GEMINI: Virtual Integrative Medical Group Visits for Managing Chronic Pain

Abstract Chronic pain is associated with substantial suffering and other co-morbidities such as depression, insomnia, fatigue, lowered mobility, and worse quality-of-life. Most of the care of chronic pain patients occurs during hurried primary care visits with pharmacological treatments (e.g. opioids and medications) despite mixed evidence of efficacy and increased risk of potentially dangerous side effects, including addiction and death. Even when these treatments are effective in reducing pain, they may not improve mental and functional status and may actually increase depression. The need for easy access to evidence-based non-pharmacological treatment options that include patient information and skill building would be helpful to chronic pain patients. To address the need for non-pharmacological approaches to treating chronic pain, we proposed developing the GEMINI platform to facilitate the delivery of online Integrative Medical Group Visits (IMGV) via video conferencing, eliminating a major access barrier for patients with physical and/or practical limitations that prohibit attending weekly in-person sessions. Between the online group sessions, patients use GEMINI for mind-body home practice with the ability to select evidence-based self-care practice options based on their own preferences and symptoms, and to gain peer support from group-based activities. The home practice and self-management tools covering such topics as mindfulness, mind-body practices, self-management of chronic pain, stress reduction, sleep, and nutrition. For patients, GEMINI is a unique and secure group-based intervention, uses gamification to reward engagement, and allows users to individualize self-management tools. For clinicians and researchers, GEMINI also has a Provider Portal, which uses daily measure tracking and enables monitoring of patients’ symptoms, adherence to home practice, and social interactions. Aim 1: Enhance/refine Phase I prototype based on Phase I feedback and add implementation of mostly administrative features for managing/scheduling group visits, updating intervention content, and FHIR/SMART- based EHR integration. A small pilot test will be conducted before starting the trial in Aim 2. Trial-related features will be implemented first and then the software used for the trial will be “locked.” Additional feature implementation will continue after the start of the trial, but on s separate codebase. Aim 2: Conduct a randomized 2-arm controlled trial (N=212) to test our hypotheses that the use of the GEMINI intervention would result in reduced pain impact, better pain-related outcomes, improved self-efficacy in pain management, and reduced pain medication use, as compared to the comparator control group, for up to 6 months from the start of the intervention participation.