Getting Ready to Come to Pain Center

1. Getting Ready to Come to Pain Center www.healthcare.utah.edu/paincenter 546 Chipeta Way SLC, UT

2. Thank you for choosing our pain center • Welcome. The purpose of this orientation is to help you understand how our center works. • The goals of our center are to help individuals with chronic pain problems learn to manage their pain as independently as possible. • Independence • Self management • Confidence

3. physical strength and endurance ability to maintain productivity quality of life pain and suffering Goals in this context

4. How do we treat our patients? • There are many effective treatments for pain. • We have an interdisciplinary approach to chronic pain. • We treat the whole person not just the pain. • This means all “disciplines” help to take care of you. • This type of care has been demonstrated to have the best results. • The “disciplines” are physical therapy, pain psychologist and MD

5. Our program • After appointments with the MD, the physical therapist and a psychologist, there is a team meeting where the results are discussed and a plan of care is determined. • This team meeting takes place routinely. You will be discussed • As a new patient, again at 4 weeks, 3 months and 6 months • The treatment plan visit is where we present our ideas to you • Treatment may consist of medical visits, physical therapy, behavioral medicine or continue care with primary care physician. • Everyone is unique and every TP is unique.

6. Our team meetings • In addition at our team meeting we have a pharmacist that weighs in on your care and a dietitian • There are many combinations of things that can be done for optimal care. Not every patient is treated the same way. • Prescriptions are not written on your first evaluation day • Most patients are seen for a limited time

7. Exit Wounds: the book Taken from the book Exit Wounds by Derik McGinnis “You are the critical key to success. Your doctors cannot simply wave a magic medical wand and “fix” you. Rather, you must take command: View your doctors as the expert consultant you ”hire”, who offer their skills and recommendations and who will work with you every step on your journey to overcome pain. The responsibility for success rests, ultimately, on your shoulders.” Remember: the race is not always to the swift, but to those who keep on running.

8. Can you make my pain go away? • Depends on the type of pain. • We will definitely give you tools to help you with the pain

9. Speak Up • Speak up about your healthcare • As a patient, you can make your care safer by being an active involved and informed member of your healthcare team • Write down your questions in order of importance and then write down the answers that you receive from any healthcare provider • Ask for written information if there is anything you don’t understand • Ask for clarification

10. Our Staff • In addition to our receptionists, our medical assistant, we have RN’s and an LPN to help take care of you. • We are a sub-specialty clinic • Our MD’s are all anesthesiologist and specialist in chronic pain • 3 “Fellows” • Resident • Physical Therapy specializing in pain management • Behavioral Medicine or pain psychologist • Pharmacist • We may have students in any of these areas

11. Why do I have to see a psychologist? I’m not crazy • It is hard to cope with chronic pain. • Sometimes it is hard to cope with the impact pain has on your life. • Can help you learn pacing and activity planning • Coping skills • Relaxation

12. Pain psychologist • Pain is down up and up down.  • Whatever happens in the body ends up in the head and whatever is in the head affects the body. • We have to deal with what goes on in your head. • Pain affects all areas of your life so we need to talk about all areas of your life. • And they part of the interdisciplinary team

13. Physical Therapy (PT) • Not all PT’s are alike • Our physical therapist are specialist in chronic pain • Very skilled at treating complex problems • Work to restore your body to wellness • You may be uncomfortable at times while you are getting back to a state of wellness.

14. Physical Therapy (PT) • Improve motion • Improved flexibility • Lifestyle changes • And they part of the interdisciplinary team

15. Injections • To help reduce pain or to find out the cause of your pain • Trigger point injections • Tiny needle into a knot in your muscle • Nerve block • Anesthetic is used to calm down pain signals of the nerve • Faucet joint (small joint at the back of spine) • Can be preformed for people having neck or back pain • Epidural injections • Involve introducing medication that surround the nerves in the back. • Other injections – nerve blocks are not for everyone

16. “Nuts and Bolts” of the clinic • Keep your primary care physician (PCP) • Colds • Broken toes • We treat chronic pain not acute pain • On call physician and emergencies • They are there to discuss your situation and give their best judgment • They can’t prescribe over the phone

17. “Nuts and Bolts” of the clinic • Acute pain vs. chronic pain • Acute pain has a beginning and an ending. • You can usually identify when it started for example surgery or an broken bone. • We are seeing you for chronic pain • If you have an acute pain episode during our care, that provider needs to write for you if you receive medications • Since we are not seeing you for this issue, we can’t write medications for this issue.

18. “Nuts and Bolts” of the clinic • Some days we don’t have any MD doctors in the clinic. • Different MD doctors almost every day • Our nurses are our first responders and they can handle most situations. • They will pass along concerns and discuss issues with the doctors. • When you call for a doctor, you will always get a nurse. We are their voice.

19. “Nuts and Bolts” of the clinic • FYI • Disability • Functional capacity exams are done at other centers • Generally, we don’t fill out disability papers • Social security will not take disability papers from our Pain Management Center • Handicap parking • Obtained from your PCP

20. (FYI) All Messages • Our messages are date and time stamped. • Please leave the most concise message you can on any line. • Problem in one sentence • Phone number where you can be reached • We will call back in 24 hrs or over the weekend • Say and spell your name and say your phone number a couple of times

21. Medications • Medications are a main stay to help reduce pain and improve function. • Use many combinations of medicine • We are not able to prescribe long term • Most patients are seen for a limited time

22. Medications • Some patient say “My regular doctor won’t prescribe medications” • We will work with your provider to make sure they understand what works for you. • Providers will usually prescribe if the medicine helps you AND you use if properly

23. Medications • Your medication agreement is taken seriously by our facility. • Breaking it results in being discharged from our center. • Use the same pharmacy for your safety • Medication prescriptions • 2000 active patients • Monthly refills for scheduled two opioids • Pick up, mail or pharmacy faxes are ways to receive your medications • 3 to 5 business days in advance to pick up • 7 to 10 business days to mail

24. Medications • You can order your medications on line by visiting; • www.healthcare.utah.edu/paincenter • Follow the prompts • You can also do this in My Chart • Call the refill line at 801-581-7246

25. Medications

26. My Chart • On line medical record. • Not to be used for Urgent needs • View all medications and order refills • See the dates you ordered last month • View results of tests • Many other patient related information is on “My Chart”

27. Dispenser and lock box

28. Medications • Last year, unintentional prescription pain medication overdoses were the number one cause of injury deaths in Utah, even more than motor vehicle crashes. • www.useonlyasdirected.org

29. Medications • We are all part of the process to protect the medications and those who would abuse them. • You are responsible for your medications! • Lock them • Get a prescription dispenser box • Set yourself up for success with medications

30. Medications • Federal law requires us for certain prescriptions to have original prescriptions every time. • No early refills. • No replacement for lost or stolen medications • We take our responsibility seriously to protect the innocent. • Take meds as prescribed – don’t treat yourself

31. Medications • Never take prescription pain medication that is not prescribed to you. • Never adjust your own doses. • Never mix with alcohol or take with other depressants such as sleep aids or anti-anxiety medications. • Always dispose of any unused or expired medications. • Take back to police stations • Never dispose in the water system • Mix in a plastic bag with coffee grounds, cat litter etc.

32. Summary • You have received a handout today • Medication agreement • Information about pain and a question form • Things to remember • Medications are taken seriously • Our goals • independence, self management, confidence along with increasing physical strength, function, quality of life, decrease pain • Interdisciplinary care info • We treat the whole patient not just the pain • How to get refills

33. Finances • No business is complete without this aspect. • Co-payments and self pay due at the time of service • “No show” fee • Too many cancelled appointments even with notice to ANY provider are counted and considered • Insurance pre-authorization are a joint responsibility at our center

34. You have rights and responsibilities • We strive to protect and promote the rights of the people we serve. • If you have questions, comments or concerns, we want to hear them • You have many forums to discuss any problems • Members of the care team • Medical Director • Nurse Manager

35. Thanks you for entrusting your care to us. We strive to serve our patients in a caring environment where they can expect to receive high quality care with dignity and respect. • Thank you for choosing our center and for taking time out of your busy day to attend orientation.

36. Good health information at your library • UtahHealthNet • Consumer information, resources and services for Utah – Spencer S. Eccles Health Science http://utahhealthnet.utah.edu • Ask a Medical Librarian • Contact a librarian Spencer S. Eccles Health Science http://library.med.utah.edu/ or /asklibrarian.php

37. Medline Plus • Trusted consumer health information for you • National Library of Medicine • http://medlineplus.gov • Utah State Library Division • Find a public library near you • Director of public library • http://library.utah.gov/directory

38. Pioneer • Utah’s Online Library • Utah State Library Division • http://pioneer.utah.gov • UWIN • Supporting clinic/library partnerships and creating systems change in women’s health care for Utah • Utah Women’s Health Information Network • http://womenshealthuwin.utah.edu