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

Gardiner, Paula; Luo, Man; D’Amico, Salvatore; Barnett, Katherine Gergen; White, Laura F.; Saper, Robert B.; Mitchell, Suzanne; Liebschutz, Jane M.

doi:10.1371/journal.pone.0225540

Cited by 35 publications

(77 citation statements)

References 87 publications

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“…The most pronounced degree of beneficial pre–post changes for all evaluated patients was in the PROMIS Pain Interference (PI) and Fatigue domains (mean changes of -3.5 and -3.1, respectively) ( Table 3 ). The mean pain intensity on the Likert scale decreased by 1.0 (from 6.2 to 5.2) (not shown; see also Table 2 for mean changes), similar to the value reported recently for patients with chronic pain and depression who were randomly assigned to participate in integrative medical group visits or primary care provider visits [ 22 ].…”

Section: Discussionsupporting

confidence: 83%

“…It is possible that potential patients in a control group would improve without any of the nonpharmacological interventions used in our studies as a result of simply being in the group setting and possibly as a result of the placebo effect [ 13 , 36 , 37 ]. It was recently reported in a controlled study [ 22 ] that patients in the control group reported multiple pre–post improvements, with no significant differences between the control (visits with the primary care physician) and the intervention groups (several integrative modalities), except in reducing emergency department visits and pain medication use.…”

Section: Discussionmentioning

confidence: 99%

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“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: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

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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“…Sixteen trials (70%) were for a single LTC, of these: 13 were for diabetes [23,25,26,[29][30][31][32][33][34][37][38][39]53], two for hypertension [50,51]; and one was for osteoporosis [52]. Eight trials considered multiple LTCs: three were diabetes and hypertension/cardiovascular risk [40][41][42]46]; one was diabetes and depression [43], one was for overweight patients with diabetes [44]; one was chronic pain and depression [22] two in China [32,50] and one each in Australia [31], Germany [51] and the United Kingdom [52]. Twelve trials were measured the effectiveness, impact or efficacy of SMAs compared to usual care [19,22,23,26,29,32,33,38,39,42,46,53], nine trials examined feasibility parameters [24,30,31,34,37,38,…”

Section: Characteristics Of the Included Studiesmentioning

confidence: 99%

Effectiveness of shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials

Tang

Graham

O’Donnell

et al. 2022

Preprint

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Background: Shared medical appointments (SMAs) have the potential to address interlinked challenges of limited capacity in primary healthcare and rising prevalence of patients with multiple long-term conditions (LTCs). This review aimed to examine the effectiveness of SMAs compared to one-to-one appointments in primary care at improving health outcomes and reducing demand on healthcare services. Methods: We searched for randomised controlled trials (RCTs) of SMAs involving patients with LTCs in primary care across six databases from 2013 and added eligible papers identified from previous relevant reviews. Data were extracted and outcomes narratively synthesised, meta-analysis was undertaken where possible. Results: Twenty-three unique trials were included. SMA models varied in terms of components, mode of delivery and target population. Most trials recruited patients with a single LTC, mostly commonly diabetes (n=13), although eight trials selected patients with multiple LTCs. There was substantial heterogeneity in outcome measures which we categorised into health outcomes (biomedical indicators, psychological and well-being measures), behavioural outcomes, and resource use. Meta-analysis showed that participants in SMA groups had lower diastolic blood pressure than those in usual care (d=-0.123, 95%CI = -0.22, -0.03, k=8). No statistically significant differences were found across other outcomes. Where individual studies showed significant differences (patient self-efficacy), these trended in favour of SMAs. Compared with usual care, SMAs had no significant effect on healthcare service use. Conclusions: SMAs were at least as effective as usual care in terms of health outcomes and did not lead to increased healthcare service use in the short-term. They show some potential in improving self-efficacy which may boost self-care. To strengthen the evidence base, future studies should target standardised behavioural and health outcomes and clearly report SMA components so key behavioural ingredients can be identified. Similarly, transparent approaches to measuring costs would improve comparability between studies.

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“…IMGVs significantly reduce emergency department visits among patients with chronic pain, decrease pain medication usage, and increase patient mental and emotional well-being. 32 IMGV participants may experience a greater amount of social and emotional support than they would in individualized medical appointments and often report a greater quality of life. 33 Clinicians consistently report that group medical visit programs allow them to participate in a community of support, develop more personal relationships with their patients, and gain insight from patients with chronic conditions.…”

Section: Integrative Medical Group Visitsmentioning

confidence: 99%

Feasibility of Implementation Mapping for Integrative Medical Group Visits

Roth

Tiedt

Barnhill

et al. 2021

The Journal of Alternative and Complementary Medicine

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Objectives: Implementation science is key to translating complementary and integrative health intervention research into practice as it can increase accessibility and affordability while maximizing patient health outcomes. The authors describe using implementation mapping to (1) identify barriers and facilitators impacting the implementation of an Integrative Medical Group Visit (IMGV) intervention in an outpatient setting with a high burden of patients with chronic pain and (2) select and develop implementation strategies utilizing theory and stakeholder input to address those barriers and facilitators.Design: The authors selected a packaged, evidence-based, integrative pain management intervention, the IMGV, to implement in an outpatient clinic with a high burden of patients with chronic pain. The authors used implementation mapping to identify implementation strategies for IMGV, considering theory and stakeholder input. Stakeholder interviews with clinic staff, faculty, and administrators (n = 15) were guided by the Consolidated Framework for Implementation Research.Results: Based on interview data, the authors identified administrators, physicians, nursing staff, and scheduling staff as key stakeholders involved in implementation. Barriers and facilitators focused on knowledge, buy-in, and operational procedures needed to successfully implement IMGV. The implementation team identified three cognitive influences on behavior that would impact performance: knowledge, outcome expectations, and self-efficacy; and three theoretical change methods: cue to participate, communication, and mobilization. Implementation strategies identified included identifying and preparing champions, participation in ongoing training, developing and distributing educational materials, and organizing clinician implementation team meetings.Conclusions: This study provides an example of the application of implementation mapping to identify theory-driven implementation strategies for IMGV. Implementation mapping is a feasible method that may be useful in providing a guiding structure for implementation teams as they employ implementation frameworks and select implementation strategies for integrative health interventions.

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

Cited by 35 publications

References 87 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 shared medical appointments delivered in primary care for improving health outcomes in patients with long-term conditions: a systematic review of randomised controlled trials

Feasibility of Implementation Mapping for Integrative Medical Group Visits

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