Shared Care Panel Discussion Caring for your Patient with Low Back Pain

Panelists Moderator: Dr. Julia Alleyne Dr. Brenda Lau Dr. Linda Li Dr. Pankaj Dhawan Dr. Scott Paquette Dr. Michael Look Dr. Tim Dundas

Format Provide the Panel with a Rolling Case Direct Questions to Panel Ask the panel to limit answers to 2 minutes Ask Audience for Questions and Comments Closing Video

Ben al-Backer Ben has had recurrent back pain for 10 weeks He doesn’t remember what happened. He complains of stiffness and tightness in his low back after waking or when he's been sitting for longer than 20 minutes..

Ben’s Life…. He is 32 years old and separated from his wife but has partial custody of his 3 year old son and is finding that he can’t bend down to lift up his son without experiencing excruciating back pain. He works as a self-employed taxi driver, which he finds very uncomfortable. He often has to stop to get out and walk between fares. He thinks that he may need to apply for bank loan if he can’t work and will need to pay for therapy on top of everything else.

Ben’s Voice…. “My biggest concern was that I went from being this active guy to a couch potato. I am having trouble working, taking care of my son and I can’t even go out with the guys. I can’t go to sleep without sleeping pills, and I have to sleep in a nest of pillows. This is really getting me down.”

Panelists Ben’s last words are ringing with you, I can’t go to sleep…What do you do with a patient with low back pain and trouble sleeping ? Q1 Pankaj Sleep, risk of Chronic pain, Myofascial Tension, short term Muscle relaxants only Education on posture and pain management.

Panelists What do you think the patient expects from the visit and from you as a clinician ? And , how do you manage these? Q2 Mike - Common Expectations- Investigations, referrals Funded therapy Time off work Education, plan of action

Panellist What about time off work ? Will this help? How much ? Modified Duties ? Q 3 Tim Dundas Creating Disability Needing to self-pace, modifications Giving the patient language

Ben al-Backer Ben has had recurrent back pain for 10 weeks He doesn’t remember what happened. He complains of stiffness and tightness in his low back after waking or when he's been sitting for longer than 20 minutes..

Panelists What treatment would you suggest for Ben ? How can you engage him in self-management? Q 4 Linda Li Non-Pharmacological Pain management Role of Exercise Activity Management Community Resources

Panelist He has leg pain, does he meet surgical criteria ? What about escalating pain Q5 Surgical Criteria - Scott Explain surgical emergency as Cauda Equina, stats on rarity, how not to miss Explain surgical referral criteria, what type of back pain does surgery help What is recovery like? New and updated techniques

Ben’s Life…. He is 32 years old and separated from his wife but has partial custody of his 3 year old son and is finding that he can’t bend down to lift up his son without experiencing excruciating back pain. He works as a self-employed taxi driver, which he finds very uncomfortable. He often has to stop to get out and walk between fares. He thinks that he may need to apply for bank loan if he can’t work and will need to pay for therapy on top of everything else.

Panellist We are back to pain management, what would you do ? I can’t ignore the yellow flags, does this influence you ? Pain Management Principles, Yellow Flags, Medications, Overall all approach

Pain Toolkit www.painbc.ca 15

Mon-Fri 8am-5pm: 1-877-696-2131, ‘0’ Pain Supporting Providers RACE telephone advice (Rapid Access to Consultative Expertise) Shared Care Committee initiative. GP to specialist urgent advice access – within 2 hours GP and specialist can both bill for the call Multiple specialties Pain added as a pilot April 2012 for Lower Mainland Pain to become a provincial resource Continued GP management Mon-Fri 8am-5pm: 1-877-696-2131, ‘0’ Pain Types of calls: What else can I do? What other resources? Patient on waitlist, is there anything I can do in the meantime? I started this drug, am I doing right? I am worried about the opiates in this patient I inherited from the hospital? etc 16

Supporting Providers Practice Support Program (PSP) – Pain Work started September 2012, rollout 2013-2014 BCMA led – GPSC funded program helping GPs with chronic condition patients. Province-wide funded GP education and consideration of specialist funded education Interesting aspects: Mentor-Mentee networks to expand capacity using e- technologies and preceptorships Use of pain champions in hospitals Non-MD health professionals involved So we see this as targeting multiple layers and types of HCPs I’ll explain more about mentorship in a bit when I get to Nova Scotia Other HCP will be involved in the development and we hope into the mentorship groups as well. Mentioned earlier the collaborative community multidisciplinary type intermediate clinic going forth in Cowichan DoFP 17

Understanding Pain http://www.bing.com/videos/search?q=Understanding+Pain&view= detail&mid=9D4C9994C877EC9C9FFB9D4C9994C877EC9C9FFB &first=0&FORM=NVPFVR

Thank you