1. PMP Outcomes

2. Background to Chronic Pain One of the most prevalent physical complaints - defined as prolonged pain of at least 3 months’ duration 10-20% of adults in the general population experience pain of this duration In the UK, more than 50% of patients going to GPs complain of chronic pain but not all seek treatment Chronic pain is typically compounded with other physical, functional and psychological syndromes 61% of those with ‘severe’ pain and significant functional limitation are not working

3. Biopsychosocial Model Views pain and disability as a complex interaction among physiological, psychological and social factors. Biomedical approach assumes a specific, identifiable, treatable cause. Currently no definitive cures for the most prevalent chronic pain syndromes. Holding out the promise for a, non-existent, elusive cure adversely effects people with musculoskeletal pain thereby driving up healthcare costs. Rehabilitation, rather than cure, is the most appropriate therapeutic option

4. Pain Management Programme “Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” IASP No single medication, procedure, or therapy can address all the aspects involved in a complex case of chronic pain. In practice, patients are tried on medical treatment or surgical repair of pathology. Only when they do not respond are they sent to our PMP. Therefore, our patients exhibit higher degrees of pain, disability and mood dysfunction than those undergoing earlier medical interventions

5. Systematic Review - statistics PMPsUnimodal or No Treatment Return to work68%32% Pain Reduction37%4% Activity Increase53%13% Medication Reduction 63%21%

6. Cognitive Behavioural Therapy Aim: to replace unhelpful patient cognitions and behaviours with more helpful ones An individual’s interpretation, evaluation and beliefs about his/her health condition and coping repertoire will effect the degree of emotional and physical disability Interventions may include: self-instruction, developing coping strategies, changing maladaptive beliefs and goal setting. Studies consistently show efficacy of CBT for chronic pain and other chronic health conditions

7. Pain and Healthcare Utilization PMPs can result in a 60-90% of patients not seeking any additional therapy for pain in the year following programme attendance. 50% of conventionally treated pain patients would be subsequently hospitalized compared to 16% of PMP patients. Estimated that annual medical costs following a PMP are reduced by 68%.

8. Depression

9. Average Pain

10. Mental Health

14. Physical Health

15. Catastrophising

16. Benchmarking Table 1 Demographic characteristics of NHS patients and Shaw Trust clients Characteristic Bronllys(n=33) Shaw (n=37) Male1118 Female2219 Age: <30 2 1 30-39 4 9 40-491514 50-59 613 >60 6 0 Mean (sd) duration of chronic pain in years.10 (8.1)5.3 (6.0) t = 2.984 p =.004