Living with chronic pain: Evaluating patient experiences with a medical group visit focused on mindfulness and non-pharmacological strategies.


Author: Lestoquoy AS1, Laird LD2, Mitchell S2, Gergen-Barnett K1, Negash NL1, McCue K1, Enad R1, Gardiner P3

Affiliation: <sup>1</sup>Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA.

<sup>2</sup>Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA.

<sup>3</sup>Department of Family Medicine, Boston Medical Center, Dowling 5 South, 1 Boston Medical Center Place, Boston, MA 02118, USA; Boston University School of Medicine, 72 E Concord St, Boston, MA 02118, USA. Electronic address: paula.gardiner@bmc.org.
Conference/Journal: Complement Ther Med.
Date published: 2017 Dec
Other:
 Volume ID: 35   ,  Pages: 33-38   ,  Special Notes: doi: 10.1016/j.ctim.2017.09.002. Epub  2017 Sep 12.   ,  Word Count: 271  
    OBJECTIVES: Little is known about the acceptance of non-pharmacological group strategies delivered to low income racially diverse patients with chronic pain and depression. This paper examines how the Integrative Medical Group Visit (IMGV) addresses many of the deficits identified with usual care.



DESIGN AND SETTING: Six IMGVs cohorts were held at a safety net hospital and two federally funded community health centres. Data was gathered through focus groups. Transcripts were analysed using both a priori codes and inductive coding.



INTERVENTION: The intervention included ten sessions of Integrative Medical Group Visits with a primary care provider and a meditation instructor. The curriculum uses principles of Mindfulness Based Stress Reduction and evidence based integrative medicine. The visit is structured similarly to other group medical visits.



MAIN OUTCOME MEASURES: Data was gathered through four focus groups held after the cohorts were completed.



RESULTS: Participants (N=20) were largely low income minority adults with chronic pain and comorbid depression. Six themes emerged from the coding including: chronic pain is isolating; group treatment contributes to better coping with pain; loss of control and autonomy because of the unpredictability of pain as well as dependence on medication and frequent medical appointments; groups improve agency and control over one's health condition; navigating the healthcare system and unsatisfactory treatment options; and changes after the IMGV due to non-pharmacological health management.



CONCLUSIONS: The IMGV is a promising format of delivering integrative care for chronic pain and depression which addresses many of the problems identified by patients in usual care.



Copyright © 2017 Elsevier Ltd. All rights reserved.



KEYWORDS: Chronic pain; Group medical visits; Integrative medicine; Mindfulness; Shared medical appointments



PMID: 29154064  DOI: 10.1016/j.ctim.2017.09.002