Murray Hames MNZSP, MNZCP (Pain Management), Dip MT

The Auckland Regional Pain Service

Causes of activity intolerance

Principles of activation

TARPS Pain Management Programme

Change in level of function due to :

Pain

Physiological and anatomical factors

Suffering

X-ray changes show a weak correlation to pain and disability experienced

MRI of 46 patients with LBP and sciatica requiring discectomy were compared with 46 age-, sex- and risk factor matched asymptomatic volunteers

Patients 96%

Volunteers 76%

Carragee et al. Are first-time episodes of serious LBP associated with new MRI findings? The Spine Journal 6 (2006) 624-635

Masui T, et al. 'Natural History of Patients with Lumbar Disc Herniation Observed by Magnetic Resonance Imaging for Minimum 7 Years.' J Spinal Disord Tech. 2005 Apr;18(2):121-126.

Carragee E, Barcohana B, Alamin T, van den Haak E. Prospective controlled study of the development of lower back pain in previously asymptomatic subjects undergoing experimental discographySpine 29(2004);10:1112-1117

Bigos S and Davis G. Scientific application of sports medicine principles for acute low back problems. JOSPT(1996)24:192-207

Jensen MC, et al. “MRI imaging of the lumbar spine in people without back pain.” N Engl J Med – 1994; 331:369-373

Haefeli M, Kalberer F, Saegesser D et al. The course of macroscopic degeneration in the human lumbar intervertebral disc. Spine (2006) 31; 1522-1531

“Look at me,” she cries to everyone who passes by. “No-one has ever had pain like mine. Pain that the Lord brought on me in the time of his anger.

“He sent fire from above, a fire that burnt inside me. He set a trap for me and brought me to the ground. Then he abandoned me and left me in constant pain.”

Lamentations I, 12-13

beliefs about damage and disease

fear of hurt and harm

fear avoidance beliefs

personal responsibility and self-efficacy

belief and expectation about treatment

Injury

Recovery

Disuse

Depression

Disability

Avoidance

Pain experience

Confrontation

Fear of re-injury

Catastrophizing No fear

Negative affectivity Information

Anxiety sensitivity (Health Professional)

Progressive confrontation with the feared stimuli

Consistent information

Adequate pain control particularly when starting to get active and exercising

Increasing activity levels with incremented, time dependent increase

Quota system

Changing behaviour changing behaviour may be equally or more

important than physical changes

Overcoming negative beliefs overcoming negative beliefs and coping may

be most important of all

Link rehabilitation to return to work

1974: 2 anaesthetists

2015: 6 anaesthetists, pain fellow, 1 psychiatrist, 5 psychologists, 3 physiotherapists, nurse specialist, occupational

therapist,

Located in Building 7,

Greenlane Clinical

Centre

PATIENT

SPECIALIST ASSESSMENT ACC

GP

TARPS TRIAGE

TRIPLE ASSSESSMENTMed/Psych/PT

ANAESTHETIC PROCEDURE

PTACTIVITY

PSYCH/OTRELAXATION

PAIN MANAGEMENT PROGRAMME

DISCHARGE

Application Interview

Rejection following:

Disinterest

Further medical assistance wanted

Prior failure in a pain management programme

Active alcohol or drug abuse

Significant psychopathology

Incompatibility with group activities

3 weeks

Monday to Friday, 8.15am – 3.30pm

Education, activation and relaxation

Follow-up at 1 month, 6 months and 12 months

125 Articles were reviewed and results

were averaged to provide a

comprehensive report on outcomes of

a PMP.

PMP Conventional

Pain ↓ 20 -30 % ↓ 20 -30 %

Function ↑ 65% ↑ 35%

Medication ↓ 65% On-going

Return to

work66% 27%

Estimated

lifetime

Healthcare

costs (2004)

US $ 175638 US $ 423279

Estimated

lifetime

Disability

costs (2004)

US $ 72950 US $ 156628