Transcript Slide 1
September 5th – 8th 2013 Nottingham Conference Centre, United Kingdom www.nspine.co.uk Delivering a Pain Management Programme Anna Ruskin Advanced Practitioner – Physiotherapist Nottingham Back and Pain Team 06/09/13 Agenda • Aims of a pain management programme for back pain. • Inclusion and exclusion criteria- assessing for suitability. • Timing of the intervention • How programmes should be delivered- who, where and what. • Assessing treatment effectiveness. Aims of a pain management programme • To improve participation in daily activities and enhance “quality of life” for those with persistent pain. - Encouraging behaviour change - Challenging popular misconceptions - Modifying unhelpful beliefs and ways of thinking. • To provide a ‘toolkit’ for self management of pain - Reducing reliance on healthcare resources. Patient Suitability • Inclusion - Presence of persistent pain ( more than 3/12) causing some disability or distress. - > 18 years old - Willing and able to participate independently in a group. - Stable mental health • - Exclusion Red flags Psychosis or severe cognitive impairment Unresolved drug and alcohol problems When is a programme suitable? • Earlier access to programmes is generally needed. • Could potentially run alongside medical treatments in some cases. • For others they will need to exhaust other treatment options before they accept self management strategies are indicated. • Exploring the patient’s thoughts, expectations and understanding is key. Nottingham Pain Management Programmes • Level 2 4 weeks, 2 hours per week. • Level 3 7 weeks, 3 hours per week. • Level 4 10 weeks, 3 hours per week Delivery Style • • • • • MDT approach Group Treatment Community Setting Course duration/intensity Follow up Programme content • Education • Exercise • Goal setting • Skills training • Activity management • Cognitive methods Treatment Outcomes • • • • Disability/physical function Quality of life Emotional wellbeing Self efficacy and coping Nottingham Programme Outcomes • All outcomes showed a statistically significant improvement at the end of programmes. • Changes were maintained at review and at 1 year follow up. • Most frequently reported lifestyle change was increased physical activity. • Other benefits - Improved flare up management - Reduced consultations with HCPs. Summary • There is strong evidence for the use of CBT based PMPs for long term back pain. • Programmes aim to improve “quality of life”. • Treatment is best delivered in a group by a MDT. • Optimal duration and intensity is yet to be determined. • Programme content should include methods for behaviour change. • The optimal timing of a PMP in relation to other treatment will vary, but earlier access is needed. Any Questions