A Crack in the Wall: Chronic Pain Care in Integrative Group Medical Visits.

Amidst a national crisis of opioid overdose, there is substantial uncertainty about how to safely and effectively address chronic pain. This article focuses on integrative group medical visits (IGMVs), a model of care that seeks to ameliorate health care inequalities by increasing access to nonpharmacological chronic pain care. We find that several conditions of possibility make IGMVs the right tool for the job of improving chronic pain care in safety-net settings. These conditions of possibility--the current opioid crisis, uncertainty surrounding chronic pain and its treatment, and clinicians with particular commitments--allow IGMVs to open a crack in the wall of US health care as typically practiced. IGMVs have been an innovation spearheaded by individual providers rather than organizational or policy changes, and as such, their expansion has been limited. The consequences of this limited growth include opportunity for clinicians and patients to innovate together, but also further uncertainty about the value of integrative medicine and group-based care, and stratified access to IGMVs. Many patients and providers described IGMVs as better than individual care for chronic pain and saw benefits to both patient health and provider job satisfaction. Where dissemination of health care interventions often begins with the most privileged and trickles slowly, if at all, to those served in the safety-net, IGMVs have the potential to do the opposite. [ABSTRACT FROM AUTHOR]

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