New Approaches for Chronic Pain.. Dr Suyin Tan Clinical Director - PowerPoint PPT Presentation

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.