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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

Pain diagrams

Disability assessment tools

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