Registrar pre teaching session worksheet
>click here for printable version<Why are we talking about chronic pain?
Chronic pain is common and is experienced by up to 20% of the Australian population. Many of these patients manage their pain themselves, but up to 5% have what is considered severe pain that interferes with their life and function. These patients are difficult to treat as drug treatments have a limited role and the patient needs to be educated to manage their pain themselves. This takes time, which may be an extra challenge for the practitioner. Management includes active physiotherapy, psychological therapies, basic lifestyle change and education regarding the appropriate use of medication. Patients are often looking for a cure and practitioners who are trained with the medical model, where cure is the aim, may find it difficult to accept that these patients suffer from a chronic disease that can be managed but rarely cured. These patients can be demanding and it can be difficult to differentiate between the patient who has chronic pain and the one who may be using chronic pain as an excuse to obtain opioids. It is important to acknowledge that making small changes to the patent’s pain experience can result in large changes to their general wellbeing and function.
Where can I go to get further information?
Task
Before attending your teaching session it is important to have a good understanding about the pathophysiology and evidence around treating chronic pain. You must read and digest the following two articles prior to your teaching session.
Goucke, R. (2003). The Management of Persistent Pain, MJA, 178, 444
http://www.mja.com.au/public/issues/178_09_050503/gou10286_fm.pdf
Graziotti, P. & Goucke, R. (1997). Oral opioids for chronic non-cancer pain, MJA, 167, 30
http://www.mja.com.au/public/issues/jul7/graziott/graz.html
Further reading
You may find it interesting and useful to spend some time exploring the topic further on these websites:
British Pain Society Website
http://www.britishpainsociety.org/pub_professional.htm
Hunter Integrated Pain Service
http://www.hnehealth.nsw.gov.au/pain/health_professionals
Australian Pain Society
http://www.apsoc.org.au
Task
With the reading you have completed can you identify why General Practitioners may be the right people to manage chronic pain?
If you manage pain early do you think that it could have an impact on the patient’s long-term experience? Is there any evidence to support your opinion?
Identify a patient that you have seen in the last week who has chronic pain.
- How has it affected their quality of life?
- What impact has it had on their family?
- How did it affect your approach to the consultation?
- Did you have any personal reactions to the consultation? Why do you think this might have been?
- With your reading, do you think their management has been appropriate?
Be prepared to discuss your answers in the teaching session. Think about further treatment options for this patient.