GEMINI: Virtual Integrative Medicine Group Visits (IMGV) for Managing Depression and Chronic Pain

Abstract Chronic pain is associated with substantial suffering and other co morbidities such as depressioninsomniafatiguelowered mobilityand worse quality of lifeMost of the care of chronic pain patients occurs during hurried primary care visits with pharmacological treatmentse gopioids and medicationsdespite mixed evidence of efficacy and increased risk of potentially dangerous side effectsincluding addiction and deathEven when these treatments are effective in reducing painthey may not improve mental and functional status and may actually increase depressionThe need for easy access to evidence based non pharmacological treatment options that include patient information and skill building would be helpful to chronic pain patientsTo address this need for non pharmacological approaches to treating chronic painwe propose developing the GEMINI platform to facilitate the delivery of online Integrative Medical Group VisitsIMGVvia video conferencing with evidence based home practice self management tools covering such topics as mindfulnessmind body practicesself management of chronic painstress reductionsleepand nutritionGEMINI includes two primary componentsonline group visit sessions andonline mind body home practice activities between sessionsGEMINI will allow the online delivery of the medical group visit via video conferencingeliminating a major access barrier for patients with physical and or practical limitationswhich prohibits attending weekly in person sessionsBetween the online sessionspatients will use GEMINI for mind body home practice with the ability to select evidence based self care practice options based on their own preferences and symptomsand to gain peer support from group based activitiesGEMINI will also have a Provider Portal to facilitate the management of online sessionsthe maintenance of course contentand the tracking of patient progressPhase I aims areCollect stakeholder feedback from chronic pain patients and primary care providers via focus groupsDevelop the GEMINI prototype using user centered design and latest mobile friendly technologiesEvaluate GEMINI s Patient Portal via two rounds of usability testsandEvaluate GEMINI s Provider Portal with another round of usability testThe success criteria will be based on system usabilityusefulnessand acceptabilityThe expected benefits of GEMINI include reduced pain impactbetter painrelated patient outcomesimproved self efficacy in pain managementand reduced opioid useDrGardiner sMPIprior work has provided preliminary evidence of such benefitsWe will validate these hypotheses with a randomized controlled trial in Phase II Project Narrative Depression is commonaffectingof people in the USand is recognized as an important risk factor for poor outcomes among patients with chronic illnessMany patients with depression also have chronic painAmong adult patients with chronic painhigh levels of depression may worsen pain and pain related disabilityThese conditions have overlapping neurophysiological processeswhich complicate the treatment outcomesIn the face of the over prescribing of opioidsthere is a strong need for non pharmacological approaches to chronic pain management in those with active depressionTo address this need for non pharmacological approaches to treating chronic pain with active depressionwe propose to develop the GEMINI platform to facilitate the delivery of Integrative Medicine Group VisitIMGVintervention model with online IMGV sessions and evidence based home practice self management toolsThe IMGV model incorporates the concepts of medical group visits and mindfulness based stress reductionWe hypothesize that the use of the GEMINI intervention would result in reduced depressionreduced pain impactbetter pain related patient outcomesimproved self efficacy in self managementand reduced opioid use