pain conf working version 1
TRANSCRIPT
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Biopsychosocial Approach to Chronic
Pain Management: The Selayang
Hospital Experience
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Overview
1. Chronic Pain
2. The Biopsychosocial Model of Pain
3. Pain Management at Pain Clinic HospitalSelayang
4. MENANG Program
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Pain
Acute Pain Chronic Pain
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Prevalence of Chronic Pain in Malaysia
A major healthcare problem worldwide,especially Asia Pacific1
Often neglected due to lack of awareness1
Prevalence of chronic pain in Malaysia is about7% with higher proportion in older age group2
Age group >75 years21.5% in average
Age group
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Challenge to pain management
Most Malaysian adhere to standard medical
model and depend on health care providers as
it was based on the Cartesian model of pain2
However, the Cartesian model is unable to
explain many clinical and social observations
E.g. The presence of pain with the absence of
tissue damage
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Pain defined
International Association of the Study of Paindefined pain as:
An unpleasant sensory and emotionaldisturbances, associated with actual or potentialtissue damage
Pain is always subjective
Many people report pan in the absence of tissuedamageit should be accepted as pain3
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Pain is not the only presenting issue
Chronic pain is a complicated condition
Is a major threat to on multiple levels:
o Physical
o Emotionalo Behavioral
o Relational
o Environmental
82% of patient with chronic pain patients reportedemotional, behavioral and social challenges interferedwith their daily activities4
Quality of Life
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The biopsychosocial model of pain5
Pain
Nociception Pain
Suffering Painbehavior
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Pain Management at Pain Clinic,
Selayang Hospital
Employs a biopsychosocial approach to
chronic pain management for more than a
decade
The first multidisciplinary pain service in
Malaysia
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Multidisciplinary team in Pain Clinic,
Hospital Selayang
Pain specialists
Physiotherapists
Clinical psychologists
Medical social worker
Pain nurses
Promote well-
being andfunctioning of
patients with
chronic pain
In a holistic
manner
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Management of chronic pain
Analgesics
Nerve blocks
Acupuncture Physiotherapy
Cognitive Behavior Therapy
Clinical Hypnosis Etc.
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MENANG PROGRAM2
Group-based pain management
10-days intensive program promoting self-management in pain
Based on ADAPT Programmed at the Pain Management
Research Centre at the Royal North Shore Hospital inSydney
Emphasizes importance of physiotherapy and
psychological interventions Deemphasize surgical interventions and roles of
medications
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MENANG PROGRAM (2)
Patients selection are based on teams assessment and regularmultidisciplinary team meeting
Teaches patients to re-conceptualise pain:
o Education about pain
o Goal setting
o Relaxation and desensitisation training
o Identifying and challenging unhelpful cognitions
o Effective problem-solving
o
Pacing and daily planningo Programmed exercise and systematic encouragement of
activities that limit avoidance behaviours
o Medical withdrawal
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Evaluation of MENANG program2
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Reconceptualizing pain
Complete pain relief is not necessary for
maintaining normal life style, given an active
pain management approach
It is important to have more training and
education for healthcare professionals and the
community on the role of self-management in
chronic pain
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References
1 Malaysian Association of the Study of Pain (2010). ChronicPain Declaration. www.masp.org.my
2 Cardosa, M, S., Osman, Z, J., Nicholas, M., Tonkin, L.,Williams, A., Aziz, K, A., Ali, R, M., & Dahari, N, M (2012).Self-management of chronic pain in Malaysian patients:Effectiveness Trial with 1-year follow up. TBM, 2, 30-37
3 Merskey, H. & Bogduk, N (1994). Classification of ChronicPain. International Association of the Study of Pain. UnitedStates
4 Cardosa, M. S. (2006). Pain Management: Trends andChallenges. Med Journal Malaysia, 61, 2.
5 Loeser, J. D. (1982). Concepts of Pain. Chronic Low Back Pain.New York: Ravens
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Thank you