Wellness Skills for Pain Management at Unity Care Northwest
Thursday, October 6, 2016
Stacey Speelman, Integrated Behavioral Health Supervisor, Unity Care Northwest
One of the great challenges in any primary care setting is the management of chronic pain. Estimates from the 2012 National Health Interview Study indicate about 11% of adults in the United States report daily pain.1 At Unity Care Northwest (UCNW), with more than 18,500 patients, we encounter this challenge daily. As a nation, we have come to rely on prescription, opioid-based medications to respond to chronic pain. Studies show, however, that long-term opioid use in the treatment of chronic pain is associated with gastrointestinal problems, sleep disturbance, and respiratory and cardiovascular complications,2 as well as the increasing prevalence of opioid addiction and overdose, which has become the leading cause of accidental death in the United States.3 In Washington State alone, estimated deaths by opioid overdose average approximately 600 per year.4
Unity Care’s treatment protocol for our patients is to use more than one approach to treating chronic pain. Included in this multimodality approach is the Wellness Skills for Pain Management group, offered as an 8-week session. The group is led by Behavioral Health Clinicians, with participation from multi-disciplinary staff including nurses and our Registered Dietician. Upon referral, UCNW’s behavioral health staff work with each individual patient, addressing barriers such as transportation, assessing for program appropriateness, and setting positive expectations for participation. With a focus on behavioral activation and Cognitive Behavioral Therapy, participants learn self-care skills, meditation, guided imagery, mindfulness, and breathing. These evidence-based modalities improve pain management outcomes and also address secondary diagnoses, such as Major Depressive Disorder and Anxiety. Patients are coached on communicating with their medical team regarding symptoms and preferences for treatment. Clinicians work with patients to set measureable, attainable goals for behavior change at the start of each session, and revisit goals throughout the course. Participation in the group also provides socialization and peer support for patients, many of whom have become isolated by pain, mood, and/or mobility challenges.
An associated benefit of participation in UCNW’s pain management group is patient access to on-site acupuncture, which is provided weekly at no cost during group enrollment. This service may be continued for an additional 18 sessions after group completion on UCNW’s sliding fee scale. We also offer Qi Gong in the clinic twice weekly, and we encourage patients of all ambulatory levels to participate.
For Primary Care Physicians, UCNW’s various chronic pain interventions provide an important alternative to long-term medication use. “These groups are more effective than opiates for treating chronic pain because not only do they empower patients to care for themselves in an active manner, but they also help patients build community which is often difficult in people faced with chronic medical issues,” says Barbara Clure, M.D., UCNW Medical Director. "Some of my patients have gotten so much out of these groups that even after the formal group is over, they continue to meet with each other outside of the clinic to share resources and to support each other."
Patient feedback from this group highlights the impact of coaching on communicating with providers, addressing negative self-talk, and the benefits of “go anywhere” tools, such as breathing and relaxation skills. Patients also report feeling greater satisfaction in their relationship with their primary care provider, improved self-worth, and more effective sleep. Utilizing pre- and post- intervention function and pain assessment tools, as well as the PHQ9, patient progress, symptom distress, and skill development can be tracked and used to demonstrate group efficacy. More than half of participants in our 101 introductory group return for the 102 session, which builds more intensively on skills obtained in the introductory course.
As the treatment of chronic pain in Washington State and nationwide transforms to move away from an over-reliance on opioid pain medications and consideration of alternative means of addressing chronic pain, primary care clinics must respond. The provision of groups and alternative pain interventions will be key to both patient and provider success. As UCNW looks forward to continued service growth and innovation, pain management remains a priority effort.
If you have questions, please contact Stacey at Unity Care Northwest at (360) 594-6608.
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