2. Hello. This presentation has been prepared to run on PowerPoint 97. To advance through the show click the left mouse button anywhere inside the active screen. Your keyboard’s arrow keys are also enabled and offer the advantage of being able to go backwards as well as forwards. Several additional slides have been included beyond those shown at the RACGP conference as these may contain information that is of use. Please contact me for clarification or discussion of issues raised. NB This presentation was prepared to be given as a lecture. Simon Strauss 07 55313810 E-mail simon@pain-education.com URL www.pain-education.com Click your left mouse button on the next slide to begin

3. Do short courses on Pain Management provoke changes in General Practitioners’ pain patient management? Presented by Simon Strauss adviser Medical Pain Education

4. One in three Australian households has one or more members with a pain complaint usually (80%) managed by a General Practitioner. From: The Prevalence of Pain Complaints in a General Population: An Australian Study. Brisbane.1986. Fiona Guthrie, Fred Nicolosi and Simon Strauss

5. Little data seems to have been published on: Educational intervention influences General Practitioners’ pain management The actual management of pain patients in the General Practice setting And whether or not

6. Objectives 1. To collect sentinel data on General Practitioners’ management of Initial Pain Consultations 2. Assess changes, if any, made following differing brief educational interventions.

7. Overview MPE’s Practice Assessment Activities Sentinel Data 58 medical practitioners 628 Initial Pain Consults Postal (Pain Tools) 20 medical practitioners 247 Initial Pain Consults Post Myofascial Seminar 34 medical practitioners 339 Initial Pain Consults Post Acupuncture Seminar 44 medical practitioners 535 Initial Pain Consults Knowledge Acquisition Assessed by formal written Examination Maintenance of Changes 39 medical practitioners followed at 4 months Knowledge Acquisition Assessed by formal written Examination

8. Overview -Extended for non- lecture attendees. Knowledge acquisition and maintenance of provoked changes are not included in this presentation. The postal group undertook an educational activity designed to increase usage of Pain Assessment Tools. The postal group and the sentinel groups provide a useful view of what happens in the ‘wild’. Many of the myofascial seminar attendees were extensively involved in chronic pain management prior to attending.

9. Usage of Pain Assessment Tools Investigation Rates Initial / Presenting Pain Consultations Referral Rates Script Generation Rates This presentation details the In the context of o

10. Usage of Pain Assessment Tools Sentinel Group % of Initial Pain Consults Data acquired prior to attending a Medical Pain Education acupuncture or myofascial pain management seminar

11. Usage of Pain Assessment Tools Postal Group Postal group received written educational material on the usage of VAS, McGill and Pain Diagrams % of Initial Pain Consults

12. Usage of Pain Assessment Tools Pre - Post Myofascial Seminar 34 GPs 339 Audits % of Initial Pain Consults

13. Usage of Pain Assessment Tools Pre - Post Acupuncture Seminar 44 GPs 535 audits % of Initial Pain Consults

14. The following slides represent the ‘worst case’ figures That is, they reflect the number of initial pain consultations that resulted in the ordering of one or more investigations/scripts/referrals. Therefore they cannot be used to give the actual numbers of x-rays ordered.

15. Investigation Rates % of Initial Pain Consults

16. Investigation Rate Pre - Post Myofascial Seminar 34 GPs 339 Audits No clear trend % of Initial Pain Consults

17. Investigation Rate Pre-Post Acupuncture Seminar 44 medical practitioners 535 Audits Pre-Post Investigations rates X-rays -35%, CT -31%, MRI -50% and Serology -46% % of Initial Pain Consults

18. Referral rates % of Initial Pain Consults

19. Referral rates Pre-Post Myofascial Seminar 34 GPs 339 Consults % of Initial Pain Consults A mixed bag

20. Referral Rates Pre-Post Acupuncture Seminar 44 medical practitioners 535 consults Physiotherapy referrals -52%, Physician -70%, Orthopaedic -44%, Neurosurgeon -66%, Rheumatologist -34%, Counselling -33% % of Initial Pain Consults

21. Script Rates 127 scripts per 100 Initial Pain Consultations % of Initial Pain Consults

22. Script Rates Pre - Post Myofascial Seminar 34 GPs 339 Audits Pre-Post Myofascial seminar Analgesics +20%, NSAIs -16%, Steroids +18%, Antidepressants +220% % of Initial Pain Consults

23. Script Rates Pre - Post Acupuncture Seminar 44 medical practitioners 535 consults Pre-Post Acupuncture seminar Analgesics -38%, NSAIs -24%, Steroids -44%, Antidepressants - 49% % of Consults

24. Conclusions Comparison of sentinel and pre to post educational activity data reveals that General Practitioners’ pain patients’ management is modifiable by short educational interventions. The extent of the changes provoked seems to be affected by the nature of the educational material presented. The proposition that the provoked changes could lead to decreased health care costs has not been proven but seems to be attractive.

25. Medical Pain Education 31 Charlton Street. Southport. Qld. 4215 Tel: 07 5531 3810, Fax: 07 5532 6199 URL: www.pain-education.com E-Mail: simon@pain-education.com