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Category: PBSGL module

  • Multidisciplinary Chronic Pain PBSGL

    Despite studying for a foundation module in pain management, I learnt an awful lot. It was great other members found the biopsychosocial model of chronic pain so useful. It reinforced what I have been learning. I shared some of the resources which are available for general access which I think is essential as we all want to improve patient care. Right at the end, the physiotherapist who attended this session mentioned establishing a chronic pain clinic with education and paced activities at its heart. I am very keen to get involved so volunteered to help. I hope to include neuropathy patients (non-freezing cold injury). My own hypothesis is if we can normalise what these individuals are complaining of, give them a label of chronic pain (albeit of neuropathic origin) and get them to engage with other chronic pain sufferers, I think they will do better. They will feel engaged and empowered.

    Interestingly and once again, we had a physiotherapist attend as an observer but who also played an active part.  He is about to undertake a dissertation as part of an MSc in pain management.  In the end, he was one of the group, contributing and discussing like the rest of us.  Having a healthcare professional from other disciplines in a small group learning environment represents a wonderful opportunity.  There is the possibility of funding for a more widespread study into PBSGL within Defence Primary Healthcare and I hope we can extend it to our physiotherapy and nursing colleagues.

    In the end, we summarised what we had learned and shared the resources.  Here are a few & I hope you find them useful:

    Palouse mindfulness – I shared this after I discovered about it at a psychiatry course.  Well worth a look.

    Head Space as the go-to app (based on evidence, albeit one study, small & undertaken by the app authors!).  Also, highest rated mindfulness app according to another paper using the MARS scale.  I should add, there doesn’t appear to be hard evidence that Mindfulness improves chronic pain.  It enhances acceptability but not intensity, probably by enhancing affective elements.

    ‘Struggling to be me‘ video (plus the healthcare professional opinions – a real eye-opener).  Based on a BJGP paper exploring patients experiences of living with chronic pain.

    www.paincommunitycentre.org – requires registration but a fantastic resource for chronic pain presentations and educational material. UPDATE Unfortunately this website was discontinued on Feb 19.  However, a lot of the talks are available at the Vimeo site.

    pain-ed.com – not thoroughly evaluated but looks good.

    The pain team page at the University College Hospital London – some good videos for patients who want to learn more.

    Understanding pain in less than 5 minutes – YouTube video

    Lower Back Pain by DocMikeEvans – YouTube video

    Am I safe to move – Audio lecture by Prof Lorimer Moseley on pain

  • PBSGL within an interprofessional​ group of doctors.​

    A belated post about my article for the Journal of the Royal Army Medical Corps.  It is available here but alas not in full text.  Indeed I am not sure I am allowed to link to a full-text version as that would make it open access and that in turn makes it expensive to publish.

    Anyhow, it was published, and I am clearly delighted that at the ripe old age of 50, I have discovered chapter 3 (or 4) of my career.  I found the whole process of designing the questionnaire, setting it up on a commercial survey website, seeing the responses come in, importing into Nvivo and doing the thematic analysis fascinating.  After this, relating it to what I had read and understood from the literature, what was replicated, what was new.  I was enthralled, and I can see what makes research so exciting (although this wasn’t research, it was a service evaluation).

    I hope I can do some more work on PBSGL and its impact.  Indeed the next area is to incorporate our Practice Nurse cadre into it, so we have a genuinely interprofessional demographic.

    I think the next areas I am going to divert my attention to are how a GP Registrar and/or a GP answers a clinical question (in response to a DEN) and an exploration of the impact of NFCI on a soldier.  Two completely separate things but also aligning with my day job.  It means more literature searches and more protocol writing, but I think both areas will reveal some rich data and stimulate debate.  My hypotheses (if one can have one when undertaking a ‘service evaluation’) are that the former will throw up some concerns and under-utilisation of Web 2.0/SMS in answering clinical questions.  I think the latter will demonstrate a significant psychological overlay in neuropathy (NFCI) with a subsequent effect on ADLs, and that the first line of treatment should be a set number of early CBT/psychological interventions to mitigate against longer-term disability.

  • Chronic Pain

    After our 2 sessions on chronic pain, we have performed a couple of audits at Bulford.  My own is here: . Tony Dickinson has also done one here:

    I found both sessions incredibly useful.  I am finding I am being more pragmatic with patients and being realistic with outcomes.  I think the main learning points for me have been

    a. what is feeding the chronic pain cycle?  Catastrophising I think is an excellent term.

    b. recording follow up thoroughly in follow up using the 6A’s.  In particular affect, adverse effects and analgesic effect.

    I think there is probably some more work to do on the occupational aspects of strong analgesia.