With this piece I’d like to highlight the “Power of the Group”, when it comes to Integrated Pain Management programs.
What I’ve noticed from 20 years in practice is that the small group component is a crucial element and allows for more rapid learning of pain management tools – especially with people who aren’t clinically minded.
Often the group prospect may be quite daunting for our patients, to openly meet and talk with people they don’t know about their pain, disability and impact on their mood and lifestyle. However, when framed correctly and focused on concepts which promote practical understanding and tools for management this medium is extremely effective.
The Top 4 elements from the Power of the Group I have noticed are:
1. Identifying a sense of commonality and familiarity in experience – Some of the most common phrases we hear when initially assessing patients is “surely this isn’t normal”, “is this all in my head”, or “I cannot believe this has happened to me” – the group story session rapidly makes every participant realise that what they have experienced is horrible, but is unfortunately very common. This leads into the second element,
2. Empathy for their situation, pathway since injury and current pain experience – All group members are usually very different in backgrounds and who they are as people, but they are living with similar experiences. This allows a greater appreciation and flow of empathy towards each other’s presentation, and often prompts greater support networks between one another post programs, from having had the group experience.
3. Validation of individual thoughts, concerns, and barriers to improvement – similar to reasons for why empathy is much more prevalent through small groups. People feel like they are “finally being heard”, and when they understand they are the most important piece of the puzzle for effective pain management, they can start setting achievable goals together.
4. Identifications of mutually helpful tools and future goal setting – What strategies work for one person may work for others, and that’s helpful when being relayed by a participant as they can attest to the success for managing their own pain experience, with immediate credibility.
Playing Devil’s advocate, there have also been some pitfalls to group learning when the following factors occur. These may include:
1. The group size is too big. If more than 6-8 people per group, I tend to find our approaches to teaching concepts cannot be individualised enough, or there simply isn’t enough time to get “buy in” from all participants
2. Participants have not been screened as suitable, and have either been enrolled or participated in the program “because I have too”. Examples of exclusion criteria may include pending surgery, concurrent psychiatric comorbidity, common law proceedings pending, not motivated to attend etc.
3. Teaching style is lecture based and heavily scientific in content, as opposed to simple, specific focuses on key learning strategies – using practical and interactive methods. ie. Progressive muscles relaxation, deep breathing exercises, Planning examples with Pacing activities, Ergonomics and Exercise demonstrations – are real tools people can use with simple constructs.
4. Program focus becomes more “boot camp” and functionally focused, or misconstrued as “No pain no gain” approaches that encourage the individual to simply “harden up and ignore pain” or “soldier on”. The long term evidence for these types of programs is limited.
An Interesting fact we’ve noticed for the future of Pain management programs has arisen with the current COVID-19 crisis limiting our participation to Virtual groups via Zoom meetings. Presentation of content, interaction of group members and post-program feedback from both presenters and participants has been highly consistent to our traditional face to face group programs, and this has demonstrated extremely credible and accessible options for persistent pain sufferers located interstate or regionally based, or whom simply cannot commute to programs. Further research to the efficacy between a blend of the two options is warranted to canvass whether better outcomes are still available for “hybrid” approaches.
Thus in summary, it is my personal view that the most effective pain management programs cannot be delivered without some small group component, and over time have found that the earlier on this component of pain management features in the individuals rehabilitation, the more likely individualised rehabilitation goals and outcomes will be realised. Most people tend to gain more out of environments whereby education is practical and relevant; empathy and validation is widespread, and credible goals can be set and then achieved.
For more information on our group programs, email or live chat with the writer.