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Presentation on theme: " Chronic Pain Module MOA Breakout Adapted from Barb Aasen, David Jermey, and Josefa Kontogiannis,"— Presentation transcript:

1 Chronic Pain Module MOA Breakout Adapted from Barb Aasen, David Jermey, and Josefa Kontogiannis,

2 2  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

3 3  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

4 4  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

5 5  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 Consequences This is what some of them are experiencing due to pain

6 6  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 Consequences These are what they are now calling norms in their life

7 20 minutes a month with my healthcare provider leaves- So, the rest is down to me! 43,180 minutes before my next appointment

8 8  Hopelessness  Stigma  Mistrust  Knowledge gap  Lack of accountability  Resource strain What’s going on during the 43,180 minutes before they see you again?

9 9  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

10 10  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

11 11 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

12 12 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

13 13  What they are used for  When they are given  Who gives them A good awareness of the screening tools

14  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

15  Pain diagrams  Disability assessment tools Structured Assessments

16 16  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

17 17 Tools



20 20 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

21 21 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

22 22  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

23 23  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

24 24  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

25 25  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

26 26  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


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