A novel interdisciplinary model for chronic pain education Sally Curtis BSc, PhD 1 Marilyn Monkhouse MB, FFARCS, FFPMRCA 1&2,Norma Waite BM MSc MBAcC 2 and Cathy Price MBBCH, DCH, FRCA, FFPMRCA 1&2
1 Faculty of Medicine, University of Southampton, Southampton, UK; 2 Pain Management Clinic, Royal South Hants Hospital, Southampton, UKE-mail: [email protected]
Aim
An interactive interdisciplinary teaching model, integrated with patient experience, was developed to address the needs of chronic pain education for undergraduate medical students. The aim was to enlighten students to the causes and consequences of chronic pain. This approach was adopted to maximise understanding of the multifaceted nature of this condition. The session was embedded within a multidisciplinary pain teaching week. The session was delivered by a physiologist, a pain specialist doctor, a pain specialist nurse and expert patients (Figure 1).Methods
The 2.5 hr session began with a mock video consultation between a GP and chronic pain patient. Students were given a paper-based patient history before watching the video, to enhance understanding. Comment and debate was encouraged to air a range of student opinions. This was followed by presentation of an integrated model for the development of chronic pain (Figure 2). A novel analogy of living with chronic pain as a comparison to the stages of loss was presented and discussed (Figure 3). Real patient volunteers then delivered presentations on the effects of chronic pain on their lives and joined in a Q&A session with the students.
90% of 97 students found the session very useful or useful (Figure 4).
74% said listening to and talking with patients were the most useful aspects (Figure 5)
79% stated it altered their perception of chronic pain (Figure 6);
36% said it helped them gain insight and understanding of the condition 24% stated it had made them more open-minded (Figure 7).Conclusions
The interdisciplinary model was successful in raising awareness of the chronic pain condition
Students value learning from patient experience
This model could be incorporated into any undergraduate healthcare curriculum.
Pain
Tissue heals pain goes
Short-term SNS activity
Altered motor control strategies
Long-term SNS activity –neuronal modification
family issues
compensation issues
emotional factors
aberrant beliefs
Tissue heals Minimizing
thoughts/overload Persistent pain
Feelings of Loss
Tissue heals catastrophising
avoidance –Persistent pain
Tissue heals irritated/depressive
avoidance –Persistent pain
Incident –trauma or
non-traumatic
Incorporating the Fear avoidance/Endurance model
Hasenbring(2000)
Kübler-Ross(1969)
Murray-Parkes(1971)
Denial Realisation Understanding that you have long-term pain that will not go
away
Anger Anxiety/Fear Fear anxiety about what is wrong, why does it still hurt when tissue
has healed? Could it be more serious?
Bargaining Urge to find or search for what is
missing
Try to identify with problem, research, medical tests,
self-diagnosis
Depression Feelings of internal loss of self
Acceptance Identification phenomenon
(Pathological variants of grief)
Poor coping strategies
Identification of new sense of self. Good coping strategies,
good management
Loss of identity, lifestyle, relationships,
independence
How the stages of loss relate to chronic pain
Figure 1. “Keeping Pace with Pain”Chronic Pain Support Group - Southampton
Figure 2. an integrated model for the development of chronic pain
Figure 3. An analogy of living with chronic pain as a comparisonto the stages of loss
0
10
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30
40
50
60
Response (%)
Very useful Useful Neutral Not veryuseful
How useful did you find this session?
010
20
30
40
50
6070
80
Response (%)
Patients Understandingof chronic pain
Stages of grief Learning aboutpain clinics
What did you find most useful about this session?
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20
40
60
80
Response (%)
Yes No Maybe
Has this session altered your perception of chronic pain?
05
10152025303540
Response (%)
Gaining insight,understanding, appreciationof living with chronic pain
Realising it is a condition inits own right
Made me more open minded
How has it altered your perception of chronic pain?
Figure 4. Usefulness of the sessionFigure 5. Useful Aspects of the session
Figure 6. Was perception of chronic pain affected?
Figure 7. How perception of chronic pain was affected
Results
References:Hasenbring M.I. 2000, Attentional control of pain and the process of chronification., Progress inPain Research, vol 129, pp 525-534.