Chronic Pain Self Management

Professor Michael Cousins took some time to read and comment on ‘Is chronic pain a disease in its own right‘. It was so good that we didn’t want it to get lost at the end of the comments section so we have made it a post in its own right. Here he is:

Recognition of chronic pain as a chronic disease is not only a key element of the National Pain Strategy (painaustralia.org.au) - it is also a key principle of the prestigious Institute of Medicine(IOM) report to U.S. Congress – Relieving Pain in America, a Blueprint for Transforming Prevention, Care, Education and Research.

Both reports result from the concerted efforts of a wide range of scientists, clinicians, consumers and community. Driving forces behind these efforts are the documented deficiencies in the management of all pain, but particularly for those suffering chronic pain. Extensive changes to education, training, attitudes and practice are needed (see ref 1 below), and this will accompany the recognition of chronic pain as a chronic disease.

In my experience post National Pain Summit, patients, carers, community and government do understand the concept of chronic pain as a chronic disease, if appropriately explained. This is exemplified in the cover story of Time magazine (Understanding Pain, Time 2011, March, page 30-34).

With respect to other bloggers, it is important to realise the critical nature of what is at stake here : the allocation by Governments of resources for improved clinical care, education and research. Therefore I strongly urge people to read the recommendations of the National Pain Strategy.

These recommendations are already being implemented in Queensland with funding of $39 million, and are currently under consideration in NSW, following a Ministerial Task Force report.

I also urge you to read in detail the case assembled in the paper by Phil Siddall and I in 2004 (see ref 2 below). Briefly, we propose that the disease of chronic pain consists of physical, psychological and environmental changes, all of which represent maladaptations. Often the changes (and the pain) become rapidly worse. Whist in recent studies brain imaging reveals brain changes that correlate with pain severity, there is long standing evidence of psychological and environmental changes that also make a strong case for a ‘disease.’ Importantly effective treatments are associated with reduction in the bio-psycho-social changes associated with this disease.

In the Siddall – Cousins paper, we discuss implications for assessment and treatment. Step 1 is to identify any underlying treatable condition, ‘red flags’, for low back pain. Thus the adoption of chronic pain as a disease (and associated measures) will result in improved assessment and treatment of chronic pain (ref 2).

Why has there been little progress in treatment of chronic pain? Lack of a clear, understandable message about the science and treatment of chronic pain. In Australia and America we now have an opportunity to make major progress. Similar initiatives are underway in Canada and Europe.

Prof. Michael Cousins Chair, National Pain Summit/ National Pain Strategy.
Chair, IASP International Pain Summit.
http://bodyinmind.org/prof-cousins-response-is-chronic-pain-a-disease/

Chronic Pain Self-Management

Benefits to the Health Care System and People living with Persistent Pain

When a person who is living with persistent pain learns to incorporate the tools of the Chronic Pain Self-Management Program, (CPSMP) the Stanford Model, good things happen. Good things for the person living with persistent pain and their family, the healthcare system, the community and the economy.

This Stanford Model of pain self-management has been proven to help people living with persistent pain help in the self-management of their pain and improve their quality of life. For the past 20 years, Stanford Patient Education Research Center (formerly the Stanford Arthritis Center Education Office) has developed, tested, and evaluated self-management programs for people with chronic health problems.
The Chronic Pain Self-Management Program (CPSMP) aims to improve coping strategies and quality of life for people who have a primary or secondary diagnosis of persistent pain. The CPSMP was developed by Sandra LeFort, PhD, MN, and RN in 1996 at McGill University in Montreal and later updated at Memorial University, St. John's, Newfoundland, Canada with Lisa (Cardas) Sulyok, RN of Toronto, Ontario. It was developed in conjunction with Dr. Kate Lorig of the Patient Education Research Centre, Stanford University, and Palo Alto, California and derived from Stanford’s Arthritis Self-Management Program and the Chronic Diseases Self-Management program. It was revised in 2008 and a new Chronic Pain Workbook was written to accompany the program. This same workbook will be available for use as People in Pain Network roll out this program to our local community level chronic pain peer support group members. In addition, Pain BC Society, a non-profit organization made up of patients, health care providers and others with a passion to reduce the burden of pain in B.C endorses and links patients to the CPSMP. We have established an ongoing partnership to continue with Pain B.C and People in Pain Network for providing CPSMP.
In 2009 this program was added to the University of Victoria's Centre of Aging's CDSMP. The program has been shown to be safe and effective in helping people improve the quality of their lives. Research has shown that when trained peer leaders teach this program, participants report higher levels of credibility in the information and more willingness to incorporate the tools into their lives.Statistics have shown that one in five Canadians live with persistent pain, costing billions of dollars in healthcare costs and major losses in national productivity. Persistent pain costs the Canadian Healthcare System more than diabetes, HIV and cancer put together. The Canadian Pain Society has reviewed statistics that estimates that currently persistent pain costs the Canadian economy and health care system over $60 billion dollars annually. This number is expected to increase with the demographics of an aging population nationwide increasing the burden of care on our health care system.Without the delivery of Chronic Pain Self-Management Program, (CPSMP), these costs will continue to escalate with little or no help being provided to the patient.
In 2008 the Centres of Disease Control and Prevention and the National Council of Aging studied the Stanford CDSMP and made the following statements;
"There is evidence that the CDSMP results in a reduction of healthcare
expenditures"

● In four studies there were fewer emergency department visits
● In three studies there were fewer hospitalizations
● In four studies there were fewer days spent in hospital
● In two studies there were fewer outpatient visits.

As people living with chronic pain begin using the tools and skills taught in the CPSMP, along with an improvement in their quality of life, the following benefits to the health care system have been documented.

● As the pain sufferer learns to accept and take responsibility for the management of their pain, healthcare costs are reduced due mainly to a reduced need to access the healthcare system.
● As a person's general health improves, both physically and emotionally, there is a decrease in the need to consult their family doctor.
● A reduction in the number of acute flare-ups of their pain reduces trips to emergency departments and medical clinics.
● With the understanding that persistent pain is a chronic disease and not a symptom of something else, the need to visit the doctor’s office, specialists and for repetitive diagnostic testing decreases.

Benefits of Partnering with People in Pain Network (PIPN)

You will be aligning with a non-profit patient organization with vision and mission statements that are supported by a solid strategic plan that reflects the values of PIPN board.
nationally. People in Pain's Network's strategic plan to continue to develop local level peer support groups nationally, and to continue to roll out the CPSMP to these groups, presents the opportunity for your company to be seen supporting patients

You will be aligned with a patient driven organization (People in Pain Network) that has over 20 years of previous experience in peer support group development and in helping people manage their pain.
organization (People in Pain Network) with
connections with National and
Aligned with a patient driven Provincial organizations including:-
● Canadian Pain Society
● Canadian Pain Coalition
● Alberta Pain Society
● Pain BC Society
● University of Victoria's Centre of Aging, CPSMP
● Presently working with fourteen local support groups
● Supporting the government ministries of health initiative in programs built to support teaching self-management skills and which provides a guide for people and families living with persistent pain for improvements in daily living and quality of life.
● Providing support and resources to an organization that promotes self-management for patients whereby providing a balanced portfolio between pharmaceuticals and non-pharmaceutical approach to healthcare.