1. Chronic Pain Self Management Program

2. CPSMP
CSMPs developed at Stanford University using the principles of self-management and self-efficacy (Dr. K. Lorig)
CPSMP developed by Dr. Sandra LeFort (Nurse – McGill University)
The Arthritis society offers the same 6 week program but is Arthritis based
For those that can’t commit to 6 weeks, the Arthritis society also offers a 1 day workshop which covers almost the same content
Contact CCAC for further info on their Chronic disease program

3. Overview
Foundational points of CSMPs – focus on self-efficacy theory (Stanford University Approach)
Demonstrate how these processes have been incorporated in the pain program
Overview of the 6-week program
Evidence – is this worth our time?
Referral process
Every FHT has physicians, nurse practitioners and nurses.
Other providers can include: social workers. dietitians, pharmacists, addictions counselors, psychologists, chiropodists, etc.

4. Definition of Self-Management
The individual’s ability to manage the symptoms, treatment, physical and social consequences and lifestyle changes inherent in living with a chronic condition.

5. Basic Self-Management Prinicples
Willing to learn and take responsibility for daily management their chronic pain
Tasks (take care of own health, complete normal activities, manage their emotions)
Focus on taking some responsibility for managing their health

6. 5 Core Self-Management Skills
Problem Solving
Decision Making
Use Resources
Partnership with HCPs
Take action for change

7. What is Self-Management Education?
Programs based on adult learning principles, that provide patients with the 5 core skills to live an active and meaningful life.
Maintain a wellness focus to improve QOL
Come to terms with their “new self”

8. CPSMP Early Origins
Provide patients with behaviour change strategies (exercise, nutrition, etc.) → lead to active self management
Early studies – found no differences in outcomes (despite exercising more, eating better, etc.)
Change approach using self-efficacy theory

9. Self-Efficacy Developed Albert Bandura (Stanford)
The exercise of human agency through people’s beliefs in their capabilities to produce desired effects in their actions
Need to believe you can attain the goal!

10. Theory of Self-Efficacy
Not as simple as knowing what to do
Must believe in your ability to organize and integrate cognitive / social / behavioural skills to achieve control over everyday circumstances

11. Four Key Components of Self-Efficacy
Skills mastery – opportunity to practice in a supportive environment
Modelling – peers … “if they can do it … I can do it”
Re-interpretation of symptoms – cognitive re-framing; examination of illness related beliefs
Social persuasion – gentle encouragement by peers / family / friends / HCPs (action plan)

12. CPSMP
A standardized, Community-based education program (adapted CDSMP)
Based on the self-management & self-efficacy theory
Runs for 2.5 hrs per week for 6 weeks (10-16 participants and two facilitators)
2.5 hrs but a break is offered, and suggest participants to bring pillows/back support, or stand and move around to keep comfortable
We only have a few Living a Healthy Life books so they are able to borrow them for a week at a time
Confidentiality in the group, except in suicidal or threatening situations

13. CPSMP Content Self-management (concept) What is chronic pain
Pacing (balancing activity / rest)
Exercise
Using your mind
Dealing with difficult emotions
depression

14. CPSMP Content Con’t Fatigue Medications Communication – family / HCPs
Evaluating non-traditional treatments
Weekly contracts / problem solving steps

15. Strategies Used in all Stanford Self-Management Programs
Mini-lectures (information sharing)
Self-reflection (how chronic pain affects their lives)
Quiz (common myths)
Brainstorming
Weekly action plans (process of attaining short term goals)
Feedback
Group problem solving
Mid week phone call

16. CPSMP Model Content may change – but process must be consistent:
Action plans (weekly, acheivable)
Feedback (action plans)
Modelling - for each other
Reinterpreting symptoms / changing beliefs (cognitive re-framing)
Persuasion – seeing peers succeed in class / facilitator encourage to “do a bit more”

17. LeFort et al. Pain 1998; 74(2-3): 297-306.
Evidence
2 RCTs funded by Health Canada & Canadian Institutes for Health and Research (CIHR)
110 patients with mixed idiopathic chronic pain
75% female (mean age 40y, ~ 6 year hx pain)
Randomized to intervention or 3-month wait list control group
Self report measures of pain & QOL indicators
LeFort et al. Pain 1998; 74(2-3):

18. LeFort et al. Pain 1998; 74(2-3): 297-306.
Evidence Con’t
102 patients completed the study
Data collected pre and 3 mos post study by blinded assessors
Results: significant short term improvements in pain, dependency, vitality, aspects of role functioning, life satisfaction, and self-efficacy
LeFort et al. Pain 1998; 74(2-3):

19. What are Patients Saying about the Program?
Having their voice heard
Felt that they were not alone
Share with others who understand
safe environment
Able to take ownership of their pain
Learning from others / help others
Hope / direction

20. Principles of Self-Management Education:
Active self-managers are willing to learn about and take responsibility of their daily management of chronic conditions, and are able to:
Take care of overall health
Carry out normal activities
Manage emotional changes

21. Suggestions for Referrals:
Chronic (> 3 to 6 months)
MSK
Fibromyalgia
Diabetic neuropathy
Whiplash injuries
Persistent headaches MS

22. Week One Introduction- identifying common feelings
Workshop overview and responsibilities
Debunking myths about chronic pain
Differences between acute and chronic pain
Understanding the pain and symptom cycle
Introducing action plans
Introduce themselves and their story, this can be a very emotional but bonding time for the group
What chronic pain means to me
Reinforce the commitment to attend all 6 sessions as able
Lots of emphasis on the pain and symptom cycle
Introduction to action plans We offer to call them mid week to follow up how they are doing with these

23. Week Two Feedback and problem solving from the past week
Introduction to physical activity and exercise
Pacing-balancing activity and rest
Better breathing and progressive muscle relaxation
Making an action plan
Start with problem solving and brain storming from the group- use problem solving steps
Lots of stress placed on the importance of physical activity and breaking the P+S cycle
Practice breathing exercise, dim the lights and do progressive muscle relaxation with background music
Work on an action plan for next week
Find a buddy, we no longer call them this week but they join a buddy system in the group

24. Week Three Feedback and problem solving Moving easy program
Dealing with difficult emotions
Using the mind: distraction
Fatigue and sleep management
Guided imagery relaxation
Making an action plan
Again with the problem solving as a group
Use the CD for the exercise program
A listening exercise for dealing with difficult emotions, partners report for the other
Distraction- count backwards by 3’s, thinking of a flower or bird for every letter of the alphabet
An exercise of thinking about your pain, time this for 30 secs, now try a distraction technique and time this for 45 secs- Ask how they felt the difference
Sleep tips- lots of resources and ideas in the book, a good sharing topic
Guided imagery- background music
Again action plans for the week

25. Week Four Feedback and problem solving Moving easy program
Communication skills
Healthy eating
Problem solving
Making an action plan
Again feedback and problem solving as a group
Improved communication skills
Canada’s food guide but lots of group interaction with their own ideas of ‘what helps their chronic pain’
Focus on problem solving skills without the team approach
Again an action plan for the week

26. Week Five Feedback and problem solving Moving easy program
Medications and chronic pain
Depression
Positive thinking
Visualization
Making an action plan
Only individual issues and how they problem solved this week
Information on different types of pain medications and how they work (offer RPh as needed)
Talk about the difference between physical dependence and addiction
Dealing with the blues and depression – group ideas of how to help with these feelings
Steps towards positive thinking
Visualization exercise with background music
Again an action plan for the week

27. Week Six Feedback and problem solving
Making informed treatment decisions
Working with your healthcare provider
Communicating about pain
Moving easy program
Looking back and planning for the future
Making a long term action plan
Evaluating treatment options out there, how to determine a legitimate suggestions vs. sales gimmick
Researching on the internet and value based sites that originate from university, government or healthcare based sites
Problems with healthcare organizations or providers and how to improve these- try to mend the bridge!
Patients may be making more frequent appts to follow up – but hopefully the quality of these appts will be improved as well
Communicating- using tools in the book, photocopy some of the pages- pain profile, describing words, the intensity scale
Looking back and summarizing all the tools covered in the toolbox- using various ones to break the pain and symptom cycle
Look at goals for the next 3-6 mths-how do you plan to get there, confidence levels
Group persuasion is felt by seeing others succeed to do ‘a bit’ more
Pull up the “What chronic pain means to me” list and ask how they feel now- list the differences – this can be enlightening to most !
Short visualization exercise to reinforce positive feelings about the progress made during the past 6 weeks
Encourage members to stay in touch either with their buddy or form a contact list if they are interested.
Evaluation survey to be completed

28. CPSMP-TVFHT
Sessions are offered a few times throughout the year but as referrals come in they are placed on a waiting list for next group
We also have access to other sites and their programs if evening session or other site preferred