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UMMS study finds group medical meetings help low-income patients with chronic pain, depression

Paula Gardiner incorporates mindfulness to reduce medication use and emergency room visits

By Sandra Gray

UMass Medical School Communications

December 18, 2019
 
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Paula Gardiner, MD, MPH

A study by UMass Medical School integrative medicine expert Paula Gardiner, MD, MPH, finds that patients with chronic pain and depression who participated in medical group visits in which they learned mindfulness techniques were able to reduce their use of pain medications and made fewer emergency room visits.

“We have to help patients find strategies to reduce their pain other than just taking opioids,” said Dr. Gardiner, associate professor of family medicine & community health. “There is more and more evidence for the effectiveness of nonmedical treatments, including mindfulness and stress reduction techniques.”

The study, funded by the Patient-Centered Outcomes Research Institute and published online by PLOS ONE on Dec. 18, compares the effectiveness of an integrative medical group visit intervention with a control group in reducing pain and depressive symptoms for patients with chronic pain. The study included 159 patients with chronic pain and depression symptoms receiving care at three health clinics serving low-income neighborhoods. Patients were randomized to join the 10-week group intervention or visit their primary care provider once during the study period.

Especially valuable for low-income patients for whom accessing complementary therapies may be limited, integrative medical groups are an innovative approach to primary care in which up to 15 patients meet with a primary care clinician. After each patient is seen individually, the entire group participates in educational activities designed to help reduce pain through mindfulness and yoga. Participants also learn lifestyle practices such as healthy eating and movement that can help ameliorate chronic conditions. Participants agree to share health information in the group setting.

“This is an empowerment model in which we conduct medical consults in a group setting that integrates all allopathic medicine, but then takes a deep dive into complementary nonprescription techniques,” said Gardiner.  “The goal is to use all the methods shared by the group to help them improve their quality of life.

Patients completed surveys when the study began, nine weeks later and 21 weeks later. The research team analyzed patients’ health records.

“Overall, the integrative medical group visit intervention was not more effective than usual care at reducing depressive symptoms,” Gardiner noted. “It was, however, found to reduce pain and depression in those that attended at least half the visits. It is important for us to next study which patients will be most likely to benefit from group participation.”

Participants did realize some benefits. Compared with the controls, patients in the group intervention were less likely to use pain medication at the end of the study, showed a greater increase in mental health-related quality of life at the end of the study and had a greater decrease in emergency department visits when weekly group visits ended. And while medical group visits are different from support groups, they can create a supportive community of peers.

“They don’t come to see me, they come to see their friends. A lot of the care can happen within the supportive nature of a group with shared experiences,” Gardiner said. “We do a lot of goal setting around self-care and learning new lifestyle skills, including stress reduction and meditation.”

Gardiner is associate director of research and director of the Group Visits Program for the UMMS Center for Integrated Primary Care. Her ongoing patient-centered research regarding chronic conditions, depression, chronic pain, and non-pharmacological evidenced-based medicine seeks to identify the characteristics of patients who can benefit from group medical visits and other tools like an online e-health toolkit that teaches mind body techniques.