Pain Management session one
Introduction to pain management.
I attended the first of 10 Pain management sessions this week. The programme is organised and run by our local pain clinic. The introduction was done by a clinical psychologist and a physiotherapist. There is also a specialist nurse involved.
The group was asked for the reasons they wanted to attend. Many had been referred but didn’t really understand why they were there or what they would get out of the course. A few wanted to know what they were going to be given for their pain. I think it may have been beneficial for every one to have been given more information at the time of referral.
Pain management programmes(PMP) are the gold standard in chronic pain management. They were recognised and are recommended by Scottish intercollegiate guideline network (SIGN) in 2016 as part of their pain management guideline. The guideline has been adopted by clinicians across the UK and can be found here.http://solidviews.com/IvOZTa
There are no claims that participants will be cured or given a magic pill. It is made clear that it’s about providing us with the information we need to use in our own way. Although it isn’t supposed to be a last resort, I got the impression that everyone was on maximum doses of meds. I would imagine that this is why people were referred to pain clinic in the first place, because their GPS didn’t know what else to do. I would suggest that earlier referral may be beneficial. Certainly, for me, I think earlier referral may have prevented my current situation, but who knows!
So, the structure for us is 30 mins to discuss a range of strategies including pacing, sleeping and mindfulness. Then a skills session which includes exercise, relaxation and mindfulness.
Lastly some group work. The group work rules were discussed. We decided on the standard concepts of –
One person talks
Mobile on silent
Time keeping / attendance
The content is based on the SIGN (2016) guidelines and uses a proactive Bio- psycho-social approach and part of this is cognitive behavioural therapy (CBT). This is the basis for the programme, CBT uses a concept that the pain we have, leads to certain thoughts, feeling, behaviour, emotions and sensation which all influence each other. Therefore by changing behaviour for example, you will influence your emotions and/or thoughts and/or sensations therefore changing pain. I am a logical thinker so this makes complete sense to me.
We were then asked to complete a registration form if we were committed to the 10 week course and Questionnaires were passed around to be completed too.
The brief illness perception questionnaire Broadbent (2006)http://solidviews.com/z4Iv. A pain self efficacy questionnaire, Nicholas (1989)http://solidviews.com/XbrYoxDU And the Tampa scale for Kinesiophobia Miller (1991)http://solidviews.com/dzDJrceX. I believe these would be used to determine if there had been any change in symptoms by comparing responses at the start and end of the course.
The last part of the morning was education about pain by the physiotherapist. She introduced what pain is, how the brain processes pain stimuli and the differences between chronic and acute pain. She felt it would be more appropriate to refer to them as long and Short term pain. Pain is a very complex subject, as we all know but she simplified the process as much as possible. Some members of the group just didn’t get it, but most were able to get a handle on it. I think it is worth the explanation in order to show the reasons why, even some clinicians don’t understand it fully.
She went on to explain the process of pain in relation to memory, thoughts and feelings and the concept of triggers .
I would like to think I am pretty clued up about FMS and feel that I am already using a number of techniques and strategies that were touched on in the session, so I am interested to see if there is anything else I can do. I don’t expect to reduce pain but I would like to reduce the frequency and severity of my flares, so we shall see?????