A novel interdisciplinary model for chronic pain education Sally Curtis BSc, PhD 1 Marilyn Monkhouse MB, FFARCS, FFPMRCA 1&2,Norma Waite BM MSc MBAcC 2 and Cathy Price MBBCH, DCH, FRCA, FFPMRCA 1&2

1 Faculty of Medicine, University of Southampton, Southampton, UK; 2 Pain Management Clinic, Royal South Hants Hospital, Southampton, UKE-mail: S.A.Curtis@southampton.ac.uk

Aim

An interactive interdisciplinary teaching model, integrated with patient experience, was developed to address the needs of chronic pain education for undergraduate medical students. The aim was to enlighten students to the causes and consequences of chronic pain. This approach was adopted to maximise understanding of the multifaceted nature of this condition. The session was embedded within a multidisciplinary pain teaching week. The session was delivered by a physiologist, a pain specialist doctor, a pain specialist nurse and expert patients (Figure 1).Methods

The 2.5 hr session began with a mock video consultation between a GP and chronic pain patient. Students were given a paper-based patient history before watching the video, to enhance understanding. Comment and debate was encouraged to air a range of student opinions. This was followed by presentation of an integrated model for the development of chronic pain (Figure 2). A novel analogy of living with chronic pain as a comparison to the stages of loss was presented and discussed (Figure 3). Real patient volunteers then delivered presentations on the effects of chronic pain on their lives and joined in a Q&A session with the students.

90% of 97 students found the session very useful or useful (Figure 4).

74% said listening to and talking with patients were the most useful aspects (Figure 5)

79% stated it altered their perception of chronic pain (Figure 6);

36% said it helped them gain insight and understanding of the condition 24% stated it had made them more open-minded (Figure 7).Conclusions

The interdisciplinary model was successful in raising awareness of the chronic pain condition

Students value learning from patient experience

This model could be incorporated into any undergraduate healthcare curriculum.

Pain

Tissue heals pain goes

Short-term SNS activity

Altered motor control strategies

Long-term SNS activity –neuronal modification

family issues

compensation issues

emotional factors

aberrant beliefs

Tissue heals Minimizing

thoughts/overload Persistent pain

Feelings of Loss

Tissue heals catastrophising

avoidance –Persistent pain

Tissue heals irritated/depressive

avoidance –Persistent pain

Incident –trauma or

non-traumatic

Incorporating the Fear avoidance/Endurance model

Hasenbring(2000)

Kübler-Ross(1969)

Murray-Parkes(1971)

Denial Realisation Understanding that you have long-term pain that will not go

away

Anger Anxiety/Fear Fear anxiety about what is wrong, why does it still hurt when tissue

has healed? Could it be more serious?

Bargaining Urge to find or search for what is

missing

Try to identify with problem, research, medical tests,

self-diagnosis

Depression Feelings of internal loss of self

Acceptance Identification phenomenon

(Pathological variants of grief)

Poor coping strategies

Identification of new sense of self. Good coping strategies,

good management

Loss of identity, lifestyle, relationships,

independence

How the stages of loss relate to chronic pain

Figure 1. “Keeping Pace with Pain”Chronic Pain Support Group - Southampton

Figure 2. an integrated model for the development of chronic pain

Figure 3. An analogy of living with chronic pain as a comparisonto the stages of loss

0

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40

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60

Response (%)

Very useful Useful Neutral Not veryuseful

How useful did you find this session?

010

20

30

40

50

6070

80

Response (%)

Patients Understandingof chronic pain

Stages of grief Learning aboutpain clinics

What did you find most useful about this session?

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40

60

80

Response (%)

Yes No Maybe

Has this session altered your perception of chronic pain?

05

10152025303540

Response (%)

Gaining insight,understanding, appreciationof living with chronic pain

Realising it is a condition inits own right

Made me more open minded

How has it altered your perception of chronic pain?

Figure 4. Usefulness of the sessionFigure 5. Useful Aspects of the session

Figure 6. Was perception of chronic pain affected?

Figure 7. How perception of chronic pain was affected

Results

References:Hasenbring M.I. 2000, Attentional control of pain and the process of chronification., Progress inPain Research, vol 129, pp 525-534.