Fast track pain management - video transcript
JAY WHITTEM:
Hi. I'm Jay. I'm the project lead for Fast Track Pain Management, where we as a multidisciplinary team delivered evidence based care to people living in persistent pain to the rural areas of Cairns hinterlands. We were a multidisciplinary team involving physios, psychology, pharmacy, a pain medical specialist and an Indigenous liaison officer not only delivering clinical services but helping to build capacity of the people in the community, clinicians in the community.
We proved this model worked. Patients were able to get back to doing things that mattered to them. We we showed this through functional measures, but also they required ED less.
As a whole, 84% less once they'd seen us. Patients really find it difficult to travel long distances to access pain services. So traveling for at least the initial appointment patients really valued us, delivering care closer to their home.
MICHELLE:
I did not suffer chronic pain. And then one day, just this, literally one day I woke up and couldn't walk on my left side just out of the blue. I had no pain leading up to that. I just couldn't put any weight. And from that point on, I suffered pain and it just never went away. It's exhausting because people don't realise it's 24 hours a day that you're in pain from the minute you wake up to the minute you go to sleep and sometimes you don't sleep because you have it.
It makes you lose hope. You feel like you can't go out and do the things that you used to do with your friends. So you become a little bit isolated. It's depressing. Very depressing. I was scared to walk 10 minutes. I wouldn't even do that. That terrified I was. And when when your pain is really bad, you think really bad things.
ANNETTE BUSH:
Because somebody for whom pain is part of everyday life, it cannot be understated. The discomfort and the difficulty of arriving at appointments. There's often a little bit a lack of understanding, I guess, in the mainstream health system that when patients don't come to an appointment, that it's seen as like some sort of major failing on the part of the patient.
But even some of our patients that we saw in Atherton you know, they might be coming from more than an hour further beyond Atherton. So to come to care for those patients would have involved more than a six hour round trip to come to a pain appointment. So I think by going out to these areas, we actually took a degree of health care that would not be available to them, not just difficult for them, but not be available to them. If we hadn't have traveled.
JAY:
It was really the going out to the towns and doing a lot of listening. We call them focus groups. It was really listening, listening to GPs, the hospital clinicians, the patients, what they wanted. If we have a great team, how can we best help you?
DR YVETTE MORCOS:
From my experience being up here, the waiting time to see a pain specialist was quite lengthy. It'd be months and months and months. So when Fast-Track came in, my patients were being seen much quicker, and so the efficiency improved. One of my patients especially had read an article about the fast track pain. He actually asked me about it. He said, I've heard about this group. So he was actually thrilled.
JAY:
Okay. So it seems like reducing the wait times was one of the key gaps we wanted to address. Was there any other emerging issues?
YVETTTE:
Unfortunately, I couldn't get every patient to see the Fast-Track Pain Team. So that problem still exists and I would very much like them to be seen again. I guess it would be helpful if the procedures could be done maybe locally and if maybe at the start you guys could come regularly so that every patient with an issue could be reviewed here, but we'd still take it even if you had it elsewhere.
Yeah, because my patients had great success, completely pain free now. So it's wonderful on no medication. Being off everything and living the life they wanted to is really important and it lifts depression, makes you go out, have fun, go back to work. Instead of always thinking, Oh, if I go out within 5 minutes, I'll be in agony. So I can't, you know, it's just changed their lives.
JAY:
It is really nice when you do hear that stories of people that either reduce their pain or become pain free. I think that's, you know, that's that's absolutely fantastic to hear. But that's not generally not the message that we want to sell to patients or set any expectations. It's really to self-manage their pain so they can get on and do what's important to them and live the life that they want to live.
JOSHUA:
About a year ago, I was struggling really severely with mental health. I was very suicidal, very, very depressed, and my pain was flaring up as well, like it was the worst that ever been. I couldn't I didn't want to move at all. I just walking is a basic thing, a human, regular person, wouldn’t think twice of doing.
And when you can't do it, it's one of the worst feelings in life. Feels like pure entrapment from your own body. And since I've joined with the Fast Track Pain Program, I've been able to, I guess, just adapt my strategies and my understanding of my pain. And that's what that program showed me. That's what it taught me was that my chronic pain isn't me and I can still function even through my chronic pain.
Chronic pain is the traumatisation of your nervous system. So in my case it was, and that there is more likely some sort of reason that it's traumatised. But I don't remember it. And it's put my mind at ease that I'm not in pain for no reason. I have a reason. It's that my body is damaged and I'm trying to let it heal slowly.
PENNY MACKAY:
And I think the patients themselves don't realise, you know, psychology plays a role in persistent pain or some of these different disciplines play a role. I think a lot of the patients are very much stuck in that biomedical model of treating their pain just from a purely medicine perspective. So they don't see that role of psychology in terms of looking at how pain can affect their whole lives and how what they've actually experienced in their lives can impact on their pain as well.
So I think because they're not aware of that, they don't necessarily access those services. When you don't have those services available, it is easier just to see your GP and get prescribed medication. You know, I think that's a lot of what we saw as well, that a lot of patients had been relying very much on that medication.
JAY:
It sounds like you found the service was a high value to the patients.
PENNY:
Absolutely. Yeah.
JAY:
We’re off to Atherton to see a GP and she also coordinates a lot of GP education sessions across the tabelands. The GP education component I felt was significant. So for two reasons. One, the GP felt that discussing contemporary pain management was really beneficial for the high capacity building. But two, I felt that GPs were having a deeper understanding of our model of care and what we offer. It just meant that we were sending the same message to the patients.
So how does that differ to just accessing Allied health in the community? Why is fast track different from that?
DR LAURA VALLERINE:
I think having you guys that are interested in it and that educating the patients was helpful. But I found it easier as well to convince patients that I thought it would be helpful for them to go and see the chronic pain team that involved multiple different allied health specialists rather than “Can you please go and see this person and this person and this person” as a separate entity.
So a lot of them might be okay to go and see say the exercise physiologist to do some strengthening but would decline an offer to go and see the psychologist. Just because they didn't understand why I felt that that would be helpful. And I kind of struggled to put that into words, I think, and have the time to explain that.
A lot of the chronic pain stuff, I can manage medications, I can prescribe all of the things that they need. I just need a little bit of guidance and advice. Sometimes I don't necessarily need the patient to go and see another doctor. I do need them to see a physiotherapist, a psychologist. There are things that I can't do that I'm not trained in.
I think it's essentially just a team model where you guys get in and really engage the patients. And I think that you could pick it up and put it in a lot of different areas across Queensland and have the same sort of successes as you had up here.
I think they're all really valuable together, just you need the education from all aspects. You can't just have it from one because I was already seeing a physio that wasn't working. So I think it's seeing a psychologist to help manage the mental side of your pain, the physio, understanding medication, just all that education together, I think is what made it work.
MICHELLE:
If you could see where I was before to my life now I was giving up and I thought, this is the end for me. Like I'm going to have. I actually said to my husband, maybe we should get divorced. Like you need to be with someone that you can go and do things with. I'm not going to be that person because I just felt like I was just going downhill.
Yep. Until them. Until pain management.
JOSHUA:
When I was first starting my chronic pain when I hadn't received any help, I couldn't get a job and I couldn't go to school properly. I had very low attendance and I just physically could not get a job. Through doing all my, going through these programs, seeing Fast-Track Pain, helping me, seeing the other pain project I did in Cairns, helping me.
They allowed me to, I guess, better understand myself and allow me to live with myself, allow me to be happy in my own body with being in pain. Allow me to get a job to work. Allow me to do the things I still enjoy with my pain.
MICHELLE:
So I'm 48 at the moment, so my dream is when I'm 50 is to do the Cradle Mountain hike for seven days. There’s two years to go. And I'll be doing that. And that was my, that was my bucket list thing to do when I did the program, I’ve got a little bit more work to do. But I'm absolutely doing it and I'm not afraid to.
I know I can do it.
ANNETTE:
I feel 100% confident we have completely changed somebody’s life. We have also saved the government a lot of money by taking somebody who would have been welfare dependent for the duration of their life and and brought them into a happy and functional and contributing member of the community. But unfortunately, the way data is collected, that didn't necessarily tick some of the boxes that they needed.
It doesn't tick the boxes for refunding you know, which is kind of disappointing because that sort of evidence is overwhelming of the value of the program. But we want to be aware also of not having it put down to financial things. I mean, the gain in quality of life for that person, you know, those people who get out of this pain cycle is incredible.
LUKE CASSALE:
And I think another message we always get a lot from these patients is that they say they've tried everything. You know, they've been to physio, they've been to multiple doctors, GP's, they've tried nearly every medication under the sun, but obviously nothing has been able to help them. So yeah, and then they kind of come and see us. So you kind of see unfortunately they come to us in that kind of time of need and desperation that no one else has been able to to help them.
So it's very rewarding being able to then provide them that support and help them manage their pain.
PENNY:
When I am working one on one with someone who has chronic pain, I sort of feel like I have to cover the role of the physio in the role of occupational therapy nursing all in one or pharmacy all in one. So it's a lot more challenging. So I think being in a team and working in a team is very beneficial for patients.
JAY:
We always know that long wait lists are detrimental to patient outcomes, but it was interesting to see just how beneficial GP's found that the short wait lists that fast track could offer and that may well be one of the parts that we showed such good patient outcomes. Our biggest finding for running fast track was the importance of the relationships, relationships with the people in primary care and in the hospital setting.
Once we found that everybody was on board and on the same page, the barriers were dropped, the doors were opened and were able to get on to doing our work that we intended to do.
