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Essential Pain Management
A System for Managing Patients with Pain
Dr Roger Goucke
Dr Wayne Morriss
Dr Linda Huggins
Plan
Pain education – the need for a system
Outline of EPM
EPM principles and development
Disclosures
No conflicts of interest
Co-author of “Essential Pain Management”
With permission
The Global Burden of Pain
Trauma
Post-operative
Childbirth
Arthritis
Back pain
Diabetes
Cancer
HIV-AIDS
Sickle cell disease
Pain Education
APPEAL study (2013)
15 European countries
242 medical schools
Little or no teaching
Not dedicated
Not practical
Pain Education
• IASP Task Force for Developing Countries
(Bond et al, 2007)
– 49 countries / 189 respondents
– Findings
• Undergraduate training is inadequate
– 90% considered training inadequate
– 80% did not receive formal training
• Specialized postgraduate training is variable
• Other postgraduate training?
BARRIERS TO GOOD PAIN MANAGEMENT
• 85% Lack of Education
• 65%
Government
Question
32. In yourPolicy
country,
• 55%
cost
of Drugs
whatHigh
are the
barriers
to good
• 50%
patient compliance
painPoor
management?
(select all
• 90% Fear
opioid Addiction
thatof
apply)
Barriers to good pain management
in developing countries
Lack of
education, 91%
Government
policy, 74%
Fear of opioid
addiction, 69%
%
High cost of
drugs, 58%
Poor patient
compliance, 35%
Other, 11%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90% 100%
www.wfsahq.org
A System?
Trauma
Pain
Multiple causes
Multiple causes
Team management
Team management
ABC system
No system
ATLS, PTC training
?
We also need a simple system for
managing pain.
www.medicinenet.com
Essential Pain Management
(EPM)
Recognize
Assess
Treat
What is EPM?
•
•
•
•
One day workshop
Doctors, nurses, other health workers
System for managing pain
System for teaching others about managing
pain
Global EPM
EPM 2010-2015
• 41 countries
• 173 workshops / 4770 participants
• 56 instructor workshops / 783 instructors
Reconocer
Analizar
Tratar
R Nhận biết
A Đánh giá
T Xử lý
R การตระหนัก
A การประเมิน
T การรักษา
Xeroderma pigmentosum - squamous cell carcinoma
How does EPM work?
Simple system
Case discussions
Local ownership
K.I.S.S.
Any fool can make something complicated.
It is hard to make something simple.
The EPM RAT
• Recognize
• Assess
– Severity
– Classification
– Other factors
• Treat
– Non-drug
– Drug treatments
Case Discussions
• Level of discussion
depends on the group
• Local relevance
• Local solutions
Local Ownership
1-day
EPM
workshop
1-day
EPM
workshop
Half-day
instructor
workshop
1-day
EPM
workshop
Day 1
Day 2
Day 3
The Snowball
Evaluation
Some Feedback
“EPM has changed my mind set-up.”
”EPM has changed so many wrong ideas about
pain management.”
”This needs to become part of every medical
school's curriculum!! I would have been more
effective in clinic work if I had this knowledge
earlier on in my studies.”
Pre and Post Testing Suva 1 (2011)
Correct answers (N=25)
25
20
15
Nurses
Doctors
10
5
0
Mean Pre
Mean Post
Health Workers
•
•
•
•
•
Lack of knowledge (especially chronic pain)
Afraid of complications of morphine
Not organised
Lack of cooperation with surgeons
Not being aware of the emotional aspects of
pain
www.wfsahq.org
System Issues
•
•
•
•
•
Lack of leadership in Pain Management
No Support
Complicated administrative structure
Limited prescribing rights, especially morphine
Health insurance may not pay for pain
medications
• Not all medications are easily available
www.wfsahq.org
Patient Issues
•
•
•
•
•
Don’t complain about pain
Accept their pain even if can’t function
Fear of treatment
Listen to the surgeon more than other doctors
Cost of analgesics
www.wfsahq.org
Would the FAS be useful in LMICs
www.wfsahq.org
EPM in Arkhangelsk, Russia
Colombo, Sri Lanka
Essential Pain Management
• Pain management needs
a systematic approach
• EPM provides a system
– For managing patients
– For teaching others
• EPM Lite
– Undergraduates
www.essentialpainmanagement.org
Join us!
•
•
•
•
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