Download to read offline
Uploaded byRichmond Stace MCSP MSc (Pain) BSc (Hons)
GP Talk 30.4.16
This document discusses strategies for addressing persistent pain in 10 minutes. It emphasizes understanding the patient's story and pain from a biopsychosocial perspective. The clinician should listen empathetically, provide a neuroscience-informed explanation for the pain, and collaboratively make a plan focusing on outcomes rather than symptoms. Explaining pain reduces the perceived threat and can change pain. The goal is for the patient to become their own "pain coach" and independently manage their condition.
More Related Content
GP Talk 30.4.16
- 1. PERSISTENT PAIN: WHAT YOUCAN DO IN 10 MINUTES? Richmond Stace MCSP MSc (Pain) BSc (Hons) Specialist Pain Physiotherapist
- 2. patient Low backpain Headaches Multiple joint pain IBS Anxiety & low mood Picture the patient…..sitting in your office
- 3. First thoughts andfeelings? Interested? Curious? Anxious? Frustrated? Excited? Worried?
- 4. Inner consultation Whatis your inner dialogue? What are you telling yourself? What questions are you asking yourself? Impact upon the consultation? Impact upon the person? Effect on next patient?
- 5. The problem ofpain A systematic analysis for the Global Burden of Disease (Vos et al. 2012) No. 2 -- back and neck pain No. 10 – migraine No. 11 – osteoarthritis No. 1 – depression How many have pain & depression? How many people are in pain for all reasons?
- 6. What is pain? Protection A protective device A motivator Compels action Survival Adaptive To the person, it hurts
- 7. What if painpersists? Why in some people and not others? Why in this person? What do they tell you in their story? What don’t they tell you?
- 8. Pain vulnerabilities Whyis there on-going protection? Reasons why pain may persist: Prior experiences of pain Kindling or priming Functional pain syndromes E.g./ IBS, pelvic pain, migraine Existing sensitivity On-going stress/anxiety Genetics
- 9. The story Patientstory Needs validating We acknowledge their suffering with compassion Needs meaning How have they got to the present moment Nothing happens in isolation Gives clues…
- 10. Here’s a story… Leg pain 18/12, worsening Incident => pain but no injury Previous leg pain Sensitive digestive system Insomniac Has nothing to do with my pain I don’t have any stresses…. About to start IVF
- 11. Pain Pain isnot an accurate indicator of tissue damage It is the person who experiences pain, not the body part Shift in sense of self Pain is a response to a perceived threat Pain is experienced in a ‘space’ What is threatening? A movement, an action, a thought?
- 12. What I amfeeling now… Is the brain’s best guess Selection of a hypothesis What does all this sensory information infer? What does it infer based on what I know? What does it infer based on what has happened before? Pain, pain, pain, pain, pain…. A prediction
- 13. The person Beliefs Expectations Thoughts Movements & posturing Role in life: work, home Lifestyle patterns Ever changing….adapting…learning
- 14. The person inpain How do they change? Body sense Movement Planning Thinking Emotions Perception Self
- 15. What story arethey telling themselves? The story of their pain Cause and effect I must avoid…. I can’t….
- 16. All consuming Paincan pervade into all aspects of existence Feeling Thinking Sensing The lived experience Moment by moment
- 17. Biology of pain? Where is it? Whole person Many body systems that protect Most of it is not where the pain is lived A thought about the pain is biology ‘Biology in the dark’
- 18. Where is thepain coming from?
- 19. What influences pain? The way we think about it; the meaning to ‘me’ Beliefs about pain Attentional bias – vigilance to body Stress (threat) Tiredness – more sensitive, less resilient Context Environment Prior experience
- 20. Stress and pain Pain is a stressor Chronic stress => more inflamed Situation => perception/meaning => response Prepared for/reacting to perceived threat Systems ready Systems dampened: GI, reproductive
- 21. Think of atime… ….when you were feeling stressed How do you feel now? Where did you feel it? What did you feel it with? Your mind -- where is your mind? Embodied cognition No separation of body-brain-mind-environment ‘Whole person’
- 22. Sleep and pain Sleep problems appear to predict onset of chronic pain Predict persistency and increase in pain levels Effect of pain on sleep less strong We need sleep! And a good period of sleep
- 23. Improving sleep Calmconditions before bed Bath, mindfulness, reading Associate bed with sleep Unhelpful thoughts – mindful practice Lifestyle patterns Eating time Refresh and renew through the day
- 24.
- 25. Functional pain syndromes IBS Migraine Pelvic pain Dysmenorrhoea vulvodynia Fibromyalgia Often with: Anxiety Hypermobility
- 26. Functional Pain Syndromes(2) Vulnerable to persisting pain Common adaptations underpinning all Protection Perception of threat: cues & triggers widen Great example of need to tackle whole person
- 27. Getting better Whatis getting better? Who gets better? I am better The person gets better Who do we treat?
- 28. Who gets better? Those who understand their pain Those who use their working knowledge of pain Those who use their strengths Those who persevere Those who focus on an outcome not the pain Those who see the flare-up as a challenge to overcome Those who deal with distractions
- 29. What does anapproach need? To be a lived experience Be available moment to moment Promote independence A focus on the outcome For the ‘action’ to change the prediction At any given moment
- 30. Pain Coach Coachingthe person to become their own coach What do I think? What do I do? Create the conditions for the desired outcome Outcome focused – their vision of healthy self A blend of pain neuroscience and strengths based coaching Getting the best out of a person Maximising their potential
- 31. The early messages Set the scene Need to be accurate Need to answer: What is wrong? What do I need to do? What will you (clinician) do? How long will it take?
- 32.
- 33. 10 minutes to…. Listen Work out what is happening Explain Make a plan Take some action Patient’s perception of the consultation? Their reality
- 34. How long doesit take for pain to change? Pain – No pain On – off Pain is not constant Each moment is new Each moment is an opportunity You cannot not change!
- 35. The potency ofyou…know that… Behind your words Knowledge Insight Understanding A trusted advisor, a coach You are a ‘drug’ affecting their physiology Compassion Approach Words of advice
- 36. Understand pain Understandpain to change pain – explain it What is pain? What is their pain about? Specific to them and their story Creates a foundation to start reducing threat Working knowledge: what do I think? What do I do? Independence, control, empowered Pain is about perceived threat Reduce the threat = reduce pain
- 37. UP | UnderstandPain @upandsing understandpain.co m
- 38. Actions (1) Referral Reasons explained Investigation(s) Reasons explained Lifestyle advice Reasons explained Influencing pain; e.g. sleep pattern, stress
- 39. Actions (2) Furtherinformation Quality reading material, website Medication Reasons and explanation of how it works Expectations primed Foundation of understanding that creates ‘safety’, confidence and motivation Changing their perception/relationship with pain
- 40. For you: keepingyour clarity Focused attention (mindfulness) Breathing between patients Movement between patients Greeting style as a way to shape session Actions emerge from clear thinking, engagement & compassion
- 41. The person needsto… Understand their pain Understand what influences their pain Understand what they can and must do Understand that their pain can and does change Show them and give examples Focus on their desired outcome Know they are believed and supported
- 42. Pain Coach Coachingthe person to be their own coach Realise their independence Moment to moment decisions Moment to moment actions Pointed towards desired outcome Optimising potential Resume a meaningful life I feel like ‘me’ again
- 43.
- 44. Thank you www.understandpain.com www.specialistpainphysio.com @painphysio @upandsing [email protected]