practice partner
Primary care professionals met recently to discuss de-indentified
cases through videoconference.
it will be 8 out of 10. Doctors keep increasing doses,
thinking more is better, and all they’re doing is creating
a mix that can lead to addiction.”
“Acute pain is a symptom that something is wrong
with the body, while chronic pain is a disease,” Dr. Furlan continues. “In most cases, chronic pain doesn’t have
a cure. But we can do a lot of things for patients to help
them lead a better life.”
Focus on function, not pain
An estimated one in five Ontarians suffers from moderate-to-severe chronic pain (non-cancer) daily or most
days. It’s one of the most common reasons that patients
visit their doctors. ECHO Ontario notes that these
patients can be complex and costly, often with double or
triple diagnoses (physical, mental health and addictions).
As ECHO participants have learned, sometimes
alternative therapies like exercise can help. Pain rehabilitation and occupational therapy might also provide
44
better functional outcomes. Simply talking to chronic
pain patients about goals can make a difference, says
Dr. Declan Rowan, a family physician in Petawawa and
an ECHO spoke participant.
“Now I might shift the conversation,” he says. “Instead of asking ‘How’s your pain?’ I’ll ask if they’ve been
able to get out and walk or go shopping, or about their
relationship with their spouse. We’ll talk about what’s
important in life for them, and improving function. So
I’m not focusing on the pain score. It’s important, but
it’s not the only thing we dwell on.”
Dr. Rowan says health-care professionals want to
relieve suffering, and become frustrated when they realize that sometimes they lack the skills. With ECHO,
“I connect with practices all across the province, so
feel much more confident that I have resources to tap
into.”
In Thunder Bay, Dr. Claudette Chase, a family physician who works mainly with First Nations communities, has also signed in for the videoconferences. She
says ECHO “decreases my sense of isolation”.
“Before, I was overconfident that my knowledge was
up to date,” she says. “I see so many patients with this
complaint. … I tended to lump people into a basket
of chronic pain, instead of teasing out what was going
on and treating that.”
Dr. Chase says having case discussions and hearing
views from multiple disciplines, makes the information in the ECHO sessions come alive. “I learn much
better through stories. It feels more real than a straight
didactic session at a conference.”
Dr. Dubin, who is also Chair of the College of Family Physicians of Canada’s Chronic Pain Committee,
mentions the GAG reflex – Got Another Guideline.
“You’re overrun by them, and the information isn’t
always easy to get. Here, there are just discussions on
the best practice information.”
What does success look like in chronic pain management? “I tell my patients that everybody else tries to
treat the symptom; I try to improve the person,” says
Dr. Furlan. “When you treat the person you increase
resilience. The pain might still be there but it doesn’t
dictate what you do. You’re in control of your life
again.”
Dialogue Issue 1, 2015
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2015-03-19 11:18 AM