SCIENTIFIC OUTCOMES FROM INAUGURAL RELIEF RETREAT IN 2017

As we prepare to embark on our second Relief Retreat in October 2020, it seemed a good time to share what I mean when I say “evidence-based.”   If I’m going to offer a service to someone, and charge them an out-of-pocket expense, I want to be sure it works!

The major downside to the first retreat was the time (2 weeks) and expense. (Most people cannot leave work or family for 2 weeks, and the cost would have been $6000 per person had I not subsidized 75% of it with my own funds; bear in mind that I had an independent body collect and analyze the data so there would be no conflict of interest.)

I have spent the past 2 years getting certified so I could do my own health coaching for this retreat, and developing a mobile app based on all the content of the original retreat, resulting in Beyond Pain (now available on Google Play and the App Store) containing 4 months of daily 10 minute modules that participants can use to reinforce learned skills after transition back to home.

Some other changes:  Although we don’t have time to offer the in-person “family day” on this retreat, I plan to incorporate family work into the web-based coaching sessions after the retreat. And although the psychologist (Tobi Fishel) and physical therapist (Julie Richard) won’t be present this time around (SAD EMOJI), they are both present throughout the app.  Also, I will be using their techniques during this retreat, and they (and some alumni!) will pop in on zoom to say hello and answer questions anyone may have.

It is ONLY with all this done, that I feel confident I can get the same results of the original retreat in a shorter period of time, and at a cost comparable to other sorts of healing retreats (although ours is WAY better).  And to confirm that, I will also be studying this retreat, using the exact same metrics I used with the original, so we can understand how or if we need to keep evolving in the future.

Either way, I’m so proud of what this is becoming, and that it remains a viable option for those who need it.

Read on below for the summary of the scientific data of the first retreat.  Then feel free to contact me with questions and/or apply for the retreat and see if it is a good fit for you!

The inaugural Relief Retreat, a novel functional rehabilitation program for chronic pain, was completed in October 2017 under the direction of Tracy Jackson, MD, with independently contracted support from previous and current Osher faculty in psychology, physical therapy, and health care coaching.  The retreat was conducted over 14 days/13 nights at Gray Bear Lodge (www.graybear.org) in Hohenwald, Tennessee.  The entire site on 400 wooded acres was reserved for the group, with both individual and group cabin-style lodging.   The site had no wifi, television, alcohol or smoking, limited cellular access, and included a warm water pool, hot tub, wood-fired sauna, and on-site preparation of locally-sourced, organic, whole foods.  Components of the curriculum included qi gong, regular group mindfulness practice, coping skills training, didactic education, nature walks, restorative yoga, aquatherapy, equipment-independent active physical therapy, art therapy, guided meditation, and optional massage, acupuncture, or healing touch sessions.  Family members were included in the programming on days 1, 8, and 14.

Twelve participants (10 women, 2 men) attended the retreat, ranging in age from 26-72, with a variety of diagnoses including low back pain, neck pain, post-laminectomy pain, migraine, pelvic pain, anxiety, depression, and PTSD.  Average fibromyalgia survey score (FSS) was 15, indicating most participants met clinical criteria for fibromyalgia with widespread pain and high symptom severity.   Of note, the FSS declined to 10.8, 10.2 and 9.6 at 0, 1 and 6 months post-retreat, respectively, but this was not statistically significant. (p=0.18).  Other clinical outcomes were assessed via redcap survey at baseline (first column), immediately post-retreat (second column), and at 1 (3rd column) and 6 months (last column).  Statistically significant improvements were seen in virtually all metrics, becoming more pronounced with time.   These improved outcomes included NIH PROMIS metrics for pain behavior, depression, fatigue, sexual function, physical disability, pain interference and social satisfaction as well as quality of life (nqol).  Pain self-efficacy demonstrated the most dramatic improvement.  Pain catastrophizing (PCS6), a phenotype of anxiety consistently associated with the development and maintenance of chronic pain, was also significantly reduced.   PROMIS scores for anxiety decreased at every time point, but did not reach clinical significance, and PROMIS anger scores transiently reduced, then returned to baseline by the end of the study period.   Validated measures of coping skills, sleep quality, and two scales of mindfulness trended to improvement, while locus of control (internal vs external) did not demonstrate change (and are not pictured).  The statistics are graphed below (p values < 0.05 represent statistical significance).

Of the 12 participants, 7 had used opioids for at least 5 years prior to the retreat, with an average morphine milligram equivalent (MME) of >250 and an average score on an opioid risk tool (SOAPP-R) of >45, indicating high risk .  At the conclusion of the program, including 6 months of weekly web-based health coaching, 4 had completely eliminated opioids, 2 had reduced the dose by >75% percent to <50 MME, and one had transitioned from a regimen including one long-acting and two short-acting opioids to a stable dose of buprenorphine.

When compared to the 6 months prior to the retreat, eight of twelve participants demonstrated a reduction in both health care encounters and payments per encounter with less utilization of specialty services.  Outliers were explained by planned pre-retreat operations and subsequent non-pain-related complications, and follow-up of immediate pre-retreat myocardial infarction and GI bleed.

Anecdotally, each patient independently reported the greatest perceived benefit from being together in a remote, natural setting instead of the traditional sterile (and triggering) clinic or hospital environment.  Powerful testimonials include multiple declarations of lives “given back,” and/or utterly transformed in a variety of ways.   A recent front page headline in the Sunday edition of Tennessee’s state newspaper, the Tennessean, details one such transformation a year later.

In summary, this functional rehabilitation pilot proved to be a highly effective – and durable – way to reduce opioid use, improve clinical outcomes, restore function, increase quality of life and lower health care costs.  Ongoing advocacy for reimbursement of such programs by insurers is critical to the sustainability of this type of model in the future.