Understanding Pain. Outline. Hunter Integrated Pain Service (HIPS) What is pain? The new science

Transcription

1 Understanding Pain Hunter Integrated Pain Service (HIPS) Outline What is pain? The new science Whole person management Introducing HIPS & what next? 1

2 What is pain? Indication of threat Actual or potential damage Emotional experience What is acute pain? Short term Often linked to body structures under threat damaged Egloff N, Hirschi A, von Känel R. J Pain Research 2013;6: threat... damage... 2

3 What is chronic pain? Lasts 3 months or more Often persisting after body structures heal Wind up of nervous system Egloff N, Hirschi A, von Känel R. J Pain Research 2013;6: hyper-alert... flea bite feels like the eagles claws Role of nervous system Wind up or sensitisation increases pain Winding down reduces pain 2 The new science 3

4 Structural changes and ongoing pain Symptoms without the structure Painful, swollen, stiff left ankle Imagined exercise of the phantom limb relieved symptoms Haigh et al 2003 Rheumatology 4

5 Chronic stress changes neurons Davidson, McEwen. Social influences on neuroplasticity. Nat Neurosci. 2012;15(5): Brain changes predict persisting pain Ongoing pain linked to emotional response to initial injury Traumatic memory imprints the brain in a different way Back pain recovering Back pain persisting Baliki, Apkarian et al. Corticostriatal functional connectivity predicts transition to CBP. Nature Neurosci

6 Brain habits Sheep tracks Winding up or down A need to restore balance Body structures Medical treatments Nervous system Active treatments For many people the balance is not right 6

7 Connection Mindbody Activity Nutrition Biomedical 3 Whole person management Adapted from Hayes & Hodson. A whole person approach to persistent pain. Pain Medicine 2011;12(12): Brainman s choices Think well Move well Eat well 7

8 What is the evidence for medical treatments? I think the dose needs adjusting. I m not nearly as happy as the people in the ads. Morphine in chronic pain Moulin et al. Lancet time (weeks) 8

9 Well known Constipation Drowsy, clouded thinking Tolerance Addiction Opioid side effects Did you know about? Worsening pain (opioid induced hyperalgesia) Sexual dysfunction Driving impairment, risk of death (especially with sleeping tablets) Biomedical STEP 1: Rule out danger Harmful structural problems? Red flags cancer, fracture, infection, nerve pressure STEP 2: Medical treatment as part of broad approach Medications / procedures Time limited Pain recovery plan 9

10 Opioid strategy Time limited HIPS support you & GP for as long as needed to wean off opioids Mindbody This is normal Mind & body interweave Awareness of thoughts Peace of mind Eccleston C. A normal psychology of chronic pain. 2011;24(6):

11 Timeline Connection People, purpose, place Isolation & disconnection are common Reconnecting - part of recovery & wellbeing 11

12 Activity Finding the right balance Body awareness Awareness of thoughts behind the movement Ease of movement, ease of mind Inflammatory diet Nutrition Nutrition worsening pain Fruit & vegetables (2 & 5) Less sugary drinks Time limited supplements Address smoking, alcohol, other drugs 12

13 Brian s story 6 months of low back pain after an injury at work Scan - disc bulge & tear Brian s assessment No red flags - spinal structure less relevant More about changes in brain & spinal cord Oxycontin not working Men should get on with it Pushing through, boom & bust cycle 13

14 Brian s pain recovery plan Opioid wean over 4 months Goal setting travel & grandchildren Awareness of thoughts Pacing activity Improve flare up management Brian s recovery Background pain from 8/10 to 6/10 Positive changes in thinking, mood & activity Less interference with life Flare ups fewer managing differently 14

15 Anna s story 30 yrs married Not working due to poor health Chronic widespread pain & fatigue Anna after Understanding Pain Nutrition less processed food more vegetables omega 3 fish oil weight loss 5 kg Psychological aspects local counsellor 15

16 Anna s assessment Onset pain & fatigue age 15 years; fibromyalgia Widespread pain in muscles & joints 6-8/10 Long term Norspan no ongoing benefit Low mood Avoidance of activity Anna s timeline Large family, Anna eldest child Father s business failed when Anna was 15 yrs; he moved away my childhood ended weight of responsibility settled on my shoulders 16

17 Anna s pain recovery plan Biomedical - wean Norspan over 3 months Mindbody workbook / local counsellor Return to work & future education options Walking program - pacing Continue anti-inflammatory eating Anna s recovery Phone call at 1 month Continuing with pain recovery plan Phone call at 8 months 80% less pain & fatigue Further 5 kg weight loss Work as part-time cleaner TAFE course Mindbody Workbook forgiveness 17

18 Public system Types of pain Chronic non-cancer Acute Cancer General practice links 4 Hunter Integrated Pain Service Key messages 1. Use active treatments 2. Get support 3. Wean pain medication 18

19 HIPS website Google: Hunter Integrated Pain Service Assessment and Planning Small group Supported self-assessment Pain assessment & recovery plan biomedical mindbody connection activity nutrition 19

20 Where next? Your choice GP Early community link HIPS Assessment & Planning Community options HIPS options 20