Pain

Question 1

Name some common unhelpful clinical approaches to Chronic Pain Mx by clinicians

Answer 1

• Repeated investigations
• Escalating analgesia focusing on short-term pain relief
• Reassuring results from investigations explained as ‘there is nothing wrong
• Persuading distressed patients that their pain might be caused by emotions
• Advising patients that they need to ‘learn to live with their problem’

Question 2

Rationale and philosophy of pain Mx programme depends on 3 things:

Answer 2

• (i) a proper understanding of chronic-pain states,
• (ii) realizing the limits of medical treatment,
• (iii) an understanding of what true ‘self-management’ of a chronic condition can look like

Question 3

Patholphysiology of Chronic pain (1)

Answer 3

• chronic pain is often driven by central sensitization and altered descending control of nociceptive input
  
  • pain system can become sensitized, resulting in high levelsof pain being evoked spontaneously, or from minimal stimuli

Question 4

Complete the table on helpful strategies to combat chronic pain

Answer 4

(non highlighted bit)

Question 5

What is the prevalence of depression in chronic pain

Answer 5

prevalance of depression vary between 30% and 60%

Question 6

Content and techniques involved in a Pain Mx Programme

Answer 6

Cognitive and behavioural methods

Skills training and activity management (goal setting)

Physical activity - graded exercise program

Education

Question 7

British Pain Society reccomendation of min amount of time for a PMP

Answer 7

12 half-days of input (36 h)

Question 8

Minimum staffing for a pain Mx programme

Answer 8

• includes a doctor
• a psychologist
• a physiotherapist

Question 9

Positive indicators for referral to a Pain Mx programme (apart from absence of treatable disease safety to exercise)

Answer 9

• Readiness to experi- ment with the PMP agenda
• Absence of practical barriers to engagement in a group-based self-management treatment
• they must be willing to try things out, even if they entail emotional and physical challenges

Question 10

True self-management approaches in the pain management programme

Answer 10

• Teach patient to manage and progress own exercise programme.
• Support patient to develop flexible and independent goal- setting skills.
• Where appropriate, refrain from expert problem solving and create an opportunity for patient to use own skills.
• Give good explanations and information, yet acknowledge that difficult habit change will require difficult repeated practice.
• Stay close to key message that ‘hurt does not equal harm’, project the idea that the patient does not necessarily need ‘rescuing’, and that the patient has behavioural choices and options in the face of pain and difficulty.