Philosophy

FINER (Functional INtEgrative Restoration) Program: A developing virtual, interdisciplinary program for chronic pain

Jennifer Kurz, MD 

Chronic pain is a complex, biopsychosocial condition that requires integrative and psychological strategies that target the root causes: the negative thoughts, beliefs, and behaviors that sustain it.  Conventional pain care, with its numerous specialty visits, diagnostic imaging, repetitive therapy referrals, pharmacological treatments, and procedures, is becoming increasingly costly and unsustainable for the individual, health care insurers, and society as a whole.  Even a decade ago, chronic pain was recognized as one of the highest impact problems in health care today, with more than 100 million American adults affected.  Pain care costs the nation upwards of $635 billion annually (1), and represents the number one cause of long-term disability in the United States, with indirect costs (reduced or missed work productivity) accounting for more than 50% of this burden (2).  Persistent pain syndromes can destroy an individual’s quality of life, including engagement in society or other meaningful activity, as well as increase the risks of other serious chronic diseases, such as obesity, cardiovascular disease, and mental health disorders, including addiction.  Inappropriate opioid prescribing and misuse of opioids has been associated with 130 U.S. deaths per day from opioid overdose and an economic burden of $78.5 billion per year (3).  There have been over 100,000 U.S. deaths from drug overdoses in the year ending 2021.

Despite our increasingly advanced diagnostic capabilities, including even future identification of biomarkers, fMRI brain discoveries, and genes that predispose individuals to chronic pain, none of these have yet to result in any measurable improvement in the function or quality of life of a chronic pain patient.  For decades, the gold standard approach to comprehensive pain care involves interdisciplinary programs that can integrate behavioral-psychological approaches and group support, with patient engagement in healthy lifestyle behaviors, mindfulness, and cognitive reappraisal.  Telemedicine-delivered pain psychology and self-management programs for chronic pain, which are cost effective compared to multiple specialty visits and physical interventions, may be more beneficial for this population than interventional procedures or surgery.  Functional restoration pain rehabilitation models that encourage activity engagement despite pain, cognitive coping strategies, and address underlying serious mental health issues, are the gold standard approach to chronic pain care (5, 6).  Unfortunately, due to our health care culture’s incentivization of pharmacological care and procedures over self-care and education (7), and because access to multidisciplinary pain programs has been historically limited for the majority of chronic pain patients, including the most vulnerable, low income patients with few resources and mobility obstacles, the problem of chronic pain and its cost is not going away any time soon.  With the COVID-19 pandemic, which brings forced isolation and restrictions on helpful resources such as live group therapies, physical treatments, and access to pain management providers, this problem is highlighted even more.  However, the current pandemic also brings hope for the newly expanded role of Telemedicine (8) to improve access to evidence-based cognitive behavioral and integrative pain management therapies. 

Over the past year, the new interdisciplinary virtual pain program, F.I.N.E.R. (Functional INtEgrative Restoration) program has engaged dozens of chronic pain patients in live pain education workshops and group therapy.  During the 8-9 weeks of live sessions, the essential components of a gold standard non-pharmacological, interdisciplinary approach to chronic pain are offered, including: 1. Pain education 2. Physical activity engagement, and 3. Cognitive strategies (9).  These components are successfully implemented using the Zoom platform.  With the support of a regularly meeting, live interdisciplinary group for engagement of concepts introduced during the course related to evidence-based pain psychology strategies (i.e., CBT, ACT, mindfulness meditation/MBSR, and Empowered Relief), lifestyle management, and a growing number of integrative mind body disciplines, patients finally have the chance to feel supported and motivated enough to make a significant mindset shift.  This program has already empowered patients to take control of their pain situations and live more functional lives. 

Patient engagement in the Zoom Telemedicine platform, which involves their own trusted pain physicians, a physical therapist trained in chronic pain, and an occasional team psychologist, has been the key to success.  Patients follow up in real time with these same pain physicians and physical therapists, so that the adaptive messages of pain coping skills, pain acceptance, and healthy activity engagement may continue long-term.  It is possible to enable mobility-impaired, isolated individuals to find evidence-based self-management options for their pain through the power of 1) healthy social connection and 2) consistent, adaptive messages about pain.  Patients and their own providers within the chronic pain health care setting are both actively involved in this process, and providers follow up with patients in real time, which improves accountability and compliance – the crucial ingredient to successful non-pharmacological, multidisciplinary pain management programs and long-term patient engagement.