New Approaches for Chronic Pain.. Dr Suyin Tan Clinical Director Anaesthesia & Pain Mx NBMLHD
Pain is EVERYBODY’s problem.
National Pain Plan Tertiary Multidisciplinary pain service in teaching hospital Moderate-high complexity , , , , University, research, education Specialist care Smaller hospital or non-hospital based teams, led Secondary by a medical specialist , , , , Moderate-high complexity Primary health care , , , Primary Low-high complexity Population health Information, education, self-help, patient-led support groups Legend Psychologist Pain medicine specialist Other medical specialist GP with specific interest in pain GP Physiotherapist/Occupational therapist Nurse Pharmacist
What are we going to talk about ? Problems with Opioids Definitions Models of Care Resources
Atlas in Healthcare Variation 2015 Opioid dispensing
Efficacy of opioids Acute pain (RCTs) • Cancer pain (Systematic reviews) • Palliative care (Systematic reviews) • Opioid dependency (Systematic reviews) • Chronic non-cancer pain: evidence not • supportive; guidelines lack clarity
PAIN – “ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms” IASP
Definitions Acute pain : less than 3/12 duration usually a clear pain generator eg fracture self limiting Chronic pain: more than 6/12 duration multifactorial generators can become endless ! Subacute pain : 3-6/12 grey zone ‘Window of opportunity”
Models of Care: The Medical Model Patient has PAIN sees a health professional Hx,exam,Ix Diagnosis Treatment CURE !!!
Models of Care : The PsychosocialBio Model Psycho : A patient’s beliefs , expectations, experiences. Social : External factors eg family support, finances,litigation. Cultural and societal beliefs and expectations. Bio : Tissue injury, genetic factors, peripheral and central sensitisation.
Which model are you working in ?? Pain Score < 3 or a healthy meaningful life ?
Sociopsychobiomedical approach Connection Activity Mindbody Nutrition Biomedical ‘whole person’ approach White R, Hayes C. Using social media to challenge unwarranted clinical variation in CNCP treatment: the “Brainman” story. J Pain Research 2016
So what should we be doing? Bio : Exclude significant pathology –”red flags” • Avoid opioids > 40mg Morphine daily equivalent. Avoid over investigating. Use function not pain scores as the therapeutic goal.
Psychological approaches Identify and address psychological problems -especially comorbid anxiety and depression Strengthen patient’s coping strategies –improve self efficacy and address catastrophising Educate the patient and their family Use an interdisciplinary model of care
Social approaches Address social support Manage lifestyle issues eg smoking,obesity Improve physical activity and fitness Use a rehabilitative approach
Brainman YouTube Understanding pain 1. Brainman chooses 2. Brainman stops his 3. opioids Workbooks On-line CBT Rewire your pain: an evidence thiswayup or based approach to reduce chronic mindspot pain: Davies 2015 Manage your pain: Nicholas 2011
ACI chronic pain website The ACI website offers draft care plans for chronic pain
Resources www.aci.health.nsw.gov.au/chronic-pain www.betterpainmanagement.com.au Thank you.
Chronic Pain and Depression Michael R. Clark, MD, MPH, MBA Director, Chronic
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Non-Pharmacological Methods for Managing Chronic Pain October 26, 2017 Mindy
3/12/2016 I have no disclosures to report. Complex Chronic Pain: Cases
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Workshop: Music and Pain BRAMS -- Montreal Music, Pain and Emotions
Combating the Opioid Epidemic With Integrative Pain Management Acute and
TESTIMONY OF RAMSIN BENYAMIN, MD, BLOOMINGTON, IL BEFORE WAYS AND MEANS
Clinical trials in paediatric pain treatment Katri Hamunen Dept. of
Perinatal, Neonatal, Pediatric Conference Presented By: Cheryl Piper, R.N.,
OPIO IOID ID EPI EPIDEM DEMIC DO DO NO NOT BE BE A CONTRI NTRIBUT BUTOR!
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Annu H. Navani, M.D., Q.M.E. Medical Director, Comprehensive Pain Management
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Secret Keys to open the lock of Chronic Pain Conflict of Interest