Pain Management UCLH Members meeting October 2014

Transcription

1 Pain Management UCLH Members meeting October 2014 Anna Mandeville Senior Pain Psychologist Ali Mofeez Consultant in Pain Management and Anaesthesia Viki Mitchell Chair of Pain Steering Group and DCD for Theatres Pain Steering Group Chair

2 If medical model is inadequate what else is there? What is Pain Management? How does it help people?

3 Medical model what we expect o illness can be fixed by Dr s o successful treatment brings back health, abolishes illness (no inbetween) o This doesn t fit for complex medical cases (e.g gastro, gynae acute & chronic pain ) o Doesn t fit for chronic illness & persistent pain o Difficult for everyone Dr s & patients

4 Big impact on healthcare use Repeat GP visits trying to get help A&E visits Consults with many different specialties Different medications All yielding a poor return for patients

5 Need for prompt response Is evidence that pain is a disease Structural changes to the brain and nervous system in CP Changes in gray matter Changes in sodium & calcium channels Less reversible with time so prompt treatment & access to expertise is essential! Psychological / physio interventions can be as effective or better than medications (Prof Irene Tracey Oxford group)

6 What is the real cost of waiting? Patient S.G Age 33 Had waited 8 years before seeing a pain specialist After giving up on potential pain killers.

7 Complex conditions can t be cured Many people have to live with unremitting symptoms Pain is often one of these If medicine can t cure it and return the person to the before state then what actually helps? Medicine fails to integrate impact of illness on life!

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9 Pain (chronic Illness) many impacts Don t understand pain mechanisms poorly explained Fear movement may make it worse Increased disability not able to engage in valued activities (or remember what they are) Loss relationships, roles, identity Mood low & fearful of the future

10 This video gives some idea of impact of chronic pain

11 Pain management programmes effective help UCLH specialised outpatient programmes About Face facial pain COPE MSK pain BJHS LINK Pelvic Pain Neuropathic pain

12 Components of pain management programmes Understanding pain mechanisms Role of medication & surgery Movement & stretch Setting goals Thoughts / cognitions & pain Communicating about pain Relationships & sexual intimacy Coping with flare-ups

13 How does this help? Good quality knowledge & understanding provides a baseline Skills to be with a condition mindfulness Increased confidence to use the body, despite pain Ways to be involved & value life even in the face of pain Increased confidence and efficacy Increased positive outlook & reduced anxiety Achieving goals Working on relationships Paradoxically these all help to moderate pain sensation anyway!

14 Proper medicine PMP s have been shown to change brain structure Kelley et al (2012) J.Bone & Joint Surgery Increased brain activation in regions associated with top down modulation of pain PMP for CLBP Hypnosis, mindfulness other effective approaches

15 Specialist PMP s at UCLH outcomes COPE BJHS COPE LINK ABOUT FACE

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17 Pain at UCLH Viki Mitchell Pain Steering Group Chair

18 Barts (8.2) King s (8.3) GSTT (8.7) Imperial (8.4) Marsden (9.2) Inpatient survey Q. 39: Hospital staff did all they could to help control pain 2011 Score Score Score 8.2 UCLH (8.2)

19 Operational Structure Governance Structure Stakeholder Community Board of Directors Project Group Executive Board Making A Difference Together Steering Group Pain Steering Group Patients Nursing Governors GPs Medical Staff Specialist Pain Teams Allied Health Professionals Work Stream Subgroups

20 Context of UCLH Pain Services Inpatient Acute pain UCH NHNN Outpatient Chronic / complex pain PMC Facial Pain Service IOS - Medical and behavioural approaches - Specialist MDT care: Medical, nursing, psychology, physiotherapy - Improving quality of life 21

21 UCLH inpatient pain Complex 250 Cancer 100 Perioperative (Acute)

22 Benchmarking and raising awareness 2 hours 50 volunteers 381 patients 10,000 pieces of data 23

23 Inpatient pain raid data 381 Patients surveyed 50% Patients currently in pain 5.07/10 Average rating of current pain 24

24 Inpatient pain raid data 41.4 % of all patients surveyed had long-term or chronic pain 24.4% of all patients surveyed had cancer 44.3% of all patients surveyed were undergoing surgery 25

25 Patients admitted with chronic pain More likely to be currently in pain No Yes No Yes No Yes No Yes Rate pain as more severe at its worst Pain is more likely to affect their ability to do things they want to (7.49/10)

26 What would help our nurses Continuous follow up Variety and adequate medication available Ability/awareness of referral options to specialists Early referral/more time with patient Alternative treatments Integrated pain care plan Out of hours support Increased knowledge/training Standardised prescription for acute pain Daily pain round Adequate staff levels Psychology input 4% 8% 23% 8% 4% 4% 8% 31% 4% 4% 4% 4% 27

27 Education E-learning package for nurses 120+ completed Ward based training 4 pilot sites completed Workbook available Quick guide to pain management available Workshop sessions piloted Senior CPF support short-term funding Integrated approach short-term funding MDT support Sustainable plan for ward-based training roll out Develop e-learning for other groups Integrate CPD activities for wider pain team 28

28 Patient information Patient booklet - available Website/portal NHNN website development ongoing Podcasts Pain App 29

29 Strengthening and integrating services Acute pain Extend to 7 day service extended to cover Saturdays Integrate CPD with QS team all staff invited CPF to support training linking education across services Chronic pain (bringing outpatient support to inpatients ) Pilot introducing psychology and physiotherapy support to UCH Tower Oct 2013 August

30 Inpatient MDT pain management pilot The caring and support (the psychologist gave me) gave me the strength and confidence to challenge negative feelings and emotions Anna s input has also allowed for XX to be managed with a totally holistic approach in an acute setting. On ASU we often admit patients with long term complex chronic pain management issues. It can be difficult to know that we are providing the right support for their needs 31

31 Quality v cost? 32

32 Proposal 2 year pilot of complex/chronic pain team Extend specialist service for inpatients with transitionary care and follow up in community* Consultant Clinical Nurse Specialist Senior Clinical Practice Facilitator Psychologist Physiotherapy Administration & Managerial support Set up costs Working alongside current teams Key role in education delivery to clinical staff 33

33 Monitoring and tracking benefits UCLH Primary care Patients 34