BRIDGING THE GAP IN CHRONIC PAIN CARE: THE ROLE OF INTEGRATED BEHAVIORAL HEALTH

Abstract

Chronic pain remains predominantly managed through medication-centered approaches despite decades of biopsychosocial pain science supporting multimodal care. This dissertation investigates the integration of behavioral health within rural primary care as a strategy to address this gap. A retrospective chart review (n = 120) at a rural Federally Qualified Health Center reveals low rates of behavioral health referral (6.7%), minimal documentation of psychosocial contributors (6.8%), and infrequent mental health screening, alongside widespread pharmacological treatment. A subsequent randomized study (n = 103) found that a brief psychoeducation intervention delivered by a Medical Family Therapist was linked to patients’ intention to pursue behavioral health services and biopsychosocial pain beliefs, particularly when accompanied by provider endorsement. The final chapter translates these findings into policy recommendations designed to realign reimbursement, accreditation, and regulatory structures with contemporary pain science. Collectively, the findings suggest that medication-centered chronic pain management reflects structural policy misalignment rather than insufficient scientific evidence, highlighting the need for systems-level reform in primary care.