Group Visits for Chronic Pain

Abstract

Purpose: To evaluate the efficacy of group visits for chronic pain patients on opioids. Methods: Nineteen chronic pain patients participated in a year-long program consisting of monthly visits. Visits consisted of a check-in with a healthcare provider, urine sampling, assessment of mood and pain by surveys, an educational component, and group support discussion. Mindfulness meditation, music therapy, education on use of pain medications, and other topics were taught. Five patients also participated in a focus group to evaluate their experiences with healthcare as a chronic pain patient and to elicit thoughts on the group visit program. Fourteen primary care providers of the same clinic were surveyed to assess thoughts on treatment of pain patients on an individual and clinic-wide level. Results: Baseline assessment with the Opioid Risk Tool showed >50% of patients had a moderate to high risk for opioid abuse. There was no significant difference in opioid usage at 6 months. Due to the increased frequency of urine sampling with the program, several patients were noted to have cocaine in the urine and were able to be counseled appropriately. Most (89%) of subjects had a substance use contract established when one did not exist previously. Patients in the focus group felt they had been subject to bias in the healthcare system as pain patients, but were comfortable with their current primary care provider and not concerned that the group visit program would force them to stop taking opiates that they might need. Providers surveyed at the clinic felt that there needed to be clear, clinic-wide guidelines for how to treat pain patients to allow for better individual practice and improved cross-coverage of patients. Results of PHQ-9 (depression), PEG (pain), GAD-7 (anxiety), and SF-20 (physical functioning) are pending completion of the study in the fall of 2017. Conclusions: Interim results of a group visit program for chronic pain patients suggest that this format is a low-cost, effective way to improve management of this population.