This pilot study examines referral and documentation practices for chronic pain management in a rural Federally Qualified Health Center (FQHC). Although nonpharmacological treatments like behavioral health interventions are effective, they are often underutilized in primary care. A retrospective chart review of 120 adult patients with chronic pain was conducted to analyze referrals, mental health screening rates, and provider documentation. Findings revealed that referrals to behavioral health were rare, and psychosocial factors were seldom documented. However, patients seen by Medical Family Therapists (MedFTs) were significantly more likely to receive mental health screenings. These results highlight missed opportunities for integrated care and suggest the need for improved training and systems to support biopsychosocial approaches to chronic pain.

Abstract

Chronic pain affects over 50 million adults in the United States and contributes to significant physical, emotional, and financial burdens. Although psychological interventions such as cognitive behavioral therapy and acceptance and commitment therapy are supported by evidence as effective treatments, they remain underutilized in primary care settings. This pilot study examined referral patterns and documentation practices related to chronic pain management within a rural Federally Qualified Health Center (FQHC). A retrospective chart review was conducted on 120 adult patients (mean age = 56.2; 70% female) diagnosed with chronic pain between January 2023 and April 2024. The racially and ethnically diverse sample included 43.3% Black, 26.7% White, and 24.2% Hispanic participants, most of whom were low-income. Data extracted from electronic medical records included demographics, pain diagnoses, pain severity (Numeric Pain Rating Scale), prescriptions, referrals to behavioral health, and mental health screenings (PHQ-9 and GAD-7). Provider notes were qualitatively analyzed to assess whether psychosocial factors were considered in treatment planning. Descriptive statistics were used to summarize sample characteristics and referral patterns. Chi-square tests examined associations between mental health screenings, referral activity, and involvement of Medical Family Therapists (MedFTs), while Spearman correlations explored relationships between pain severity, depression, and anxiety scores. Results showed that only 6.7% of patients were referred to behavioral health services, and 93.2% of provider notes did not mention psychosocial factors. Patients seen by MedFTs were significantly more likely to have PHQ-9 and GAD-7 scores documented during visits (χ² = 37.17 and 42.12, respectively; p < .001). A significant positive correlation was found between PHQ-9 scores and pain severity among patients with nonzero depression scores (rs = .68, p = .031). These findings highlight a persistent biomedical focus in chronic pain treatment and suggest missed opportunities for integrated, biopsychosocial care. Enhancing provider training, documentation practices, and referral systems may improve access to nonpharmacological interventions and support more comprehensive chronic pain management in primary care.