Chronic Pain Module MOA Breakout Barb Aasen , Family Tree Clinic David Jermey , VCH PSP Josefa Kontogiannis , VCH PSP

1. Chronic Pain Module MOA Breakout Barb Aasen, Family Tree Clinic David Jermey, VCH PSP JosefaKontogiannis, VCH PSP

2. 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 minutes?

3. Today we heard the definition of Pain • Pain is an unpleasant sensory andemotional experience associated with actual orpotential 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

4. 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

5. ConsequencesThis 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 co-morbidity • Job loss and financial stress freedigitalimages.net

6. ConsequencesThese 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

7. 20 minutes a month with my healthcare provider leaves- 43,180 minutes before my next appointment So, the rest is down to me!

8. What’s going on during the 43,180 minutes before they see you again? • Hopelessness • Stigma • Mistrust • Knowledge gap • Lack of accountability • Resource strain

9. 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

10. 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

11. 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

12. 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

13. A good awareness of the screening tools • What they are used for • When they are given • Who gives them

14. 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.

15. Tools

18. Diffusing difficult conversations Communication is not just saying words; it is creating true understanding. Active listening is an important skill in the communication process “Listen Non-judgementally”

19. 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

20. 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 listening • Think before you respond

21. 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

22. 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

23. 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”

24. Watch non-verbal behaviour • Pay attention to your non-verbal signals, as well as the other person’s • Keep an open body posture to show you care & are listening • Try to maintain eye contact