The Pain Management Programme

Transcription

1 The Pain Management Programme Lorraine Moores Operational Lead for the PMP / Principal Physiotherapist Melanie Smith Clinical Psychologist Manchester and Salford Pain Centre Salford Royal NHS Foundation Trust

2 Outline of Presentation: To raise awareness of the Pain Management Programme (PMP) service To outline suitability for a PMP / referral criteria To outline content of the PMP To review outcome of the PMP Review video assessment

3 What is a Pain Management Programme? A Pain Management Programme is a psychologically based rehabilitative treatment for people with chronic pain which remains unresolved by currently available medical and other physically based treatments. The British Pain Society

4 Who is suitable for a Pain Management Programme? Chronic musculoskeletal pain causing significant disability and distress Over 18 years old All appropriate investigations and treatments for pain have been completed Other health problems not risk factors for rehabilitation Some understanding of benefits of pain management No major substance misuse (including alcohol) Can manage basic activities of daily living and is self-caring No major psychiatric disorders of current significance Willing to participate in a group programme involving psychological and activity based interventions

5 Types of Pain Management Programme Foundation 8 days, 9.3am 4.3pm Follow up 1, 3 and 6 months. Questionnaire at 12 months Local patients More functional Lower levels of distress Much more likely to be in work Intensive 15 days, 9.3am- 4.3pm Follow up at 1, 3 & 6 months. Questionnaire at 12 months. Long distance patients attend as a resident. Less functional Higher levels of distress Higher levels of fear avoidance

6 Aims of Physiotherapy input To provide active functional rehabilitation Emphasis on self management Reduce use of aids / appliances where appropriate Address activity cycling Work on feared / avoided activities Improve fitness and confidence with exercise Transfer this into rewarding meaningful activities

7 What happens in the Physiotherapy sessions: Advice on effects of inactivity and benefits of exercise Advice on pacing activity to reduce activity cycling Advice on pacing up to gradually increase activity Goal setting (joint session) Flare-up planning (joint session) Partner/friend/family member session (joint session) Chronic pain and intimate relationships (joint session) Home programme

8 Aims of Psychology input Help patients move from a medical model of pain to a biopsycho-social model of pain and disability Common emotional responses Social impact of pain Build patients self management skills, and reduce reliance on healthcare professionals Live with rather than treat / cure Educate about the physiological and psychological effects of chronic pain Vicious cycle of pain and stress Improve mood / reduce emotional distress Facilitate positive lifestyle changes Stress management Psychosocial pain related problems

9 What happens in the Psychology sessions Education stress response and muscular activity LT stress and psychological impact Relaxation training & diaphragmatic breathing Development of Cognitive Behaviour Therapy (CBT) skills to understand and unhelpful responses to pain and develop coping strategies Development of problem solving skills to address psychosocial difficulties arising from pain (really a subset of CBT skills) and work towards individualised goals Miscellaneous e.g. sleep management, assertiveness

10 What is the role of the Medic? Education re: chronic pain Education re: medication and individual review Provides opportunity for medical questions Supports the rehabilitation input

11 What is the outcome from the PMP? The following slides present data on patients: a) Before they have their initial assessment b) Just prior to starting a PMP c) Just after they have completed a PMP d) 6 months after completion of the PMP

12 Depression (CES-D scores) 35 3 Intensive PMP (N=126) 35 3 Foundation PMP (N=189) Pre-PFC 6 Mth F/U Pre-PFC 6 Mth F/U 5 5 Comparisons between consecutive stages were significant at p<.1

13 Pain Anxiety Scores (PASS) Intensive PMP Foundation PMP Pre-PFC Pre-PFC Post-PM P 6 M th F/U 4 6 mths F/U Comparisons between consecutive stages were significant at p<.1

14 Roland & Morris Disability Questionnaire (RMDQ) Scores Intensive PMP Foundation PMP Pre-PFC Mth F/U 1 8 Pre-PFC Post-PM P 6 M th F/U Comparisons between consecutive stages were significant at p<.1

15 Pain Intensity (visual analogue scale) Intensive PMP Foundation PMP Pre-PFC 6 Mth F/U Pre-PFC 6 M th F/U All comparisons, pre-pmp to post, and pre-pmp to follow up significant at p<.1

16 5 minute walk (metres) Intensive PMP Foundation PMP Mth F/U Post-PM P 6 M th F/U All comparisons, pre to post, and pre to follow up significant at p<.1

17 2 metre walk (seconds) Intensive PMP Foundation PMP Mth F/U Mth F/U All comparisons, pre to post, and pre to follow up significant at p<.1 2

18 Step-ups completed in 1 minute Intensive PMP Foundation PMP M th F/U 1 6 Mth F/U All comparisons, pre to post, and pre to follow up significant at p<.1

19 Patient comments I can see a future for myself through the techniques I have been shown. It s life changing. I can t believe the change in myself both physically and mentally. I wish I d come to the programme sooner, I might still have had my job and would not have been depressed as much.

20 Patient video: 56 year old lady 11 year history chronic low back pain and fibromyalgia Past treatments physiotherapy / acupuncture / injections / chiropractice Spends much of the day resting Attended an intensive PMP in 27

21 Thank you