Pain management. Quick reference guide to our services
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1 Pain management Quick reference guide to our services 1
2 The philosophy underpinning ACC s Pain Management s Pain is a unique experience that varies within the same person in terms of frequency, intensity and impact. Because of its subjective nature, the impact of pain can be defined only by the person suffering from it. Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage. Pain Definition - International Association for the Study of Pain (IASP). For clients reporting undue pain, assessment using the appropriate tools is the cornerstone of addressing their pain related factors. Early recognition, acknowledgement, accurate assessment and timely intervention can lead to a reduction in the risk of pain related disability, and to significant enhancement of the person s quality of life. A holistic approach, addressing physical, emotional, vocational and social need, and an active client participation in their own rehabilitation plan are essential to effective rehabilitation. In order to optimise rehabilitation outcomes for clients reporting undue pain, it is essential that we provide appropriate multimodal services for the purpose of maintaining and restoring the client s functionality. It is also vital that treatment and rehabilitation efforts are monitored for effectiveness in returning clients to work or independence.
3 ACC Pain s Progressive Goal Attainment Programme (PGAP) 4 Pain Disability Prevention (PDP) Programme 6 Functional Reactivation Programme (FRP) 7 Pain Management Psychological (PMP) 9 Comprehensive Pain Assessment (CPA) 11 Activity Focus Programme (AFP) 13 Multidisciplinary Pain Management Programme (MDPP) 15 Interventional Pain Management (IPM) 17
4 Progressive Goal Attainment Programme (PGAP) What is it? The Progressive Goal Attainment Programme (PGAP) is a disability-prevention programme specifically designed to target psychosocial risk factors for pain and disability. PGAP is a 10-week activity mobilisation programme that has been tailored to meet the rehabilitation needs of individuals who are struggling to overcome the challenges associated with a wide range of persistent pain conditions. PGAP is suitable for clients who are suffering from persistent pain conditions and for whom pain symptoms and psychosocial factors are likely to be significant barriers to rehabilitation progress. PGAP services are not intended to replace or alter current medical approaches to the treatment of persistent pain conditions. PGAP focuses specifically on maintaining mobility and preventing disability that might arise from the injury. Criteria for referral Clients are referred when all of the following criteria are met: significant psychosocial risk factors and persistent pain have been identified as likely barriers to rehabilitation the client has no medical contraindications to their participation, and the client s General Practitioner has been consulted about the referral. What is involved? PGAP is a structured 10-week activity mobilisation programme that has been tailored to meet the rehabilitation needs of individuals who are struggling to overcome the challenges associated with a wide range of persistent pain conditions. PGAP focuses on supporting clients to return to work. PGAP services are not intended to replace or alter current medical approaches to the treatment of persistent pain conditions. 4
5 Who provides it? Providers who: are a Physiotherapist, Occupational Therapist, Registered Nurse, Osteopath or Chiropractor are registered with ACC as a Treatment Provider, and have completed the ACC approved PGAP training and hold a completion certificate from the Centre for Research on Pain and Disability, McGill University, Montreal. Codes PGAP1 PGAP5 PGAPDNA PGAP Rehabilitation Provider Non-clinical work PGAP Rehabilitation Provider Non-attendance Fee Report templates ACC4220 Progress Report for PGAP ACC4221 Termination Report for PGAP 5
6 Pain Disability Prevention (PDP) Programme What is it? The Pain Disability Prevention (PDP) Programme is a disability-prevention programme specifically designed to target psychosocial risk factors for pain and disability, for clients who also have mental health concerns e.g.depression. Criteria for referral Clients are referred when all of the following criteria are met: significant psychosocial risk factors have been identified the client has no medical contraindications, and the client s General Practitioner has been consulted about the referral. What is involved? PDP is a 10-week activity mobilisation programme that has been tailored to meet the rehabilitation needs of individuals who are struggling to overcome the challenges associated with a wide range of persistent pain conditions. The psychological risk factors targeted by PDP include depression, catastrophic thinking, fear of movement and re-injury and perceived disability. PDP services are not intended to replace or alter current medical approaches to the treatment of persistent pain conditions; PDP focuses specifically on managing the disability associated with the injury. Who provides it? Providers who: are General Practitioners, Psychiatrists, Clinical Psychologists or Health Psychologists have completed the ACC-approved PDP training and hold a completion certificate from the Centre for Research on Pain and Disability, McGill University, Montreal, and are registered with ACC as a Treatment Provider. Codes PDP01 PDP02 PDP03 PDPDNA PDP Psychologist PDP Medical Practitioner Non-clinical work undertaken by the PDP Provider Non-attendance Fee Report templates 6 ACC4222 Progress Report for PDP ACC4223 Termination Report for PDP
7 Functional Reactivation Programme (FRP) What is it? The Functional Reactivation Programme (FRP) is for clients whose pain has persisted for more than six weeks. The programme addresses key pain-related disability factors using a physical reactivation approach to help clients manage a return to independent functioning at work and home. Criteria for referral Clients may be referred when all of the following criteria are met: the client has functional difficulties due to their personal injury the onset of the pain problem occurred at least six weeks ago the client has not returned to full independence and/or work due to injury for more than six weeks since the date of incapacity the client has completed or is nearing completion of manual therapy the case owner has consulted with the client s Medical Practitioner and primary treatment provider e.g. Physiotherapist, as to the suitability of a FRP for the client, and the case owner has established that referral for a FRP is appropriate. What is involved? FRP comprises a programme of exercise, activity and education that incorporates a self management approach and addresses: limitations in physical function graded exposure to specific movements /exercise fear of movement and activity teaching of pacing skills, realistic goal-setting and problem-solving skills the provision of information about persistent pain problems and contributing factors, and monitors and supervises client exercise and activity. Note: the programme may include an additional component of a worksite visit if required. Who provides it? The key providers of this service include: Registered Physiotherapists, and/or Registered Occupational Therapists. 7
8 Codes FR01 Assessment and Plan of Action FRNC Non-Completion Fee FR02 Worksite/home visit FRCC Case Conference and Report Functional Reactivation FR03 Programme and Report FR05 Extension of Programme 3-6 weeks FR04 Functional Reactivation Programme and Report FR06 Follow-up session Up to 12 weeks FRDNA Non-attendance Fee for initial interview and/or worksite visit Report templates ACC4224 Assessment Report ACC4225 Progress Report ACC4226 Completion Report ACC4227 Non-completion Report 8
9 Pain Management Psychological (PMP) What is it? The purpose of the Pain Management Psychological (PMP) is to provide appropriate psychological assessment and interventions for pain management. PMP s are provided to help clients use psychological strategies to manage persistent pain that is the result of their physical injury. Criteria for referral Clients are referred to PMP s when all of the following criteria are met: the client has a persistent pain problem due to their covered personal injury the client s personal injury has resulted in significant behavioural, cognitive, social or psychological dysfunction, requiring PMP s to assist with their rehabilitation, and the case manager has consulted with the client s General Practitioner as to the suitability of PMP s for the client. What is involved? Assessment and treatment services that: provide cognitive-behavioural therapy or acceptance and commitment therapy provide information to clients about pain management and its effects educate the client s family/whanau about pain management and the rehabilitation strategies being used for the client work with the client to reassess goals and discuss progress made throughout the sessions monitor clinical outcomes, and liaise with the client s other Treatment Providers. Who provides it? Registered Psychologists 9
10 Codes PMP1 Initial simple Assessment, Treatment Plan and Report PMP10 Progress and Completion Report PMP2 Initial extensive Assessment, Treatment Plan and Report PMP11 Case Conference PMP5 Treatment sessions as per Treatment Plan PMPDNA Non-Attendance Fee for Initial interview and Treatment Sessions PMP6 Further discretionary or intermittent sessions Report templates ACC4228 Assessment Report and Treatment Plan ACC4229 Progress Report ACC4230 Completion Report 10
11 Comprehensive Pain Assessment (CPA) What is it? A Comprehensive Pain Assessment (CPA) is a multidisciplinary assessment that includes integrated clinical formulation and pain management recommendations. Objective The objective of CPA is to provide a thorough multidisciplinary assessment, including integrated clinical formulation and multidisciplinary pain management recommendations that can be used by case owners and rehabilitation providers to plan treatment and rehabilitation services. Criteria for referral For all clients with pain that has persisted for 12 weeks or more. The client must meet all of the following criteria: the client s General Practitioner (GP) and/or specialist has requested a referral (or the referral has been discussed with and agreed to by the GP) the client s injury diagnosis is not in doubt pain has persisted for at least 12 weeks from the date of injury ACC information has identified that the client has significant pain issues the client s injury is stable and there is no surgery scheduled, and the client has no other medical problems that either: - contribute to the pain, or - would be incompatible with pain management services. What is involved? Three separate assessments, as described below, are carried out. The providers conducting the assessments then collaborate to provide an integrated report, based on their individual reports. 1. Medical assessment The assessment is carried out by a medical practitioner who holds vocational registration in a medical speciality. The assessment includes a physical examination as well as consideration of: a pain and treatment history the client s beliefs, knowledge and expectations regarding pain prognosis and management, and an assessment of any physiological changes or instability. The report must include recommendations regarding pain medication and any tests, investigations, treatment or activities. 11
12 2. Psychological assessment The assessment is carried out by a Clinical or Health Psychologist and includes assessments of: clinical presentation and behavioural observations impact of pain on current psychological/psychosocial functioning current methods of coping, including both adaptive and maladaptive relationships cognitive disorders inactivity fear of movement, and coping strategies for pain management. The report must provide recommendations, including whether further psychological treatment is required. 3. Functional assessment The assessment is carried out by a physiotherapist or occupational therapist who assesses the client s ability to: undertake specific functions work travel to and from work engage in productive non-work activities, and participate in social, recreational and leisure activities. Who provides it? The multidisciplinary team (MDT) consists of a: Medical Practitioner who holds vocational registration in a medical speciality Physiotherapist and/or Occupational Therapist, and Psychologist. Codes CPA03 Medical Assessment and Report CPA06 Integrated Comprehensive Pain Assessment Report CPA04 Functional Assessment and Report CPA10 Pain Management Medical Follow-up CPA05 Psychological Assessment and Report Report templates 12 ACC4232 Comprehensive Pain Assessment Report
13 Activity Focus Programme (AFP) What is it? The Activity Focus Programme (AFP) is a multidisciplinary programme provided to clients who have persistent pain-related disability with significant functional problems due to their injury for more than 12 weeks. The purpose of this programme is to assist clients to incorporate a self-management approach to independent functioning at both work and home, despite the presence of pain. The programme is aimed at meaningful activities and education that they will be able to apply after the completion of the programme. Criteria for referral Clients are referred when all of the following criteria are met: the client has a persistent pain problem due to their personal injury the client has more than 12 weeks pain-related disability with reduced function and loss of independence the client has undergone a Comprehensive Pain Assessment, and the Comprehensive Pain Assessment recommends that they require an AFP to assist with their rehabilitation. What is involved? Each programme must include information and assistance regarding: pain beliefs (the significance and meaning a person attaches to their pain) misunderstandings about injury and health status any fears that the client may have about movement and activity persistent pain problems and contributing factors, (including psychosocial factors) activity-pacing skills and muscle-relaxation techniques problem-solving, coping skills, and goal setting. The programme is based on: identifying current thinking and problematic behaviours active participation goal orientation and problem focus educating the client to self-manage following their treatment, and structured and time-limited intervention. 13
14 Who provides it? The AFP is provided by a multidisciplinary team consisting of the following: Physiotherapist (essential) Medical Practitioner (essential) Clinical or Health Psychologist (essential) Occupational Therapist (optional), and Registered Nurse/Nurse Practitioner (optional). Codes AF01 Activity Focus Initial Assessment and Plan of Action AF07 AF02 Worksite/home visit AF08 AF03 AF04 AF05 AF06 Activity Focus Programme Reports: Activity Focus - Rehabilitation Professional. Individual rate Activity Focus - Rehabilitation Professional. Group rate Activity Focus Psychologist. Individual rate AF09 AFCC AF10 AFDNA1 AFDNA2 Activity Focus Psychologist. Group rate Activity Focus - Medical Practitioner Component. Individual rate Activity Focus - Medical Practitioner Component. Group rate Case Conference Follow-up sessions Non-Attendance Fee for Initial Interview and/or Worksite visit Non-Attendance Fee for individual or group components Report templates ACC4233 Assessment Report ACC4234 Progress Report ACC4235 Completion Report ACC4236 Non-completion Report 14
15 Multidisciplinary Pain Management Programme (MDPP) What is it? The Multidisciplinary Pain Management Programme (MDPP) is a three-week intensive programme that: incorporates aspects of psychosocial, physical and occupational therapies as well as vocational rehabilitation aims to modify the client s response to pain, rather than removing the pain stimulus, and aims to increase the client s ability to manage pain and to participate in agreed home and work activities. Criteria for referral For clients with persistent pain conditions that have lasted for 12 weeks or more. Consider referral when all of the following apply: pain relates to injury and lasts for at least 12 weeks normal activities are limited conventional therapies haven t worked the General Practitioner approves the referral the client agrees to participate no medical treatment or assessment is pending no other medical issues are contributing to the pain or incompatible with pain management, and the service has been recommended by a Comprehensive Pain Assessment or other specialised assessment. What is involved? Intensive contact with the client at least five hours per day, five days per week, for three weeks (may include residential accommodation), including: information to address pain beliefs and fear of movement or activity identification of psychosocial barriers activity-pacing skills, relaxation techniques problem-solving, coping and goal-setting skills cognitive and behavioural techniques counselling vocational rehabilitation individual exercise/activity programme, and occupational therapy. 15
16 Who provides it? MDPP is provided by a multidisciplinary team consisting of the following: Physiotherapist (essential) Medical Practitioner (essential) Clinical or Health Psychologist (essential) Occupational Therapist (optional), and Registered Nurse/Nurse Practitioner (optional). Codes PPP01 Initial Screening Assessment (ISA) PPP05 Partial Completion Fee - MDPP - 2 weeks PPP02 Three-week MDPP PPP06 First Follow-up Session PPP03 Accommodation Package for MDPP PPP07 Second Follow-up Session PPP04 Partial Completion Fee - MDPP - 1 week Report templates 16
17 Interventional Pain Management (IPM) What is it? Interventional Pain Management (IPM) services provide a specialised assessment and treatment service for clients who have an accepted claim for cover for a personal injury. Interventions are used to diagnose or alleviate pain and discomfort. The service is intended to function from a multimodal approach to enhance functional outcomes by approaching pain management from interventional, psychological and functionally based modalities. Criteria for referral For clients with persistent pain, when there has been no response to conventional therapy or medication. The need for IPM services will be identified through a Comprehensive Pain Assessment or by a vocationally registered clinician. The client s treating specialist or General Practitioner may refer directly for IPM assessment services. IPM treatment services require ACC prior approval. What is involved? IPM services are made up of: assessment services, and treatment services, which focus on treatment intervention and the removal of the source of pain. Injections are used to diagnose or alleviate pain and discomfort and aim to increase a client s participation in agreed activities at home and work. Who provides it? A vocationally registered Medical Practitioner in a specified branch of medicine including: Anaesthetics Occupational Medicine Musculoskeletal Medicine Neurosurgery Orthopaedic Surgery, or Rheumatology. 17
18 Codes IPM1 IPM2 IPM3 IPM4 Initial Simple Assessment Initial Complex Assessment Reassessment Follow-up visit Report templates Assessment Report and Treatment Plan End of Care Report 18
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20 This paper was manufactured using Elemental Chlorine Free (ECF) pulp sourced from sustainable, Well Managed Forests ACC4467 ISBN February 2008
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