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The BraveNet prospective observational study on integrative medicine treatment approaches for pain

Donald I Abrams1*, Rowena Dolor2, Rhonda Roberts2, Constance Pechura3, Jeffery Dusek4, Sandi Amoils5, Steven Amoils5, Kevin Barrows1, Joel S Edman6, Joyce Frye7, Erminia Guarneri8, Ben Kligler9, Daniel Monti6, Myles Spar10 and Ruth Q Wolever11

Author affiliations

1 UCSF Osher Center for Integrative Medicine, University of California San Francisco, 1545 Divisadero Street, 4th Floor, San Francisco, CA 94115, USA

2 Duke Clinical Research Institute, Duke University Health System, Durham, NC, USA

3 Bravewell Collaborative, Minneapolis, MN, USA

4 Penny George Institute for Health and Healing, Allina Health, Minneapolis, MN, USA

5 Alliance Institute for Integrative Medicine, Cincinnati, OH, USA

6 Myrna Brind Center of Integrative Medicine, Thomas Jefferson University, Philadelphia, PA, USA

7 University of Maryland School of Medicine, Baltimore, MD, USA

8 Scripps Center for Integrative Medicine, La Jolla, CA, USA

9 Continuum Center for Health and Healing, Beth Israel Medical Center, New York, NY, USA

10 Venice Family Clinic, Venice, CA, USA

11 Duke Integrative Medicine, Duke University Health System, Durham, NC, USA

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Citation and License

BMC Complementary and Alternative Medicine 2013, 13:146  doi:10.1186/1472-6882-13-146

Published: 24 June 2013



Chronic pain affects nearly 116 million American adults at an estimated cost of up to $635 billion annually and is the No. 1 condition for which patients seek care at integrative medicine clinics. In our Study on Integrative Medicine Treatment Approaches for Pain (SIMTAP), we observed the impact of an integrative approach on chronic pain and a number of other related patient-reported outcome measures.


Our prospective, non-randomized, open-label observational evaluation was conducted over six months, at nine clinical sites. Participants received a non-standardized, personalized, multimodal approach to chronic pain. Validated instruments for pain (severity and interference levels), quality of life, mood, stress, sleep, fatigue, sense of control, overall well-being, and work productivity were completed at baseline and at six, 12, and 24 weeks. Blood was collected at baseline and week 12 for analysis of high-sensitivity C-reactive protein and 25-hydroxyvitamin D levels. Repeated-measures analysis was performed on data to assess change from baseline at 24 weeks.


Of 409 participants initially enrolled, 252 completed all follow-up visits during the 6 month evaluation. Participants were predominantly white (81%) and female (73%), with a mean age of 49.1 years (15.44) and an average of 8.0 (9.26) years of chronic pain. At baseline, 52% of patients reported symptoms consistent with depression. At 24 weeks, significantly decreased pain severity (−23%) and interference (−28%) were seen. Significant improvements in mood, stress, quality of life, fatigue, sleep and well-being were also observed. Mean 25-hydroxyvitamin D levels increased from 33.4 (17.05) ng/mL at baseline to 39.6 (16.68) ng/mL at week 12.


Among participants completing an integrative medicine program for chronic pain, significant improvements were seen in pain as well as other relevant patient-reported outcome measures.

Trial Registration, NCT01186341

Integrative medicine; Chronic pain; Patient-reported outcomes; Complementary therapies; Musculoskeletal disorders