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Airing Pain 41: Inside a Multidisciplinary Pain Team

A look at how experts from dif­fer­ent back­grounds work togeth­er in mul­ti­dis­ci­pli­nary pain teams

This edi­tion was fund­ed by the Big Lot­tery Fund’s Awards For All pro­gramme in North­ern Ireland.

Pre­sen­ter Paul Evans trav­els to North­ern Ire­land to meet a mul­ti­dis­ci­pli­nary pain team at Craigavon Area Hop­si­tal, includ­ing doc­tors, psy­chol­o­gists and phys­io­ther­a­pists, led by Dr Paul McConaghy. We find out how cas­es of chron­ic pain are dis­cussed by experts of dif­fer­ent dis­ci­plines and how man­age­ment strate­gies are then put into place. The impor­tance of edu­cat­ing GPs about chron­ic pain is dis­cussed, as well as the need for empath­ic and respect­ful professionals.

Paul Evans sees how the team works by sit­ting in on a meet­ing about an exam­ple patient: Dr Sam Daw­son presents the case of a 38 year old woman with chron­ic low­er back pain. Referred by her GP, treat­ment so far has not led to improve­ment and she is now expe­ri­enc­ing depression.

The team dis­cuss the strate­gies they would use in work­ing togeth­er with such a patient. Psy­chol­o­gist Dr Nico­la Sher­lock stress­es the impor­tance of treat­ing depres­sion as it not only hin­ders the man­age­ment of a person’s pain but wors­ens the symp­toms and she and phys­io­ther­a­pist Michele McGe­own explain the impor­tance of deal­ing with pyscho­log­i­cal issues, par­tic­u­lar­ly fear of move­ment, in help­ing patients improve their phys­i­cal fit­ness. The team also talk about how they could use TENS (tran­scu­ta­neous elec­tri­cal nerve stim­u­la­tion) machines to help some patients and how med­ical doc­tors and psy­chol­o­gists can work togeth­er to under­stand how a patient is like­ly to respond to injec­tions. Final­ly, Dr Jim McMul­lan explains how GPs can learn from and com­ple­ment the mul­ti­dis­ci­pli­nary approach by lis­ten­ing care­ful­ly to the patient and tak­ing into account psy­cho­log­i­cal and social as well as phys­i­cal aspects of their condition.

Issues cov­ered in this pro­gramme include: Mul­ti­dis­ci­pli­nary team, psy­chol­o­gy, phys­io­ther­a­py, health­care pro­fes­sion­als, man­age­ment strate­gies, low­er back pain, depres­sion, TENS, phar­ma­col­o­gy, radi­og­ra­phy, tai­lored treat­ment, com­bined clin­ic, fear, anx­i­ety, exer­cise, the biopsy­choso­cial mod­el, man­ag­ing appoint­ments and com­mu­ni­cat­ing pain.


Glos­sary:

  • Red flag: Red flags are clin­i­cal indi­ca­tors of pos­si­ble seri­ous under­ly­ing con­di­tions requir­ing fur­ther med­ical inter­ven­tion. Red flags were designed for use in acute low back pain, but the same prin­ci­ple can be applied more broad­ly in the search for seri­ous under­ly­ing health prob­lems in assess­ing a patient with any kind of acute pain.
  • Yel­low flag: Yel­low flags are psy­choso­cial indi­ca­tors sug­gest­ing increased risk of pro­gres­sion to long-term dis­tress, dis­abil­i­ty and pain. Like Red Flags, yel­low flags were designed for use in acute low back pain but can also be applied more broad­ly to assess the like­li­hood of the devel­op­ment of per­sis­tent prob­lems in patients with any kind of acute pain.

Con­trib­u­tors:

  • Dr Nico­la Sher­lock, Clin­i­cal Psy­cholol­o­gist with an inter­est in Pain Management
  • Dr Sam Daw­son, Registrar
  • Dr Paul McConaghy, Con­sul­tant in Anaes­the­sia & Pain Management
  • Mrs Michele McGe­own, Spe­cial­ist Pain Physiotherapist
  • Sis­ter Bríd McIn­er­ney, Pain Sister
  • Dr Jacek Sobocin­s­ki, Con­sul­tant in Pain Man­age­ment & Anaesthesia
  • Dr Jim McMul­lan, GP and lec­tur­er at Queens University.

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