GEMINI: a brighter path for managing chronic pain
Chronic pain affects millions of people and often leads to reduced functioning, depression and a diminished quality of life. Niina Haas, president of BrightOutcome Inc. in Illinois, USA, and Dr Paula Gardiner, a medical researcher at the University of Massachusetts Chan Medical School and the Center for Mindfulness and Compassion at Cambridge Health Alliance, are developing an innovative platform that helps patients manage their pain through mindfulness and peer support. This platform, called GEMINI, aims to provide an approach to chronic pain management that works alongside conventional medicine.
Talk like a Mindfulness-Based Stress Reduction researcher
Chronic pain — pain that lasts for an extended period, typically more than three months, and often persists despite treatment
Integrative medicine group visits (IMGVs) — group sessions led by a clinician that combine medical care with complementary therapies like mindfulness to treat chronic conditions
Mindfulness-Based Stress Reduction (MBSR) — a therapeutic programme that incorporates mindfulness, meditation and mindful movement to help individuals manage stress and pain
Non-pharmacological treatments – healthcare interventions that are not primarily based on medication
Self-management — the process by which individuals take responsibility for managing their health conditions
Telemedicine — the use of digital communication technologies to provide medical care and services remotely
Whether from a minor injury or a more serious medical condition, everyone experiences physical pain at some point in their life. Pain is a natural signal from the brain, alerting us to potential harm. When the body detects an injury or inflammation, nerves send electrical impulses to the brain, which are interpreted as pain. This mechanism helps protect us by making us aware that something is wrong.
Usually, our body is able to fix the problem or we receive medical treatment and the pain fades away; however, chronic pain is different. This type of pain stems from long-term conditions, and when pain signals are continuously sent to the brain over a long period of time, a person’s life can be seriously disrupted.
Chronic pain can stem from various sources, including long-term illnesses, like arthritis or cancer, past injuries that still affect the body, or even emotional factors, like stress and anxiety. Suffering from chronic pain often causes a host of other problems, such as depression, anxiety and sleep disturbances.
To address these challenges, Niina Haas, president of a patient-centred healthcare company called BrightOutcome Inc., and Dr Paula Gardiner, a medical researcher and doctor who cares for patients who have chronic pain, are developing an innovative platform, called GEMINI, that is designed to help individuals manage chronic pain by focusing on mindfulness and peer support. GEMINI aims to empower patients to manage their pain and improve their quality of life.
Current treatments: what is the problem?
“Most care for chronic pain happens during rushed visits with primary care providers, and often relies on medications that can have mixed effectiveness and serious side effects, including addiction,” explains Niina. “Therefore, there is a need for easy access to evidence-based, non-pharmacological treatments such as self-management and community support.”
In recent years, healthcare researchers and professionals have recognised the need to tailor pain management to an individual’s experiences. They have also begun exploring the benefits of complementary therapies (evidence-based therapies that are not often taught in medical school) as they can provide safe, patient-centred pain management that can improve quality of life. These therapies can reduce the need for pain medications, alleviate associated conditions and boost patients’ confidence in carrying out activities while in pain.
The rise of telemedicine, accelerated by the need for healthcare to be delivered remotely during the COVID-19 pandemic, has made it more feasible for patients to access these home-based options.
What is GEMINI?
GEMINI, or Group IntEgrative MINdfulness over the Internet, is an innovative platform designed to help people manage chronic pain through online integrative medicine group visits (IMGVs). These IMGVs combine medical care with Mindfulness-Based Stress Reduction (MBSR) and peer support, and involve group video calls led by a licensed clinician, where patients can discuss medical concerns, learn self-management skills, receive guidance and share experiences with others facing similar challenges.
IMGVs are different from standard MBSR courses. While both teach mindfulness skills, IMGVs are led by clinicians and provide medical care, including prescriptions, lab tests and referrals. This added medical support is something that MBSR instructors cannot offer. “For instance, if a patient feels pain during a standard MBSR exercise, the instructor can only ask the patient to stop and consult with a physician before further participation,” says Niina. “In contrast, the licensed clinician leading an IMGV can immediately discuss a treatment plan with the patient, review their medical history and provide necessary medical care during the session.”
The benefits of GEMINI
GEMINI offers a range of online resources, including a journal for self-reflection, a discussion board for community engagement and a library of educational materials. By providing these tools online, GEMINI ensures that patients can access them regardless of their physical condition or location. This patient-centred platform helps alleviate feelings of isolation, promotes self-management and offers a comprehensive, non-pharmacological approach to chronic pain management.
“The primary benefit to patients that attend online group meetings with clinicians and peers is that the patient experiences a sense of community and connection to other people who are also experiencing the same condition,” explains Niina. “In the case of chronic pain, patients often also experience a sense of isolation, especially if their conditions tie them to their home and exclude them from social activities.” GEMINI group meetings not only help to reduce this isolation, but also provide valuable education and support, helping patients to better manage their conditions.
How is GEMINI being assessed?
GEMINI is being carefully tested in a study with 212 patients who have chronic musculoskeletal pain (affecting muscles, tendons, bones and joints). These patients are split into two equally-sized groups, one of which uses GEMINI and participates in IMGVs, while the other only uses GEMINI. “The main goals are to see if GEMINI can lower pain levels, improve pain-related issues, boost patients’ confidence in managing their pain and reduce their use of pain medications,” explains Niina.
As telemedicine and digital health solutions become increasingly important, GEMINI stands poised to offer a patient-centred approach to chronic pain management that could transform lives.
Niina Haas
President of BrightOutcome Inc., Illinois, USA
Dr Paula Gardiner
Associate Professor, University of Massachusetts Chan Medical School, USA
Fields of research: Primary care, chronic pain, mindfulness, pain reduction, healthcare technology
Research project: Group intEgrative MINdfulness over the Internet (GEMINI): developing an online platform where people can use mindfulness to manage chronic pain
Funders: US National Institutes of Health (NIH), Patient-Centered Outcomes Research Institute (PCORI), Aetna Foundation
Reference
https://doi.org/10.33424/FUTURUM567
About Mindfulness-Based Stress Reduction
Mindfulness-Based Stress Reduction (MBSR) is a relatively recent field of study that has gained traction over the past five decades. Developed by Jon Kabat-Zinn in 1979, MBSR was initially designed as an eight-week, evidence-based stress management programme. “However, in the time since its development, MBSR research has expanded and evolved to be included in treatments for a number of different health conditions,” says Niina. “The positive results from this research have encouraged healthcare providers to recognise the benefits of mindfulness practices and to incorporate them into treatment plans for various conditions, including stress, pain management, anxiety, depression and chronic illnesses.”
The excitement in this field comes from the idea that individuals can learn to manage their reactions to life events, including health-related issues. “We may not be able to change a health event, such as an illness or an accident, but we can change how we choose to react and think about it,” says Niina. “Perhaps, by extending awareness through MBSR techniques, we can all find more peace in our lives, no matter what happens to us.” This approach creates a sense of personal control and resilience, allowing individuals to choose how they respond to stress.
For students, MBSR can offer numerous practical benefits. “A student may employ different meditation methods to reduce stress or anxiety about a social situation or a test,” explains Niina. “Or a student may take the time to find gratitude in the small things in their lives. These things help to re-frame that inner voice in our heads which determines how we experience the world.”
To explore MBSR more deeply, students can enrol in online courses, some of which are free, though they may not include live instructors. There are also numerous books and workbooks available that guide self-study. Many universities offer MBSR courses, and some community programmes provide training. This accessibility makes it easier for individuals at different stages of life to incorporate mindfulness into their daily routines.
Pathway from school to Mindfulness-Based Stress Reduction
In high school, courses in psychology, health and biology can provide a solid foundation. At the college and university levels, you should consider studying psychology, public health, social work or any field related to clinical care. “Incorporate your enthusiasm for MBSR with a degree involving clinical care (e.g., therapy, primary care, social work) or research (e.g., psychology or public health),” says Niina.
Aspiring MBSR instructors can pursue certification programmes, available both online and in person. These programmes train individuals to teach MBSR in various settings, from clinical environments to community programmes. Additionally, students can explore complementary disciplines, such as cognitive-behavioural therapy, which often intersect with mindfulness practices.
Explore careers in Mindfulness-Based Stress Reduction
“When searching for information online, make sure you are looking at credible sources, like official university or government sites,” says Niina. “It would also be a good idea to find researchers that are currently doing the type of MBSR research that is of interest to you and contact them.”
Some useful websites include The Mindfulness Center at Brown University, the Centre for Mindfulness at the University of Massachusetts Medical School, American Mindfulness Research Association and Mindfulness Journal.
Meet Niina
As a teenager, I was very interested in anthropology, archaeology and sociocultural anthropology. I saw the inequities in life for different people, and this motivated me to want to make a difference in people’s lives. I thought that maybe I could find a way to contribute some small solutions to larger-scale societal problems.
When I was studying anthropology in undergraduate and graduate school, it was a time when technology in education was growing. I was an undergraduate when my college first started offering online courses. I was lucky enough to have professors that embraced this technological change and found opportunities for undergrad students. I developed a belief that technology could help us understand societal problems a little more fluently through computer-based modelling methods. My interest in technology as a tool has allowed me to pursue my passion of helping to solve real-world societal problems and has led me to where I am today.
Finding joy in what I learn and create motivates me the most. I truly enjoy what I do. I love meeting new people and learning about new research. I get a lot of satisfaction from finding technical solutions to real-world problems. I’ve not really had any role models. This may sound unconventional, but I believe that while I certainly learn from many others’ experiences and wisdom, I can really only compare myself to myself.
I hope that society becomes more compassionate. Many of the world’s problems would be solved if we were less judgemental and more understanding of each other.
Niina’s top tip
Sometimes, we start with a plan and a timeline, but life takes us in unexpected directions. As long as you follow your heart, you’ll end up where you’re meant to be, learning and gaining wisdom from new experiences along the way.
Meet Paula
When I was a teenager, I was interested in dancing and yoga. Medicine has changed over the years and now, as a clinician, I like to integrate mindfulness and meditation into my clinical practice.
I have always been highly motivated by social equity and have decided to work with a lower-income patient population. I have had many wonderful female role models who have paved the way for women in medicine.
I hope that medical care will continue to move in the direction of equal care for all people, regardless of their ability to pay. Personally, I’d like to do more writing later in my career to share with people what I’ve learnt about through my work.
Paula’s top tip
Try lots of different jobs until you find something that you feel passionate about. It’s okay not to know what you want to do when you graduate. Getting lots of different types of work experience will help in the long run.
Do you have a question for Niina or Paula?
Write it in the comments box below and Niina or Paula will get back to you. (Remember, researchers are very busy people, so you may have to wait a few days.)
Learn more about how mindfulness stress reduction techniques can improve your health:
www.futurumcareers.com/how-can-protecting-our-telomeres-help-us-live-longer-healthier-lives
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