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Session 7 rodrigues practical tools

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The Foundation for Medical Excellence
The Foundation for Medical Excellence

This document provides practical tools and tips for family physicians to take a biopsychosocial approach to chronic pain patients. It emphasizes validating the patient's pain experience, focusing on function over passive treatments, and supporting return to work. Tools discussed include explaining pain neurophysiology to change beliefs about harm, prescribing movement, and addressing yellow flags like fear and avoidance. The goal is to shape patient expectations and reduce disability by promoting active coping strategies over resting or relying solely on medication.

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S Practical Tools & Tips from an Interdisciplinary Pain Team for Use in the Busy Family Physician‟s Office Dr. Matt Graham, R. Psych Jimena Malzahn, B.Sc.(PT) Cara Rodrigues, B.Sc., B.Sc.(OT) OrionHealth Rehabilitation & Assessment Centres
exercise
objectives S our Lens: how we see the chronic pain patient (biopsychosocial) S our Approach: literature understandable language S some Tools: translated for the sole practitioner
key messages for our patients S validate the pain experience S acutechronic S pain neurophysiology S active vs passive coping S treatment vs management S talk „nervous system sensitivity‟ language S function focus S ADLs/IADLs and the value of WORK S “it hurts but it‟s not harm”
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)
biopsychosocial Reference: Main, C.J., de C Williams, A.C. (2002) ABC of psychological medicine: Musculoskeletal pain. British Medical Journal, 325, 534- 537.
yellow flags—early signs of Pain Disability Early warnings of pain disability S Belief that back pain is harmful or potentially severely disabling S Fear and avoidance of activity or movement S Tendency to low mood and withdrawal from social interaction S 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
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)
Key tool today: starts with how we talk about pain S video—Understanding Pain: what to do about it in less than 5 minutes (http://youtu.be/4b8oB757DKc) S 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
(today) stories connect people
what pain scales don‟t show us
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
why work? S The longer a person is off work, the less likely they are to return (Crook and Modolfsky, 1994) S Early return to work contributes to decrease in overall work disability (Lydell et al., 2009, Loisel et al. 1994)
how we shape recovery? S May inadvertently promote fear avoidance in our language and actions (Linton et al., 2002) S Taking people off work when they can do their job, modified or alternate duties can contribute to fear avoidance S Need a culture where we talk about sustaining or returning to work as a given step in recovery
summary: key message
summary: key message
summary: key message
take home messages S hold an interdisciplinary mindset S see pain from a nervous system sensitivity perspective vs tissue damage S watch out for reinforcement of fear and avoidance S active vs passive S support for movement & work
S why are we hopeful our work why we love it
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
Dr. Matt Graham, R. Psych Jimena Malzahn, B.Sc.(PT) Cara Rodrigues, B.Sc., B.Sc.(OT) OrionHealth Rehabilitation & Assessment Centres Thank you
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.

More Related Content

Session 7 rodrigues practical tools

  • 1. S Practical Tools & Tips from an Interdisciplinary Pain Team for Use in the Busy Family Physician‟s Office Dr. Matt Graham, R. Psych Jimena Malzahn, B.Sc.(PT) Cara Rodrigues, B.Sc., B.Sc.(OT) OrionHealth Rehabilitation & Assessment Centres
  • 3. objectives S our Lens: how we see the chronic pain patient (biopsychosocial) S our Approach: literature understandable language S some Tools: translated for the sole practitioner
  • 4. key messages for our patients S validate the pain experience S acutechronic S pain neurophysiology S active vs passive coping S treatment vs management S talk „nervous system sensitivity‟ language S function focus S ADLs/IADLs and the value of WORK S “it hurts but it‟s not harm”
  • 5. 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)
  • 6. biopsychosocial Reference: Main, C.J., de C Williams, A.C. (2002) ABC of psychological medicine: Musculoskeletal pain. British Medical Journal, 325, 534- 537.
  • 7. yellow flags—early signs of Pain Disability Early warnings of pain disability S Belief that back pain is harmful or potentially severely disabling S Fear and avoidance of activity or movement S Tendency to low mood and withdrawal from social interaction S 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
  • 8. 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)
  • 9. Key tool today: starts with how we talk about pain S video—Understanding Pain: what to do about it in less than 5 minutes (http://youtu.be/4b8oB757DKc) S 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
  • 11. what pain scales don‟t show us
  • 12. 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
  • 13. why work? S The longer a person is off work, the less likely they are to return (Crook and Modolfsky, 1994) S Early return to work contributes to decrease in overall work disability (Lydell et al., 2009, Loisel et al. 1994)
  • 14. how we shape recovery? S May inadvertently promote fear avoidance in our language and actions (Linton et al., 2002) S Taking people off work when they can do their job, modified or alternate duties can contribute to fear avoidance S Need a culture where we talk about sustaining or returning to work as a given step in recovery
  • 18. take home messages S hold an interdisciplinary mindset S see pain from a nervous system sensitivity perspective vs tissue damage S watch out for reinforcement of fear and avoidance S active vs passive S support for movement & work
  • 19. S why are we hopeful our work why we love it
  • 20. 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
  • 21. Dr. Matt Graham, R. Psych Jimena Malzahn, B.Sc.(PT) Cara Rodrigues, B.Sc., B.Sc.(OT) OrionHealth Rehabilitation & Assessment Centres Thank you
  • 22. 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.

Editor's Notes

  1. Us to youAnd you to your clients (this is our experience)
  2. Relate to our experience in how we talk about work—what we see as the barriers for RTW