As a GP seeing potentially hundreds of patients per week, no doubt you regularly work with people who experience persisting pain – approximately 1 in 5 Australians do.
You want to help your patients but you also understand that the efficacy of prescribing pain medications for someone long-term has its limitations. You know that referring for a pain management program is an option, but when trying to explain to your patient what a program like this involves, you feel like you can’t give a clear description. Well, here are some tips of what constitutes an evidence-based pain management program. This should help you refer with greater confidence. This should also help the puzzle of persistent pain to take shape.
1. A TEAM APPROACH
When pain hangs around longer than expected, it clearly affects more than just the physical. The interactions between emotional, psychological, social and physical factors drive the ongoing perception of pain. As a result, addressing the contribution of these many complex areas is at the core of effective and evidence-based pain management. This is best achieved through an inter-disciplinary team approach where a patient can work closely with allied health clinicians including occupational therapists, physiotherapists and psychologists, collaborating, which will maximise our patients level of function and self-management of the persisting pain.
2. PAIN EDUCATION
“Can you think of a time when a patient has said they feel like something is still wrong or damaged, even when all scans and investigations come back clear?” We now clearly know that the presence of pain is not always the result of damaged tissue. Research suggests that the more a patient can understand about their pain neurophysiology and the principles behind effective pain management, the more this can lead to improved outcomes. By developing greater knowledge and understanding, patients can begin to feel more empowerment and confidence in exploring a gradual return to normal movement and exercise, daily activity and work.
3. DEVELOP ACTIVE PAIN MANAGEMENT STRATEGIES
“Think of a time when you have seen a patient who is constantly exploring various treatment options, looking for the cure to their pain. Completely understandable of course, no one chooses to be in long-term pain.” However, helping someone to maximise the active self-management of their pain rather than seeking expensive and time-demanding treatments that often only provide brief periods of symptom reduction can be a step in the right direction. These strategies explored in pain management programs may include stretching, relaxation and breathing techniques, regular movement and return to enjoyable activity. Simple strategies can do wonders for pain patients.
4. PHYSICAL ACTIVITY
When pain persists, the ability for someone to tolerate exercise and physical activity can become much more challenging and people may look to reduce or even avoid exercise due to fear that this may aggravate their pain or even cause further injury. Subsequent physical deconditioning may then contribute further to the problem. The benefits of a graded return to physical activity are widely agreed on within the research, and therefore regular exercise-based sessions that are tailored to the individual should become a central piece of the puzzle for any effective pain management program.
5. PSYCHOLOGICAL EDUCATION & SUPPORT
“Have you ever heard a patient tell you that they feel like people think they are going crazy or that the pain is all in their head?” Sometimes suggesting to a patient that they should consider seeing a psychologist can be tricky, as they may feel you doubt the reality of their pain. Try telling your pain patients that pain psychology is all about providing them with additional support because chronic pain can be emotionally draining!
By beginning to learn techniques such as mindfulness, identifying and addressing any links between mood and pain, and using approaches such as cognitive behavioural therapy (CBT) or acceptance cognitive therapy (ACT) (see links) which allow them to modify their thoughts and behaviours. People can now begin working towards valued goals – even in the presence of ongoing pain.
Read a bit more on mind-body therapies used in chronic pain management
Read a bit more of psychological therapies used in chronic pain management
Speaking of goals, the use of goal setting within a pain management program is vital. Helping people to identify the areas of their life that hold most meaning and developing a stepped plan towards specific valued goals can assist someone to see that they are making improvements, even if they are very gradual. It’s also ok to make getting to those goals fun! This is what some good pain management programs do, make it fun!
7. RETURN TO WORK & DAILY ACTIVITY
While the constant presence of pain can be enough to deal with for many people, being less able to complete daily activities as a result just adds to everything. By learning and practising different ways to gradually get back to doing normal everyday tasks, people with chronic pain can start to see and feel like they are achieving more – which in itself can help to manage pain better! Pain management programs also focus effort towards supporting people to maximise their tolerance to their current work, or help to explore opportunities for returning to employment or volunteer-based roles. Although this can at times be a daunting prospect for some people to consider, staying at work or achieving a return to productive activity is an important piece in the puzzle.
8. INVOLVING FAMILY
As pain persists, the impact on those close to the person experiencing the pain should also be considered. Sometimes family members can feel uncertain about what they can do or how best they can help. By assisting loved ones to understand more about chronic pain and what can be done to manage it better, the person in pain may begin to feel more understood and have greater support in working towards their goals. Pain management programs can be conducted in a group setting or within individual sessions depending on the person, with programs available around Victoria to privately funded patients as well as those under TAC or WorkSafe. With the current evidence suggesting that the best treatment of long-term pain sits within an inter-disciplinary approach to address the many complex factors involved, referring someone for a pain management program may be the best thing you can offer your patient.
Written by: Tim Roocke, pain occupational therapist
TREATING CHRONIC PAIN GP EBOOK
As one of Australia's leading multidisciplinary pain specialist clinics, we'll explain what chronic pain is and why it occurs. We'll also explain that chronic pain should be managed as a chronic illness and not just a symptom of an illness.