- Part 2

June Wrap

Written by louise.sheppard
Monday, 01 June 2015

With today the official first day of winter, you may well need something to do on these long dark winter nights. Here’s a few ideas…

Have you considered taking a MOOC? The term MOOC – a Massive Open Online Course – was coined in 2008 and there are now dozens of MOOCs, many offered by top universities – and the best bit is they are usually free!

I’m currently doing the ‘Medicine in the Digital Age’ MOOC through Rice University

The idea that medicine is likely to be the next industry ‘disrupted’ by technology is a fascinating one – what will a doctors visit look like in 5 years time? How useful are FitBits and other wearable technologies? How safe is it to Google your health?

If you are interested in these types of questions here are three books that are on my ‘to read’ list:

The Guide to the Future of Medicine: Technology and The Human Touch by Bertalan Mesko
Networked: The New Social Operating System By Lee Rainie & Barry Wellman
The Creative Destruction of Medicine: How the Digital Revolution Will Create Better Health by Eric Topol

Lynda.com is another good site for a cold winters eve. With courses covering design to photography, business and education – Lynda.coms courses are bite sized sessions, where you set the pace for online learning (you do need a subscription).

Pain in the News: Researcher explores how NZers live with chronic pain

Written by louise.sheppard
Monday, 20 April 2015

A news story about our very own Dr. Bronwyn Thompson….

Source: www.voxy.co.nz Thursday, 16 April, 2015 – 07:30

A University of Canterbury researcher who graduates with her PhD this week has been examining how one in six New Zealanders live with chronic pain.

While many people think all pain can be treated successfully, for every four people being treated with chronic pain, only one is likely to get pain relief and they may only be able to reduce their pain by 50 percent.

Dr Bronnie Thompson’s work at the university’s School of Health Sciences was supervised by Professor Ray Kirk and Dr Jeff Gage. She says despite the glum figures for treating chronic pain, about 30 percent of those people cope well and don’t seek treatment.

“This group of people don’t get studied often, possibly because they just get on with life and we don’t see them, or maybe because they’re not the people costing our health system. Consequently we don’t know very much about how or why they do so well.

“This means when we’re developing treatments for people who can’t otherwise get pain relief, we don’t know very much about what is working well in daily life for people who are successfully coping. I studied this group of people and found that when people first develop pain, life becomes incoherent and chaotic and nothing makes sense any more.

“They seek to make sense of their pain, their diagnosis and what is important in life. They focus on their work or activities so life has purpose and meaning. With the support of a clinician, and when they have a strong drive to work and have activities, people begin to get on with their lives so that they can look to a new future.

“What’s important about my research is that it shows us something about the process of adapting to a common problem. It’s not about being a special kind of person. It’s about being passionate about something that expresses important parts of self-concept and having the support to do this.

“Many people don’t benefit from drugs, surgery and other treatments, but there are ways for people to take control of their lives and do what’s important to them. If they’re prepared to change the way they do things they can develop effective coping strategies.”

Dr Thompson says in an aging society where pain from osteoarthritis and other chronic conditions is increasing, helping people identify what motivates them and makes them feel better is something the New Zealand health system could benefit from.

She presented her research at the recent Pain Science in Motion Colloquium in Brussels where she won first prize for her abstract. Dr Thompson provides pain management advice in private practice under her Healthskills banner and from her blog www.healthskills.co.nz.

Dr Thompson is one of 1200 University of Canterbury students who are graduating this week.

March Wrap

Written by louise.sheppard
Friday, 03 April 2015

Happy Easter everyone! It’s hard to believe we are a quarter of the way through 2015 already! March has been a quiet month for me online but here is what has caught my eye:

This Information Paper from The Australian National Health and Medical Research Council ‘Evidence on the effectiveness of homeopathy for treating health conditions’– pain gets several mentions

The video made by Carly Fleischmann, who lives with non-verbal autism, is a great lesson in empathy

This list of 30 physio-relevant Twitter accounts to follow

A whole weekend for live tweeting by @noigroup during their ‘Explain Pain 3’ Course held in Melbourne using #noiep3 … and the cracker of a reference list on the noijam.com site

If you have seen something that’s worth sharing please drop me an email and let me know… louise.sheppard@clear.net.nz

#nzps2015

Written by louise.sheppard
Wednesday, 25 March 2015

Heading to the 40th NZPS Annual Scientific Meeting this weekend?

On Twitter?

Let us know whats going on by tweeting updates using #nzps2015

Pain in the News: Press Release on opioid prescribing from the NZ Health Quality & Safety Commission

Written by louise.sheppard
Saturday, 21 March 2015

Three-fold opioid variation a cue to look at prescribing, says Commission

Evidence that the number of people being given one of the most dangerous classes of medicine varies up to three-fold around New Zealand is a cue for hospitals and primary health care providers to take a close look at their prescribing, says the Health Quality & Safety Commission.

Opioids include fentanyl, methadone, morphine, oxycodone and pethidine at the stronger end and tramadol, codeine and dihydrocodeine at the weaker, and are highly effective in managing pain.

But they are also the class of medicine most commonly implicated in patient harm – which might include nausea, constipation, delirium, hypotension, addiction or even potentially life-threatening over-sedation and respiratory depression.

March, the final month of the Commission’s Open for better care national patient safety campaign’s six-month focus on reducing harm from high-risk medicines, looks at the safe use of opioids.

The wide differences in usage are shown in the recently published opioid domain of the Commission’s Atlas of Healthcare Variation – a series of easy-to-use maps, graphs, tables and commentaries that chart the provision and use of specific health services and outcomes.

The domain records subsidised opioids dispensed from community pharmacies in 2013, but not those used in hospitals. However, the prescription may have come from a hospital, as nearly half of those dispensed a strong opioid had been a public hospital inpatient or outpatient in the week prior.

‘The question is do we need to use strong opioids as much as we do and are there alternatives?’ says Dr Alan Davis, chair of the Commission’s opioid expert advisory group.

‘Yes, there are alternatives, and district health boards need to investigate why their usage is different to other district health boards’ and if they should be exploring those alternatives.

‘It may be a patient who’s had an operation doesn’t actually need strong opioids once they leave hospital but they’ve been given them anyway. It may be appropriate they change at that stage to weaker-strength painkillers. Maybe they could get by without painkillers at all. There might be lifestyle strategies to help them manage discomfort.

‘Of course, it may also be the prescription is completely appropriate as it is. The atlas itself doesn’t tell us this, but by showing such wide variation it does tell us these are important questions for clinicians to be asking themselves.’

Among the atlas’s key findings are:

An average of 17/1000 people received a strong opioid, with a greater than three-fold variation between district health board (DHB) geographical areas
An average of 64/1000 people received a weak opioid, with a two-fold variation between DHB areas
Women were dispensed significantly more both weak and strong opioids than men
Opioid use increased significantly with age: 1 in 10 people aged 80 and over received a strong opioid and 1 in 7 a weak opioid
People identifying as European or Other ethnicity had two to four times the use of strong opioids as those of Maori, Pacific or Asian ethnicity
People identifying as European or Other received significantly more weak opioids, and Asian peoples significantly fewer
An average of 11/1000 people received morphine, 10,000 more than in 2011, with a two-fold variation between DHB areas
An average of 6.4/1000 people received oxycodone, 5000 fewer than in 2011, with a three-fold variation between DHB areas.

Dr Davis says it is unlikely all – or even most – of the variations are due to the DHB areas having different populations with different needs.

‘So there is a great deal to consider in the atlas for DHBs, along with primary health organisations, general practices and others prescribing opioids in their communities.’

The opioid domain of the Atlas of Healthcare Variation can be viewed at www.hqsc.govt.nz/our-programmes/health-quality-evaluation/projects/atlas-of-healthcare-variation/opioids/.

February Wrap

Written by louise.sheppard
Sunday, 08 March 2015

Here’s what has caught my attention this month:

‘Cake’ – this movie about chronic pain, starring Jennifer Aniston hits cinemas soon

A very interesting patients explanation of the article “A critical evaluation of the trigger point phenomenon” written by John Quniter, Geoffery Bove & Milton Cohen, published late last year in ‘Rhematology’.

This very sensible BJSM blog post by Jørgen Jevne on the reconceptualisation needed in low back pain

Ouch! An episode on Australian TV station SBS with Lormier Moseley

This neat wee video ‘Kids and Pain’ video produced in part by the NZPS Pain in Childhood SIG

‘Picture of Pain’ Blog – penned by Dr. Kim Kristiansen, M.D.

An interesting article from the Harvard Gazette about a study of neuroimmune cells in Thalamus

The latest offering from Noi Group – ‘The Explain Pain Handbook: Protectometer’ launched this month

If you have seen something that’s worth sharing please drop me an email and let me know… louise.sheppard@clear.net.nz

Mini Blog: 2 minutes with…Dr David Rice

Written by louise.sheppard
Sunday, 01 March 2015

It is now less than 4 week until #nzps2015 Annual Scientific Meeting kicks off in Auckland. Online registrations close in a little over 2 weeks – have you registered yet?

What is your current role/job/position?

I am a Senior Lecturer in the School of Physiotherapy at AUT, a Senior Research Officer in the Health and Rehabilitation Research Institute at AUT and I also work in the multidisciplinary pain service at WDHB, where I help to co-ordinate various research projects related to the prevention, treatment and underlying mechanisms of chronic pain conditions.

How did you get into working in Pain Management?

I became particularly interested in pain when I was working towards my PhD and began to read lots about neuroplasticity in the pain system and concepts like peripheral and central sensitisation. This interest was cemented on a trip to Aalborg, Denmark in 2010, where I was lucky enough to spend some time with some of the best pain researchers in the world. Then, when the WDHB developed its multidisciplinary pain service in 2011, I was appointed to my current position to help to develop a collaborative programme of pain research between the WDHB and AUT University.

What do you hope people might take away from your presentation?

That pain directly affects important aspects of motor performance including muscle strength, endurance, co-ordination and maybe even our ability to learn new motor skills. Where possible, it may be much easier to rehabilitate these aspects of motor performance by treating pain effectively first. Where pain cannot be reduced, we may need to employ innovate rehabilitation strategies that try to reverse these deficits in motor control.

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CONFERENCE WEBSITE
ONLINE REGISTRATION CLOSES MONDAY 16TH MARCH

Mini Blog: 2 minutes with…Catriona McLean

Written by louise.sheppard
Sunday, 22 February 2015

What is your current role/job/position?

I’m currently a Clinical Nurse Consultant in the Department of Pain Medicine and Palliative Care at the Children’s Hospital at Westmead, Sydney. I have experience across Pain and Palliative Care but work primarily in Acute Pain Management and I have specific interest in managing children through painful/ distressing procedures.

How did you get into working in Pain Management?

I came to Sydney in 1990 to work in a paediatric high dependency unit. I remember being so impressed seeing PCAs and epidurals used on a regular basis and how well many of the children recovered from surgery and trauma that when an opportunity became available in the Pain Service at the Children’s Hospital at Westmead, I didn’t hesitate in applying.

What do you hope people might take away from your presentation?

I hope that all health care professionals continue to be mindful of the issues surrounding short and longer term pain management when working with children, adolescents and their families and the impact it can have on them . It’s important it is for us all to do our best to strive for and promote excellence in care.

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CONFERENCE WEBSITE
ONLINE REGISTRATION CLOSES MONDAY 16TH MARCH

Mini Blog: 2 minutes with…Karyn Bycroft

Written by louise.sheppard
Thursday, 19 February 2015

Catch Karyn speaking on Friday afternoon on ‘Developing the Art of Decision Making in Pain Relief and Palliative Care for Children’

What is your current role/job/position?

I am a Nurse Practitioner working in the Paediatric Palliative Care Team at Starship Children’s Hospital. I am involved with providing direct care to children and their families in the Greater Auckland Region and also provide a consultative service nationally to support health professionals to care for children wherever they are.

How did you get into working in Pain Management?

My involvement in pain management has developed out of wanting to provide the best possible care for children with life-limiting conditions, to minimise their suffering and to support them to maximise their potential as much as possible. Having been involved in paediatric palliative care now for many years I have seen many changes in prognosis of many conditions and in turn this influences how we provide care. I find working in this dynamic field challenging and inspiring. I believe there is still so much to learn and still so much we can do to improve comfort and quality of life for children and their families with palliative care needs.

What do you hope people might take away from your presentation?

Providing paediatric palliative care is not easy; providing the best comfort care and minimising pain and suffering often requires complex decisions depending on where the child might be in the trajectory of their illness. The process of pain management in this time of unknown prognosis, and the experience and knowledge of those providing the care, can influence how these symptoms including pain are managed.

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CONFERENCE WEBSITE
ONLINE REGISTRATION CLOSES MONDAY 16TH MARCH

Mini Blog: 2 minutes with…Leah Hodgkinson

Written by louise.sheppard
Saturday, 14 February 2015

What is your current role/job/position?

I completed my pharmacy degree in Australia and moved to New Zealand just over 2 years ago. I am currently working at Middlemore Hospital with Counties Manukau Health in South Auckland. My position involves working within the Acute Pain Service to provide MDT care to our post-operative and other patients with acute pain. I also am a part of the Well Managed Pain initiative which is a project is a multidisciplinary approach to managing complex inpatient pain. Our project aims to improve the co-ordination of care of patients with complex pain by working with them to improve their ability to manage their pain out of hospital and to minimise their risk of medication-related harm.

My contribution to both of these teams largely involves review of medications with regards to quality and safety and this is with a pain focus as well as with a holistic view. Patient education and discharge planning for pain management is also a key responsibility.

The rest of my time is spent working with one of our General Surgical teams to provide clinical pharmacy input.

How did you get into working in Pain Management?

I actually started out working in pain management during my first year as a brand new pharmacist. This was when I was still in Australia and, despite being so junior, the encouragement of my manager at the time stirred up my interest and enthusiasm for the area.

After moving to New Zealand I was assigned to a rotational position with the Acute Pain Service at Middlemore Hospital and have been there ever since. The role of pharmacists working in Pain Management is still developing in New Zealand and it is really great to be a part of this. The pain teams, pharmacy department and anaesthetic department are incredibly supportive of my position and I’m really lucky to work with such an amazing group of people.

What do you hope people might take away from your presentation?

I guess I’m just hoping that what I talk about is useful and relevant to all people working in pain. I have put together this talk so that it includes the sorts of things I am often asked about. Hopefully this means that my presentation will answer the kinds of questions many others have often wondered about.

Sometimes when working in a specialist area it is easy to forget how our medications might interfere with other issues for our patients. I hope this presentation will also get people thinking about the effects of analgesics outside of their use in pain.

Lastly, I hope my talk might encourage other DHBs to consider introducing pharmacists into their pain management teams to help with the numerous medication-related issues involved in the management of these patients.

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CONFERENCE WEBSITE
ONLINE REGISTRATION CLOSES MONDAY 16TH MARCH