Chronic Pain Module MOA Breakout Barb Aasen, Family Tree Clinic

Chronic Pain Module
MOA Breakout
Barb Aasen, Family Tree Clinic
David Jermey, VCH PSP
Josefa Kontogiannis, VCH PSP
Let’s recap what we heard today
Definition of pain
People in Pain
Consequences of pain
Other problems brought on by pain
Types of pain
What can MOAs do to help these patients when
they come in for their appointments every 43,180
Today we heard the definition of Pain
 Pain is an unpleasant sensory and emotional experience
associated with actual or potential tissue damage, or described
in terms of such damage.
- International Association for the Study of Pain(1979)
A warning sign
A potential lead to red flags
It is costly if not caught, to the patient and to the system
An experience created in our brain that is influenced by things
other than tissue damage
 An experience not dependent on tissue damage
People in Pain ??!!
There may be some patients that you have been thinking about today
 Diverse Population:
› Chronic Disease eg Cardiac disease, Diabetes, Osteoarthritis
› Chronic Post Surgical Pain
› Chronic Pain Post Injury eg Whiplash, Spinal Cord Injury
› Chronic Headaches eg Tension, Migraine, Cluster.
› Neuropathic Pain eg Post Herpetic Neuralgia, Diabetic Neuropathy
› Complex Regional pain Syndrome
› Recurrent Abdominal pain / Visceral Pain
› Fibromyalgia
› Back Pain
› Post trauma/burns/stroke
› Cancer
This is what some of them are experiencing due to pain
 Person with pain:
› Lowest Quality of Life scores
of any chronic disease
› Depression and anxiety (5X)
› Suicide (2X)
› Sleep disorder
› Addiction/Substance abuse
› Job loss and financial stress
These are what they are now calling norms in their life
 Direct Healthcare Consumption
• 4x GP visits
• 2x hospital admissions and length of stay
• Use Emergency for treatment (esp. no GP or marginalized)
• Increased drug costs and surgeries/procedures
 Indirect Societal Costs
• Lost productivity
• Lost tax revenue
• Increased benefit payments
• Social issues: prescription diversion, homelessness, poverty
20 minutes a month with my
healthcare provider leaves43,180 minutes
before my next
So, the rest
is down to
What’s going on during the 43,180 minutes before
they see you again?
 Hopelessness
 Stigma
 Mistrust
 Knowledge gap
 Lack of accountability
 Resource strain
Basic Science of Persistent Pain
 Vicious cycles develop between pain and its effects
› Pain - shallow, tight, apical breathing - pain
› Pain - altered body awareness - pain
› Pain - muscle inhibition - pain
› Pain - muscle tension - pain
› Pain - altered body image - pain
› Pain - anxiety - pain
MOA Role in Support for Patients with Chronic Pain
 Understanding the severity range of Chronic pain
 Being aware of what is needed for an appointment ie:
› Time required
› Tools needed
› Follow up appointments/specialist appointments
A good awareness of the screening tools, when they are used
and needed
Billing required
Opioid management
Diffusing difficult conversations
Urine testing
Understanding Range and Severity
People in pain may be…..
 Needing assistance
 Accompanied by someone
 Not feeling like engaging in conversation
 Slow moving
 Needing more time
 Unpleasant
Being aware of what is needed for an appointment
Discuss with the doctor about the appointment logistics
 The length of the appointment/ how often this patient
should be seen
 The screening tools/lab reqs required and who is to give
them out
 Use the closest exam room if possible, less walking
 Whether this patient should come earlier for any prep or
filling out of forms
 Empathy
A good awareness of the screening tools
 What they are used for
 When they are given
 Who gives them
Opioid Management/Urine testing
 When the patient comes in for a pain appointment, a
random urine drug screen (RUDS) may be done to verify
what drugs the patient is taking. Some physicians like this
to be a witnessed collection at the clinic.
 There can be a narcotic contract between the physician
and patient so that the agreement is clear on both sides of
what is expected as far as compliance, early release etc.
 The physician can access PharmaNet to see what
prescriptions the patient has had filled recently.
Managing Pain
Pain Diagram
Name: ____________________________________________
Date: _____________________________
Please colour the areas where you experience pain. Use one of the five colouring pens to shade the specific
type of pain that you are experiencing. Then circle with a pen all the areas of pain and starting with the
worst, number the areas in order of severity.
Red - Burning
Green - Tingling
Blue - Numbness
If you have other pain
sensations name them here
and colour as yellow or black
Yellow Black -
It is the intention of the PSP that health educators and health providers only use this publication and its content for non-
Diffusing difficult conversations
Communication is not just saying words; it is creating true
Active listening is an important skill in the communication process
“Listen Non-judgementally”
Tips to be a better Active Listener
Don’t interrupt
 Silence is a powerful listening skill. Be quiet & give the person
time to think, as well as talk
 Let the person finish what they are saying
 It’s not possible to talk & listen at the same time
Keep an open mind
 Listen, don’t judge. Jumping to conclusions & looking for the
right or wrong in what is being said can prevent you from
 Think before you respond
Make listening a priority
 Stay focused on what is being said – don’t let your mind wander
 Stay in the present. Try not to think ahead of what you are going
to say
 Let go of your agenda & listen & focus on theirs
Show respect for the person & their feelings
 Show respect even if you disagree with what is being said
Avoid giving advice, even when asked
 Offer options & suggestions rather than advice. Give people the
opportunity to discover their own best answer.
Learn the art of asking good questions
 Open ended questions. These questions encourage people to
go into more depth about the situation
 Closed ended questions. People usually answer these
questions with short “yes/no” type responses
Listen with empathy
 This shows that you are trying to understand their situation.
 By paraphrasing, you show concern, interest & empathy. “ So
you feel _____because_____”
 Let the person know you are listening with minimal prompts like
“uh –huh” or “I see”
Watch non-verbal behaviour
 Pay attention to your non-verbal signals, as well as the other
 Keep an open body posture to show you care & are listening
 Try to maintain eye contact