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

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

3. 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

4. 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..

5. 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.

6. 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.”

7. 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.

8. 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

9. 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

10. 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..

11. 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

12. 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

13. 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.

14. 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

15. Pain Toolkit 15

16. 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: , ‘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

17. Supporting Providers Practice Support Program (PSP) – Pain
Work started September 2012, rollout
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

18. Understanding Pain
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19. Thank you