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September 5 th – 8 th 2013 Nottingham Conference Centre, United Kingdom nspine.co.uk

September 5 th – 8 th 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.

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September 5 th – 8 th 2013 Nottingham Conference Centre, United Kingdom nspine.co.uk

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  1. September 5th – 8th 2013 Nottingham Conference Centre, United Kingdom www.nspine.co.uk

  2. Delivering a Pain Management Programme Anna Ruskin Advanced Practitioner – Physiotherapist Nottingham Back and Pain Team 06/09/13

  3. 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.

  4. 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.

  5. 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

  6. 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.

  7. 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

  8. Delivery Style MDT approach Group Treatment Community Setting Course duration/intensity Follow up

  9. Programme content • Education • Exercise • Goal setting • Skills training • Activity management • Cognitive methods

  10. Treatment Outcomes Disability/physical function Quality of life Emotional wellbeing Self efficacy and coping

  11. 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.

  12. 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.

  13. Any Questions

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