Pain Conf Working Version 1

8/11/2019 Pain Conf Working Version 1

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Biopsychosocial Approach to Chronic

Pain Management: The Selayang

Hospital Experience


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Overview

1. Chronic Pain

2. The Biopsychosocial Model of Pain

3. Pain Management at Pain Clinic HospitalSelayang

4. MENANG Program


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Pain

Acute Pain Chronic Pain


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Prevalence of Chronic Pain in Malaysia

A major healthcare problem worldwide,especially Asia Pacific1

Often neglected due to lack of awareness1

Prevalence of chronic pain in Malaysia is about7% with higher proportion in older age group2

Age group >75 years21.5% in average

Age group


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Challenge to pain management

Most Malaysian adhere to standard medical

model and depend on health care providers as

it was based on the Cartesian model of pain2

However, the Cartesian model is unable to

explain many clinical and social observations

E.g. The presence of pain with the absence of

tissue damage


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Pain defined

International Association of the Study of Paindefined pain as:

An unpleasant sensory and emotionaldisturbances, associated with actual or potentialtissue damage

Pain is always subjective

Many people report pan in the absence of tissuedamageit should be accepted as pain3


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Pain is not the only presenting issue

Chronic pain is a complicated condition

Is a major threat to on multiple levels:

o Physical

o Emotionalo Behavioral

o Relational

o Environmental

82% of patient with chronic pain patients reportedemotional, behavioral and social challenges interferedwith their daily activities4

Quality of Life


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The biopsychosocial model of pain5

Pain

Nociception Pain

Suffering Painbehavior


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Pain Management at Pain Clinic,

Selayang Hospital

Employs a biopsychosocial approach to

chronic pain management for more than a

decade

The first multidisciplinary pain service in

Malaysia


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Multidisciplinary team in Pain Clinic,

Hospital Selayang

Pain specialists

Physiotherapists

Clinical psychologists

Medical social worker

Pain nurses

Promote well-

being andfunctioning of

patients with

chronic pain

In a holistic

manner


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Management of chronic pain

Analgesics

Nerve blocks

Acupuncture Physiotherapy

Cognitive Behavior Therapy

Clinical Hypnosis Etc.


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MENANG PROGRAM2

Group-based pain management

10-days intensive program promoting self-management in pain

Based on ADAPT Programmed at the Pain Management

Research Centre at the Royal North Shore Hospital inSydney

Emphasizes importance of physiotherapy and

psychological interventions Deemphasize surgical interventions and roles of

medications


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MENANG PROGRAM (2)

Patients selection are based on teams assessment and regularmultidisciplinary team meeting

Teaches patients to re-conceptualise pain:

o Education about pain

o Goal setting

o Relaxation and desensitisation training

o Identifying and challenging unhelpful cognitions

o Effective problem-solving

o

Pacing and daily planningo Programmed exercise and systematic encouragement of

activities that limit avoidance behaviours

o Medical withdrawal


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Evaluation of MENANG program2


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Reconceptualizing pain

Complete pain relief is not necessary for

maintaining normal life style, given an active

pain management approach

It is important to have more training and

education for healthcare professionals and the

community on the role of self-management in

chronic pain


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References

1 Malaysian Association of the Study of Pain (2010). ChronicPain Declaration. www.masp.org.my

2 Cardosa, M, S., Osman, Z, J., Nicholas, M., Tonkin, L.,Williams, A., Aziz, K, A., Ali, R, M., & Dahari, N, M (2012).Self-management of chronic pain in Malaysian patients:Effectiveness Trial with 1-year follow up. TBM, 2, 30-37

3 Merskey, H. & Bogduk, N (1994). Classification of ChronicPain. International Association of the Study of Pain. UnitedStates

4 Cardosa, M. S. (2006). Pain Management: Trends andChallenges. Med Journal Malaysia, 61, 2.

5 Loeser, J. D. (1982). Concepts of Pain. Chronic Low Back Pain.New York: Ravens


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Thank you

Documents

Pain Conf Working Version 1