session 7 rodrigues practical tools
DESCRIPTION
The Foundation for Medical Excellence 27th Annual Pain & Suffering Symposium http://tfme.orgTRANSCRIPT
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Practical Tools & Tips from an Interdisciplinary Pain Teamfor Use in the Busy Family Physician’s Office
Dr. Matt Graham, R. PsychJimena Malzahn, B.Sc.(PT)
Cara Rodrigues, B.Sc., B.Sc.(OT)
OrionHealth Rehabilitation & Assessment Centres
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exercise
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objectives
our Lens: how we see the chronic pain patient (biopsychosocial)
our Approach: literature understandable language
some Tools: translated for the sole practitioner
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key messages for our patients
validate the pain experience acutechronic pain neurophysiology
active vs passive coping treatment vs management talk ‘nervous system sensitivity’ language
function focus ADLs/IADLs and the value of WORK “it hurts but it’s not harm”
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what does the literature say
regarding approach
“An approach that would include a focus on fear and avoidance beliefs, catastrophizing, and depression could greatly improve patient functioning and enhance the secondary prevention of chronic disability, including sick leave.” (p 165)
(Boersma & Linton, 2006)
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biopsychosocial
Reference: Main, C.J., de C Williams, A.C. (2002) ABC of psychological medicine: Musculoskeletal pain. British Medical Journal, 325, 534- 537.
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yellow flags—early signs of Pain Disability
Early warnings of pain disability Belief that back pain is harmful or potentially severely
disabling Fear and avoidance of activity or movement Tendency to low mood and withdrawal from social
interaction Expectation of passive treatment(s) rather than a belief
that active participation will help
Reference: Guide to Assessing Psychosocial Yellow Flags in Acute Low Back Pain: Risk Factors for Long-Term Disability and Work Loss, 1997
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yellow flags updated: (Nicholas, Linton, Watson, &
Main, 2011)
Beliefs, appraisals, and judgments Unhelpful beliefs about pain; indication of injury as uncontrollable or likely to worsen
Expectations of poor treatment outcome, delayed return to work
Emotional Responses Distress not meeting criteria for diagnosis of mental disorder
Worries, fears, anxieties
Pain Behaviour Avoidance of activities due to expectations of pain and possible re-injury
Over reliance on passive treatments (hot packs, cold packs, analgesics)
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Key tool today: starts with how we talk about pain
video—Understanding Pain: what to do about it in less than 5 minutes (http://youtu.be/4b8oB757DKc)
Lorimer Mosely: pain as an OUTPUT
acute chronic
generally accepted as pain due to damage in body tissue
generally accepted as pain that persists longer than expected healing time
pain is still an output less about tissue and more about maladaptive output from the brain
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(today)stories connect people
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what pain scales don’t show us
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tools:
• pain neurophysiology hurt vs harm (language)
• prescription for movement
• mindfulness /breathing practice
• cognitive awareness tool• activity log/journal• work as a determinant
of health
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why work?
The longer a person is off work, the less likely they are to return (Crook and Modolfsky, 1994)
Early return to work contributes to decrease in overall work disability (Lydell et al., 2009, Loisel et al. 1994)
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how we shape recovery?
May inadvertently promote fear avoidance in our language and actions (Linton et al., 2002)
Taking people off work when they can do their job, modified or alternate duties can contribute to fear avoidance
Need a culture where we talk about sustaining or returning to work as a given step in recovery
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summary: key message
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summary: key message
movement
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summary: key message
work
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take home messages
hold an interdisciplinary mindset
see pain from a nervous system sensitivity perspective vs tissue damage
watch out for reinforcement of fear and avoidance active vs passive
support for movement & work
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why are we hopefulour work
why we love it
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resources
Butler, D, & Mosely, G.L., Explain Pain. Pearson, N., Understand Pain Live Well Again.
NOI group website: www.noigroup.com; great resources/anecdotes
Pain BC website: www.painbc.ca; Pain Toolbox download
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Dr. Matt Graham, R. PsychJimena Malzahn, B.Sc.(PT)Cara Rodrigues, B.Sc., B.Sc.(OT)
OrionHealth Rehabilitation & Assessment Centres
Thank you
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references
Boersma, K.& Linton, S.J. (2006). Psychological Processes Underlying the Development of a Chronic Pain Problem: A Prospective Study of the Relationship Between Profiles of Psychological Variables in the Fear–Avoidance Model and Disability. Clinical Journal of Pain, 22 (2), 160 – 166.
Crook, J., Modolfsky, H.(1994). The probability of recover and return to work from work disability as a function of time. Quality of Life Research, 3 (Supplement 1), S97 - S109.Providers: Are We Fear Avoidant? Journal of Occupational Rehabilitation,12 (4), 223-232.
Linton, S.J., Vlayeyn, J., Ostelo, R. (2002). The Back Pain Beliefs of Health Care Providers: Are We Fear Avoidant?Journal of Occupational Rehabilitation,12 (4), 223-232.
Loisel, P., Durand, P., Abenhaim, L., Gosselin, L., Simard, R., Turcotte, J., & Esdaile, J. M. (1994). Management of occupational back pain: the Sherbrooke Model. Results of a pilot and feasibility study. Occupational and Environmental Medicine, 51, 597-602.
Lydell, M., Grahn, B. Mansson, J., Baigi, A., Marklund, B. (2009). Predictive Factors of Sustained Return to Work for Persons with Musculoskeletal Disorders who Participated in Rehabilitation. Work, 33, 317-328.
Moseley, G.L. (2003). A pain neuromatrix approach to patients with chronic pain. Manual Therapy, 8(3), 130-140.
Nicholas, M.K., Linton, S.J., Watson, P.J, & Main, C.J.(2011) Early Identification and Management of Psychological Risk Factors (“Yellow Flags”) in Patients With Low Back Pain: A Reappraisal. Physical Therapy, 91, 737-753.
Neil Pearson (2012, January 23). Acute versus Chronic Pain: Understanding the difference and choosing appropriate treatment. Retrieved from: www.orionhealth.ca.