Download What We Are Trying to Accomplish

Agenda
1. Welcome/Introductions (15 mins)
2. What are we trying to accomplish? (45 mins)
• The Biopsychosocial Approach
• Patient Voice
3. The 7 Pain Tools (45 mins)
Break (15 mins)
4. Case Study Application (60mins)
5. Wrap up (30 mins)
• Action Period Planning
• Session Assessment
2
Faculty/Presenter Disclosure
Faculty’s Name: Speaker’s Name
Relationship with commercial interest:
- Grants/Research Support: PharmaCorp ABC
- Speakers Bureau/Honoraria: XYZ Biopharmaceuticals Ltd
- Consulting Fees: MedX Group Inc.
- Other: Employee of XYZ Hospital Group
3
Disclosure of Commercial Support
This program has received financial support from [organization name] in the form
of [desribe support here – e.g. educational grant]
This program has received in-kind support from [organization name] in the form
of [describe the support here – e.g. logistical support]
Potential for conflicts(s) of interest:
-
[Speaker/Faculty name] has received [payment/funding, etc.] from
[organization supporting this program AND/OR organization whose products are
being discussed in this program].
- [Supporting organization name] [developed/licenses/distributes/benefits from
the sale of, etc.] a product that will be discussed in this program. [Enter generic
and brand name here].
4
Mitigating Potential Bias
[Explain how potential sources of bias identified in slides 1 and 2 have been
mitigated].
Refer to “Quick Tips” document
5
Aim
 The aim of this module is to improve the quality of patient care
available in non-pain specialized physician practices for patients
living with chronic pain. This will be measured by an increase in
function, or reduced decline in function, as indicated by a change
in the Brief Pain Inventory Scores.
 Through this work we expect:
 The experiences of patients and their families to improve through
better management of chronic pain
 Improve physician experience through increased confidence in
identifying and managing patients with persistent pain
 Reduced health care utilization costs to the system through
optimal use of general and specialist services.
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Learning Objectives
 Describe a rationale for using a bio-psychosocial
approach to assessing and managing pain
 Identify the 10 Pain tools available through the
EMR template
 Select the appropriate tool(s) for addressing a
pain scenario
 Report increased confidence in supporting
patients that experience chronic pain
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The Situation
 The Heartsink Patient
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The Situation
 17-31% of Canadians report chronic pain (Canadian Pain
coalition)
 18% of Canadians suffer from severe chronic pain –more than
diabetes or heart disease. (Chronic pain association of Canada)
 Chronic pain prevalence is approximately 33% in those over 55
years old (Moulin et al)
 38% of institutionalized seniors experience pain on a regular
basis (Stats. Can. 2008)
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The Situation
 The single biggest cause of disability in Canada
 It affects the elderly the most
 The elderly are about to become the largest cohort of patients
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The Situation
 70% of cancer patients experience moderate to severe pain
during their illness
 The majority reported that they had not been asked about their
pain by doctors or nurses (Chronic pain association of Canada)
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The Situation
 Chronic pain is a strong independent predictor of health resource
use
 “There was a strong association between pain-related disability
and greater use of services” (Blyth et al. Pain 2004)
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The Situation
 The cost of pain to the Canadian economy is estimated at $6
Billion annually (Jovey)
 Pain is almost unmentioned in medical schools (Chronic pain
association of Canada)
 “Funding for research, training and treatment of pain in Canada is
woefully inadequate” (Jovey)
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CHRONIC PAIN IS AN EPIDEMIC THAT
AFFECTS UP TO A THIRD OF ALL
CANADIANS
WE ARE NOT ASKING ABOUT IT
WE DON’T KNOW HOW TO TREAT IT
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Chronic Pain and Depression
 People with chronic pain have a three times the average risk of
developing psychiatric symptoms, mainly depression
 Depressed people have three times the average risk of
developing chronic pain
 Nearly all medications for depression also help reduce chronic
pain (Harvard Health Publications 2004)
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Chronic Pain and Suicide
Women with chronic pain are three times
more likely to commit suicide than
matches in the general population
without chronic pain (Fishbain et al)
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CHRONIC PAIN IS A
DISEASE THAT WILL
LARGELY BE TREATED BY
FAMILY DOCTORS
Barriers for GPs
 Denial
 Lack of time
 Lack of resources
 Lack of knowledge
 Lack of effective “cures”
 Not wanting to open a “Pandora's Box”
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So what do I do with my chronic pain patients?
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What are we trying to accomplish?
Shift paradigm:
 Sole pursuit of tissue pathology…
 ….to reasonable attempt to exclude pathology and reach
diagnosis.
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What are we trying to accomplish?
Shift paradigm:
 Sole pursuit of pain reduction…
 ….to whole person centered approach aiming at functional gain
and pain reduction.
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What are we trying to accomplish?
Shift paradigm
 “There’s nothing that I can do”…
 ….to “we can together work as a team to reduce the alarm (pain)
in your nervous system and increase your function.”
freedigitalimages.net
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What are we trying to accomplish?
Shift paradigm
 “I only have one tool (prescriptions)”…
 ….to “there are a toolbox of options we can use to help reduce
your pain and increase your function.”
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What is Pain?
 Pain is an unpleasant sensory and emotional
experience associated with actual or potential
tissue damage, or described in terms of such
damage.
- International Association for the Study of
Pain(1979)
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Central Nervous System Sensitization
Pro-nociceptive
Anti-nociceptive
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Social Class
Financial
Relationships
Culture
Report: “I have pain.”
Observe: Behaviour
Life experiences
Job
Other health issues
Beliefs
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What is Pain?
 Pain in not a “thing”
 Pain is not in the tissues
 No pain receptors
 No pain pathways
 No pain centres
 It’s a multidimensional, lived, experience constructed by the brain.
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Diagnostic Framework
Peripheral
Inputs
+ Psychological
+
Inputs
Social
Inputs
+ Central
=
Sensitization
Genetic Factors
Pain
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• Progressive
• Pacing
• Goals
• Coaching
• Bounce
Back
• Coping
• Resilience
Sleep
• Gentle
Mood
Activity
Toolbox of Supports
• Sleep
hygiene
• Aids
• Medication
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• TCAs
• Anticonvulsants
• Opioids
• Other…
Interventions
• Meditation
• Yoga
• Tai Chi
• Breathing
Medications
Mindfulness
Toolbox of Supports
• Injections
• Surgery
• Manipulation
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• Family
• Friends
• Work
• SM groups
• Support
groups
Psychology
• Pain
• Body
• Self
awareness
• Concepts
Support
Knowledge
Toolbox of Supports
• CBT
• ACT
• BAP
• Coaching
• Group
Medical
Visits
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