Physiotherapy research

1. Physiotherapy research Barriers to the implementation of evidence-based chronic pain management in physio outpatients

3. 2010 research project • Shelley Barlow • Physiotherapist • Ballina Community Health • 25+ years as outpatient physiotherapist • Research scholarship CETI 2010-2012

4. pain What is it about pain that bothers us so much?

9. Or does it? Where things are at in the world of pain!

10. The human faces of pain

13. Building hope This presentation will outline some of the ‘how and why’ through pain to self management and recovery

14. What is being done? • To change pain there is a need to shift beliefs and attitudes towards people in pain • Less pain and living well with chronic pain are more about health then they are about medicine (Neil Pearson 2011)

15. Pain Summit Canberra March 2010 • 130 organisations united to back the worlds 1st national pain strategy • De-stigmatise chronic pain • Introduce of standardised interdisciplinary pain management networks

16. National pain summit Mission • To improve quality of life for people with pain and their families • minimise burden of pain on individuals and the community

17. Pain summit • National representative body include all stakeholders • Recognition pain as condition in own right • Treatment chronic disease model of care • Introduction interdisciplinary linkages through all stages of treatment from prevention, PHC, community to secondary and complex tertiary care

18. Pain summit Community-led program De-stigmatise in • Minds community and health professionals • Better education to public that a wider range of help-beyond pain killers –is available

19. Pain summit Pain as 5th vital sign • Formal coding system for pain in hospitals to allow prevalence and other data to be tracked • Item numbers in PHC, Dr’s to be reimbursed • Pain not seen as just a symptom reconceptualising as a disease in its own right

20. National Pain strategy • Pain management for all Australians • Developed from independent process including pain summit • Developed by the national pain summit initiative march 2010 • www.painsummit.org.au • www.painaustralia.org.au

21. Mission • To improve the quality of life for people with pain and their families, and to minimise the burden of pain on individuals and the community • Pain 3rd most costly health problem • Realisation there are more people with the problem of chronic pain then initially thought

22. findings Pain management is inadequate in most of the world due to…. • Inadequate access to treatment of acute pain • Failure to recognise chronic pain is a serious chronic health problem • Requiring management akin to other chronic diseases eg cardiac/diabetes

23. And Aim to • recognise Intrinsic dignity of all persons therefore • Withholding treatment wrong • Leads to unnecessary suffering • Which is harmful

24. and • Pain medicine not recognised as a distinct speciality • WHO estimates 5 billion people live in countries low or no access medicines or adequate treatment moderate or severe pain • Restrictions on adequate use opioids and other essential medicines

25. and Major deficits in knowledge of health care professionals • Regarding mechanisms and management of chronic pain • Chronic pain with or without a diagnosis highly stigmatised • Countries poor or no policies regarding research spending and education

26. Prioritising pain • 1 in 5 Australians will suffer chronic pain in their lifetime • 80% will miss out on appropriate treatment • Cost 34 billion annually

27. Chronic pain • Constant daily pain for a period of 3 or more months in the last 6 • Pain that extends beyond the expected healing time of an injury, or can accompany chronic illness such as arthritis or lupus

28. They face the following • Disease not officially recognised as a disease or public health issue • People around them often don’t believe they are in pain • Many health professionals receive little or no training • May have to wait up to a year for service

29. And • They have little access community support • Productivity at work lowered leads to unemployment and impoverishment • They are personally likely to carry 50% of the total economic cost

30. People with chronic pain have Increased risk: • Depression • Anxiety • Physical de-conditioning • Poor self esteem • Social isolation • Relationship breakdown

32. Goals • People in pain as a national health priority • Knowledge, empowered and supported consumers • Skilled professionals and best-practice evidence-based care • Access to interdisciplinary care at all levels

33. Goals continued • Quality improvement and evaluation • Research

34. Declaration Montreal IASP Sept 2010 • Declaration of Montreal 2010 September • Declaration that access to pain management is a fundamental human right

35. 3 human rights • The right of all people to have access to pain management without discrimination • To acknowledgement of their pain and be informed about how it can be assessed and managed • To have access to appropriate assessment and treatment by trained health professionals

36. Case for change • Governments becoming aware of impact of chronic pain on communities • Aging associated increased burden painful pathology • Gains made by: prevention, community awareness, early intervention and access pain services

37. Traditional views • Pain symptoms telling you there is damage to the tissues and structures in the body • As damage heals pain goes away • There is nothing that can be done • Take medication, learn to ignore, distract • Learn to live with it

38. Current understanding • Pain changes everything; • Chemistry, cells, tissues, systems, • Breathing, thinking, physical ability, roles in life • Emotions, sense of self, role in community • Ref: Neil Pearson 2011

39. Biological changes • Changes in central nervous system may develop during a transition phase acute to chronic • Already have treatments that can prevent transition, chronic pain is learned • Also treatment by targeting neuroplasticity in CNS • Pain reduced not often eliminated

40. Pain is an Output of the Brain !

42. Pain invisible • People try to convince practitioners of the intensity and discomfort • Met with disbelief and despair • Treatment must look beyond the origin of the pain

44. Specialist pain clinics • Model of care for high risk and complex • Long waiting lists • Poorly integrated into community and primary health care • Lack of continuum of care • Poor feedback and discharge between services

45. Community based services • Community based services shown to be effective for other chronic diseases • No infra structure for chronic pain

46. Draft National primary health care strategy • Reduce waiting times specialist pain clinics • Improve access to effective interdisciplinary pain management PHC • Triage criteria referral pain clinics • Role medicare locals?

47. How? • Skilled workforce consisting integrated interdisciplinary teams • Improved understanding of roles • Appropriate infrastructure • Group activities and • Co-location services • Shared care

48. How? • Strengthened regional PHC partnerships • Supplementary funding • Standardised evidence-based approaches • Flexible tailored care • Supported self management • Personalised shared care plans

49. How? • Information and IT for decision support and outcome measures • Focus on prevention and early intervention including effective treatment acute pain

50. NSW state plan for pain management • Completed and with the minister • Clinical innovations pain management group • Representatives from all areas on working parties • Chronic pain Australia involved • What might this mean for us?