Chiropractic comes to the forefront in $1.5 million grant to help researchers address health inequities in chronic pain and depression

Chronic pain and depression often go hand in hand. Both are often exacerbated by the use of opioids that dull the pain and create addiction without solving either issue.

But now a $1.5 million grant from the National Institutes of Health’s HEAL Initiative to researchers at the Indiana University School of Medicine and Regenstrief Institute will address the issue by working to address racialized disparities in chronic pain care for Black patients with comorbid chronic pain and depression, utilizing chiropractic care, exercise, personal coaching and other non-drug interventions.

The project, Equity Using Interventions for Pain and Depression (EQUIPD), will work to address racialized disparities in chronic pain care for Black patients with comorbid chronic pain and depression. The project builds on the researchers’ previous work, funded by the Department of Veterans Affairs, which was focused on helping Black veterans who experience chronic pain become more active participants in their treatment, helping them to advocate for themselves with non-drug care such as chiropractic and other treatments they may not have thought about before.

“We want to empower minoritized patients to take more control of their chronic pain so they can effectively partner with their health care providers to manage their care,” said Marianne Matthias, PhD, senior research professor of medicine. “We want to make sure they are aware of the different options available and equip them with the tools they need to take advantage of those options collaboratively with their primary care provider.”

According to Matthias, Black patients often experience greater pain severity, worse pain outcomes, and are offered fewer treatment choices than white patients. Depressive symptoms may also interfere with a patient’s ability to engage in and maintain pain self-management activities.

The project, a two-phase study taking place at Eskenazi Hospital, will use one-on-one coaching to foster motivation, help patients clarify their treatment goals, and align these goals with nonpharmacological treatment options for pain, such as exercise or chiropractic care. Matthias said these treatment options are underused and are a helpful alternative to using opioids for chronic pain.

“This project is designed to help Black patients have more options for pain treatment, especially evidence-based, nonpharmacological treatments,” Matthias said. “We want to open up more possibilities to patients through coaching sessions focused on shared decision-making about nonpharmacological approaches to chronic pain management. Our goal is to empower patients to advocate for themselves and their preferences, then work together with their doctor to make the best decision for their particular needs, preferences and values.”

While this project is focused on the individual level, the team hopes their research will ultimately lay the groundwork for later intervention at the structural level, perhaps in clinics or health care systems. The second phase of their project will expand to a full, randomized trial of patients.

“Our goal is not just to do research,” Matthias said. “We hope to ultimately make a meaningful impact on people’s pain management and quality of life.”