ST P! CHRONIC BACK PAIN
Self-management and Timely Intervention:
An Opportunity for the Prevention of
Chronic Back Pain
STOP! CHRONIC BACK PAIN
STOP! CHRONIC BACK PAIN
STOP! CHRONIC BACK PAIN
STOP! CHRONIC BACK PAIN
PAIN
“An unpleasant sensory and emotional
experience associated with real or potential
tissue damage, or described in terms of
such damage...”
-International Association for the Study of Pain
 Musculo-skeletal pain – BACK PAIN
 Neuropathic pain
 Post-surgical pain
 Idiopathic pain
STOP! CHRONIC BACK PAIN
THE HORRIFYING CURRENT SITUATION
 7.8 million people in UK suffer from chronic pain.
 3.3 m people p.a. with first episode back pain don’t
recover...
 Actual cost to the NHS is over £1 billion p.a. (Manadiakis,
2000)
 4.6 m GP appointments + 796,000 pain management
appointments each year (Belsey 2002)
 25% of all appointments are cancelled or missed by patients
 £584 million for medication which includes wastage for non-
compliance (2007)
STOP! CHRONIC BACK PAIN
TRADITIONAL CARE PATHWAY FOR PEOPLE IN
CHRONIC NON-MALIGNANT PAIN
GP:
ANALGESICS &
PHYSICAL
THERAPY
INTERVENTION
IF APPROPRIATE,
ESCALATE
ANALGESIA
REFER TO
PAIN
CLINIC
ABOUT YOUR
BACK
PROGRAMME
OR
EQUIVALENT
REFERRAL TO
RHEUMATOL
OGY
PAIN
MANAGEMENT
PROGRAMME
RETURN TO
GP
SEEK
INVESTIGATIO
N
REVIEW
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CONSTANTLY WORKING AT IMPROVEMENT ....
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STOP! CHRONIC BACK PAIN
PARTNER ORGANISATIONS THROUGH THE
DORSET PAIN SOCIETY
Poole Hospital NHS Foundation Trust:
Dorset Pain Management Unit
Self-help group of the Dorset Pain Management Unit
Physiotherapy Department
Bournemouth University: School of Health and Social Care
Dorset HealthCare University NHS Foundation Trust (DHUFT):
Orthopaedic Treatment Service
Buckland Centre Volunteer Service
University Department of Mental Health
Royal Bournemouth and Christchurch Hospitals
NHS Foundation Trust: Physiotherapy Department
NHS Dorset
Providence Surgery, Bournemouth
Pfizer
BHLive
STOP! CHRONIC BACK PAIN
Physical
pain
Increased visits
to clinics
Fear and anxiety
Anger,
frustration
Depression,
hopelessness,
helplessness
Diminishing
self-confidence
Trapped
in one’s
body
STOP! CHRONIC BACK PAIN
Physical
Deconditioning
Poor quality of
sleep, neglect
eating, fatigue,
sex
Social
isolation
Loss of
occupation
Reduced activity
Reduced
well-being
Changing role
within family
3 CENTRES, 3 LOCATIONS
1
2
3
Coh
ort
Setting
Date of delivery
Number
Number
recruited completed
1
Dorset Pain Management Unit,
Poole Hospital, Poole
15/06/11 – 27/7/11
8
7
2
Littledown Leisure Centre,
Bournemouth
12/10/11- 30/11/11
14
12
3
Weymouth Community Hospital,
Weymouth
08/02/12 – 21/3/12
13
13
STOP! CHRONIC BACK PAIN
PATIENT WITH PERSISTENT BACK
PAIN, 3-12 MONTHS AFTER ONSET
REFERRAL BY GP, ESP,
PHYSIOTHERAPIST
ST
P
CHRONIC BACK PAIN
PROJECT
ASSESSMENT TRIAGE
PSYCHOLOGICAL ASSESSMENT
BIOLOGICAL ASSESSMENT
SOCIAL / OCCUPATIONAL
ASSESSMENT
Unresolved psychological
issues
Further investigation/ physical
intervention
REQUIRED
Refer to
Rheumatology
Exit STOP
NOT
REQUIRED
PROGRESS
TO PMP
Employment
support:: OT and
PROGRESS TO
PMP
NOT
PRESENT
PROGRESS
TO PMP
PRESENT
Refer to
IAPT
Exit STOP
PAIN MANAGEMENT PROGRAMME
WEB-BASED SUPPORT
STOP! CHRONIC BACK PAIN
PERSONAL COACH
PAIN REDUCTION - DISCHARGE
PAIN ADVICE LINE
PSYCHOLOGY
The connection
between our
body and
thoughts,
feelings,
behaviour
The difficulty
with pacing
OCCUPATIONAL
THERAPY
MINDFULNESS
PHYSICAL
THERAPY
MEDICAL
INPUT
The techniques of
Pacing
Progressive Muscle
Relaxation/Body
Scan
Managing back pain Pain pathways,
Gate control
theory of pain
Goal setting
Grounding
Meditation
Pacing and goal
setting
Understanding
pain medication
Communicating Body mechanics
assertively about
pain – and
oneself
Grounding
Meditation and
Positive Word
Inhalation
(visualisation)
Posture
Understanding
medical
investigations
and interventions
Living in
accordance with
our values
Relapse
management
PMR/Visualisation
Keeping motivated
How to use a
medical
consultation
effectively
The impact of
early life
experiences on
pain
management
Relapse
signatures and
prevention
Developing a ‘First
Aid’ plan to manage
flare-ups
Breathing in the Sun
(visualisation)
Physiotherapy
revisited
Psychology
Physiotherapy
Moving into vocation, Mountain Meditation
work and leisure
Occupational
Relaxation
Therapy
Medical Input
Guest
lectures
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SUPPORTED SELF-MANAGEMENT
TIER 1 : WEB SUPPORT
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SUPPORTED SELF-MANAGEMENT
TIER 2
TIER 3
OUR INNOVATIVE
PAIN CHAIN
EACH ONE REACH ONE
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PAIN
ADVICE LINE
STAFF-MANNED
TELEPHONE LINE
WHAT WERE WE HOPING TO
ACHIEVE THROUGH EARLY
INTERVENTION?
The Individual with pain



Reduced disability – physical + emotional
Enhanced quality of life
The Clinical Team
 Collaborative working
 Better self-management, earlier in the journey
 The Commissioners
 Decreased dependence on health/social


services
Affordable health economy through prevention
of chronicity
STOP! CHRONIC BACK PAIN
STOP! CHRONIC BACK PAIN
OUTCOME DATA
A.CLINICAL OUTCOMES
B. COST EFFECTIVENESS –
HEALTH ECONOMY
C. QUALITATIVE FEEDBACK
STOP! CHRONIC BACK PAIN
Outcome Measures
RMDQ Disability
PCS Catastrophising
HADS Depression
HADS Anxiety
Euroqol Quality of life
PhysiotherapySit-to-stand
PhysiotherapyStep-ups
Self-reported change
%
STOP! CHRONIC BACK PAIN
p-value
<.001
<.001
<.001
.058
.002
<.001
<.001
<.001
STOP! CHRONIC BACK PAIN
OUR RESULTS
OUTCOME DATA
A. CLINICAL OUTCOMES
B. COST EFFECTIVENESS –
HEALTH ECONOMY: YUHASS
questionnaire
C. QUALITATIVE FEEDBACK
STOP! CHRONIC BACK PAIN
Total Number of Appointments for each
type of HCP across 30 patients in 3 months
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Appointment costs per patient in
3 months, one bar per patient
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Total Appointment Cost per profession
across 30 patients in 3 months
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Number of medicines used by each patient
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Type of paid household help used
in 3 months
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OUTCOME DATA
A. CLINICAL OUTCOMES
B. COST EFFECTIVENESS –
HEALTH ECONOMY
C.QUALITATIVE
FEEDBACK:
forms, interviews
STOP! CHRONIC BACK PAIN
“I thought that the actual programme was very good. It
covered a lot of things, we had questions raised and they
were addressed, I think they got it spot on with the
content.”
Programme participant
“The pain chain was lovely. It worked well for me –
it’s still a pleasure to work with my coach”.
Programme participant
“As a service user I was thrilled to have a chance to promote the
patients' perspective and work with health professionals who
impressed me throughout with their compassion, professionalism
and determination to meet their patients’ needs.
Caroline, Service User Advisor
“Life has changed. Can move around better. Still some
pain. But I’ve now got a part time job.”
Programme participant
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STOP! CHRONIC BACK PAIN
STOP! CHRONIC BACK PAIN
GOLD STARS FOR OUR
SERVICE
USERS
Inspiring courage
Determination, resilience
Capacity for hard work
Commitment to sessions
Willingness to participate, to risk ...
.....to change
and a hearty dose of humour!
STOP! CHRONIC BACK PAIN
OUTSTANDING ACHIEVEMENTS
Earlier intervention =
psychoneurobiological
plasticity !
Statistically significant
results:
emotional/physical
disability
pain catastrophising
Enhanced quality of
life
STOP! CHRONIC BACK PAIN
Half the time =half
the cost!
Non-clinical
settings
YUHASS:
monitor costs:
Prescription
HCP Appointments
Personal costs
Social/welfare costs
2.
Recruitment
3.
Inclusion
criteria
1.
Health
economist
8.
Realistic
time
frame
7.
Patient
volunteers
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ST
4.
Systems:
admin, IT,
finance...
P!
5.
Freeing
staff to run
the project
6.
Changes in
staff team
RECRUITMENT
DURATION OF
OVER-ALL PAIN
6 - 36 months: 8 pts
37 mths – 35 years: 27 pts
DURATION OF
CURRENT EPISODE
PSST...
WHERE IS THE
‘LOST
PATIENT’ ?
2 – 36 months: 30 pts
37 mths – 25 years: 5 pts
STOP! CHRONIC BACK PAIN
ACCESSIBILITY
=
Matching
service to need
Prevention
PREVENTION
PREVENTION
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MIND
BODY
HOLISTIC
support –
e.g.
employment
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SPREADING THE MESSAGE :
PAN DORSET PAIN SERVICES
STOP! CHRONIC BACK PAIN
Do your work with mastery
The Buddha
Like the moon, come out from behind the clouds
Shine
THANK YOU .... to
....... the real
stars ..... our patients
..... our fantastic team
..... Springfield Consultancy
..... HEALTH FOUNDATION
STOP! CHRONIC BACK PAIN