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1. Hello. This presentation has been prepared to run on PowerPoint 97. To advance through the show click the left mouse button anywhere inside the active screen. Your keyboard’s arrow keys are also enabled and offer the advantage of being able to go backwards as well as forwards. Several additional slides have been included beyond those shown at the RACGP conference as these may contain information that is of use. Please contact me for clarification or discussion of issues raised. NB This presentation was prepared to be given as a lecture. Simon Strauss 07 55313810 E-mail simon@pain-education.com URL www.pain-education.com Click your left mouse button on the next slide to begin

2. Do short courses on Pain Management provoke changes in General Practitioners’ pain patient management? Presented bySimon Strauss adviserMedical Pain Education

3. One in three Australian households has one or more members with a pain complaint usually (80%) managed by a General Practitioner. From: The Prevalence of Pain Complaints in a General Population: An Australian Study. Brisbane.1986. Fiona Guthrie , Fred Nicolosi and Simon Strauss

4. Little data seems to have been published on: The actual management of pain patients in the General Practice setting And whether or not Educational intervention influences General Practitioners’ pain management

5. Objectives 1. To collect sentinel data on General Practitioners’ management of Initial Pain Consultations 2. Assess changes, if any, made following differing brief educational interventions.

6. Knowledge AcquisitionAssessed by formal written Examination Maintenance of Changes 39 medical practitioners followed at 4 months Knowledge AcquisitionAssessed by formal written Examination Overview MPE’s Practice Assessment Activities Sentinel Data 58 medical practitioners 628 Initial Pain Consults Post Acupuncture Seminar 44 medical practitioners 535 Initial Pain Consults Post Myofascial Seminar 34 medical practitioners 339 Initial Pain Consults Postal (Pain Tools) 20 medical practitioners 247 Initial Pain Consults

7. Overview -Extended for non-lecture attendees. Knowledge acquisition and maintenance of provoked changes are not included in this presentation. The postal group undertook an educational activity designed to increase usage of Pain Assessment Tools. The postal group and the sentinel groups provide a useful view of what happens in the ‘wild’. Many of the myofascial seminar attendees were extensively involved in chronic pain management prior to attending.

8. This presentation details the Usage of Pain Assessment Tools Investigation Rates Referral Rates Script Generation Rates In the context of o Initial / Presenting Pain Consultations

9. Usage of Pain Assessment ToolsSentinel Group % of Initial PainConsults Data acquired prior to attending a Medical Pain Education acupuncture or myofascial pain management seminar

10. Usage of Pain Assessment ToolsPostal Group Postal group received written educational material on the usage of VAS, McGill and Pain Diagrams % of Initial PainConsults

11. Usage of Pain Assessment ToolsPre - Post Myofascial Seminar34 GPs 339 Audits % of Initial PainConsults

12. Usage of Pain Assessment ToolsPre - Post Acupuncture Seminar44 GPs 535 audits % of Initial PainConsults

13. The following slides represent the ‘worst case’ figures That is, they reflect the number of initial pain consultations that resulted in the ordering of one or more investigations/scripts/referrals. Therefore they cannot be used to give the actual numbers of x-rays ordered.

14. Investigation Rates % of Initial PainConsults

15. Investigation RatePre - Post Myofascial Seminar34 GPs 339 Audits % of Initial PainConsults No clear trend

16. Investigation Rate Pre-Post Acupuncture Seminar44 medical practitioners 535 Audits % of Initial PainConsults Pre-Post Investigations ratesX-rays -35%, CT -31%, MRI -50% and Serology -46%

17. Referral rates % of Initial PainConsults

18. Referral rates Pre-PostMyofascial Seminar34 GPs 339 Consults % of Initial PainConsults A mixed bag

19. Referral Rates Pre-Post Acupuncture Seminar44 medical practitioners 535 consults % of Initial PainConsults Physiotherapy referrals -52%, Physician -70%, Orthopaedic -44%, Neurosurgeon -66%, Rheumatologist -34%, Counselling -33%

20. Script Rates % of Initial PainConsults 127 scripts per 100 Initial Pain Consultations

21. Script Rates Pre - Post Myofascial Seminar34 GPs 339 Audits % of Initial PainConsults Pre-Post Myofascial seminarAnalgesics +20%, NSAIs -16%, Steroids +18%, Antidepressants +220%

22. Script Rates Pre - Post Acupuncture Seminar 44 medical practitioners 535 consults % ofConsults Pre-Post Acupuncture seminarAnalgesics -38%, NSAIs -24%, Steroids -44%, Antidepressants - 49%

23. Conclusions Comparison of sentinel and pre to post educational activity data reveals that General Practitioners’ pain patients’ management is modifiable by short educational interventions. The extent of the changes provoked seems to be affected by the nature of the educational material presented. The proposition that the provoked changes could lead to decreased health care costs has not been proven but seems to be attractive.

24. Medical Pain Education 31 Charlton Street. Southport. Qld. 4215 Tel: 07 5531 3810, Fax: 07 5532 6199 URL: www.pain-education.com E-Mail: simon@pain-education.com