Nick Wilkinson Paediatric Specialist in Rheumatology and Chronic Pain University Hospital Wales Objectives Challenge assumptions about pain What it represents and what it does not Explain pain processing ID: 1043468
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1. Chronic Pain in Children and Young People Nick WilkinsonPaediatric Specialist in Rheumatology and Chronic PainUniversity Hospital Wales
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4. Objectives Challenge assumptions about painWhat it represents and what it does notExplain pain processingDiscuss some of the language of pain How to help patients with chronic pain (before it becomes disabling)
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8. Prevalence of severe chronic painin a large school population Perquin et al., 2000
9. Perquin 2000, PainShead 2011, J Pain
10. MSK pain in primary care5-10 % in two other studies Henschke 2014 BMC
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12. Key points - IPain is common
13. Key points - IPain is common Pain score is not a marker of tissue damageBut is of distress or threat
14. What is the point of pain?
15. Key points - IPain is common Pain score is not a marker of tissue damageBut is of distress or threatPain score is entirely subjective or personal Comparisons between conditions is pointlessPain is not the fifth vital sign
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17. There is not a pain nerve
18. Interactions of nerves
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20. ContextLocaliseArousalAnxietyExpectationHappinessBeliefsExpectationGenetics
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26. TouchWarmthMovementTrustExplanation Goals
27. Key points - IIBe careful of a mind v body approach to painPain becomes self fulfilling unless challenged But in the right wayThe role of medication is limited
28. Case 2: getting it right first time15yo girl – emergency referral7mo increasing back & neck painSeen by 9 different teams / services3 x MRI (and other tests)Admitted for 10 daysMedicationMRI repeatNo improvementReferred and seen urgentlyThe importance of understanding and explaining painEnsuring a patient feels heardEffective reassurance Careful choice of languageAcknowledging complexityOne size does not fit all Build a community
29. Triaged model; matching resource to need i-THRIVE toolkiti-THRIVE Academyi-THRIVE communities of practiceSimilar to Thrive mental health model
30. Asset based healthcare
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32. Regional developmentsRegional connections >100 staff43 physios Multiple strategies forTeachingCoachingProblem solving = named therapists = new therapy led pain service
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34. Value based healthcareLow levels of staffing 0.5 WTE consultant1 WTE physio1 WTE OT1 WTE psychologist Reduced redundancy RhEvE system of care RhEve workshopsRhEve regional meetings and communities of practiceCost (millions)
35. Summary We all have a role to playThis role needs rehearsing and developingNot alone Manage as teams …. beyond organisational boundariesAnd beyond healthcare
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38. Case 2: Redundancy in current model of care15yo - 7mo Hx back & neck painSeen by 9 different teams / services3 x MRI (and other tests)Admitted for 10 daysMedicationMRI repeatNo improvement Referred as an emergency The importance of understanding and explaining painEnsuring a patient feels heardEffective reassurance Careful choice of languageAcknowledging complexityOne size does not fit all Build a community