By Tim Austin, NSW Director
At the most recent face-to-face meeting of the APS Board on 19-20 August 2017 in Sydney, a resolution was passed to adopt the NSW Government Agency for Clinical Innovation (ACI) document on Pain Management Programs.
Released in 2015, the “Pain Management Programs – Which Program for Which Patient?” document outlines the basis for group or individual pain management programs, and has reviewed the literature of the appropriateness of providing pain management programs for people experiencing persistent pain. Some of the specific details relate to the intensity of the program, which clinicians should be involved and the nature of the assessment process. Research does suggest that increased physical disability and psychological co-morbidity has a better outcome when a greater number of hours of intervention are provided.
In particular, it is essential that people experiencing persistent pain have a proper multidisciplinary assessment to establish what type of intervention would be appropriate. It is also necessary to ensure that pre- and post objective assessment measures are used in order to evaluate outcome. In this regard, APS members are reminded of the value of using ePPOC (electronic Persistent Pain Outcomes Collaboration) measures as a basis for assessment.
The Pain Management Programs document also addresses the relevance and appropriateness of pre-education prior to enrolment in a pain management program. These “STEPS” (Self Training Educative Pain Session)-type education sessions can be used in both public and private settings to introduce patients to a pain management approach and in this way to hopefully increase the efficacy of a subsequent intervention.
The ACI document is now linked through the APS website (menu selections: “Resources” and then “Position Papers”). While you are in that area, check out all the other position papers that are there. Over the last few years, the APS has attempted to provide up to date information on all range of topic areas. Some position papers have been especially written by APS members; some have been adopted from other “Pain” organisations or discipline-specific professional groups.
The APS Board has also recently endorsed some Guiding Principles for Pain Management. These are:
Pain is best understood through a biopsychosocial framework, and an assessment process identifying these pain contributors is essential. This applies to all pain; in particular, management of persistent pain should be based on a biopsychosocial approach.
The literature into the treatment and management of pain conditions consistently demonstrates that approaches addressing biopsychosocial contributors are more likely to be successful. In some circumstances, a sole clinician may be able to address the breadth of pain contributors. However, interdisciplinary care is the gold standard for the management of persisting pain, and is always encouraged. The literature also shows that treatment approaches focusing only on reducing pain intensity are less likely to be successful than those also addressing pain-related distress and disability. A multidisciplinary team approach is more likely to deliver outcomes sought by the person experiencing pain.
Interdisciplinary care is more than simply having multiple professions. Rather, it is the integration of knowledge, collaboration and shared expectations and goals by the team that defines its co-ordinated nature. The International Association for the Study of Pain (IASP) defines interdisciplinary care as “a biopsychosocial approach to assessment and management that involves a team of health care professionals working closely together within a non-hierarchical framework”.
The Australian Pain Society recommends that all pain conditions be managed with treatment approaches aspiring to the provision of interdisciplinary care.
Approved by the Australian Pain Society Board, August 2017