Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding...
-
Upload
brittany-harvey -
Category
Documents
-
view
215 -
download
0
Transcript of Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding...
![Page 1: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/1.jpg)
www.hnehealth.nsw.gov.au/pain
Hunter Integrated Pain
Service (HIPS)
Welcome to
RNC
Understanding Pain
![Page 2: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/2.jpg)
1
2
3
4
Whole person management
The new science
Introducing HIPS & what next?
What is pain?
Outline
![Page 3: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/3.jpg)
What is pain?
Indication of threat Actual or potential
damage Emotional
experience
![Page 4: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/4.jpg)
Short term Often linked to body structures
• under threat• damaged
What is acute pain?
threat ... damage ...Egloff N, Hirschi A, von Känel R. J Pain Research 2013;6:765–70
![Page 5: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/5.jpg)
Lasts 3 months or more Often persisting after body structures heal Wind up of nervous system
What is chronic pain?
hyper-alert ... flea bite feels like the eagles claws
Egloff N, Hirschi A, von Känel R. J Pain Research 2013;6:765–70
![Page 6: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/6.jpg)
The new science2
Role of nervous system Wind up or sensitisation
increases pain Winding down reduces
pain
![Page 7: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/7.jpg)
Structural changes and ongoing pain
![Page 8: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/8.jpg)
Painful, swollen, stiff left ankle
Imagined exercise of the phantom limb relieved symptoms
Haigh et al 2003 Rheumatology
Symptoms without the structure
![Page 9: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/9.jpg)
Davidson, McEwen. Social influences on neuroplasticity. Nat Neurosci. 2012;15(5):689-95
Chronic stress changes neurons
![Page 10: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/10.jpg)
• Ongoing pain linked to emotional response to initial injury
• “Traumatic” memory imprints the brain in a different way
Baliki, Apkarian et al. Corticostriatal functional connectivity predicts transition to CBP. Nature Neurosci. 2012
Back pain recovering
Back pain persisting
Brain changes predict persisting pain
![Page 11: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/11.jpg)
Brain habits
Sheep tracks
Winding up or down
![Page 12: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/12.jpg)
Nervous system
Active treatments
Body structures
Medical treatments
For many people the balance is not right
A need to restore balance
![Page 13: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/13.jpg)
Whole person management3
Biomedical
Mindbody
Connection
Activity
Nutrition
Adapted from Hayes & Hodson. A whole person approach to persistent pain. Pain Medicine 2011;12(12):1738-49
![Page 14: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/14.jpg)
Brainman’s choices Think well Move well Eat well
![Page 15: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/15.jpg)
What is the evidence for medical treatments?
“I think the dose needs adjusting. I’m not nearly as happy as the people in the ads.”
![Page 16: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/16.jpg)
0 2 4 6 8 Moulin et al. Lancet 1996 time (weeks)
Morphine in chronic pain
![Page 17: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/17.jpg)
Well known• Constipation• Drowsy, clouded thinking• Tolerance• Addiction
Did you know about ?• Worsening pain (opioid induced
hyperalgesia)• Sexual dysfunction• Driving impairment, risk of death (especially with sleeping tablets)
Opioid side effects
![Page 18: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/18.jpg)
STEP 1: Rule out danger Harmful structural problems? Red flags – cancer, fracture,
infection, nerve pressure
STEP 2: Medical treatment as part of broad approach
Medications / procedures Time limited Pain recovery plan
Biomedical
![Page 19: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/19.jpg)
Opioid strategy
HIPS support you & GP for as long as needed to wean off opioids
Time limited
![Page 20: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/20.jpg)
This is normal
Mind & body interweave
Awareness of thoughts
Peace of mind
Mindbody
Eccleston C. A normal psychology of chronic pain. 2011;24(6):422-425
![Page 21: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/21.jpg)
Timeline
![Page 22: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/22.jpg)
People, purpose, place
Isolation & disconnection are common
Reconnecting - part of recovery & wellbeing
Connection
![Page 23: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/23.jpg)
Finding the right balance
Body awareness
Awareness of thoughts behind the movement
Ease of movement, ease of mind
Activity
![Page 24: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/24.jpg)
Nutrition
Fruit & vegetables (2 & 5)
Less sugary drinks
Time limited supplements
Address smoking, alcohol, other drugs
NutritionInflammatory diet worsening pain
![Page 25: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/25.jpg)
6 months of low back pain after an injury at work
Scan - disc bulge & tear
Brian’s story
![Page 26: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/26.jpg)
No red flags - spinal structure less relevant
More about changes in brain & spinal cord
Oxycontin not working ‘Men should get on with it’ Pushing through, ‘boom &
bust’ cycle
Brian’s assessment
![Page 27: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/27.jpg)
Opioid wean over 4 months
Goal setting – travel & grandchildren
Awareness of thoughts Pacing activity Improve flare up
management
Brian’s pain recovery plan
![Page 28: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/28.jpg)
Background pain from 8/10 to 6/10
Positive changes in thinking, mood & activity
Less interference with life Flare ups
• fewer• managing differently
Brian’s recovery
![Page 29: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/29.jpg)
30 yrs married Not working due to poor
health Chronic widespread pain
& fatigue
Anna’s story
![Page 30: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/30.jpg)
Nutrition• less processed food• more vegetables• omega 3 fish oil • weight loss 5 kg
Psychological aspects • local counsellor
Anna after Understanding Pain
![Page 31: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/31.jpg)
Onset pain & fatigue age 15 years; ‘fibromyalgia’
Widespread pain in muscles & joints 6-8/10
Long term Norspan – no ongoing benefit
Low mood Avoidance of activity
Anna’s assessment
![Page 32: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/32.jpg)
Large family, Anna eldest child
Father’s business failed when Anna was 15 yrs; he moved away
“my childhood ended” “weight of responsibility
settled on my shoulders”
Anna’s timeline
![Page 33: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/33.jpg)
Biomedical - wean Norspan over 3 months Mindbody workbook / local counsellor Return to work & future education options Walking program - “pacing” Continue “anti-inflammatory” eating
Anna’s pain recovery plan
![Page 34: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/34.jpg)
Phone call at 1 month• Continuing with pain
recovery plan Phone call at 8 months
• 80% less pain & fatigue• Further 5 kg weight loss• Work as part-time cleaner• TAFE course• Mindbody Workbook –
forgiveness
Anna’s recovery
![Page 35: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/35.jpg)
Hunter Integrated Pain Service
Public system Types of pain
• Chronic non-cancer • Acute• Cancer
General practice links
4
![Page 36: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/36.jpg)
1. Use active treatments2. Get support3. Wean pain medication
Key messages
![Page 37: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/37.jpg)
HIPS websitewww.hnehealth.nsw.gov.au/pain
Google: Hunter Integrated Pain Service
![Page 38: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/38.jpg)
Small group
Supported self-assessment
Pain assessment & recovery plan• biomedical• mindbody• connection• activity• nutrition
Assessment and Planning
![Page 39: Www.hnehealth.nsw.gov.au/pain Hunter Integrated Pain Service (HIPS) Welcome to RNC Understanding Pain.](https://reader035.fdocuments.us/reader035/viewer/2022062421/56649d9e5503460f94a8797c/html5/thumbnails/39.jpg)
Your choice
GP Early community link
HIPSAssessment &
Planning
Community options
HIPSoptions
Where next?