Do short courses on Pain Management provoke changes in pain patient management?

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Do short courses on Pain Management provoke
changes in General Practitioners pain patient
management?

• Presented bySimon Strauss adviserMedical Pain
  Education

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• One in three Australian households has one
  or more members with a pain complaint usually
  (80) managed by a General Practitioner.

From The Prevalence of Pain
Complaints in a General Population
An Australian Study. Brisbane.1986.
Fiona Guthrie , Fred Nicolosi and Simon Strauss
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• Little data seems to have been published on

The actual management of pain patients in the
General Practice setting
And whether or not
Educational intervention influences General
Practitioners pain management
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Objectives

• 1. To collect sentinel data on General
  Practitioners management of Initial Pain
  Consultations

2. Assess changes, if any, made following
differing brief educational interventions.
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Overview MPEs Practice Assessment Activities
Sentinel Data 58 medical practitioners 628
Initial Pain Consults
Postal (Pain Tools) 20 medical practitioners 247
Initial Pain Consults
Post Myofascial Seminar 34 medical
practitioners 339 Initial Pain Consults
Post Acupuncture Seminar 44 medical
practitioners 535 Initial Pain Consults
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Overview -Extended for non-lecture attendees.
Knowledge acquisition and maintenance of provoked
changes are not included in this
presentation. The postal group undertook an
educational activity designed to increase usage
of Pain Assessment Tools. The postal group and
the sentinel groups provide a useful view of what
happens in the wild.
Many of the myofascial seminar attendees were
extensively involved in chronic pain management
prior to attending.
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Usage of Pain Assessment Tools
This presentation details the

• Investigation Rates

Referral Rates
Script Generation Rates
In the context of o
Initial / Presenting Pain Consultations
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Usage of Pain Assessment ToolsSentinel Group
of Initial PainConsults
Data acquired prior to attending a Medical Pain
Education acupuncture or myofascial pain
management seminar
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Usage of Pain Assessment ToolsPostal Group
Postal group received written educational
material on the usage of VAS, McGill and Pain
Diagrams
of Initial PainConsults
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Usage of Pain Assessment Tools Pre - Post
Myofascial Seminar 34 GPs 339 Audits
of Initial PainConsults
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Usage of Pain Assessment Tools Pre - Post
Acupuncture Seminar 44 GPs 535 audits
of Initial PainConsults
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The following slides represent the worst case
figures

• That is, they reflect the number of initial pain
  consultations that resulted in the ordering of
  one or more investigations/scripts/referrals.
• Therefore they cannot be used to give the actual
  numbers of x-rays ordered.

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Investigation Rates

of Initial PainConsults
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Investigation Rate Pre - Post Myofascial Seminar
34 GPs 339 Audits
of Initial PainConsults
No clear trend
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Investigation Rate Pre-Post Acupuncture Seminar
44 medical practitioners 535 Audits
of Initial PainConsults
Pre-Post Investigations rates X-rays -35, CT
-31, MRI -50 and Serology -46
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Referral rates
of Initial PainConsults
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Referral rates Pre-Post Myofascial Seminar
34 GPs 339 Consults
of Initial PainConsults
A mixed bag
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Referral Rates Pre-Post Acupuncture Seminar 44
medical practitioners 535 consults
of Initial PainConsults
Physiotherapy referrals -52, Physician -70,
Orthopaedic -44, Neurosurgeon -66,
Rheumatologist -34, Counselling -33
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Script Rates
of Initial PainConsults
127 scripts per 100 Initial Pain Consultations
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Script Rates Pre - Post Myofascial Seminar 34
GPs 339 Audits
of Initial PainConsults
Pre-Post Myofascial seminarAnalgesics 20,
NSAIs -16, Steroids 18, Antidepressants 220
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Script Rates Pre - Post Acupuncture Seminar 44
medical practitioners 535 consults
ofConsults
Pre-Post Acupuncture seminarAnalgesics -38,
NSAIs -24, Steroids -44, Antidepressants - 49
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Conclusions

• Comparison of sentinel and pre to post
  educational activity data reveals that General
  Practitioners pain patients management is
  modifiable by short educational interventions.

The extent of the changes provoked seems to be
affected by the nature of the educational
material presented.
The proposition that the provoked changes could
lead to decreased health care costs has not been
proven but seems to be attractive.
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Medical Pain Education
31 Charlton Street. Southport. Qld. 4215 Tel 07
5531 3810, Fax [phone]
URL www.pain-education.com E-Mail
simon_at_pain-education.com