MOA Breakout-Pain Management
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Transcript MOA Breakout-Pain Management
Chronic Pain Module
MOA Breakout
Adapted from Barb Aasen,
David Jermey, and
Josefa Kontogiannis,
www.pspbc.ca
Let’s recap what we heard today
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?
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Today we heard the definition of Pain
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
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People in Pain ??!!
There may be some patients that you have been thinking about today
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
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Consequences
This is what some of them are experiencing due to pain
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
freedigitalimages.net
› Job loss and financial stress
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Consequences
These are what they are now calling norms in their life
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
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20 minutes a month with my
healthcare provider leaves43,180 minutes
before my next
appointment
So, the rest
is down to
me!
What’s going on during the 43,180 minutes before
they see you again?
Hopelessness
Stigma
Mistrust
Knowledge gap
Lack of accountability
Resource strain
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Basic Science of Persistent Pain
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
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MOA Role in Support for Patients with Chronic Pain
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
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Understanding Range and Severity
People in pain may be…..
Needing assistance
Accompanied by someone
Not feeling like engaging in conversation
Slow moving
Needing more time
Unpleasant
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Being aware of what is needed for an appointment
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
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A good awareness of the screening tools
What they are used for
When they are given
Who gives them
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Structured assessments
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
Pain diagrams
Disability assessment tools
Opioid Management/Urine testing
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.
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Tools
Managing Pain
Pain Diagram
Name: ____________________________________________
Date: _____________________________
Please colour the areas where you experience pain. Use one of the five colouring pens to shade the specific
type of pain that you are experiencing. Then circle with a pen all the areas of pain and starting with the
worst, number the areas in order of severity.
Red - Burning
Green - Tingling
Blue - Numbness
If you have other pain
sensations name them here
and colour as yellow or black
Yellow Black -
It is the intention of the PSP that health educators and health providers only use this publication and its content for non-
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Diffusing difficult conversations
Communication is not just saying words; it is creating true
understanding.
Active listening is an important skill in the communication process
“Listen Non-judgementally”
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Tips to be a better Active Listener
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
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Keep an open mind
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
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Make listening a priority
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
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Avoid giving advice, even when asked
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
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Listen with empathy
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”
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Watch non-verbal behaviour
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
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