Social Support in Group Medical Visits for Chronic Pain in Primary Care

Social support is associated with improved outcomes for people with chronic pain and is an important but understudied component of biopsychosocial pain care. We sought to explore how group medical visits facilitate 4 distinct types of social support-emotional, appraisal, informational, and instrumental-among primary care patients with chronic pain.

We collected qualitative data within a randomized trial of integrative group medical visits for chronic pain, focusing on 2 cohorts of English-speaking patients randomized to group medical visits. Data came from 16 observed group medical visits, 2 focus groups, and 12 semistructured interviews. The group medical visit intervention entailed 12 weekly sessions combining clinical care, pain education, mindfulness meditation, therapeutic movement, and facilitated discussion. We analyzed data using team-based flexible coding and codebook thematic analysis.

The 26 participating patients were predominantly low-income (80.8% had an annual household income of less than $50,000); 50.0% identified as Black or African American, 15.4% as Hispanic or Latine, and 23.1% as White. On average, they had severe pain with a mean intensity rating of 7.7 out of 10. All 4 social support types emerged through structured program components (curriculum, facilitation strategies, program structure) and interactions among peers and facilitators. Emotional support fostered belonging and countered isolation and stigma. Appraisal support normalized struggles and fostered self-compassion. Informational support combined interactive education with peer-to-peer knowledge exchange. Instrumental support provided concrete assistance.

Our findings illustrate how group medical visits for chronic pain mobilize 4 interwoven and reinforcing forms of social support as core therapeutic processes. They also highlight group medical visits as a potential model for biopsychosocial chronic pain management among primary care patients.