Pain Support.org

Written by Elle (a participant) - 20/05/2010 and posted on our Pain Forum.

Given the marked lack of available information on the RPAH Pain Management Programme – Intensive (PMP-I) and facilitating staff therein, I thought it might be helpful to post a summary of my experience as a participant. I hope that this account goes a way toward assisting future participants to assess whether this intensive three week fulltime programme would be compatible with their goals in regard to chronic pain management strategies.

Referral and Assessment
I was referred to the RPAH Pain Management Centre (PMC) by my doctor on account of my having difficulty managing chronic pain in the workplace and at home. As part of a multidisciplinary assessment process I was referred to, and subsequently attended, appointments with a medical doctor, clinical psychologist and a physiotherapist. The outcome of these assessments resulted in, amongst other recommendations, a referral to participate in the PMP-I.

In hindsight, it would have been wise at that point for me to have consulted my own doctor on how the PMP-I might impact on any pre-existing medical conditions unrelated to chronic pain. It might have been beneficial to both the programme facilitators and participants for the assessment team at the RPAH to have been more thorough in their attention to participants’ co-existing medical conditions. Conversations had with PMP-I participants suggested that this oversight had a significant impact on participant attendance during the program as well as their physical and mental equilibrium after the programme had ended. Printed information provided to participants prior to the PMP-I noted that group numbers can be up to ten participants. The group in which I participated fell well short of that number and it was suggested during the programme that it had been a struggle to fill the places - a reason perhaps for the overzealous inclusion of potentially unsuitable participants (?)

Pre-Programme Information
Prior to the commencement of the PMP-I, I attended a scheduled one on one pre-programme briefing with the primary facilitators: a psychologist and a physiotherapist. They provided a printed outline of the program and discussed the information. There was an opportunity to ask questions. They were both informative and accommodating.

Programme Content
The PMP-I was conducted from 0900hrs – 1700hrs Monday to Friday for three consecutive weeks. There were one or two facilitators at different times throughout the programme, usually a psychologist, a physiotherapist or a nurse practitioner. In addition to hospital staff, there were visiting presenters e.g. an insurance company representative.

09:00 – 09:30 Pacing Review
09:30 – 10:30 Mindfulness Meditation Practice
10:30 – 10:45 Morning Tea
10:45 – 11:00 Walk
11:00 – 12:00 Anxiety and Chronic Pain
12:00 – 13:00 Physiotherapy
13:00 – 14:00 Lunch
14:00 – 15:00 Return to Work Issues
15:00 – 16:00 Physiotherapy
16:00 – 16:15 Afternoon Tea
16:15 – 17:00 Avoidance

Core PMP-I Team
Module topics such as the above “Anxiety and Chronic Pain” were, for the most part, presented from a manual by psychologist Jade Hucker. Jade Hucker’s artificial communication style and generous pacing made the information clear and easy to understand. In instances where Jade was unable to locate a suitable answer to a participant’s question in her manual, she was always willing to check with her supervisor and return with a response. Jade was quick and helpful in meeting participant requests where they related to practicalities e.g stationary, copying etc. When faced with unfamiliar, unpredictable or unexpected programme outcomes however, Jade Hucker’s unapproachable, abrasive demeanor revealed the underdeveloped interpersonal skills of someone new to the workforce and the challenges facing a recent psychology graduate new to the role.

Nurse practitioner Amal Helou presented some modules. The information was enriched by her extensive knowledge of the subject matter as well as her straight-forward, humorous and personal communication style. Amal Helou was approachable, flexible, helpful, caring, genuine and available. Her contribution was appreciated by all participants.

Physiotherapist-led activity-based reconditioning sessions were conducted by Graeme Campbell in the gym. Graeme instructed and supervised participants in generic stretches and strength building exercises including some tailored to individual participants. Graeme was always keen to share his practical and theoretical knowledge of physiotherapy. So satisfied was he by the groups’ progress that by the third week he used the scheduled group physiotherapy sessions to further his own personal exercise regimen. Graeme Campbell also presented some modules. It would have better served all parties had he restricted his medical theories to the area of physiotherapy. Future groups would certainly benefit from his broadening or at the very least, updating his general knowledge. The presentations were often punctuated by some rather unfortunate analogies that undermined the credibility of the key concepts he was presenting.

The meditation sessions were led by Jade Hucker or Tony Merritt. Tony Merritt who was introduced to the group by Jade Hucker as “just the other psychologist”, was the clinical psychologist responsible for the psychology services and pain management programmes at the RPAH PMC. In contrast to Graeme and Jade, Tony’s well developed interpersonal skills, attentiveness and professionalism were a welcome relief to all present. The patience, humour and grace with which he shared information and knowledge were appreciated as a valued contribution.

Homework
Participants are asked to complete ‘homework‘activities on week nights and weekends e.g. continuation of physical exercises, written tasks, meditation. Most nights or the following morning these tasks took one to two hours for me to complete. It would be wise to make a realistic assessment on whether this additional load is something a future participant could sustain over a three week period.

Family Day
Participants were notified of family day during the pre-programme briefing and encouraged to make arrangements for one or more family members or friends to attend a one and a half hour education session on Chronic Pain Management.

The session was presented by physiotherapist Graeme Campbell who addressed chronic pain management approaches and information on the physiological mechanisms involved in chronic pain as well as common psychological responses to chronic pain. He also provided information on the etiology and physical manifestations of medical conditions well outside the area he was qualified to address. Participants and their families were treated to statements by physiotherapist Graeme Campbell claiming that Fibromyalgia was caused exclusively by stress and stated ‘lack of pressure on bones’ was the cause of rheumatoid arthritis without including any other possible causes. The presentation was transparently incomplete and the content unsupported by references to published medical information or study outcomes. Discussion by participants and family members following the presentation revealed that those in attendance were perplexed by how a hospitable staff member could use a public forum of this type to present his personal opinions on topics well outside the area in which he was qualified to provide expert opinion. Graeme Campbell’s actions were perceived as renegade and grossly unprofessional by attendees. Given that Graeme Campbell was one of the primary facilitator’s, family member’s aired concerns about his ability to adhere to his commitments regarding duty of care to participants as well as bringing possible breaches to his code of conduct to the fore. Family members stated their disappointment, anger and overall loss of confidence in the RPAH Pain Management Programme. Programme attendance was more than halved on the day following family day with group attendance being incomplete for the duration of the program.

Individual Reviews x 2
Two individual reviews of approximately fifteen minutes each were conducted. One review was conducted by the physiotherapist and the other by the psychologist. Additional individual reviews were conducted by the nurse practitioner where it related to medication needs.

Outings x 2
Weeks two and three featured two outings. Three hours were allocated to each outing including pre and post activity feedback opportunities. Participants were encouraged to engage in activities they had avoided due to chronic pain e.g. shopping, traveling on public transport, social activity etc. This was discussed by participants as a helpful and empowering activity.

Case Conferences
As stated on RPAH Pain Management Centre Website (www.sswahs.nsw.com.au), the objective of the program is to facilitate a return to work. The programme includes both compensable patients (referred from an insurer e.g. Workcover or medical practitioner) and public patients (referred by the relevant medical practitioner.)

At the conclusion of the PMP-I, the primary facilitators organised what they called a “Case Conference” (CC) in which approximately 45 minutes was allocated for a telephone conference. These CC’s took place at the PMC in the conference room or available offices. The aim of the CC was to connect the participants’ relevant parties (insurer, case manager, rehabilitation provider, general practitioner (GP), medical specialist, psychologist etc) by telephone simultaneously with the view to feed back the participants’ involvement in the programme and provide a brief assessment of their functional capacity where it related to chronic pain. The objective of the feedback was that it provide a guideline for a future direction where it related to working with chronic pain. For obvious reasons, participation in the CC was not mandatory for public patients without insurers and a limited number of parties (e.g. one GP) to take part. Psychologist Jade Hucker insisted that, although not mandatory for the above reasons, final assessment (written and verbal) be denied from public patients and referring medical professionals who chose not to participate. This appeared to participants to indicate that the final assessment/feedback for the three week PMP-I was not intended to benefit the participant but rather to satisfy the requirements of the external stakeholders (insurance companies, rehabilitation providers).

Participants were not informed that a scheduled CC had been organised until the end of the second week of PMP-I. Prior to the commencement of the PMP-I, the PMC had contacted all the relevant parties without advising the participants. It was peculiar that the detailed pre-programme information failed to mention the CC.

The Case Conferences themselves proved to be the facilitators’ final, spectacular ignominy. Participants stated that that the process was hindered by Jade Hucker and Graeme Campbell's perilous grip on the practicalities and protocols of successful phone hook ups. Aside from delaying the process, the embarrassment resulting from the clumsy and amateurish farce was noted by all parties.

Completion
On the last day of the PMP-I, participants were asked to complete a duplicate set of the original medical questionnaires. We were advised that that one, three, six and twelve month follow-up sessions were scheduled for the group. Attendance was optional. PMC staff do not contact participants after the completion of the program.

Conclusion
Pain Management Programs are run by several NSW hospitals. Pain Clinics and Pain Management Services in NSW can be found at www.health.nsw.gov.au or contact the NSW Department of Health on 02 9391 9000. I would encourage those interested in chronic pain management programmes of this type to thoroughly research the course content as well as the qualifications and experience of the facilitators. The work standards of the latter are sadly, pot luck. Three intensive weeks is a significant physical and emotional investment into a programme one relies on, at least in part, to add value to their personal goals in managing chronic pain. I would have found it beneficial to have had access to more information and alternative options before making the commitment. One stand out, positive element was the support, humour and inspiration shared by fellow programme participants. It was from them I learned the most.

Here is a link to the RPAH Pain Clinic.