Life Beyond Pain Implementation Manual

The Challenge of Chronic Pain Care

People living with chronic pain often feel unseen, exhausted, and isolated within a healthcare system built around brief visits, medications, and procedures that rarely change their day-to-day experience. Providers share this frustration. Many of us entered healthcare to help people heal, yet chronic pain care can feel repetitive, unrewarding, and disconnected from what patients truly need. Clearly, we need a different chronic care model—one that is longitudinal, relationship-based, and focused on helping people learn how to help themselves. Our role needs to change from “treating” chronic pain to educating, coaching, and supporting people in their journey to a better life despite their pain.

The Life Beyond Pain Model

At the OHSU Richmond Clinic, Jason Kroening-Roche, Kristin Erickson, and Charles Lev developed a 10-week multidisciplinary group visit program grounded in the following:

• Education using the Pain Education Toolkit
• Team-based care
• Creation of a safe and supportive space where patients feel seen
• And financial sustainability within a fee-for-service system

This heart-centered model has demonstrated that patients improve function and confidence while providers rediscover meaning and fulfillment in their work.

Support from the Mayday Fund

The Mayday Fund has provided funding for a two-year feasibility study to determine whether the Richmond Clinic model can be replicated in other healthcare systems. We are very grateful for their trust in this Life Beyond Pain Collaborative.

Objectives of the Life Beyond Pain Collaborative

This workshop is the kickoff of the two-year study. Together, we will determine whether this model can be implemented successfully in different clinical settings, hopefully establishing proof of concept that this model can apply more widely within our healthcare systems.

The Implementation Manual

The Richmond Clinic team developed this implementation manual to make it easier and faster for you to implement similar programs in your clinics. They documented their approach and provided practical examples of how to structure sessions, prepare as a team, facilitate groups, document care, and sustain the program financially. This workshop is your opportunity to learn the Richmond Clinic’s “secret sauce” and begin adapting its essential ingredients to replicate their success in your own healthcare system.

“When patients feel seen and connected, healing begins.”

— Dr. Jason Kroening-Roche

• Phase 1: Early Planning (1 – 2 months)

  • Secure leadership support
  • Assemble core team
  • Early patient recruitment
    • Create a referral pathway
    • Advertise
    • Generate patient list

  Phase 2: Implementation Planning (2 – 3 months)

  • Organize logistics
    • Determine group timing
    • Reserve space
    • Create a template
    • Scheduling
  • Engage your team
  • Gather supplies and print paperwork

  Phase 3: Group Launch and Facilitation (10 weeks)

  • Group visit week-by-week outline
  • Session flow
  • Conduct first group visit
    • Group visit Medical Documentation and Billing
    • Facilitation Skills and Practices
    • Tips for virtual and hybrid delivery
  • Gather early feedback
  • At the halfway point, consider cohort 2 timing
  • During Session 10, set initial Lifestyle Goal with patients

  Phase 4: Feedback, Revision, and Goal Setting Follow-up (9 months)

  • Review feedback from participants
  • Evaluate and revise referral and scheduling processes
  • Begin Lifestyle Goal Check-ins with patients
  • Determine next steps for follow-on cohorts

Secure Leadership Support

Leadership support will depend on your context. This may just be you if you run your own clinic! Most likely this will involve discussing the group visit model and plan with your medical director and perhaps your institutional clinical leadership as well.

First and foremost, share with your leadership that providing a chronic pain group visit will help patients. We have seen this over and over in our Life Beyond Pain model at the Richmond Clinic.

It is also very important to discuss the billing and financial feasibility of the model. Because the model fits within fee-for-service billing systems, it does not require complicated budget restructuring. Your group can fit within an existing clinical session and replace individual visits. In this arrangement, the most important consideration is that group attendance at least replaces the number of patient visits you would have otherwise had during the group meeting time.

Additional talking points include:

• Improved provider well-being
• How the group offering can be a support to providers as they care for patients with chronic pain

Assemble Core Team

Early Patient Recruitment

It is critical that patient recruitment begins early in the process. At its core, recruitment means generating a list of interested patients who can be called later and offered participation. This requires:

• Creating a referral pathway
• Advertising the group to providers
• Maintaining a list of referred patients

Scheduling, templates, and reserving a space do not need to be sorted before recruitment can begin.

Consider the following patients for referral:

• Chronic pain >3 months
• Interested in lifestyle approaches
• Open to group participation
• Able to independently and cognitively participate

We do not recommend placing strict inclusion criteria on participation. If patients self-select to join your group visit intervention, they are likely to be a good fit. This avoids the need to decide who is “stable” or “mobile” enough to participate.

Creating a Referral Pathway

Clinic implementation leads will need to establish a referral pathway within their clinic (and from outside if external referrals are accepted).  Recruitment cannot actually begin until clinicians know how to refer potential participants.

Referrals can come through a variety of channels:

• Direct referrals
  • PCPs
  • Behavioral health consultants
  • Pharmacists, nurses, or other clinical team members
• Flyers, patient portal messages
• Word-of-mouth

Consider setting up a referral order within the EMR. If this is not possible, referrals can be routed to a lead scheduler via an EMR in-basket message and a secure patient list can be maintained for later access. Whatever referral process is decided upon, it should be simple and easy for clinicians to remember.

Some clinics might also generate a list of patients with chronic pain for specific outreach and recruitment, either via phone or a MyChart message.

Regardless of the referral process that is used, patients should be well informed of the details of the group, including that this is a Shared Medical Appointment, that other patients will be present, and that it is a 10-week commitment.

Advertising

After a referral process has been agreed upon, it is time to start advertising! The first place to start is meeting with your providers (PCPs, BHCs, RNs, etc.). The most efficient space is usually at provider meetings. Share about the groups you plan to offer and why you are participating. Be real and be yourself as you share.

Sample Introduction:

“I’m starting this group because I believe we can offer more to our patients living with chronic pain. I’ve become increasingly frustrated with the status quo: spending 20 minutes with a patient reviewing all the medications that haven’t worked and telling them their MRI or pain injection referral won’t be covered. The interaction is draining for me as a provider and frustrating for patients. I’d love to offer patients (and you) something different.”

After that, give providers a sample pitch they can use with their patients. Your goal is to inspire providers to inspire their patients. This is critical. Group visits for chronic pain will not sell themselves. But they will help patients. Because you may not have a specific start date for your groups, encourage providers to keep the specifics about timing vague.

Sample Provider Pitch:

“We’ve talked about your chronic pain over the years, and much of that has focused on medical options—medications, PT, X-rays, MRIs. Those matter, but there are many aspects of chronic pain we don’t have time to address in 20-minute visits. The good news is that our clinic is starting a group focused specifically on chronic pain. The group offers practical tools I think could help you, and gives you a chance to be with others who live with pain and may understand your experience in a different way. I also think your perspective could be meaningful to others. It would be something different and does require a time commitment, but patients at other clinics have benefited—many who were unsure at first ended up loving it. I’d encourage you to give it a try. What do you think?

If the patient is interested:

“Great! We don’t have a specific start date yet but are hoping to begin in the next few months and our schedulers will reach out with more specifics closer to that time. For now, I’ll place the referral to let them know you’re interested.”

As discussed above, referrals can also come from patients themselves. Flyers in clinic can help advertise the groups directly. Based on your specific referral pathway, patients may need to reach out to their PCP to be referred, or via another route.

For a sample pain group flyer, see Appendix A

Generate a List of patients

When a referral is sent, designate someone to maintain a list of these patients. This will often be a member of your scheduling team. This list can continue to grow until you are ready to move forward with scheduling.

Organize Logistics

Determine Group Timing

The next step in the process is to determine when you will host your group each week. We recommend groups be on the same day of the week and at the same time of day for consistency. We also recommend a duration of 1 hour and 15 minutes up to 1.5 hours long. Some pain groups are as long as 2 hours, however this can fatigue patients living with chronic pain.

This is also the time to decide when you will begin your first cohort.

Reserve Space

If you are planning an in-person group, find a group space to host. This will most often be a clinic conference room but could even be a large procedure room or lunchroom. Be creative if needed in your space. A room with windows is ideal as the fluorescent lighting in most healthcare settings can negatively impact the group setting.

Be sure the space is available on a recurring weekly basis.

If you are planning a virtual session, identify HIPAA compliant software you can use to host the group. Consider the technological complexity of the software and how patients will join the virtual session.

Create a Template

After you have chosen your start date, group timing, and reserved the space, work with your clinic schedulers to create a template where patients can be scheduled. This may be a place-holder group template or on each individual provider’s schedule. The process will vary depending on clinic scheduling considerations.

Scheduling

You are now ready to schedule patients! Identify a designated clinic support person(s) who will call patients to schedule them. We recommend scheduling 12–15 patients for the first group, anticipating a no-show rate of up to 50%.

This is a critical step in the process!  When patients are called, they may not remember agreeing to join the pain group—the conversation with a provider may have happened several months ago. Additionally, the scheduler may not be familiar with the pain group details, so providing a script will be helpful.

For a sample Patient Portal (MyChart) Invitation Message, see Appendix B.

For a sample Scheduling Script, see Appendix C.

Engage Your Team

Set aside time for a kickoff meeting or workshop to make final preparations ahead of the first group. Celebrate the birth of something new and the work it has taken to get this far. The Life Beyond Pain group intervention is powerful because providers show up in a space of vulnerability and compassion. Cultivating these qualities in your team ahead of your launch date will help lay the foundation for embodying these when you are with patients.

You can also use this time to finalize session plans and identify the remaining tasks that need to be completed.

Gather Supplies and Print Paperwork

Supplies to consider:

• Rocks to place in the middle of the circle
• Markers and easel or white board for notetaking and/or diagram drawing
• A monitor with computer connection and audio to show Pain Education Toolkit videos
• Lamps to create softer lighting if in a fluorescently lit space
• Refreshments, if planning to provide, including water, hot tea or coffee, healthy snacks

Print patient handouts of the Pain Education Toolkit patient handouts. This can be found at northwestpainguidance.org and can be printed altogether and given at the beginning of the cohort or individually and handed out each week.

Also print welcome paperwork and weekly intake sheets.

See Appendix D for example session handouts.

Group Visit Week-by-Week Outline

See Appendix E for specific session outlines or “set lists.”

Session Flow

Pre-Huddle

Hold a 5-minute pre-huddle before every session:

• Review topic and agenda
• Clarify who leads each section
• Anticipate challenges
• Ground together (brief mindfulness or shared breath)

Generic session outline

1. Opening music and mind-body practice
2. Introduction/check-ins and feelings wheel
3. Reflection on previous week’s topic
4. Education video segment
5. Group reflection
6. Goal setting
7. Mind-body practice wrap-up

Post-session debrief

• Shared gratitude
• Reflect on “What moments felt meaningful today?”
• Invite compassion for participants
• Normalize emotional reactions to patient suffering

Facilitation Skills and Practices

The Heart of Facilitation

• Listen more than you speak
• Honor stories without judgment
• Focus on empowerment, not rescue
• Invite shared wisdom

Creating Psychological Safety

• Model empathy and curiosity
• Validate patient experiences without “fixing”
• Allow silence—reflection is productive
• Normalize emotional expression
• Emphasize community over hierarchy

Managing Group Dynamics

• Set group norms early (respect, confidentiality, participation)
• Acknowledge emotion and redirect if needed
• Encourage peer-to-peer feedback

Encouraging Engagement

• Use open-ended questions: “What resonated most with you today?”
• Reflect back key points: “I hear that you’re finding movement helpful again.”
• Balance group dynamics with ‘step up, step back’ to invite quieter voices

“Avoid teaching too much. Create discovery.”

Handling Challenges

• Dominant voices: Thank and redirect (“Let’s hear from others, too.”)
• Emotional distress: Pause discussion, validate, offer opportunity to step out and take time
• Low energy: Allow space and silence

Tips for Virtual and Hybrid Delivery

Best Practices

• Use secure HIPAA-compliant platform
• Send materials before sessions
• Begin each session with a “tech check”
• Keep visual connection—encourage cameras
• Set norms for privacy
• Mix education with breakout discussions
• Use movement to combat screen fatigue

Hybrid Tips

• Ensure equal participation between virtual and in-person attendees
• Assign co-facilitator to monitor chat and virtual engagement

“In virtual settings, connection still comes from tone and presence, not just proximity.”

Approach to Goal Setting

Goal setting is a core element of effective chronic pain self-management and requires consistent engagement from the healthcare team to support meaningful behavior change. Equally important is ongoing follow-up. Without regular check-ins, even well-intentioned goals often lose momentum.

After the Life Beyond Pain cohort ends, we recommend structured Lifestyle Goal Check-ins to help patients sustain progress, build confidence, and continue applying what they have learned. These check-ins are described in more detail below.

Before follow-up begins, patients set their first Lifestyle Goal during the final group session.

Setting the First Lifestyle Goal in Session 10

Session 10 serves two purposes: it closes the shared group experience and launches the next phase of patient-led growth. During this session, it is essential to provide time and support for patients to set their first Lifestyle Goal—one they will begin working on immediately following the program.

This initial goal should be short term, the next 2 to 4 weeks and personally meaningful to the patient. The goal should be something they need to strive to succeed and will be pleased with themselves to have achieved, but not so ambitious that they are likely to fail.  Since patients have just completed a 10-week educational and experiential program, their goals should incorporate the insights, knowledge, and skills they have acquired.

We encourage facilitators to use SMART goal principles (Specific, Measurable, Achievable, Relevant, Time-limited) as guidance, not rigid requirements. Some patients will initially articulate goals that are values-based or narrative rather than strictly SMART. This is acceptable—and often preferable. Specificity and measurement can be introduced gradually through follow-up conversations.

Example Goal

The goal should be written in the patient’s own words and documented verbatim in the EHR. Avoid rephrasing or “sanitizing” the goal. This allows future check-ins to return directly to the patient’s stated intention: “This is the goal you set—how is it going?”

This handwritten note is a goal set by someone after completing the Sleep module.

Patient’s Goals

• Go to bed at a set time and get up at a set time
• Stop watching TV at least 1 hour before bed
• Meditate before going to sleep / put aside worries
• Don’t eat 2 hours before bed / limit caffeine & alcohol
• Listen to my body. Don’t push myself so hard
• Believe that these things will help improve my pain levels and make me more capable of dealing with stress and stressful situations
• Find peace of mind and have faith in my ability to cope with life’s challenges
• Mind over matter
• Do I mind and does it really matter?

Why This Goal Works (Even Though It’s Not “SMART”)

This goal is powerful because:

• It is deeply personal, addressing sleep, stress, self-trust, and peace of mind.
• It clearly reflects learning from the Sleep module.
• It connects behavior → meaning → identity
  (“believe these things will help me cope with life’s challenges”).
• It signals readiness for change, not passive compliance.
• It creates a shared narrative for follow-up conversations.

At this stage, these qualities are more important than meeting every SMART criterion.
SMART goals are tools. This goal is a compass.

1. Document the Goal Verbatim

Enter the goal into the medical record in the patient’s own words (photo attached or transcribed verbatim). Do not rewrite or sanitize it. This allows you to say:

“This is the goal you set. How is it going?”

That question alone is therapeutic.

2. Use the Lifestyle Goal Check-ins to build on the goal over time

During weekly check-ins, gently add structure without stripping meaning:

• “Which part of this feels most important this week?”
• “What feels doable right now?”
• “What got in the way?”
• “What’s one small adjustment you want to try next week?”

Over time, pieces of the goal naturally become more specific and measurable—without losing ownership or motivation.

3. Reframe SMART as Supportive, Not Prescriptive

Some patient goals will not initially meet strict SMART criteria. This is acceptable—and often preferable—at the end of the 10-week program. When goals are personally meaningful and grounded in insight gained during the program, they provide a strong foundation for follow-up. Specificity and measurement can be introduced gradually through ongoing Lifestyle Goal Check-ins, rather than imposed at the outset.

Lifestyle Goal Check-ins with Patients

Ongoing follow-up is essential to maintain the benefits of group visits. Lifestyle Goal Check-ins focus on helping patients translate insight into action, troubleshoot barriers, and build confidence through success.

Who Conducts the Lifestyle Goal Check-ins?

Lifestyle Goal Check-ins may be conducted by a medical clinician, behavioral health consultant, or nurse. We recommend selecting the team member best suited and available in your setting and maintaining the same check-in provider over time to support continuity and trust.

Because follow-up is a core component of the model, it must also be financially sustainable. Billing options based on team roles are outlined in the Financial Sustainability and Billing Models section.

Recommended Schedule for Lifestyle Goal Check-ins

The period immediately following the 10-week program is critical. This is when accountability, encouragement, and consistent support have the greatest impact.

We recommend the following schedule:

• Weekly for the first 4 weeks
• Every other week for the next 8 weeks
• At least monthly for the following 9 months

We cannot overstate the importance of weekly check-ins during the first month. This early contact helps patients stay on track, reinforces momentum, and clearly demonstrates that the care team remains present and supportive.

Outline for Lifestyle Goal Check-ins

Each check-in should be brief and focused. Suggested structure:

• Set expectations for a short, goal-focused visit
• Review the patient’s original goal as written
• Explore progress, challenges, and facilitators
• Assess confidence moving forward
• Identify adjustments or a next goal as appropriate
• Document the visit in the EHR

See Appendix F for the Session 10 Lifestyle Goal Patient Handout.

See Appendix G for Sample Lifestyle Goal Check-in Documentation.

Overview

The importance of demonstrating financial sustainability cannot be overemphasized. This chronic care model—consisting of a 10-week group visit program followed by 12 months of Lifestyle Goal Check-ins—will only be sustainable if providers bill for all patient sessions during both the group program and follow-up phase.

In most clinics, revenue from this program should be viewed as replacement revenue, as providers are typically fully scheduled. An important exception is that group visits can generate greater revenue than individual visits when attendance is high.

The billing models described below assume an average group size of eight patients per session, which is important for both operational efficiency and financial sustainability. We recognize that early cohorts may not reach this level as clinics refine workflows and referral processes. This is expected, but with experience, subsequent cohorts should aim to achieve this average.

To reach an average attendance of eight, clinics will usually need to enroll more patients than attend any given session. Based on experience, we recommend recruiting 12–16 patients per cohort to account for dropouts and missed sessions. In clinics with high no-show rates, up to 20 patients may be needed. This 8-patient average is a goal, not a requirement for early cohorts.

Medical Documentation

Medical providers should document the medical visit as they would any other visit in the patient’s chart. This includes a brief subjective, objective, and assessment and plan.

The subjective portion of the patient note can be taken from the patient’s weekly questionnaire (see Appendix D) and the medical assistant’s notes that they scribe during group. The objective portion includes:

• Any vitals (we recommend Simple Pulse and O2 sat as they can be gathered quickly, although none are technically needed)
• Patient appearance

Finally, document a unique assessment and plan for each patient. This is achieved by documenting the patient’s specific pain diagnosis/source, which is gathered from the intake paperwork they complete (see Appendix D). If a patient lists “pain all over” and they have a diagnosis of fibromyalgia, this would be the appropriate code to use. Other common codes include chronic low back pain or other chronic joint pains. “Chronic pain syndrome” is not specific enough to qualify for billing reimbursement.

The plan documentation can be similar from patient to patient but should include specific aspects relating to a patient’s journey/work. You may also choose to document the level of engagement and whether they received acupuncture and/or acupressure. Goals set and progress toward specific goals should included as well. You do not need to adjust medications or place any orders to satisfy the 99213 billing complexity requirement.

Medical Billing

Medical billing is based on the complexity of medical decision making as documented in the chart, not on time spent with patients. For most patients you will utilize a code of 99213, as the complexity of the visit does not typically satisfy a 99214.

Because you will be using a 99213 billing code, it is important to notify patients that the pain groups are medical visits and will be billed to their insurance. Co-payments apply.

See Appendix H for Medical Visit Example Documentation for each session.

Do I have to see patients individually for any portion of the group visit?

It is not required that you meet with each patient individually to bill these as medical visits, so long as you identify a chronic pain diagnosis and document the visit as described above. We recommend using a one-page intake form that asks for the patient’s pain source and a few basic questions, as well as confirms they agree to patient confidentiality. This form qualifies as an individual point of contact between you and the patient, even if you do not personally review it with them.

Behavioral Health Documentation

See Appendix I for Behavioral Health Example Documentation.

Behavioral Health Billing

It is possible to bill both medical provider “CPT codes” and behavioral health “health and behavior codes” for the same group visit. This increases the reimbursement potential from the LBP group visits.

Billing Models

Common Assumptions for All Models

Group Visit Program:

• 10 weekly group visits
• 75-minute sessions with ~30 minutes preparation
• Average attendance: ~8 patients per session

Lifestyle Goal Check-ins:

• Weekly × 4 weeks
• Bi-weekly × 8 weeks
• Monthly × ~9 months
• Total: 17 check-ins per patient x ~8 patients

Billing Codes:

• Medical providers (MD/PA/NP): CPT 99213
• Behavioral health clinicians: 96164 (first 30 min), 96165 (each additional 15 min)
• RN follow-ups: CPT 99211 under incident-to provisions

Model 1: Provider-Led Care

The medical provider conducts both group visits and all Lifestyle Goal Check-ins.

Group Visits

• Provider bills 99213 per patient per session

Lifestyle Goal Check-ins

• Provider bills 99213 × 17 visits per patient

Model 2: Provider and Behavioral Health Team-Based Care

The medical provider participates in group visits, while behavioral health clinicians (BHS) conduct Lifestyle Goal Check-ins.

Group Visits

• Provider bills 99213 per patient per session
• BHS bills 96164 (first 30 mins) and 96165 (each additional 15 mins)

Lifestyle Goal Check-ins

• Behavioral health clinician bills 96164 (16 – 30 min)
• Note: Medicare does not reimburse for BHS 96164/65 for follow up check-ins. The provider must do the check-ins.

Model 3: Provider-Led Group Visits with RN Follow-Up

The provider leads group visits and establishes the care plan. Registered nurses conduct Lifestyle Goal Check-ins under incident-to supervision.

Group Visits

• Provider bills 99213 per patient per session

Lifestyle Goal Check-ins

• RN bills 99211 under incident-to provisions bills 99213 × 17 visits per patient

Revenue Generation and Reimbursement Rates

We are not able to estimate reimbursement rates as these vary for each healthcare system and the payers. We will work with each clinic to determine their billing codes and reimbursement rates.

A goal of the Life Beyond Pain Collaborative is to better understand whether and how the LBP group visit model impacts patients. We also aim to understand how LBP group visits impact providers and whether expanding this model to new clinics is feasible.

To gather information about these questions we will be conducting surveys of patient participants at 4 time points:

• Before they start attending groups
• Immediately after they complete group visits (after the 10^th session)
• 3 months after completion of group
• 9 months after completion of group

See Appendix K to view a patient survey.

We want to avoid placing research burden on clinic staff and facilitators so we will be conducting the research centrally. Our request is that a list of patients and their contact info be shared with us after the cohort has been fully scheduled and as early as possible before groups begin. This will give us time to reach out to patients and ask them to complete their first survey.

We are also asking your clinic scheduler to read a script to patients when they are scheduled, so that they have awareness of the research. This is not a formal consent—we will consent patients later in the process. Rather, this is to make patients aware that any outreach from us is legitimate and not spam. We also do not want to surprise patients and unintentionally disrupt the provider-patient trust that you have built.

See Appendix L for the scheduler script.

We are nearing IRB approval from OHSU to proceed with our survey-based research project. Jason Kroening-Roche and Mark Stephens are Co-PIs on the project and our research coordinator is Rebecca Rdesinski.

(The yellow highlighted items may not be relevant in your clinic)

Subject line: You’re Invited: Life Beyond Pain Group

Dear <<preferred name>>,

Are you interested in changing your relationship to pain?

Does pain keep you from doing things you enjoy and that are important to you?

Maybe you just wish you knew more about where your pain comes from and what you can do to manage it better?

If this sounds familiar, you’re not alone and you’re invited to attend <<Clinic Name>>’s Life Beyond Pain group!

What can I expect?

The groups will include:

• Education – Learn more about pain and new ways to manage it
• Community Support – Learn and share with other people living with pain
• Acupuncture – We will offer clothed, seated, group acupuncture for those who are interested
• Mindfulness and other practices– Use your breath to practice paying attention without judgment

The groups will be facilitated by a behavioral health clinician, an acupuncturist, and a family medicine doctor.

We are expecting that about 6–12 patients will attend each group. This could change.

Who can attend these groups?

The groups are open to all clinic patients.

Where are the groups held?

They will be in-person at the <<Clinic Name>>.

When will the groups take place?

They will take place every <<Day of Week>> from <<Start Time>> to <<End Time>> beginning on <<Start Date>>.

You do not need to attend each group. You may join as often as you would like!

Will my insurance cover it?

This is a group medical visit. Typical visit insurance co-payments will apply.

What if transportation is a problem for me?

If you have Oregon Health Plan, you can use Ride to Care to get to and from the clinic at no cost to you!

I’ve never done acupuncture. What is it?

Acupuncture is the ancient Chinese practice of inserting hair fine needles to affect the movements of life force (Chi) in the body. The experience is usually more like a massage than getting an injection. We will primarily offer ear acupuncture, a common practice around the world for wellness and pain relief. This is an optional part of the group available while seated in the group setting. We will also offer acupressure using tuning forks.

I’m interested! How can I sign up?

Please reply to this message and we will reach out to get you scheduled for the first available group.

I still have questions. Who can I talk to?

Please reply to this message with your questions. We’re happy to help!

We believe in the science that shows chronic pain can change and that people have the power to change their daily experience and live well. Join us and see for yourself!

Intro: “Good morning. My name is <<Scheduler’s Name>> from the <<Clinic Name>>. I am calling to schedule you for the Life Beyond Pain group visits. You were referred by your PCP several weeks ago. Do you remember talking about this with them?”

If more detail is needed: “The Life Beyond Pain group is a supportive 10-week program led by your care team. The group will focus on learning practical tools to help manage your pain. It is also a place where you can connect with others like you who experience pain. The size of the group may vary from just a few patients to as many as 10 or 12. Your PCP thinks the groups will be really helpful for you.”

If patient is ready to schedule: “The groups will happen on <<Day of the week>> from <<Time frame>> at the clinic. You do not need to attend all the groups but you will get more out of them if you attend more groups. Can I answer any questions about this for you and get you scheduled?”

After scheduling: “The Life Beyond Pain group model came from the OHSU Richmond Clinic where they have been running groups for more than 2 years now. Our group is part of a learning collaborative alongside other clinics who are also starting pain groups. As part of this collaborative, a team from OHSU is studying the group to see how helpful they are. Someone from the research team may reach out to you by phone or email to see if you’d like to participate in the research project. You don’t have to participate to be part of our group—I just wanted to give you a heads up so their outreach is not a surprise.”

Life Beyond Pain Group Visit Welcome Form

Welcome to the Life Beyond Pain Program

We are excited you are here. Just being here shows your commitment to exploring a life beyond pain.

The Life Beyond Pain Group is built on 4 main pillars: mindfulness and movement practice, pain education, group support, and acupuncture/acupressure.

A few housekeeping details:

• We believe coming regularly to groups will make the biggest impact on reducing your chronic pain.
• Showing up with an open heart and open mind is best. We all have more to learn (and to teach)!
• You will get the most out of these groups by practicing what you learn between our sessions when you are at home. Setting goals and then working toward them is an important part of improving your pain. We commit to supporting you in this work.
• Participation is voluntary. If anything does not feel good or healthy for you, you do not have to participate. Please listen to your body, mind, and heart.
• What is discussed in group is confidential. There are some exceptions to this – the facilitators are mandated reporters. That means that if we have worries about harm to yourself or other people, especially children, older adults or adults with disabilities, we need to report those concerns to the appropriate agencies.
• Group visits are medical visits and will be billed in the same way regular clinic visits are billed.
• A medical assistant will be taking notes for each session and these notes will be used by the facilitators to write chart notes. These notes will be part of your medical record.
• There are Behavioral Health Consultants (BHC) available for one-on-one support for goal setting for chronic pain management outside of group. Please ask if you would like to be connected to your pod BHC.
• There are Behavioral Health Resource Specialists available for help finding resources in your neighborhood. Please ask if you would like to be connected to your resource specialist.
• Our goal in this group is to build upon the skills and resources you have as you live with your chronic pain. We want to support your relationship with your PCP and other care team members. We cannot change your PCP assignment and request that you discuss any concerns about your care team with your PCP.
• Please keep other group members’ information private.

Thanks again for being here! We are excited about our time together.

Life Beyond Pain Group Weekly Questionnaire               PATIENT LABEL

Last week’s group was about _______________________

Today, the place in my body I am feeling the most pain is:

___________________________________________________

What is one learning or takeaway from last week’s group that resonated with you in some way?     (if you weren’t there, what have you been working on?)

1. What number best describes your pain on average in the past week?

2. What number best describes how, during the past week, pain has interfered with your enjoyment of life?

3. What number best describes how, during the past week, pain has interfered with your general activity?

4. Do you agree to maintain confidentiality about everything shared in this group?

YES            NO

Week 1 Plan: Welcome + Norm Setting

Offer a very brief introduction and welcome before starting the guided exercise.

• Music and guided breath
• Story of why we’re here
• Norm setting
  • Structure of group / Risks / Benefits
  • Confidentiality
  • Mandated reporters
  • Medical visit and will be documented in medical chart
  • MA scribing
  • BHC + BHRS roles + pod-based care (for help w/ SMART goals + resources)
  • Take space / make space (talking ball or stick?)
  • Yes / and (respect for others’ experiences and views)
  • Stones in the center of the circle (everyone sees these stones from a different perspective)
  • Friendships / relationships outside of group
  • Not able to switch PCP to group leader; provider will not adjust meds during group
• Introductions
  • Names + identify one emotion you are feeling in this moment
• Pain Dial of Life Box and patient conversation (return to this and reference it during patient sharing times)
• Grounding exercise

Week 2: Understanding Pain

• Music – 2 min
• Grounding practice – Insight meditation – 5 min
  • No rules
  • Tune into natural warm-heartedness
  • What is it like to be you today?
• Names and ID a feeling
• Yoga next week
• Review norms – 5 min
  • Confidentiality and its limits, notes are part of medical record
  • Take space, make space
  • Yes / and (Honor others’ perspectives)
• ***Start acupuncture
• Stand and stretch – 2 min
• Understanding Pain video – 15 min
• Video reflections + shared learning – 20 min
  • Life box
  • Pain dial
• ***Wrap up acupuncture
• Grounding practice

Week 3: Activity

• Music and brief grounding / breathing
• **Start Acupuncture**
• Share names and ID a feeling
• YOGA – 20 minutes
• Review goals / observations from last week (Understanding Pain)
• Activity video – 14 Min
• Video reflections and shared learning
• **Wrap up acupuncture**
• Grounding / breathing practice

Week 4: Sleep

• Music and grounding exercise
• Share names + pronouns and identify a current feeling using feelings wheel
• **Start acupuncture**
• YOGA – 20 mins
• Sleep video – 14 min
• Video reflections and shared learning
• **Wrap up acupuncture**
• Grounding practice

Week 5: Mood

• Music and grounding exercise
  • 5 – see
  • 4 – touch
  • 3 – hear
  • 2 – smell
  • 1 – taste
• Share names and ID a feeling
• **Start acupuncture**
• Review goals / observations from last week (Sleep)
• Halfway point – Plus / Minus / Delta
• Mood video – 13 min
• Video reflections and shared learning
• **Wrap up acupuncture**
• Grounding practice

Week 6: Flare Ups

• Music + meditation
• ID and emotion + Introductions
  • (Start acupuncture)
• Share reflections from last week (Mood)
• Stretch / movement break!
• Flare up video
• Flare up discussion
• Loving kindness meditation
  • Recall a loving person
  • Healthy, peaceful, safe
  • I / you / we / all beings

Week 7: Nutrition

• Music and grounding practice – Mindful eating
• Share names and ID a feeling
  • **Start acupuncture**
• Review goals / observations from last week (Flare ups)
• Nutrition topic preview
  • Things to keep in mind
    • Care for self – step outside if needed
    • Not promoting a diet
    • Food does not = morally good or bad
    • Food can be enjoyable, fun, satisfying, and nurturing
    • Add, don’t subtract
    • Focus not on weight but how your body feels
    • Be curious – What might help pain? What might make it worse?
  • Stretch break!
  • Nutrition video – 15 minutes
  • Video reflections and shared learning
  • Grounding practice

Week 8: Medications

• Opening meditation
• Introductions and ID a feeling
• Review goals / observations from last week’s topic on Nutrition
• Movement break!
• Medication video
• Reflections on video and shared learning
  • Share one thing you are grateful for about medications that help with pain and share one thing that is challenging about medications
• Grounding practice – Self compassion
  • ID mild to moderate stressor
  • Notice in body, notice and be present to sensations
  • This is a moment of struggle, this hurts, this is stressful
  • Struggle is a part of life, I’m not alone, many others struggle like me
  • Offer kind touch and words to self
    • May I accept myself as I am, may I be patient w/ myself, may I forgive myself.
    • What would you say to a friend?

Week 9: Social Connection

• Grounding practice
• Introductions and ID a feeling
  • Start acupuncture
  • Last group next week!
    • Bring reading or art or another item if you want
  • Review goals / observations from last week (Medication)
  • Social video – Reflections and shared learning
  • Grounding practice – Energy buzzer

Week 10: Wrap Up

• Music and grounding practice
  • All in a day – Cynthia Rylant
• Share names and ID a feeling
• **Start acupuncture**
• General reflections, learnings, insights
• Share readings, art and other personal items
• **Wrap up acupuncture**
• Grounding practice
  • Closing circle – well wishes for each member in the group
    • 30–60 seconds each

Basic Guided Breath Practice

Take a moment to settle into this moment together.

You’re welcome to close your eyes or keep them open with a soft, steady gaze.

Bring your attention to your breathing. There is no need to change it.

Just notice where you feel the breath most easily: the nose, chest, or belly.

If breathing feels uncomfortable or painful, that’s okay.

See if you can simply notice that experience, without forcing anything to be different.

You might gently follow one full breath in… and one full breath out.

Let the breath come and go at its own pace.

If your mind wanders or attention moves away, that’s normal.

When you notice it, gently bring attention back to the next breath.

Following the breath all the way in, and then all the way out.

Continue in this way for a few minutes.

Take one more breath, just as it is.

When you’re ready, bring your attention back to the room.

Body Scan

Take a moment to settle into your body.

You’re welcome to close your eyes, or simply soften your gaze—whatever feels safest or most comfortable for you right now.

Feel the support of the chair or the floor beneath you.

Notice your breathing, just as it is.

Bring your attention to your head and shoulders.

Notice any sensations—tension, ease, or pain—without trying to change them.

No need to explain the sensations or create a story about them. See if you can just allow them to be, noticing them with curiosity.

Let awareness move to the chest and back, and then to the lower back or any area that tends to hold pain.

See if you can acknowledge what’s here, just noticing.

Bring attention to the legs and feet, feeling contact with the ground.

Now notice the body as a whole.

When you’re ready, gently bring your attention back to the room.

Session/Week 10 Patient Lifestyle SMART Goal

Which Pain Education Toolkit module do you want to focus on? (circle one)

• Understanding Pain
• Activity
• Sleep
• Nutrition
• Mood
• Flare-Ups
• Medication
• Social Connection

Write down your Lifestyle Goal below, in your own words.

This should be something you want to work on over the next 2–4 weeks. It should be meaningful to you and that you think is achievable. Your care team will help you refine and build on this goal during follow-up check-ins.

Lifestyle Goal Check-in Progress Note

Subjective:

Lifestyle Goal from previous week: ***

1. On a scale from 1–5, how much progress do you feel you have made toward this goal?

2. How confident are you that you can keep moving forward on this goal?
   • Not at all confident
   • A little confident
   • Moderately confident
   • Very confident
   • Completely confident

Objective:

Patient speaking in complete sentences, logical thought process, goal-directed.

Assessment/Plan:

<<Diagnosis Code(s)>>

(use appropriate code(s) based on patient’s chronic pain history and their self-identified problem/goal).

The patient is working toward their goal of *** by ***.

Patient will continue working toward this goal over the next week(s) by ***.

OR

The patient has achieved their goal.

New goal to work toward for the next week is ***.

Follow-up next planned in *** weeks.

LIFE BEYOND PAIN GROUP VISIT

WEEK 1

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain at above sites.

Discussed chronic pain, group norms, and class outline.

Discussed personal experience of chronic pain and the many and unique perspectives of each individual.

Explored the importance of community, shared experience.

Discussed self-concept, allowing emotion and what is present.

Acupuncture/acupressure intervention introduced.

Engaged in group mindfulness practice.

Patient invited to consider personal take-aways from today’s group and bring reflections to next session.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 2 – UNDERSTANDING PAIN

Facilitators: ***

Number of participants: ***

Completed confidentiality form: yes

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Discussed chronic pain, including etiology, neurobiology of neuroplasticity and change, and the power of thought to shape pain and expand/suppress emotion.

Watched Oregon Pain Education Toolkit Understanding Pain video together, with discussion of personal reflections following.

Acupuncture/acupressure intervention provided: ***

Utilized breath work and practiced this skill together.

Participated in seated meditation with focus on observing judgmental thoughts.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 3 – ACTIVITY

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Discussed activity, including the importance of movement, graded exercise/pacing, and the difference between hurt and harm.

Introduced the concept of being sore but safe.

Watched Oregon Pain Education Toolkit video on Activity together, with discussion of personal reflections following.

Discussion of starting where you are, not where one used to be, and the balance of grief vs allowing/accepting what is.

Acupuncture/acupressure intervention provided.

Participated in chair yoga session during group.

Utilized breath work and practiced this skill together, including meditation.

Patient encouraged to create activity goal for this week, to follow-up next week on progress prn.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

______________________________________________________________________________

WEEK 4 – SLEEP

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Reviewed activity with conversation about reflections from the week.

Exploration of emotion and engagement of well-being in the face of external stressors.

Explored identification with self, with emotion, with thoughts, and the power of “there is” rather than “I am”.

Participated in chair yoga session during group.

Watched Oregon Pain Education Toolkit video on Sleep together, with discussion of personal reflections following.

Discussed sleep and the importance of sleep hygiene, including regular sleep and wake times, cool room, electronic hygiene, etc.

Acupuncture intervention provided: acupuncture/acupressure***

Utilized breath work and mindfulness practice together, including body scan.

Patient encouraged to reflect on learnings from this week for follow-up next week on progress prn.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 5 – MOOD

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Reviewed the impact of sleep on chronic pain and discussed strategies for improving insomnia.

Discussed mood, including the importance of noticing and allowing emotions, the power of negative (and positive) thoughts, and cognitive distortions.

Watched Oregon Pain Education Toolkit video on Mood together, with discussion of personal reflections following.

Acupuncture/acupressure intervention provided

Utilized breath work and practiced this skill together, including guided breath meditation and 5 senses practice.

Patient encouraged to create a SMART goal for this week, to follow-up next week on progress prn.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 6 – Flare-ups

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

We reviewed the contribution of mood to chronic pain, the importance of thoughts and emotions.

Explored how to navigate external stress and expectations–and the contribution to chronic pain experience.

Watched Pain Education Toolkit video on Flare-ups and discussed flare-up management and individual flare-ups contributors.

We reviewed the importance of a flare-up toolkit, which includes activities to do (and avoid) during a flare-up, with group discussion of personal reflections following.

Acupuncture/acupressure intervention provided.

Utilized breath work and practiced mindfulness together, music therapy.

Encouraged self-work on Flare-up Kit this week at home.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 7 – NUTRITION

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Reviewed flare-ups and participants shared their strategies and progress in the preceding week.

Discussed nutrition, including the importance of mind-body connection when eating.

Introduced the concept of mindful eating.

Watched Pain Education Toolkit video about nutrition, including concepts of the gut microbiome, with discussion of personal reflections following.

Acupuncture/acupressure intervention provided.

Utilized breath work and practiced this skill together, including meditation and mindful eating.

Patient encouraged to incorporate learnings from group into their nutrition choices over the coming week.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 8 – Medications

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent acute flare-ups.

Discussed grief and loss and how this can impact our chronic pain.

Explored how meditation, living in the present, and gratitude are helpful approaches/tools.

Watched Pain Education Toolkit on Medications.

Discussed medications, including OTC, anti-epileptics (neuropathic pain meds), muscle relaxers, and opiates.

Discussed the effects, and side effects, of medications, the importance of taking them as prescribed, and the balance of benefits and risks with regards to opioid medications.

Acupuncture/acupressure intervention provided.

Practiced loving kindness meditation together.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 9 – Social Connection

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Today reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with intermittent flare-ups.

Reviewed risks and benefits of medication in chronic pain and reflected on role of opioid medications in medical system and culture.

Watched Pain Education Toolkit video on Social Connection together, followed up with a discussion of personal reflections of the ways social connection can help chronic pain.

We also reviewed how isolation and loneliness can increase mortality and worsen chronic pain.

Participants shared their experiences with isolation and how they develop/maintain social connection in their lives.

Acupuncture/acupressure intervention provided.

Practiced mindfulness and modeled bio-feedback of connection with bio stick.

Patient given opportunity to create a SMART goal for this week, to follow-up next week on progress prn.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

LIFE BEYOND PAIN GROUP VISIT

WEEK 10 – Closing Wrap-Up

Facilitators: ***

Number of participants: ***

Completed confidentiality form: ***

CC: Chronic Pain

HPI:

Patient reports feeling: ***

***

Medication list reviewed, updated.

@VS@

@BMIEST@

Gen: well groomed, seated, in no acute distress

Psych: engaged, conversant, linear and logical thought process

Resp: no increased work of breathing

Diagnosis Documentation: ***

Active chronic pain with flare-ups.

Reviewed Pain Education Toolkit sessions and reflected on meaningful learning experiences and take-aways.

Discussed the importance of tending to the nervous system as part of the pain experience.

Acupuncture/acupressure intervention provided.

Participated in group mindfulness/meditation.

Wishing well exercise for group members.

The patient identified a Lifestyle Goal using the SMART framework that they will work on over the next week.

The patient’s Lifestyle Goal is in the area of ***.

The patient’s Lifestyle goal is: ***

The patient will follow-up in 1 week for their first Lifestyle Goal Check-in.

This patient’s visit occurred in the ambulatory setting and is billed based on medical decision making.

_____________________________________________________________________________

Life Beyond Pain Group Medical Visit

Date of Visit:  ***

Duration of Visit: 75 minutes – 10:30 AM to 11:45 AM

Providers present:  ***

Number of patients present: ***

Visit Diagnoses:

Goals and Objectives

The Life Beyond Pain group medical visit is a multi-disciplinary approach to chronic pain management.

Key elements of the group include:

Education – Learning more about pain and new ways to manage it

Community Support – Learning and sharing with other people living with pain

Acupuncture – Clothed, seated, group acupuncture offered by an licensed acupuncturist

Mindfulness – Guidance on using your breath to practice paying attention without judgment

Interventions used during the session:

***(see Session Specific Notes below)

Progress made by the participant during the session:

***

Session-Specific Notes

Session 1 – Intro

• Today with the first session of a 10-week series
• Facilitators and members introduced themselves, we engaged in norm setting including confidentiality (and limits to confidentiality) and respecting others’ perspectives.
• We discussed what patients can expect from each group in terms of structure and offerings
• Acupuncturist offered overview of acupuncture and tuning fork offerings. (Information shared, questions answered, no intervention provided)
• MD and BHC each guided patients in two different mindfulness exercises.

Session 2 – Understanding Pain

• Group 2 of 10
• We reviewed group norms and guidelines
• We discussed pain science using the associated Pain Education Toolkit video and offered a space to discuss what group members have generally found useful for pain management and whet challenges they have experienced
• Acupuncturist offered seated, clothed acupuncture and tuning forks
• BHC and MD each led the group in a guided mindfulness practice – one at the beginning of our group and one at the end.

Session 3 – Activity

• Group visit 3 of 10
• We discussed using activity / exercise / movement to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• Yoga Instructor led group members in 20 minutes of seated yoga.
• Acupuncturist offered seated, clothed acupuncture and tuning forks and guided patient in a Qi Gong practice
• MD offered a mindfulness exercise

Session 4 – Sleep

• Group visit 4 of 10
• We discussed using sleep to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• Yoga instructor led group members in 20 minutes of seated yoga.
• Acupuncturist offered seated, clothed acupuncture and tuning forks
• BHC offered progressive muscle relaxation practice

Session 5

• Group visit 5 of 10
• We discussed using mood management tools to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• We reviewed how group participants have incorporated sleep hygiene practices into their routines.
• We gathered group feedback using the plus / minus / delta framework.
• Acupuncturist offered seated, clothed acupuncture and tuning forks
• BHC offered practice using the 5-4-3-2-1 sensory grounding technique
• MD offered instruction in mindfulness practice

Session 6

• Group visit 6 of 10
• We discussed flare up management tools using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• We reviewed how group participants have incorporated mood management practices into their routines.
• Acupuncturist offered seated, clothed acupuncture and tuning forks
• Acupuncturist offered instruction in the Emotional Freedom Technique (EFT).

Session 7

• Group visit 7 of 10
• We discussed using nutrition to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• We reviewed how group participants have incorporated flare up management practices into their routines.
• Acupuncturist offered seated, clothed acupuncture and tuning forks
• BHC offered guidance in a mindful eating practice

Session 8

• Group visit 8 of 10
• We discussed using medication to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video including the risks and benefits of medications.
• We reviewed how group participants have incorporated nutrition principles into their routines.
• Acupuncturist offered clothed, seated acupuncture and tuning forks
• BHC offered guidance in the Emotional Freedom Technique (EFT) and a mindfulness exercise.

Session 9

• Group visit 9 of 10
• Acupuncturist offered clothed, seated acupuncture and tuning forks.
• BHC guided patients in a self-compassion exercise.
• We discussed leveraging social connection and community to manage chronic pain using the associated Pain Education Toolkit video and offered a therapeutic space to discuss the content in the video.
• We reviewed how group participants have incorporated medication into their routines. We discussed the pros/cons or costs/benefits of different mediations.
• We used an “energy stick” to demonstrate the potency of social connection.

Group 10

• Group visit 10 of 10
• This was the final session of the 10-week group series so much of the time together was dedicated to reflecting on learnings, insights and next steps.
• Group members and facilitators shared music, art and poetry with one another.
• MD guided patients in a mindfulness meditation
• BHC guided patients in a silent “well-wishing” exercise
• Acupuncturist offered clothed, seated acupuncture and tuning forks.

Date: ____________________

Site: _____________________

SECTION 1: Participant Demographics

1. What is your current employment status? (circle all that apply)

2. How satisfied are you with your current job, if applicable? (circle one)

3. What is your current housing status? (circle one)

4. What type of transportation do you currently use to get to health care appointments? (circle all that apply)

SECTION 2: PEG Scale (Pain, Enjoyment, General Activity)

Please rate the following questions on a scale from 0 to 10.

In the past week…

1. What number best describes your pain on average in the past week?

2. What number best describes how, during the past week, pain has interfered with your enjoyment of life?

3. What number best describes how, during the past week, pain has interfered with your general activity?

SECTION 3: Pain Self Efficacy Questionnaire (PSEQ)

1. Please rate your level of knowledge about your chronic pain:

• Not at all knowledgeable
• Slightly knowledgeable
• Moderately knowledgeable
• Very knowledgeable
• Extremely knowledgeable

2. I have the tools and strategies I need to manage my chronic pain in my daily life:

SECTION 4: Lifestyle Satisfaction

In the past month, how satisfied are you in each of the following areas in your life?

SECTION 5: PAIN GROUP IMPACT

1. For me, this group has been:

2. What were the most helpful sessions for you? (circle all that apply)

3. What were the most helpful aspects of the Life Beyond Pain group for you? (Circle up to 3)

4. What are 1-3 things you’ve learned in this program?

5. Do you have any other feedback about your experience in the program?

Intro: “Good morning. My name is <<Scheduler’s Name>> from the <<Clinic Name>>. I am calling to schedule you for the Life Beyond Pain Group visits. You were referred by your PCP several weeks ago. Do you remember talking about this with them?”

If more detail is needed: “The Life Beyond Pain Group is a supportive 10-week program led by your care team. The group will focus on learning practical tools to help manage your pain. It is also a place where you can connect with others like you who experience pain. The size of the group may vary from just a few patients to as many as 10 or 12. Your PCP thinks the groups will be really helpful for you.”

If patient is ready to schedule: “The groups will happen on <<Day of the week>> from <<Time frame>> at the clinic. You do not need to attend all the groups but you will get more out of them if you attend more groups. Can I answer any questions about this for you and get you scheduled?”

After scheduling: “The Life Beyond Pain Group model came from the OHSU Richmond Clinic where they have been running groups for more than 2 years now. Our group is part of a learning collaborative alongside other clinics who are also starting pain groups. As part of this collaborative, a team from OHSU is studying the group to see how helpful they are. Someone from the research team may reach out to you by phone or email to see if you’d like to participate in the research project. You don’t have to participate to be part of our group—I just wanted to give you a heads up so their outreach is not a surprise.”

Do you prefer to be contacted via email? phone? or text?