Health Professionals

Facilitating patients in their goals to wellness can be stressful. I know. I have found many tools to help me cope with stress, all of which I have shared on my website and on the Blog section (2019/Aug/20).

PTSD is a major cause of chronic physical and mental ill health. Beyondtrauma.ca

First rule in care – start with yourself. Managing patients with chronic pain is difficult and can be draining. Another helpful link – Fight Burnout

If you have any suggestions, please help build and improve this website by adding your thoughts to the contact area or to comment sections found on most pages. Thank you for helping families and communites cope with chronic pain.  I have included some research in section Articles

I have outlined Case Scenarios which I hope may help navigating the site. I welcome suggestions and critique.

Forms are a great way to initiate management of Chronic pain.

Forms relating to Pain

Managing chronic pain is an opportunity to manage far more . . .

bridging cultures

 The image above and the image below are from a presentation by Linn Getz.

unexplained physical symptoms

Below is a wonderful video which is just over twenty minutes long but well worth listening to. 

To paraphrase the Linn Getz, the evidence now for chronic disease being seen in terms of the course of a person’s life and their genetic inheritance is no longer a bone of contention. Difficult life situations, adutl trauma, and childhood trauma are the most important riskf factors for disease. “Hardly need any more evidence to act on that.” 

There are many ways to assess trauma – copy and paste this address for an easy form to print in your office. 

Childhood Trauma  ACE Score

Trauma (Stressor) assessment scores: Holmes and Rahe Stress Scale

You can refer your patients to the sidebar area  Stress Anxiety and PTSD

Chronic pain management is a complex problem and there are risks to undertreating pain, as well as opioid use. Consider the legal and ethical implications of pain management.

There are many health professionals who can form part of a multidisciplinary approach to pain management.

Article in BCMJ on Resources in BC and Chronic pain Management.  Web-based Pain Management by Judy Dercksen

There are also physicians dedicated to chronic pain. Here is a great website with helpful tips in managing complex pain: Pain Medical Musing and links to articles on managing pain.

There are many resources available to physicians and doctors to make this approach possible.
Consider referral to Pain BC
Referral to Self-Management BC

British Columbia Resources

For improvement of mental health: Mental Health Improvement Canada

Specialized Clinics can offer invasive pain procedures like epidurals and other steroid infiltrations. These procedures can be used to assess whether more invasive treatment is warranted.

Cariboo:  Cariboo Memorial Hospital

British Columbia: BC interventional Services

Great link to an article on Buprenorphine https://www.wired.com/2005/04/bupe/

Another article with important information – there are some inaccuracies with regard prescribing practise – in Canada – Buprenorphine is prescribed as other opioids on a special prescription. There are certain rules. It is used only off-label for pain – do your research. https://edsinfo.wordpress.com/2018/08/02/what-makes-buprenorphine-risky-for-pain-patients/

People with chronic pain have a hard time understanding the cause of their suffering. When the cause of chronic pain is not obvious, explaining pain is hard.

Healthcare providers may be too busy to provide the time necessary to explain pain. There are many theories as to the causes of widespread pain:

1.   Neuroplasticity and the development of central and peripheral sensitization [1]
2.   Nerve hormone changes (Neuro-endocrine) changes;                                                                      3.   Anxiety                                                                                                                                                        4.  Small fibre polyneuropathy [2]

Small-fiber polyneuropathy (2)
Development of myofascial trigger points (MTP)2
Decreased anti-nocioceptive substances (3)
Increased production of toxic metabolites with exercise (2)
Sleep disorders (3)
Genetic transmission; mechanical traumas; conditions which include autoimmune
disorders, celiac disease and cerebral palsy; and toxins, like alcohol, excess glucose, drugs and
infectious agents.

Once a serious disease has been excluded, healthcare providers can use available resources to
relieve the heavy load of managing all aspects of chronic pain. Referring patients to allied health
professionals and self-management programs will improve patients’ self-efficacy and lead to
long term improved chronic pain.

People living in pain can find it hard to describe the intensity of their pain and how much it
affects their lives. There are many forms available that make such assessments easier. Families
or friends can help those who are too tired or overwhelmed to complete the forms and in doing
these tasks, the support system for the person in pain is often improved.

Physicians play a vital role in the pain management team. They can assess readiness for
change and once patients feel able, can help them navigate the programs and provide support and guidance as they travel through their pain journey.

Pain may require medications, even opioids. Although opioids come with inherent risks, there
are safer options which can drastically alter the quality of a person’s life.
In B.C. the RACE line is a fast and convenient way to consult a specialist pain physician. Physicians can bill for the time spent consulting these specialists. These specialists can assist with the management of the more complex, at risk individuals.
The opioid crisis is only one of many reasons to join the battle against chronic pain, but it is an
important one. It is only by effectively managing people who endure chronic pain that we can
truly assess what role we physicians play in preventing opioid overdoses and deaths.
Join the battle against chronic pain.
Please send any comments your feel necessary or provide feedback in the Community of Pain
Blog area.
Thank you valued member of the Battle against Chronic Pain.

References
1. Staud Roland, Peripheral Pain Mechanisms in Chronic Widespread Pain, Best Practice Res in
Clin Rheumatology, 2011, April; 25(2):155-164.
2. Oaklander AL, Herzog, ZD, Downs HM; Objective evidence that small-fibre polyneuropathy
underlies some illnesses currently labelled as fibromyalgia. Pain 2016, Nov; 157(11) 2493-
2503.
3. Bellato E, Marinin E, Castoldi F, et al. Fibromyalgia Syndrome: Etiology, Pathogenesis,
Diagnosis, and Treatment. Pain Res Treat. 2012; 2012:426130. Published online 2012 Nov 4.
Doj: 10.1155/2012/426130