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New Approaches for Chronic Pain.. Dr Suyin Tan Clinical Director - - PowerPoint PPT Presentation
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 EVERYBODYs problem. National Pain Plan Tertiary Multidisciplinary pain service in teaching hospital Moderate-high complexity ,
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National Pain Plan
Tertiary ,,,, ,,,,
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Moderate-high complexity University, research, education Secondary Moderate-high complexity Primary Low-high complexity
Multidisciplinary pain service in teaching hospital Specialist care Smaller hospital or non-hospital based teams, led by a medical specialist Primary health care Population health Information, education, self-help, patient-led support groups
Legend Pain medicine specialist GP with specific interest in pain Psychologist Physiotherapist/Occupational therapist Nurse Other medical specialist GP Pharmacist
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What are we going to talk about ?
Problems with Opioids Definitions Models of Care Resources
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Atlas in Healthcare Variation 2015
Opioid dispensing
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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
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PAIN – “ An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in such terms” IASP
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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”
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Models of Care: The Medical Model Patient has PAIN sees a health professional Hx,exam,Ix Diagnosis Treatment CURE !!!
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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.
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Which model are you working in ?? Pain Score < 3 or a healthy meaningful life ?
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Sociopsychobiomedical approach
Biomedical Mindbody Connection Activity Nutrition
‘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
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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.
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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
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Social approaches
Address social support Manage lifestyle issues eg smoking,obesity Improve physical activity and fitness Use a rehabilitative approach
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Brainman YouTube
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Understanding pain
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Brainman chooses
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Brainman stops his
- pioids
Workbooks Rewire your pain: an evidence based approach to reduce chronic pain: Davies 2015 Manage your pain: Nicholas 2011 On-line CBT thiswayup or mindspot
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ACI chronic pain website
The ACI website offers draft care plans for chronic pain
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