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PSP Musculoskeletal (MSK) Arthritis & Low Back Pain Patient Self Care Resources / Handouts Train the Trainer Session 1 April 4 – 5, 2013 1 of 31 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 2 of 31 Goal Setting – Supporting Patient Self Management 3 of 31 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: ___________________________________________________ 4 of 31 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. 5 of 31 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. 6 of 31 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 7 of 31 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. 8 of 31 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. 9 of 31 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. 10 of 31 Handouts for Arthritis Patients 11 of 31 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. 12 of 31 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. 13 of 31 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) 14 of 31 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 15 of 31 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. 16 of 31 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 17 of 31 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 18 of 31 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 19 of 31 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 20 of 31 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. 21 of 31 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 22 of 31 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). 23 of 31 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) 24 of 31 25 of 31 Handouts and Exercises for Low Back Pain Patients 26 of 31 27 of 31 28 of 31 29 of 31 30 of 31 31 of 31