CHRONIC PAIN MANAGEMENT WORKSHOP FOR CHIROPRACTORS VANCOUVER Pain Foundations Friday, September 22, 2017 (3-hr evening session) Goal: Explain pain using a biopsychosocial model, and apply basics of pain management theory and concepts to your healthcare practice to improve outcomes for patients in pain. Learning Objectives: 1. Describe the multidimensional experience of pain and identify how it impacts the person, their community, and the health care system 2. Examine your beliefs and attitudes about pain and pain management 3. Delineate and distinguish between nociceptive, neuropathic and central sensitization pain 4. Recognize the prevalence of pain 5. Explain non-pharmacological and pharmacological pain management methods 6. Explain the importance of the biopsychosocial model of pain to positive health outcomes 7. Define pain in a broader context beyond physical tissue damage to examine your knowledge on: a. Mechanisms of pain: acute to chronic b. Physiology of pain/pathophysiology c. Types of pain d. Value of an interdisciplinary approach to pain management e. Pain assessment and pain assessment tools
8. Review pain management approaches (pharmacological and nonpharmacological) 9. Incorporate Brief Action Planning (BAP) for patient-centered care 10.Navigate to pain self-management tools and patient education resources for patients and health care practitioners 11. Educate patients on self-management and pain science basics Chronic Pain Management Workshop for Chiropractors September 23, 24, 2017 (two full-day workshops) Goal: Integrate pain management theory and concepts specific to the chiropractic practice. Learning Objectives: 1. Use standard pain assessments in relation to specific chiropractic case studies 2. Perform a thorough biopsychosocial chronic pain history on a chronic pain patient a. Chronology and temporal change of pain b. Pain ratings and pain quality a. Psychosocial history which may change prognosis and overall management of chiropractic management b. Past treatments which have failed or succeeded 3. Adequately perform a physical examination on a chronic pain patient that enables diagnosis of a chronic pain condition 4. Demonstrate and execute a comprehensive sensory examination on a chronic pain patient 5. Recall, understand, and distinguish between various common chronic pain conditions, based on the history and physical examination (case based) 6. Describe, illustrate, execute and compose a chronic pain management biopsychosocial treatment plan, based on individual patient needs
7. To identify different clinical targets for management of chronic pain 8. Use chiropractic case studies to delineate and differentiate treatment approaches 9. Acknowledge the role other health care providers play in a supporting you and your chiropractic clients in a multi-modal practice 10. Understand how to utilize different chronic pain assessment tools in the clinic Topics Covered: 1. Review: Reflective questions from the Pain Foundations evening course 2. Phenotyping of chronic pain patients, its importance and examples 3. History taking a. Elements of motivational interviewing (briefly) tell me your story b. Etiology and evolution of chronic pain c. Pain descriptions d. Pain ratings e. Pain quality f. Past treatments g. Psychosocial history i. Depression/Anxiety/PTSD ii. Somatization iii. Catastrophization iv. Kinesiophobia v. Sleep vi. Stress h. Goals and Expectations
4. Physical Examination 5. Diagnosis a. Observations b. Range of motion c. Physical capacity d. Non-organic signs e. Sensory examination a. Phenotyping chronic pain patients b. Putting biopsychosocial history into action c. Diagnostic buckets biomedical, psychosocial, mixed d. Cases (not to be shared with audience) 6. Treatment i. Neuropathic pain ii. Chronic widespread pain iii. Central Sensitization a. Treat Based on phenotypes (i.e. Identification of clinical targets, not on diagnostic entity) b. Measuring improvement c. Brief discussion about medication d. Sleep hygiene e. Stress mindfulness/deep slow breathing f. Pain Neuroscience Education (PNE) g. Goal setting (Brief Action Plan BAP)
h. Generalized physical activity and exercise using the FITT principle i. Manual therapy j. Joint mobilization/smt i. SMT and biomechanics and temporal summation studies included in workbook k. The benefits of the combination of manual therapy and PNE l. Approach to patient recovery