Download Patient Resources

PSP Musculoskeletal (MSK)
Arthritis & Low Back Pain
Patient Self Care
Resources / Handouts
Train the Trainer Session 1
April 4 – 5, 2013
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It is the intention of the PSP that health educators and health providers only use this publication and its content for
non-commercial educational purposes only.
TABLE OF CONTENTS
Goal Setting – Supporting Patient Self Management ..................................................................... 3
Summary by Organization: Education Programs and Resources for Patients ................................ 6
Information Resources for Patients ................................................................................................ 9
Health Passport Overview ............................................................................................................ 10
Handouts for Arthritis Patients ..................................................................................................... 11
Handouts and Exercises for Low Back Pain Patients ................................................................... 26
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Goal Setting – Supporting Patient Self Management
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Patient Action Plan
Date: _____________________
My goal:
__________________________________________________________________
__________________________________________________________________
1. First step to help me achieve my goal: Something I WANT to do this week:
__________________________________________________________________
__________________________________________________________________
Describe your goal - so that someone else can understand and see it:
How often:
_________________________________________________________________
When (time of day):
_________________________________________________________________
Where: ___________________________________________________________
2. Confidence rating: (0 - 10) ________
How confident (sure) are you that you can do the whole plan on a 0-10 scale? If
confidence is less than 7, see problem solving suggestions
3. Follow-Up: Who are you going to talk to about how the plan went?
4. When are you going to check in?
Patient Signature: ___________________________________________________
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Problem Solving Suggestions
If your confidence is low, or you encounter barriers completing your plan, try
problem solving:
1. Identify the problem. Be specific! What’s getting in the way of being sure you
can complete your plan before your start or carrying it out once you start.
2. List all possible solutions. Brainstorm ideas, from the ridiculous to the sublime.
3. Pick one. Sometimes a combination of a couple of ideas works.
4. Try it for 2 weeks. Give it a good test!
5. If it doesn’t work, try another.
6. If that doesn’t work, find a resource for ideas. Maybe a friend or a
professional can help.
7. If that doesn’t work, accept that the problem may not be solvable now. Set it
aside for now and work on something else.
Reference for Action Plan and Problem-solving:
Centre for Comprehensive Motivational Interventions, www.centreCMI.ca
Kate Lorig et al Living a Healthy Life with Chronic Conditions 2 ed., Bull Publishing, San
Francisco, 2001.
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Summary by Organization:
Education Programs and Resources for Patients
Education Program / Resource
Description
The Arthritis Society
Website
Downloadable PDF handouts, information about programs
www.arthritis.ca
The Arthritis Answers Line
Lower Mainland: 604 875 5051
A telephone service available in English, French, Cantonese,
Mandarin and Punjabi.
Other: 1 800 3211433
Arthritis Self-Management Program (ASMP)
Improve understanding of arthritis, pain management and selfmanagement strategies. Program is taught by1-2 trained
volunteers who either have arthritis or are health care
professionals. 6 sessions (2 hours, once/week), $25.00 per person.
Chronic Pain Management Workshop
Improve understanding of treatment and management of pain in
arthritis. Workshop is led by ASMP leaders. Classes range from 10
- 14 people
Lifestyle Makeover Challenge
4 week programs that encourage exercise and healthy eating to
delay the onset and reduce pain of osteoarthritis
Take Charge! Early Intervention for
Osteoarthritis
4 week program to help patients with arthritis deal with the
physical and emotional aspects of the disease
Joint Works and Water Works group exercise
programs
45 min – 1 hr group exercise programs for people with arthritis,
offered in various BC communities
HealthLink BC
www.healthlinkbc.ca
8 1 1 on your telephone to speak to a
nurse, pharmacist or dietician
Large online database offering general information on
Osteoarthritis, Rheumatoid Arthritis and Low Back Pain among
hundreds of other health issues.
Translation services available in over 130 languages by request.
Hospital Programs / Services
Some hospitals offer independent programs and services for
patients with arthritis or MSK issues. Contact your local hospital to
enquire about available programs.
Mary Pack Arthritis Program
www.arthritis.ca/local%20programs/bcyuko
n/publications%20and%20resources/MPAP/
default.asp?s=1
Locations:
Vancouver - 895 W 10th Avenue, Vancouver, BC, V5Z 1L7
Victoria - 2680 Richmond Avenue, Victoria, BC, V8R 4S9
Penticton - 550 Carmi Avenue, Penticton, BC, V2A 3G6
Cranbrook - 13 – 24th Avenue North, Cranbrook, BC, V1C 3H9
Patient Education Program (all sites)
Free classes on a range of topics to help patients manage their
arthritis.
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Education Program / Resource
Description
Outpatient Rehabilitation Services (all sites)
Treatment services for children and adults with all forms of
arthritis. Referral is needed by family physician for physical and
occupational therapy. Referrals for nursing, and vocational
counseling can be from any health care professional. Referrals for
social work can be self-referred.
Specialized Programs / Services
Specialized programs and services that require rheumatologist
referral.
(services vary by location)
Outpatient Day Programs
Drug Monitoring Program (Vancouver and Penticton)
Rapid Access for Diagnosis of Early Rheumatoid Arthritis
(Vancouver)
Children and Young Adults Program (Vancouver, Victoria and
Penticton)
Fibromyalgia Self- Management Program (Victoria and Penticton)
Outreach Services
Consultations, treatment and education services to underserved
rural communities provided by rheumatologists, occupational
therapists, and multidisciplinary teams
Travelling Rheumatology Consultation Service - Pender Harbour,
Powell River, Comox, Campbell River, Port Alberni, Alert Bay,
Cranbrook, Valemount, Nelson, Castlegar, Trail, Williams Lake,
Burns Lake, Dawson Creek, Fort St. John, Fraser Lake, Hazelton,
Kitimat, Massett, New Aiyansh, Prince George, Prince Rupert,
Smithers, Terrace, and Queen Charlotte City.
Travelling Occupational Therapy Service - Bella Bella, Bella Coola,
Klemtu, 100 Mile House, Lillooet, Merritt, Williams Lake, Hazelton,
Prince George, Quesnel, Smithers, Terrace
OASIS – OsteoArthritis Service Integration System
Website:
http://oasis.vch.ca/
Information and videos for people with OA who want to learn
about self-management strategies and joint replacement surgery.
Translated documents in Punjabi, Farsi, Traditional Chinese and
Simplified Chinese
Multidisciplinary Assessment
An assessment with a nurse, PT, and/or OT to create an Action
Plan for self-management of OA with referral to community
resources. Available in Vancouver, Richmond and West Vancouver
Primary Education Sessions
Free education sessions for patients with OA to encourage selfmanagement. Topics include disease information, goal setting,
joint protection, exercise, pain management, nutrition and weight
control.
Listing of Community Services:
Searchable database to link patients to hundreds of programs,
organizations and resources throughout BC
http://oasis-services.vch.ca/search.aspx
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Education Program / Resource
Description
Patient Voices Network
Website:
www.patientvoices.ca
Peer Coaching Program
The Patient Voices Network is led by ImpactBC in collaboration
with Patients as Partners, Ministry of Health.
Telephone based model where people can phone in to get support
and motivation towards healthy lifestyle changes. Free but
requires registration.
University of Victoria – Centre on Aging
Website:
http://web.uvic.ca/~pmcgowan/researc
h/cdsmp/index.htm
The Centre on Aging at the University of Victoria is a
multidisciplinary research centre established in 1992. Their
mandate is to promote and conduct basic and applied research
throughout the lifespan.
Chronic Disease Self–Management Program
Free general education program for adults experiencing chronic
health conditions (e.g., hypertension, arthritis, heart disease,
stroke, diabetes, etc.)
Chronic Pain Self- Management Program
Free education program developed specifically for persons
experiencing chronic musculoskeletal pain.
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Information Resources for Patients
Program / Resource
Description
Arthritis is Cured
www.arthritisiscured.org
Arthritis Quick Reference tool - handout for physicians that
includes (1) arthritis indicators for RA and OA, (2) Red Flag
Indicators/Symptoms, (3) Course of Action for Physicians. Also
accessible to the public.
Arthritis Research Centre (ARC)
www.arthritisresearch.ca
Provides educational videos, decision tools (ANSWER, etc.),
research plain language summaries, a comprehensive list of terms
and acronyms to help patients/consumers disseminate research
results, and a support group (Consumer Advisory Board) that
publishes a quarterly newsletter.
Arthritis Resource Guide for BC
http://www.argbc.ca/
Links to resources based on patient’s input of geographical
location.
PDFs not easily accessible by arthritis patients as these documents
are only located under the “practitioner” tab.
Back Care Canada
www.backcarecanada.ca/
Information addressing topics for people suffering from back and
leg pain in an easy-to-read and focused format
Canadian Arthritis Patient Alliance
www.arthritispatient.ca
Support community to promote advocacy of arthritis to improve
the quality of life and care of people with arthritis
Cochrane Musculoskeletal Group
http://musculoskeletal.cochrane.org/
Dedicated to evidence-based research in the form of plain
language summaries. These summaries recap the main ideas and
results of systematic reviews in everyday language. Also available,
decision aids.
Guidelines and Protocols Advisory Committee (GPAC) – Patient Guidelines
http://www.bcguidelines.ca/gpac/patient_g
uides.html
Patient information guides: Downloadable PDF files on a variety of
topics including RA and OA
Joint Health (formerly Arthritis Consumer Experts)
www.jointhealth.org
Offers subscriptions to monthly newsletters, breaking news
subscriptions, podcasts, online video workshops, and surveys
regarding arthritis.
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Health Passport Overview
What is the Health Passport?
The Health Passport is a comprehensive tool that has been designed to support individuals in
the management of their health care conditions. It can be used for any state of health from
healthy living choices for those who are generally healthy to people that are living with one or
more chronic illnesses such as arthritis.
How is the Health Passport useful to patients?
The Health Passport has a number of tools to support patient self-care including goal setting,
tracking the progress of a condition, preparing for medical visits and helping to find information
or education resources. Individuals will use the passport differently; some may fill it out in its
entirety or just use the sections that are most meaningful to them.
The Heath Passport has the following sections:
Section
Purpose
To provide information on the Health Passport including why and how to use it
Introduction
To discuss some common health care terms such as prevention and selfmanagement
About Me
To provide patients with a one page information sheet to record their personal
and health care information, including allergies, medical conditions and
medications
Working with My Health Care Team
To provide various self-management tools including a tracking diary, information
on how to set goals, recording test results and finding education resources
My Community Contact Information
To provide contact information for a list of national and provincial health care
resources
Miscellaneous
To provide some useful websites with information on symptoms, tests,
medications and making medical decisions
Retired Health Records
To provide a section for patients to store older health records for safekeeping and
future reference
Forms for Photocopying
To provide a section for patients to store forms that are used on a regular basis
How is the Health Passport useful to family physicians?
Although a patient-focused tool, the Health Passport can be useful to family physicians in two
ways: (1) as an optional tool to help patients coordinate and direct their self-care efforts; and
(2) to serve as a reference point for various self-care discussions and interventions such as goal
setting, tracking symptoms and drug interactions, recording test results and finding community
resources.
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Handouts for Arthritis Patients
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PATIENT HANDOUT – Specific Disease (RA) Information for Patients
What is Rheumatoid Arthritis?
Most common type of inflammatory arthritis
affects ~1% of the adult population and affects women more than men
can start at any age but most commonly occurs in the 30-50 age group
Inflamed joints are painful, swollen, hot and stiff
Inflammation is in the lining of the joints, and if it is not controlled, it will
cause permanent damage to the bone and cartilage
Cause
Unknown
Caused by the body’s immune system attacking the joints—is an
autoimmune disease
Smoking increases the risk of developing RA
Diagnosis
Symptoms:
may be sudden or gradual
pain or stiffness with swelling in joints, usually worse in the morning
commonly starts in the fingers, wrists and feet although other joints may be
involved
most often tends to be symmetrical, involving joints on both sides of the
body
Blood test is not completely diagnostic; may take months to confirm
diagnosis
Treatment
Important to treat RA early and aggressively
DMARDs can slow or stop inflammation that causes joint damage, but
cannot reverse damage
Referral to rheumatologist
Learn about RA, set goals
Most well-balanced RA treatment plans include medications, weight
control, exercise, pain management, relaxation, healthy eating, smoking
cessation
Access community services/programs
Access other healthcare providers as needed, e.g. physiotherapist,
occupational therapist, dietitian, etc.
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PATIENT HANDOUT – Specific Disease (OA) Information for Patients
What is Osteoarthritis?
Most common type of arthritis
Most common in the hands, hips, knees and spine
Breakdown of the cartilage on the ends of bones
Symptoms can include pain, stiffness and mild swelling
Cause
Unknown
Factors that increase your chance of getting OA include
Examples of Team members:
Age (getting older)
Excess weight
Heredity
Injury and overuse
Other types of arthritis
Treatment
Learn about OA, set goals
Weight control, exercise, pain management, relaxation, healthy eating
Access community services/programs
Access other healthcare providers as needed, e.g. physiotherapist,
occupational therapist, dietitian, etc.
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PATIENT HANDOUT – A Comparison of Inflammatory Arthritis and
Osteoarthritis
Features
Inflammatory Arthritis
Osteoarthritis
What are examples of diseases?
Rheumatoid arthritis
Osteoarthritis
Psoriatic arthritis
Ankylosing spondylitis
Systemic lupus erythematosus
Who gets it?
Usually starts in middle age (30 –
60) and tends to get worse over
time. However, it can start at
any age.
More common as we age, tending to
occur in joints that have been subject to
“wear and tear” by excessive use
What is the cause?
The body’s immune system
attacking the joints
Deterioration of cartilage
How quickly does it start?
Fairly quickly, affecting joints
over a period of weeks to months
Usually slowly, with joints getting worse
over a period of months to years
How many joints does it affect?
Usually lots of joints and tends to
be symmetrical, involving joints
on both sides of the body (i.e.
both hands, both elbows etc.)
Usually a few joints and tends to be
asymmetrical (not matching), with
swelling and pain in single joints (i.e. on
knee, one finger etc.)
What joints can be affected?
Small joints of the hands and feet
Most commonly joints of the fingers,
neck, lower back, knees and hips
Wrists, elbows, shoulders, knees,
hips
Can occur in any joint
Any joint can be affected
What are the usual symptoms?
Joint pain, swelling, tenderness
and redness of the joints
Stiff, painful and enlarged joints
Gradual onset and worsening
Prolonged morning stiffness and
less range of movement
Sometimes fever, weight loss,
fatigue and/or anemia
What amount of morning
stiffness is experienced?
Morning stiffness lasting more
than 30 minutes
Morning stiffness lasting about 15-30
minutes
What medications are available?
Non-steroidal anti-inflammatory
Drugs (NSAIDS)
Analgesics
Disease-modifying AntiRheumatic Drugs (DMARDS)
Injections, steroids and
viscosupplementation
NSAIDS
Steroids
Biologics
Steroid Injections
(Source: the Arthritis Society - Arthritis Medications – A Consumer’s guide, January 2011)
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PATIENT HANDOUT – Access to Services / Resources
Internet
Social media sites that offer tools for education, information-sharing
and advocacy, i.e. websites, blogs, forums, YouTube, Facebook,
twitter, MySpace, etc.
Look for:
Established arthritis organizations that are patient focused
Full acknowledgement of funding sources to promote transparency
The URL extension on the website address. E.g. Non-profit
organizations usually end in .org; educational institutions in .edu; and
government websites in .gov
Be wary of pharmaceutical product advertising
Resources – In addition to these resources, please refer to the Patient Self-Management Toolkit
For additional information on education programs and other useful sources of information.
http://www.fcns-caregiving.org
1 877 520 FCNS (3267)
http://www.sparc.bc.ca
Family Caregiver Network Society. Support for families of patients
with disabilities.
The Social Planning and Research Council of BC (SPARC BC) – who you
contact to get a Disability Parking pass.
1-(604)-718-7744 Parking Permit
http://www.labour.gov.bc.ca/wab
Workers Advisor Group, for issues related to WorkSafeBC.
1 800 663 4261
http://www.seedsbdc.com
1 604 590 4144
http://www.bccpd.bc.ca/contactus.htm
1 604 872 1278
1 800 663 1278
http://www.bchousing.org
SEEDS. An Employment Insurance (EI)-based funding program for
starting up a business.
BC Coalition of People with Disabilities’ Advocacy Access Program.
Provide individual and group advocacy for people with disabilities and
develop educational publications for people with disabilities,
governments and the public.
BC Housing. Information on rental subsidies and light housekeeping.
1 800 257 7756
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PATIENT HANDOUT – Dealing with Psycho-Social Issues
Feelings about diagnosis
Support for sense of grief or loss associated with diagnosis
Discuss common emotional reactions, signs and symptoms of
stress, depression, social isolation
Discuss coping strategies
Stress
Can impact the management of arthritis and compound illness
Discuss the signs and symptoms of stress, techniques for becoming
self-aware and strategies for coping with stress
Depression
Is treatable
Strategies for mild depression:
Interests, hobbies, distraction
Support network – family, friends, group
Positive thinking, sense of humor
Exercise
Healthy eating
Exercise
Pain management
Relaxation techniques
Deep breathing
Progressive muscle relaxation
Guiding imagery
Visualization
Cognitive behavioral therapy
Model developed by Psychologists to help us understand how our
thoughts, feelings and behaviors/actions are connected
Useful in the treatment of anxiety, stress, depression and chronic
pain
Social Engagement
Important for a sense of purpose and wellbeing
Important to avoid becoming isolated
Benefits of peer support group: sharing experiences and lessons
learned, providing hope support and encouragement when dealing
with emotional and physical pain
Sexual intimacy
Can be maintained
Most couples living with arthritis find it necessary to experiment
with new positions for intercourse that put less strain on painful
joints
Sexual concerns arising from arthritis are completely valid.
Open communication between partners, and between people with
arthritis and health professionals, is vital to maintaining an active
sex life.
Important to note that arthritis disease does not cause a loss of
sex drive. However, the physical and emotional hardships that
result from arthritis can create barriers that undermine sexual
needs, ability, and satisfaction.
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Resources
www.arthritis.ca
The Arthritis Society – Lifestyle Series: Intimacy and Arthritis; SelfManagement Program
http://web.uvic.ca/~pmcgowan/research/cd
smp/index.htm
University of Victoria Centre on Aging - Chronic Disease SelfManagement Program
www.cmha.bc.ca/services/bounceback
Bounce Back, Canadian Mental Health Association. Community
based mental health support to patients to help improve their
mood and quality of life through free psycho-education and guided
self-help.
1 604 688 3234
1 800 555 8222 extension 235
“Living Life to the Full” DVD
Overcoming Depression, low Mood and Anxiety via telephone
coaching
http://www.getselfhelp.co.uk/chronicfp.htm
This is a self-help website for people that feel stuck that offers
people strategies for change. Focus on cognitive behavioural
therapy.
http://www.comh.ca/antidepressantskills/adult/
Anti-depressant Skills Workbook – helping you deal with
depression
www.heretohelp.bc.ca
A project of the BC Partners for Mental Health and Addictions
Information, intended to help people better prevent and manage
mental health and substance abuse problems
www.mooddisorderscanada.ca/
Mood Disorders Society of Canada (MDSC) is a national, not for
profit, consumer driven, voluntary health charity committed to
ensuring that the voices of consumers, family members and
caregivers are heard on issues relating to mental health and
mental illness; and in particular with regard to depression,
bipolar illness and other associated mood disorders.
http://www.mdabc.net/
Mood Disorders Association of British Columbia
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PATIENT HANDOUT – Managing Daily Activities
Keywords
Discussion
Pacing and Energy Conservation
Pace activities and take frequent breaks. Balance work with rest.
Plan ahead and do the most difficult tasks when feeling best.
Prioritize.
Avoid repetitive tasks and sustained postures
Find the easiest way to work. Modify or avoid activities that
cause pain.
Be realistic of abilities. Ask for help with more difficult tasks
Modifying Activities/ Equipment
Use large muscles whenever possible, i.e. push/pull rather than
carry items
Stairs – avoid and use the elevator/escalator. If necessary, lead
with the good leg going up and the painful leg going down
Unload joints with a cane, walker, Nordic walking poles
Make sitting/standing easier by using higher chairs, armrest,
raised cushion, raised toilet seat
Hands – use large-handled pens, garden tools, kitchen aids (or
enlarge standard items with foam tubing)
Bathroom safety / reducing risk of falls – grab bars, shower
seats, etc
Consider referral to an occupational therapist for hand splints,
knee/ankle braces, supportive footwear/orthotics
Sleep
Lack of sleep can lead to low energy,
fatigue, increased pain and depression
Work
Work (paid and unpaid) is important to
both physical and mental health and is a
very important part of life for many people
Consider body positioning
Good sleep hygiene
Consider the rate, duration and nature of work.
Consider workplace ergonomics
May need to provide plan for progressive return to work,
changing jobs or re-entering the workforce
Consider the type and duration of commute, and consider
telecommuting where feasible
Resources
www.arthritis.ca
The Arthritis Society – Lifestyle Series: Arthritis in the Workplace
http://oasis.vch.ca/
OASIS Program – Primary Education Sessions
www.cbtforinsomnia.com
A 5 week, 5 session online cognitive-behavioural therapy (CBT)
program for insomnia
Resources
http://yoursleep.aasmnet.org/
American Academy of Sleep Medicine
http://www.sleepfoundation.org
National Sleep Foundation – information on how to sleep well
http://www.sleepeducation.com/pdf/sleepdiar
y.pdf
A Sleep Diary for documenting sleep so that health care
providers can help determine the problem
http://www.css.to/centers.html
Canadian Sleep Society. Find a sleep lab near you
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Footeducation.com
Created by orthopaedic surgeons to provide patients and
medical providers with current and accurate information on foot
and ankle conditions and their treatments.
Foothealth.ca
British Columbia Podiatric Medical Association
http://podiatrycanada.org
Canadian Podiatric Medical Association
http://apma.org
American Podiatric Medical Association
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PATIENT HANDOUT – EXERCISE
Benefits
Maintain/restore joint movement and relieve stiffness
Cartilage nutrition
Stabilize joints with strong muscles
Improve energy and endurance
Reduce risk of falling by improving posture and balance
Maintain a healthy body weight (every extra lb puts 4-6lbs or stress
through weight-bearing joints)
Components
Cardiovascular exercise
Strength training
Balance and Core body strengthening
Flexibility training (range of motion and stretching exercises
General Principles
Start slowly and gradually progress intensity and duration.
Break activities up throughout the day
Warm up before exercising by doing range of motion exercises or by
applying heat to the joint (warm shower, hot pack, etc)
Taking medication before exercise may help to minimize symptoms and
improve exercise tolerance
Reduce load on joints by exercising in water or cycling
Use walking aids such as a cane, walker or Nordic walking poles
Refer to a physiotherapist for a specific exercise program and advice on
proper joint positioning, exercise equipment and technique
Pain
Avoid exercises that increase joint pain
If exercise causes joint pain that lasts more than 2 hours or in to the
next day, re-evaluate the exercise program.
During a flare-up, use ice, medications and rest to relieve symptoms.
Move the joint in a non-weight bearing position and avoid resistance
exercise
Non-pharmacological options are available for pain management,
Please see the Pain Toolbox Treatment Options for Pain – Beyond
Medications, Surgery and Injections for more information:
http://www.painbc.ca/sites/default/files/images/The_Pain_Toolbox_M
ay_6_2011_TF-edit.pdf
Resources
www.arthritis.ca
The Arthritis Society – Lifestyle Series: Physical Activity and Arthritis
http://oasis.vch.ca/
OASIS Program – Primary Education Sessions
www.physicalactivityline.com
A free resource for physical activity and healthy living information.
604 241 2266
1 877 725 1149
www.phac-aspc.gc.ca/hp-ps/hl-mvs/paap/index-eng.php
Canada’s Guide to Physical Activity
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PATIENT HANDOUT – Healthy Eating & Weight Management
Nutrition
Eat according to Canada’s Food Guide. Serving recommendations by
age and sex are designed to meet minimal daily nutrient requirements
Anyone over 50 should supplement a minimum of 400 IU of Vit D
Include Omega-3 Fatty Acids in your diet. Increased intake has been
linked to a reduction in RA symptoms and inflammation
If you’re low in any food group on a regular basis, a multivitamin/mineral supplement is recommended, as is improving your diet
Patients who are unsure of how to change their diet should be referred
to a dietitian or telephone resource
Tips for Weight Management
Being overweight puts extra stress
on weight bearing joints
Eat breakfast to boost metabolism
Take at least 20 minutes to eat a meal and chew slowly to give your
body time to know when you are full
Eat smaller meals more often so you can burn calories between meals.
If you eat too much at one time your body will store extra calories as
fat.
Do not eat for 2 to 3 hours before going to sleep. If you eat a large meal
or snack non-stop before going to bed, your body may not have a
chance to burn calories.
Drink low calorie fluids like water, herbal teas, flavoured water and
vegetable juices. Aim for 8 glasses or 2 liters a day.
Eat your vegetables. Vegetables are low in calories and full of nutrients.
Limit foods and beverages high in calories, fat, sugar and sodium.
Eat moderate portions. Use smaller plates, bowls, forks, spoons, etc.
Tell your friends and family that you are trying to lose weight and you
need their support.
Resources
www.arthritis.ca
The Arthritis Society – Lifestyle Series: Nutrition and Arthritis
http://oasis.vch.ca/
OASIS Program – Primary Education Sessions
www.healthlinkbc.ca
HealthLink BC – Speak with a Dietitian
8 1 1 on your telephone
www.healthcanada.gc.ca/foodguide
Canada’s Food Guide
www.dietitians.ca
Dietitians of Canada – Current food and nutrition information.
www.eatracker.ca
Track and analyze your day’s food and activity choices and compare
them to the guidelines laid out by Health Canada.
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PATIENT HANDOUT – Managing Pain
General
Pain may come and go as arthritis flares or subsides, but for many
people with arthritis, pain will never entirely disappear
Pain does not always mean damage to the joint(s)
Pain is different from muscle discomfort associated with exercising.
Chronic pain management aided by:
Knowledge of pain, treatment options
Support from friends, family, others with chronic pain
Behavioral change
Heat & Cold Therapies
Heat therapies may help to decrease pain and stiffness of the muscles
and joints and should be applied for 15-20 minutes at a time
Cold therapies may relieve pain and reduce swelling
Complementary Therapies
Risks and benefits often not clear. Examples may include:
Vitamins, minerals, herbal supplements
Acupuncture, massage, chiropractor, relaxation, visualization, TENS
Dietary changes
Consider
What you are trying to achieve
Costs
Risks and side-effects
Interactions with other medications
Trying only one therapy at a time to determine the effect
Resources
www.arthritis.ca
The Arthritis Society – Chronic Pain Management Workshop
http://oasis.vch.ca/
OASIS Program – Primary Education Sessions
http://web.uvic.ca/~pmcgowan/resear
ch/cdsmp/index.htm
University of Victoria Centre on Aging - Chronic Pain Self-Management
Program
www.painbc.ca
Pain BC – Non-profit organization aiming to furthering support and
education for patients and promoting engagement of patients in health
care decision making
Non-pharmacological options are available for pain management,
Please see the Pain Toolbox Treatment Options for Pain – Beyond
Medications, Surgery and Injections for more information:
http://www.painbc.ca/sites/default/files/images/The_Pain_Toolbox_Ma
y_6_2011_TF-edit.pdf
http://www.canadianpaincoalition.ca/i
ndex.php/en/help-centre/conqueringpain
Canadian Pain Coalition – “Conquering Pain for Canadians” booklet and
“Conquering your Pain” video
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Lifeisnow.ca
Public education sessions provided by Neil Pearson to help people
understand pain and provide optimistic guidance about pain selfmanagement technique
http://www.medschoolforyou.com/
Med School for You. A free online pain education module supported by
the Canadian Pain Society (CPS) & the Canadian Pain Coalition (CPC).
http://www.calgaryhealthregion.ca/pr
ograms/rpp/resources/lectures.htm
The Calgary Pain Centre. Online pain education lecture series.
http://psychologyofpain.blogspot.com/
Psychology of Pain. A blog created by Gary B. Rollman, Professor of
Psychology at the University of Western Ontario and the former
President of the Canadian Pain Society. Contains links to many useful
pain resources and discussions on a number of pain issues.
http://www.cci.health.wa.gov.au/reso
urces/doctors.cfm
Centre for Clinical Interventions. A resource centre with handouts
aiming to help people change the way they think. It also has
psychotherapy course material for family physicians and might be
helpful for physicians who are interested in running group sessions on
coping with pain.
> click on the [resources] button in the
upper left column, and then
> click on the button for [consumers].
http://www.chronicpaincanada.com/
1 780 482 6727
[email protected]
The Chronic Pain Association of Canada (CPAC) is committed to
advancing the treatment and management of chronic intractable pain,
developing research projects to promote the discovery of a cure for this
disease, and educating both the health care community and the public
to accomplish this mission.
http://www.painexplained.ca/
The Canadian Pain Society has a website for pain information for
patients and healthcare providers:
http://www.iasp-pain.org
The International Association for the Study of Pain (IASP).
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PATIENT HANDOUT - Medication Management
Goals
Control the symptoms of pain, stiffness and swelling
Patient needs to know:
Reason for taking medication
Expected benefits and timeframe
How long they’ll be taking medication
Types
Different types of arthritis have are treated with very different
medication classes. OA medications focus on pain and
inflammation, treating symptoms. RA medications work to treat
both symptoms and the underlying disease process.
Analgesic - pain management (all)
Anti-inflammatory – inflammation (all)
DMARDs—including biologic response modifiers (RA)
Patient needs to know:
How medication works
How to take it
Possible interactions
Patient’s Role
Communication. All medications have potential side effects.
Patients need to share any nutritional / herbal supplements and
other complementary therapies being used.
Use a Pharmacist as a resource
Reminder system (pill box or diary)
Record of medications tried, side effects, benefits, loss of effect
Resources
www.arthritis.ca
The Arthritis Society – Consumer’s Guide to Medications; “An
Introduction to Complementary and Alternative Therapies”
www.healthcanada.gc.ca/medeffect
MedEffect Canada provides consumers, patients, and health
professionals with easy access to: report an adverse reaction or
side effect; obtain new safety information on drugs and other
health products; and learn and better understand the importance
of reporting side effects
www.nccam.nih.gov
National Centre for Complementary & Alternative Medicine
(American)
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Handouts and Exercises for
Low Back Pain Patients
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