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.