Essential Pain Management A System for Managing Patients with Pain Dr Roger Goucke Dr Wayne Morriss Dr Linda Huggins

Plan Pain education – the need for a system Outline of EPM EPM principles and development Disclosures No conflicts of interest Co-author of “Essential Pain Management”

With permission

The Global Burden of Pain Trauma Post-operative Childbirth Arthritis Back pain Diabetes Cancer HIV-AIDS Sickle cell disease

Pain Education APPEAL study (2013) 15 European countries 242 medical schools Little or no teaching Not dedicated Not practical

Pain Education IASP Task Force for Developing Countries (Bond et al, 2007) – 49 countries / 189 respondents – Findings Undergraduate training is inadequate – 90% considered training inadequate – 80% did not receive formal training Specialized postgraduate training is variable Other postgraduate training?

BARRIERS TO GOOD PAIN MANAGEMENT 85% Lack of Education 65% Government Policy 55% High cost of Drugs 50% Poor patient compliance 90% Fear of opioid Addiction Question 32. In your country, what are the barriers to good pain management? (select all that apply)

Barriers to good pain management in developing countries

What is Needed to Overcome these Barriers? Better Training ( 1 = needed least, 5 = needed most)

Barriers to Pain Relief Pain & Policy Studies Group Knowledge Attitudes Policies

A System? TraumaPain Multiple causes Team management ABC systemNo system ATLS, PTC training?

We also need a simple system for managing pain.

Essential Pain Management (EPM) Recognize Assess Treat

What is EPM? One day workshop Doctors, nurses, other health workers System for managing pain System for teaching others about managing pain

Global EPM

EPM countries 173 workshops / 4770 participants 56 instructor workshops / 783 instructors

Reconocer Analizar Tratar R Nhận biết A Đánh giá T Xử lý R การตระหนัก A การประเมิน T การรักษา

Xeroderma pigmentosum - squamous cell carcinoma

How does EPM work? Simple system Case discussions Local ownership

K.I.S.S. Any fool can make something complicated. It is hard to make something simple.

The EPM RAT Recognize Assess – Severity – Classification – Other factors Treat – Non-drug – Drug treatments

Case Discussions Level of discussion depends on the group Local relevance Local solutions

Local Ownership 1-day EPM workshop 1-day EPM workshop Half-day instructor workshop Half-day instructor workshop 1-day EPM workshop 1-day EPM workshop 1-day EPM workshop 1-day EPM workshop Day 1Day 2Day 3

The Snowball

Evaluation

Some Feedback “EPM has changed my mind set-up.” ”EPM has changed so many wrong ideas about pain management.” ”This needs to become part of every medical school's curriculum!! I would have been more effective in clinic work if I had this knowledge earlier on in my studies.”

Health Workers Lack of knowledge (especially chronic pain) Afraid of complications of morphine Not organised Lack of cooperation with surgeons Not being aware of the emotional aspects of pain

System Issues Lack of leadership in Pain Management No Support Complicated administrative structure Limited prescribing rights, especially morphine Health insurance may not pay for pain medications Not all medications are easily available

Patient Issues Don’t complain about pain Accept their pain even if can’t function Fear of treatment Listen to the surgeon more than other doctors Cost of analgesics

Would the FAS be useful in LMICs

EPM in Arkhangelsk, Russia

Colombo, Sri Lanka

Essential Pain Management Pain management needs a systematic approach EPM provides a system – For managing patients – For teaching others EPM Lite – Undergraduates

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