Integrative Health Group Visits (IHGV): A Pilot Feasibility Study to Manage People with Chronic Pain in a Nordic Inner-City Medical Clinic
Noble-Letort SR; Appa RS; Bangsgaard K

Background:

Chronic pain is a condition that 75% of North American highly esteemed academic medical centers and affiliate institutions practicing integrative medicine, report the most clinical success[1]. Increasingly, evidence suggests that Integrative Health and Medicine (IHM) visits are effective for treating chronic pain; similarly, a number of studies demonstrate the effectiveness of certain evidence-based complementary therapies in managing pain.

Objectives:

The primary goal of this 2017 study is to evaluate the feasibility of the integrative health group visit (IHGV) care model in a Nordic inner-city outpatient medical clinic. IHGV combines patient-centered, non-pharmacologic strategies that complement pharmacological treatments and incorporate the principles of National Institute of Health / National Center for Complementary and Integrative Health (NIH NCCIH) recommended therapies for the management of chronic pain and associated symptoms.

We will survey groups of people, pre and post, who will each undergo a 6 week/8-session IHGV program (5 – 6 groups; median 12 people/group; range 8-16 participants) over the course of 12 months to evaluate qualitative changes in pain (0-10 point scale and Autonomic Symptoms Questionnare), sleep quality and co-morbid symptoms as well as perceived stress, anxiety and depression (Patient Health Questionaire 15 [PHQ-15] Hospital Anxiety and Depression Scale [HADS]).

Proposed Results and Conclusion:

Based on the overall findings of the 2016 NIH NCCIH / Mayo Clinic Review of 150 Randomized Control Trials (RCT) investigating Complementary Approaches to Pain, as well as the Boston Medical Center (BMC) Integrative Medicine Group Visit (IMGV) 2014 study, we now propose a similarly inspired interventional pilot study to begin a process to determine effectiveness and feasibility in the Nordic region. The 2014 IMGV study, which combined both conventional and integrative medicine therapies, enrolled 65 (93%) out of 75 people in the study. Over the course of 12 months, 7 groups met (median 9 patients/group; range 8-13 participants). Mean difference in pain level for all patients between baseline and 8 weeks was 0.7 (SD=2.0, P=.005). Mean difference in PHQ-8 depression score for patients with baseline score ≥5 was 2.6 (SD=4.6, P<.001). In addition, statistically significant improvements were also seen in sleep quality and perceived stress.

Key Words:

Group medical visit, patient-centered non-pharmacologic strategies, chronic pain, Integrative Health Group Visits (IHGV), National Institute of Health (NIH), National Center for Complementary and Integrative Health (NCCIH), Integrative Medicine Group Visits (IMGV), Integrative Health and Medicine (IHM)

[1] Integrative Medicine in America: How Integrative Medicine is Being Practiced in Clinical Centers Across the United States, The Bravewell Collaborative, 2012, page 34

NIM Chronic Pain Program I (September 18 – October 25, 2017) completed

Location:
NIM Clinic, Østerbrogade 94, 1
2100 Copenhagen Ø Denmark

We welcome you to participate in our NIM Chronic Pain Study II that offers you an opportunity to receive support from our collaborative team of health practitioners who provide clinical nutritional consultation, clinical psychology, yoga therapy and music therapy.  Our innovative integrative model places people in the center surrounded by a team of support which incorporates non-pharmacologic strategies and principles of evidence-based complementary and integrative health therapies for the management and reduction of pain and associative symptoms. Our integrative health program includes:

Integrative Health Care Consultations

Integrative Clinical Nutrition Counseling conducted by SRAB Naturopaths who are Certified Naturopathic Physicians (Canada)

Integrative Clinical Psychology based in Compassionate Focused Therapy (CFT) version 2.0 of Cognitive Based Therapy (CBT) conducted by Licensed Danish Clinical Psychologists

Integrative Stress Resilience which includes Yoga Alliance E-RYT C-IAYT Certified Yoga Therapy and SRAB Music Therapy

Integrative Physical Medicine that includes SRAB Massage and Acupuncture

Name of Study: Integrative Health Group Visits (IHGV): A Pilot Feasibility Study to Manage People with Chronic Pain in a Nordic Inner-City Medical Clinic

6 Week Program: One-hour consultation/treatment every Wednesday for 6 weeks plus 2 one-hour evening group sessions

Cost: DKK 1800

Location: TBD

Hours of Operation: 9:00 – 16:00 (clinical visits) 16:00 – 18:00 (stress resilience group sessions)

Main Focus Groups:

Gastrointestinal (ie. Irritable Bowel Syndrome IBS)

Cancer (ie. Late Consequential Symptoms of Radiation and Chemotherapy)

Heart (ie. Angina, High Blood Pressure)

Menopause (ie. Hot Flashes, Sleep Disturbance)

Physical injury/trauma (ie. Back/Neck, Migraine, Brain/Concussion)

Participants Criteria:

Must be 18 or older

Must be available on Wednesdays

Must be experiencing some form of chronic pain (including associative stress, anxiety and depression)

Must not have severe mental illness