"Living Well with Chronic Pain": Integrative Pain Management via Shared Medical Appointments.

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.

Predictors for electronic survey completion in healthcare research.

Few studies have examined patients' preferences for and predictors of completing health surveys by paper versus Internet. The purpose of this study was to examine if participants of registry research preferred to complete health surveys by the Internet or paper, and if demographics and previous computer experiences were associated with health survey completion method preference. Using a descriptive design and convenience sample, participants of colorectal surgery registries completed an 18-item survey about Internet use and personal characteristics. Multiple linear regressions were used to determine predictors of total Internet use and access and survey preference. In 526 participants, preference for Internet-based health survey completion was associated with younger age, higher education, computer ownership, and using e-health medical records (all P ≤ .01). Those who previously completed Internet-based health surveys were more often married or divorced and computer owners and had electronic access to health records (all P ≤ .001). After multivariable regression, the Internet use/access sum score was associated with computer ownership, using a secure Web-based system and preference for completing electronic health surveys (all P < .001). In conclusion, after controlling for demographics, computer ownership, comfort in using Web-based systems including surveys, and access to computerized health records predicted preference for completing research-based health surveys by the Internet.