STRENGTH IN NUMBERS

office M

Show up at my office on a typical Friday afternoon and the waiting room generally will be well populated. People in groups of threes, twos, and solitary ones are scattered about, flipping through magazines, glancing at wristwatches, a few even catnapping, waiting to hear their names called.

However, on this Friday everyone was assembled in one end of the room, all facing the same direction, all listening to the same thing, all sharing in the same experience.

talking to

I still don’t have an official name for the happening, but I’ve nicknamed it a “SIN” session, i.e. Strength In Numbers.  However, there’s nothing sinful about it.

Strength in Numbers is geared toward patients, is part classroom, part group therapy, and entirely beneficial to all participants – including me.

I had no trouble selecting the didactic elements. My practice is located on the border between Kentucky and Indiana – two states that have recently enacted laws and regulations for treating pain with controlled substances.

bridge

Both states’ regulations are instructive regarding educational requirements.

Kentucky’s regulations mandate:

A physician prescribing or dispensing a controlled substance shall take appropriate steps to educate a patient receiving a controlled substance.

There’s even a list of educational points to consider on the Kentucky Medical Board’s website.

Not to be outdone, Indiana’s regulations state:

The physician shall discuss with the patient the potential risks and benefits of opioid treatment for chronic pain, as well as expectations related to prescription requests and proper medication use.

Hoosier State regulations go on to list specific educational points that prescribers must cover with patients that include obtaining a patient’s informed consent.

agree

Obviously, to obtain informed consent a patient must be informed.

Indeed, most states’ regulations require that physicians educate their patients. The Federation of State Medical Boards agrees:

The physician’s duty includes not only appropriate prescribing of opioid analgesics, but also appropriate education of patients… inadequate attention to patient education (is a clear) departure from accepted best clinical practices.       

But, aside from the learning part, there is another, less precise, less quantifiable, factor in the equation that produces strength at these Friday afternoon get-togethers.

The numbers.

A group dynamic is quite therapeutic. For some time, psychology researchers have been able to show that group therapy is a “powerful intervention.”

Groups foster a community spirit; a sense that “I’m not in this alone.”

The group offers a sounding board. Members can help each other come up with specific ideas for improving a difficult situation or life challenge and even offer some accountability along the way.

The key therapeutic principles involved in group therapy include:

*Hope: Being with people who are coping or recovering gives hope to others who may be running short on this.

*Universality:  People see that they are not alone.

*Information: They help each other by learning and sharing a consistent message.

*Altruism: Self-esteem and confidence is boosted by sharing and helping others.

*A sense of family: The therapy group is much like a family in some ways. And because the group shares common goals, members gain a sense of belonging and acceptance.

Now, more and more, group sessions are utilized in the treatment of conditions other than purely psychological. The American Academy of Family Physicians has stated their belief that “group visits are a proven, effective method for enhancing a patient’s self-care of chronic conditions, increasing patient satisfaction, and improving outcomes.”

So, on this Friday afternoon we had a group “SIN” session. It started with a little levity and a brief informative video.

dr pat

Next, some definitions were explained, risks and alternatives were discussed along with “SMART” goals and proper stewardship of the medications. Patient responsibilities were explained. The educational points required by the Bluegrass and Hoosier States were covered. Some Q & A was encouraged throughout. It was interactive.

This was not a purely didactic session. There was eye contact and emotional contact. After all, pain is defined as a sensory and emotional experience.

And in the end, the participants didn’t just feel like a number.

And they had more strength to do battle.

As did their doctor.

On this atypical Friday afternoon.

There truly is strength in numbers.

Fireworks-047-screen

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4 thoughts on “STRENGTH IN NUMBERS

  1. REFERENCES & LINKS:
    *
    Murphy Pain Center
    http://www.murphypaincenter.com/louisville
    *
    The Supremes “The Happening” (video)

    *
    Kentucky Board of Medical Licensure / House Bill 1
    http://kbml.ky.gov/hb1/Pages/default.aspx
    *
    A list of educational points to consider from the KBML website: http://kbml.ky.gov/hb1/Pages/Considerations-For-Patient-Education.aspx
    *
    The Medical Licensing Board of Indiana, Emergency (Pain) Rule:
    http://www.in.gov/pla/files/Emergency_Rules_Adopted_10.24.2013.pdf
    *
    Sample Informed Consent for Controlled Substances Therapy for Chronic Pain: https://jamespmurphymd.com/2014/02/19/are-we-in-agreement/comment-page-1/#comment-271
    *
    FSMB Model Policy on the Use of Opioid Analgesics in the Treatment of Chronic Pain
    http://www.fsmb.org/Media/Default/PDF/FSMB/Advocacy/pain_policy_july2013.pdf
    *
    Montgomery, Charles. “Role of dynamic group therapy in psychiatry.” Advances in Psychiatric Treatment (2002)8: 34-41doi: 10.1192/apt.8.1.34
    http://apt.rcpsych.org/content/8/1/34.full
    *
    WebMD: Group Therapy and Mental Heath.
    http://www.webmd.com/anxiety-panic/guide/mental-health-group-therapy
    *
    American Psychological Association: Understanding Group Therapy
    http://www.apa.org/helpcenter/group-therapy.aspx
    *
    The principles of group therapy as presented in: Yalom, I. D., & Lesczc, M. (2005). The theory and practice of group psychotherapy. New York, NY: Basic Books http://psychology.about.com/od/psychotherapy/f/group-therapy.htm
    *
    AAFP: Shared Medical Appointments/Group Visits Visitshttp://www.aafp.org/about/policies/all/shared-medical.html
    *
    Doctor Pat (video)

    *
    Video: “How does your brain respond to pain?” – Karen D. Davis

    *
    ASAM: Definitions Related to the Use of Opioids for the Treatment of Pain
    http://www.asam.org/docs/publicy-policy-statements/1opioid-definitions-consensus-2-011.pdf?sfvrsn=0
    *
    The ABC’s of Pain
    http://www.practicalpainmanagement.com/resources/abc-pain
    *
    IASP Definition of Pain
    http://www.iasp-pain.org/Education/Content.aspx?ItemNumber=1698#Pain
    *
    Feel Like a Number (video) – Bob Seger

  2. Dr. Murphy,

    As a member of that Friday’s “S.I.N.” session, I have to say I thoroughly enjoyed the interaction with my fellow pain patients, as well as the discussion and, of course, the now familiar “Dr. Pat”. We had all begun a healthy banter before you arrived for the actual proceedings and were getting to know each other to some extent, Some of us had met at the previous weeks’ pill count and were already somewhat familiar.

    I was discussing a recent motor vehicle accident I had and the fact you were making me go to the ER or else, you said with a wink, One patient explained that it was things like this that kept her coming to your office. She went on to say, ” They really care about you here and they don’t treat you like cattle or worse, a drug addict.” Most everyone paying any attention to our conversation agreed. I asked them if they had visited your blog and gave them the information to get here. Many jotted the information down as if they had every intention of looking into it.

    It made me proud to be associated with an office such as yours with your kind and compassionate staff. From the medical receptionists, nurses, lab personnel to the providers they are all extremely kind and I have never felt stigmatized in any way, I have found after working in the medical field for thirty years, the temperament and even the professionalism of the staff of each office tends to be a direct reflection of the doctor in charge. So Kudos to you James Patrick Murphy, M.D. Thank you for taking on the often thankless job of being a pain medicine specialist. It is clear you love your job and even more obvious you care for your patients. Let me assure you, we all know that you are special.

    Sincerely,
    Kimberly Miller

    See Link for the following page:
    “Opposition to Kentucky HB 1-Reform HB 217 aka “Pill Mill Bill”
    https://www.facebook.com/pages/Opposition-to-Kentucky-HB-1-Reform-HB-217-aka-Pill-Mill-Bill/595049517218134

  3. I love this! I am going to share this article with my pain management specialist and his staff. It sounds like a helpful step in managing the psychological issues that go along with trying to deal with pain on a daily basis and feeling so alone. I love your blog and I love your approach to medicine

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