A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain

Romanelli, Robert J.; Dolginsky, Marina; Byakina, Yuliya; Bronstein, Deborah; Wilson, Sandra R.

doi:10.1177/2374373517706837

Cited by 12 publications

(11 citation statements)

References 24 publications

(27 reference statements)

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“…Shared medical appointments (SMAs) are increasingly used to improve the health and daily living of patients with common chronic diseases, such as cardiovascular disease, obesity, diabetes, and breast cancer [ 14–18 ]. It has been reported previously that patients with chronic pain participating in the SMAs were treated with integrative medical modalities, including mindfulness practices, self-massage, acupuncture, and similar approaches, as education only [ 19 ], education plus an individual integrative modality [ 20 ], or a combination of different therapies [ 21–25 ]. Improvements in pain severity, depression, and quality of life, as well as reduced pain medication use and fewer emergency department visits, were documented.…”

Section: Introductionmentioning

confidence: 99%

“Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments

Znidarsic¹,

Kirksey²,

Dombrowski³

et al. 2021

Pain Medicine

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Objective To evaluate the effectiveness of a multidisciplinary, nonpharmacological, integrative approach that uses shared medical appointments to improve health-related quality of life and reduce opioid medication use in patients with chronic pain. Design This is a retrospective, pre–post review of “Living Well with Chronic Pain” shared medical appointments (August 2016 through May 2018). Setting The appointments included eight 3-hour-long visits held once per week at an outpatient wellness facility. Subjects Patients with chronic, non–cancer-related pain. Methods Patients received evaluation and evidence-based therapies from a team of integrative and lifestyle medicine professionals, as well as education about nonpharmacological therapeutic approaches, the etiology of pain, and the relationship of pain to lifestyle factors. Experiential elements focused on the relaxation techniques of meditation, yoga, breathing, and hypnotherapy, while patients also received acupuncture, acupressure, massage, cognitive behavioral therapy, and chiropractic education. Patients self-reported data via the Patient-Reported Outcomes Measurement Information System (PROMIS-57) standardized questionnaire. Use of opioid medications was evaluated in morphine milligram equivalents. Results A total of 178 participants completed the PROMIS-57 questionnaire at the first and the last visits. Statistically significant improvements in all domains (Physical Functioning, Anxiety, Depression, Fatigue, Social Roles, Pain Interference, and Sleep Disturbance) were observed (P < 0.001) between the pre-intervention (visit 1) and post-intervention (visit 8) scores. Average opioid use decreased nonsignificantly over the 8-week intervention, but the lower rate of opioid use was not sustained at 6 and 12 months’ follow-up. Conclusions Patients suffering from chronic pain who participated in a multidisciplinary, nonpharmacological treatment approach delivered via shared medical appointments experienced reduced pain and improved measures of physical, mental, and social health without increased use of opioid pain medications.

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Section: Introductionmentioning

confidence: 99%

“Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments

Znidarsic¹,

Kirksey²,

Dombrowski³

et al. 2021

Pain Medicine

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“…In this study, a statistically significant reduction in pain medication use occurred in the intervention compared with the control group. Other MGVS studies have found showed a reduction in pain medication use [71,84].…”

Section: Discussionmentioning

confidence: 98%

Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

et al. 2019

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BackgroundCurrent treatment options for chronic pain and depression are largely medication-based, which may cause adverse side effects. Integrative Medical Group Visits (IMGV) combines mindfulness techniques, evidence based integrative medicine, and medical group visits, and is a promising adjunct to medications, especially for diverse underserved patients who have limited access to non-pharmacological therapies.

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“…SMAs have been shown to improve clinical outcomes in various conditions including type 2 diabetes, [7][8][9] Strengths and limitations of this study Open access obesity, 10 11 chronic cardiac diseases [12][13][14] and chronic pain. [15][16][17] Several studies found this delivery model to be less costly than individual appointments, provided sufficient patients are enrolled. [18][19][20] The success of SMAs has been attributed to various factors including peer-to-peer support, 21 group size, 22 patient-provider relationship, 21 caregiver time 21 and increased patient engagement.…”

Section: Chronicmentioning

confidence: 99%

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study

et al. 2021

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ObjectiveTo compare outcomes and costs associated with functional medicine-based care delivered in a shared medical appointment (SMA) to those delivered through individual appointments.DesignA retrospective cohort study was performed to assess outcomes and cost to deliver care to patients in SMAs and compared with Propensity Score (PS)-matched patients in individual appointments.SettingA single-centre study performed at Cleveland Clinic Center for Functional Medicine.ParticipantsA total of 9778 patients were assessed for eligibility and 7323 excluded. The sample included 2455 patients (226 SMAs and 2229 individual appointments) aged ≥18 years who participated in in-person SMAs or individual appointments between 1 March 2017 and 31 December 2019. Patients had a baseline Patient-Reported Outcome Measurement Information System (PROMIS) Global Physical Health (GPH) score and follow-up score at 3 months. Patients were PS-matched 1:1 with 213 per group based on age, sex, race, marital status, income, weight, body mass index, blood pressure (BP), PROMIS score and functional medicine diagnostic category.Primary and secondary outcome measuresThe primary outcome was change in PROMIS GPH at 3 months. Secondary outcomes included change in PROMIS Global Mental Health (GMH), biometrics, and cost.ResultsAmong 213 PS-matched pairs, patients in SMAs exhibited greater improvements at 3 months in PROMIS GPH T-scores (mean difference 1.18 (95% CI 0.14 to 2.22), p=0.03) and PROMIS GMH T-scores (mean difference 1.78 (95% CI 0.66 to 2.89), p=0.002) than patients in individual appointments. SMA patients also experienced greater weight loss (kg) than patients in individual appointments (mean difference −1.4 (95% CI −2.15 to −0.64), p<0.001). Both groups experienced a 5.5 mm Hg improvement in systolic BP. SMAs were also less costly to deliver than individual appointments.ConclusionSMAs deliver functional medicine-based care that improves outcomes more than care delivered in individual appointments and is less costly to deliver.

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A Shared Medical Appointment on the Benefits and Risks of Opioids Is Associated With Improved Patient Confidence in Managing Chronic Pain

Cited by 12 publications

References 24 publications

“Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments

“Living Well with Chronic Pain”: Integrative Pain Management via Shared Medical Appointments

Effectiveness of integrative medicine group visits in chronic pain and depressive symptoms: A randomized controlled trial

Patient outcomes and costs associated with functional medicine-based care in a shared versus individual setting for patients with chronic conditions: a retrospective cohort study

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