www.pspbc.ca Chronic Pain Module MOA Breakout Adapted from Barb Aasen, David Jermey, and Josefa Kontogiannis,
www.pspbc.ca
Chronic Pain ModuleMOA Breakout
Adapted from Barb Aasen, David Jermey, and
Josefa Kontogiannis,
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Definition of pain People in Pain Consequences of pain Other problems brought on by pain Types of pain
What can MOAs do to help these patients when they come in for their appointments every 43,180 minutes?
Let’s recap what we heard today
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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)
A warning sign A potential lead to red flags It is costly if not caught, to the patient and to the system An experience created in our brain that is influenced by
things other than tissue damage An experience not dependent on tissue damage
Today we heard the definition of Pain
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Diverse Population:
› Chronic Disease eg Cardiac disease, Diabetes, Osteoarthritis
› Chronic Post Surgical Pain
› Chronic Pain Post Injury eg Whiplash, Spinal Cord Injury
› Chronic Headaches eg Tension, Migraine, Cluster.
› Neuropathic Pain eg Post Herpetic Neuralgia, Diabetic Neuropathy
› Complex Regional pain Syndrome
› Recurrent Abdominal pain / Visceral Pain
› Fibromyalgia
› Back Pain
› Post trauma/burns/stroke
› Cancer
People in Pain ??!! There may be some patients that you have been thinking about today
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Person with pain:
› Lowest Quality of Life scores of any chronic disease
› Depression and anxiety (5X)
› Suicide (2X)
› Sleep disorder
› Addiction/Substance abuse co-morbidity
› Job loss and financial stress
ConsequencesThis is what some of them are experiencing due to pain
freedigitalimages.net
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Direct Healthcare Consumption
• 4x GP visits
• 2x hospital admissions and length of stay
• Use Emergency for treatment (esp. no GP or marginalized)
• Increased drug costs and surgeries/procedures
Indirect Societal Costs• Lost productivity
• Lost tax revenue
• Increased benefit payments
• Social issues: prescription diversion, homelessness, poverty
ConsequencesThese are what they are now calling norms in their life
20 minutes a month with my healthcare provider leaves-
So, the rest is down to me!
43,180 minutes before my next appointment
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Hopelessness
Stigma
Mistrust
Knowledge gap
Lack of accountability
Resource strain
What’s going on during the 43,180 minutes before they see you again?
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Vicious cycles develop between pain and its effects
› Pain - shallow, tight, apical breathing - pain
› Pain - altered body awareness - pain
› Pain - muscle inhibition - pain
› Pain - muscle tension - pain
› Pain - altered body image - pain
› Pain - anxiety - pain
Basic Science of Persistent Pain
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Understanding the severity range of Chronic pain Being aware of what is needed for an appointment ie:
› Time required
› Tools needed
› Follow up appointments/specialist appointments A good awareness of the screening tools, when they are
used and needed Billing required Opioid management Diffusing difficult conversations Urine testing
MOA Role in Support for Patients with Chronic Pain
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People in pain may be….. Needing assistance Accompanied by someone Not feeling like engaging in conversation Slow moving Needing more time Unpleasant
Understanding Range and Severity
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Discuss with the doctor about the appointment logistics
The length of the appointment/ how often this patient should be seen
The screening tools/lab reqs required and who is to give them out
Use the closest exam room if possible, less walking Whether this patient should come earlier for any
prep or filling out of forms Empathy
Being aware of what is needed for an appointment
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What they are used for When they are given Who gives them
A good awareness of the screening tools
Can be handed out by MOA
Can be completed by patient prior to doctor-patient encounter
Can be repeated each visit to assess progress
Structured assessments
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When the patient comes in for a pain appointment, a random urine drug screen (RUDS) may be done to verify what drugs the patient is taking. Some physicians like this to be a witnessed collection at the clinic.
There can be a narcotic contract between the physician and patient so that the agreement is clear on both sides of what is expected as far as compliance, early release etc.
The physician can access PharmaNet to see what prescriptions the patient has had filled recently.
Opioid Management/Urine testing
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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-
Managing Pain
Pain Diagram Name: ____________________________________________ Date: _____________________________ Please colour the areas where you experience pain. Use one of the five colouring pens to shade the specific type of pain that you are experiencing. Then circle with a pen all the areas of pain and starting with the worst, number the areas in order of severity. Red - Burning If you have other pain
sensations name them here and colour as yellow or black
Yellow - Green - Tingling Black - Blue - Numbness
Tools
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Communication is not just saying words; it is creating true understanding.
Active listening is an important skill in the communication process
“Listen Non-judgementally”
Diffusing difficult conversations
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Don’t interrupt Silence is a powerful listening skill. Be quiet & give the
person time to think, as well as talk Let the person finish what they are saying It’s not possible to talk & listen at the same time
Tips to be a better Active Listener
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Listen, don’t judge. Jumping to conclusions & looking for the right or wrong in what is being said can prevent you from listening
Think before you respond
Keep an open mind
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Stay focused on what is being said – don’t let your mind wander
Stay in the present. Try not to think ahead of what you are going to say
Let go of your agenda & listen & focus on theirs
Show respect for the person & their feelings Show respect even if you disagree with what is being
said
Make listening a priority
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Offer options & suggestions rather than advice. Give people the opportunity to discover their own best answer.
Learn the art of asking good questions Open ended questions. These questions encourage
people to go into more depth about the situation Closed ended questions. People usually answer these
questions with short “yes/no” type responses
Avoid giving advice, even when asked
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This shows that you are trying to understand their situation.
By paraphrasing, you show concern, interest & empathy. “ So you feel _____because_____”
Let the person know you are listening with minimal prompts like “uh –huh” or “I see”
Listen with empathy
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Pay attention to your non-verbal signals, as well as the other person’s
Keep an open body posture to show you care & are listening
Try to maintain eye contact
Watch non-verbal behaviour