BY KAREN SPURGEON WELCH, MD, ABFM, Fellow in Integrative Medicine and Behavioral Health and Clinical Instructor in Family Medicine at The University of Texas Medical Branch at Galveston
We are no strangers to pain in today’s medical climate. An estimated 1.5 billion people are suffering from chronic pain worldwide. National costs for pain exceed costs for cardiovascular disease, cancer, and diabetes combined, with societal costs totaling an astonishing approximate $600 billion annually in the United States alone. As patient demand rises, so does expenditure, along with unfortunate narcotic morbidity and mortality. Many of us are finding that group medical visits (GMVs) can counter this crisis.
Group visits provide a much-needed solution in pain management and are growing in popularity for good reason. This format is a viable way to deliver therapies that can otherwise outgrow a 20-minute encounter. As Dr. Bonakdar, Dr. Sukiennik, and their team of authors point out in Integrative Pain Management, many exciting nonopioid options for pain management exist1, and GMVs provide space for education along with a whole-person approach that is optimal to deliver these remedies.
Therapies such as mindfulness, guided imagery, yoga, and tai chi are easily taught in as part of a group visit. Delivery in a group setting normalizes such novel practices and increases the likelihood that patients will adopt them as new behaviors. These therapies call for action on the part of the patient, and the group setting can be a forum for exploring motivation and finding creative solutions to any barriers. Many facilitators employ tools such as motivational interviewing to guide participants in moving forward.
Pain is strongly impacted by co-morbid conditions such as anxiety and depression. As one can imagine adverse mood intensifies pain, and increased pain leads to poor mood, a brutal cycle. These conditions are ideal for group management. Education about mood and mood management is largely generalizable. Importantly, group support in itself serves as a therapeutic remedy by alleviating common contributors including isolation and loneliness.
Consider Jim, a middle-aged man with chronic back pain. His primary doctor asked him to cut back on narcotics. He doesn’t know anything else that works and desperately needs to manage his pain so he can keep his job and support his family. He is no longer able muster through the pain. He feels depressed and is frankly embarrassed to talk about his mood.
As a family physician specializing in integrative and behavioral approaches at UTMB-Health, I co-facilitate group visits for anxiety and stress management. Jim is a typical patient in our sessions. Patients like the approach and let us know by their turnout and feedback. I find this to be both a pleasurable and uniquely effective way to provide care. Patients often help each other in ways that I, alone, could not. Questions arise in a group setting spontaneously, and the group discussion leads to clarification for all. I am amazed in every session by the level of support provided between members, and how this mutual support promotes healing.
Providers are experimenting with different models to best fit a given population. Integrative Pain Management chapter authors Geller, Truong, and Trowbridge describe a unique model for GMVs known as the Empowerment Model (EM), which is a useful forum for pain management. This type of GMV focuses on building relationships and trying new things and uses an open visit model, a one that does not have predefined curriculum and allows for participants coming and going as desired. An open visit model increases accessibility to those with transportation or other barriers who could not otherwise commit to a predetermined number of sessions.
Money talks, and as it turns out, group visits boast a desirable effect on the bottom line. While increasing patient and provider satisfaction, group visits also are proving to decrease overall healthcare spending and provide a way to deliver billable care to a room full of people in a span of 2-3 hours. Group medical visits are a savvy business model.
Pain management is a growing challenge in healthcare from perspectives of need, health care expenditures, and adverse effects of our most common therapies. We are in need of new ways to deliver safe and effective therapies. Consider treating yourself and your patients to a group medical visit as an innovative way to remedy pain by the dozens.
Referenced text: Bonakdar, Robert A. and Sukiennik, Andrew W. Integrative Pain Management. Weil Integrative Medicine Library: Oxford University Press, 2016 ISBN 978-0-19-931524