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A crack in the wall: Chronic pain management in integrative group medical visits

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  • Thompson-Lastad, Ariana
  • Rubin, Sara

Abstract

Amidst a national crisis of opioid overdose, substantial uncertainty remains over how to safely and effectively address chronic pain. In response to this crisis, safety-net primary care clinics are instituting integrative group medical visits (IGMVs) for chronic pain management. Through two qualitative studies of IGMVs, we found that these groups acted as workarounds implemented by clinicians seeking to innovate upon standard pain management protocols. While clinical uncertainty is often framed as a problem to be managed, in this instance, overlapping uncertainties provided an opportunity through which enterprising clinicians could generate reform at the local level. However, these clinician-led changes were incremental, situational, and partial, and occurred outside of broader systemic reform. In the following article, we draw on 46 interviews with clinicians and staff associated with IGMVs and observations of 34 sessions of 22 distinct IGMVs. We begin by describing the structure of the IGMVs we observed. We analyze the multiple uncertainties surrounding chronic pain and its treatment at the time of our data collection, just before the opioid crisis was declared a national public health emergency. We then demonstrate how clinicians tinkered with existing pain management protocols via their involvement with IGMVs. Lastly, we discuss the conditions of possibility that allowed for the existence of IGMVs at our study sites, as well as the conditions of limitation that restricted the expansion of these groups. Our research points to the potential of IGMVs for treating chronic pain, while showing that IGMVs continue as an innovation by individual clinicians, not as a result of broader reforms.

Suggested Citation

  • Thompson-Lastad, Ariana & Rubin, Sara, 2020. "A crack in the wall: Chronic pain management in integrative group medical visits," Social Science & Medicine, Elsevier, vol. 258(C).
  • Handle: RePEc:eee:socmed:v:258:y:2020:i:c:s027795362030280x
    DOI: 10.1016/j.socscimed.2020.113061
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    References listed on IDEAS

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    1. Reed, Kate & Kochetkova, Inna & Whitby, Elspeth, 2016. "Visualising uncertainty: Examining women's views on the role of Magnetic Resonance Imaging (MRI) in late pregnancy," Social Science & Medicine, Elsevier, vol. 164(C), pages 19-26.
    2. Kasey R Boehmer & Abd Moain Abu Dabrh & Michael R Gionfriddo & Patricia Erwin & Victor M Montori, 2018. "Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis," PLOS ONE, Public Library of Science, vol. 13(2), pages 1-17, February.
    3. Pryma, Jane, 2017. "“Even my sister says I'm acting like a crazy to get a check”: Race, gender, and moral boundary-work in women's claims of disabling chronic pain," Social Science & Medicine, Elsevier, vol. 181(C), pages 66-73.
    4. Geiger, H.J., 2016. "The first community health center in Mississippi: Communities empowering themselves," American Journal of Public Health, American Public Health Association, vol. 106(10), pages 1738-1740.
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    Cited by:

    1. Mokhtari, MohammadAli, 2023. "Opioids ease my pain: Early-life malnutrition and elderly outcomes," Social Science & Medicine, Elsevier, vol. 327(C).
    2. Cruz, Taylor M. & Paine, Emily Allen, 2021. "Capturing patients, missing inequities: Data standardization on sexual orientation and gender identity across unequal clinical contexts," Social Science & Medicine, Elsevier, vol. 285(C).
    3. Cruz, Taylor Marion, 2022. "The social life of biomedical data: Capturing, obscuring, and envisioning care in the digital safety-net," Social Science & Medicine, Elsevier, vol. 294(C).

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