2

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

3

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

4

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].

5

Mitigating Potential Bias

[Explain how potential sources of bias identified in slides 1 and 2 have been

mitigated].

Refer to “Quick Tips” document

6

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.

Aim

7

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

Learning Objectives

8

The Heartsink Patient

The Situation

9

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)

The Situation

10

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

The Situation

11

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)

The Situation

12

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)

The Situation

13

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)

The Situation

14

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

15

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)

Chronic Pain and Depression

16

Women with chronic pain are three times more likely to commit suicide than matches in the general population without chronic pain (Fishbain et al)

Chronic Pain and Suicide

CHRONIC PAIN IS A DISEASE THAT WILL

LARGELY BE TREATED BY FAMILY DOCTORS

18

Denial

Lack of time

Lack of resources

Lack of knowledge

Lack of effective “cures”

Not wanting to open a “Pandora's Box”

Barriers for GPs

19

So what do I do with my chronic pain patients?

20

Shift paradigm:

Sole pursuit of tissue pathology…

….to reasonable attempt to exclude pathology and reach diagnosis.

What are we trying to accomplish?

21

Shift paradigm:

Sole pursuit of pain reduction…

….to whole person centered approach aiming at functional gain and pain reduction.

What are we trying to accomplish?

22

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.”

What are we trying to accomplish?

freedigitalimages.net

23

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.”

What are we trying to accomplish?

24

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)

What is Pain?

25

26

Central Nervous System Sensitization

Pro-nociceptive Anti-nociceptive

27

Social Class Financial

Relationships

Job

Culture

Beliefs

Life experiences

Other health issues

Report: “I have pain.”

Observe: Behaviour

28

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.

What is Pain?

29

Diagnostic Framework

Peripheral

Inputs

Central

Sensitization

Psychological

Inputs

Social

Inputs+ + + =

PainGenetic Factors

30

Ac

tiv

ity

• Gen

tle

• Prog

ressi

ve

• Paci

ng

• Goa

ls

Mo

od

• Coa

chin

g

• Bou

nce

Bac

k

• Copi

ng

• Resi

lien

ce

Sl

ee

p

• Slee

p

hygi

ene

• Aids

• Med

icati

on

Toolbox of Supports

31

Mi

nd

ful

ne

ss

• Med

itati

on

• Yog

a

• Tai

Chi

• Bre

athi

ng

Me

dic

ati

on

s

• TCA

s

• Anti

-

con

vuls

ants

• Opi

oids

• Oth

er…

Int

er

ve

nti

on

s

• Inje

ctio

ns

• Sur

gery

• Man

ipul

atio

n

Toolbox of Supports

32

Kn

ow

le

dg

e

• Pain

• Bod

y

• Self

awa

rene

ss

• Con

cept

s

Su

pp

ort

• Fam

ily

• Frie

nds

• Wor

k

• SM

gro

ups

• Sup

port

gro

ups

Ps

yc

ho

lo

gy

• CBT

• ACT

• BAP

• Coa

chin

g

• Gro

up

Med

ical

Visit

s

Toolbox of Supports