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

2. 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”

4. With permission

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

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

7. 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?

8. 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)

9. Barriers to good pain management in developing countries

10. www.wfsahq.org

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

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

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

14. We also need a simple system for managing pain. www.medicinenet.com

15. Essential Pain Management (EPM) Recognize Assess Treat

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

17. Global EPM

19. EPM 2010-2015 41 countries 173 workshops / 4770 participants 56 instructor workshops / 783 instructors

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

21. Xeroderma pigmentosum - squamous cell carcinoma

22. How does EPM work? Simple system Case discussions Local ownership

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

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

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

26. 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

27. The Snowball

28. Evaluation

29. 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.”

31. 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 www.wfsahq.org

32. 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 www.wfsahq.org

33. 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 www.wfsahq.org

34. Would the FAS be useful in LMICs

35. EPM in Arkhangelsk, Russia

37. Colombo, Sri Lanka

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

41. www.essentialpainmanagement.org

42. Join us! Like us on Facebook Epm@anzca.edu.au Roger.goucke@gmail.com www.essentialpainmanagement.org www.wfsahq.org

44. admin@wfsahq.org facebook.com/WFSAOrg @WFSAOrg World Federation of Societies of Anaesthesiologists Subscribe to our quarterly e-newsletter www.wfsahq.org