPH, MPA
Headshot of Maria Chao
Maria Chao



Socioeconomically disadvantaged populations have a high prevalence of chronic pain, exacerbated by social isolation, intersectional stigma, and disparities in pain assessment and treatment options. Effective interventions using a multilevel, biopsychosocial approach are needed to decrease the unequal burden of pain. The proposed study will test group-based integrative models of pain management in primary care safety net clinics to improve pain care for racially and ethnically diverse low-income patients.

Official Title

Group-based Integrative Pain Management: A Multi-level Approach to Address Intersectional Stigma and Social Isolation in Diverse Primary Care Safety Net Patients With Chronic Pain


Background: The proposed study seeks to address chronic pain disparities in racially diverse, socioeconomically disadvantaged individuals by optimizing multimodal pain management provided in primary care safety net clinics. Multilevel barriers exist in primary care settings where socioeconomically disadvantaged patients are most often treated. Lack of access to multimodal and nonpharmacologic care at the organizational level alongside provider bias and other forms of discrimination at the interpersonal level contribute to unequal assessment, treatment, and quality of pain care. Stigmatization cross-cuts all levels and is closely linked with social isolation common among individuals with chronic pain. Group-based models are a promising multilevel approach to increase access to non-pharmacologic therapies, address time constraints that contribute to disparities in pain care, improve patient-clinician communication, and provide social support among safety net patients with chronic pain. Methods: This study uses mixed methods and a pragmatic 2x2 randomized factorial trial to test two group-based models: integrative group medical visits (IGMV) and group acupuncture. Study interventions include 12 weekly sessions based on existing protocols tested in primary care safety net settings. IGMV includes pain education, social and behavioral support, and mind-body approaches (meditation, yoga). Group acupuncture uses responsive manualization, allowing for a standardized yet individualized treatment. During phase 1 of the study, a panel of national experts and patient stakeholders will refine and optimize the structure, process, and content of IGMV aimed at reducing social isolation and intersectional stigma as part of pain management. Interventions will be piloted in 40 English or Spanish speaking patients with chronic pain at two primary care safety net clinics. Study procedures will be tested and adapted for a larger scale trial. The larger study will test the hypotheses that compared with usual care, each study intervention improves pain interference and social isolation (primary outcomes), and that the two combined have synergistic effects mediated by increased social support and decreased impact of intersectional stigma among safety net patients with chronic pain. Significance: Multilevel approaches are needed to advance health equity in pain management. The proposed study will contribute to knowledge of group-based integrative pain management co-located in primary care to address disparities in pain care for socioeconomically vulnerable populations. The study receives support from the Helping to End Addiction Long-term® (HEAL) Initiative (


Chronic Pain, health equity, integrative health, nonpharmacologic pain management, stigma, social isolation, primary care, group medical visits, group acupuncture, Integrative Group Medical Visits


You can join if…

Open to people ages 18 years and up

  • adults aged > 18
  • fluency in English or Spanish;
  • panelled to a primary care provider at one of the study clinics;
  • diagnosis of chronic pain (> 3 months);
  • had a primary care visit for chronic pain within the past six months;
  • ability to provide a phone number;
  • able to participate in groups;
  • intent to be available for up to 24 weeks.

You CAN'T join if...


  • Tom Waddell Urban Health Clinic accepting new patients
    San Francisco California 94102 United States

Lead Scientist at UCSF

  • Maria Chao, DrPH, MPA
    Maria T. Chao, DrPH, MPA is an associate professor at the University of California San Francisco’s Osher Center for Integrative Medicine and the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital.


accepting new patients
Start Date
Completion Date
University of California, San Francisco
Study Type
Expecting 40 study participants
Last Updated