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Www.pspbc.ca Management of Function for Patients with Pain Westin Wall Centre, Richmond December 5, 2013.

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Presentation on theme: "Www.pspbc.ca Management of Function for Patients with Pain Westin Wall Centre, Richmond December 5, 2013."— Presentation transcript:

1 www.pspbc.ca Management of Function for Patients with Pain Westin Wall Centre, Richmond December 5, 2013

2 What are we trying to accomplish? Drs. David May and Michael Negraeff

3 3  The Heartsink Patient The Burden

4 4  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 Burden

5 5  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 Burden

6 6  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 Burden

7 7  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 Burden

8 8  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 Burden

9 9 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

10 10  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

11 11 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

12 CHRONIC PAIN IS A DISEASE THAT WILL LARGELY BE TREATED BY FAMILY DOCTORS

13 13  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

14 14 So what do I do with my chronic pain patients?

15 15  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

16 16  Pain diagrams  Disability assessment tools Structured Assessments

17 17

18 18 Shift paradigm:  Sole pursuit of tissue pathology…  ….to reasonable attempt to exclude pathology and reach diagnosis. What are we trying to accomplish?

19 19 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?

20 20 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

21 21 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?

22 22 Etiology Splitters Chronic pain & consequences Lumpers Scope

23 23

24 24 "I'm not a magician, Spock, just an old country doctor."

25 25  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?

26 26

27 27 Central Nervous System Sensitization Pro-nociceptiveAnti-nociceptive

28 28 Social Class Financial Relationships Job Culture Beliefs Life experiences Other health issues Report: “I have pain.” Observe: Behaviour

29 29 Pink? Flower? Pink Flower “Pretty” I’m calm. Pink Flower Bees? I’m allergic I’m afraid

30 30  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?

31 31 Diagnostic Framework Peripheral Inputs Central Sensitization Psychological Inputs Social Inputs +++ = Pain Genetic Factors

32 32 Activity Gentle Progressive Pacing Goals Mood Coaching Bounce Back Coping Resilience Sleep Sleep hygiene Aids Medication Toolbox of Supports

33 33 Mindfulness Meditation Yoga Tai Chi Breathing Medications TCAs Anti- convulsants Opioids Other… Interventions Injections Surgery Manipulation Toolbox of Supports

34 34 Knowledge Pain Body Self awareness Concepts Support Family Friends Work SM groups Support groups Psychology CBT ACT BAP Coaching Group Medical Visits Toolbox of Supports


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