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Bevan Exemplar Cohort 8 Projects

Early Intervention Persistent Pain Management Practitioner – Primary Care

Sian Jones

Red Kite Health Solutions CIC and Powys Teaching Health Board

Hear Sian and Monika talk about their project:

The introduction of an early intervention Pain Management Practitioner aims to provide an early intervention, support, and medication optimisation service through a primary care-based, Pain Management Service.

Patients who are identified as suffering from, or at risk of developing, persistent pain will be referred to intervention measures and ongoing support in the primary care setting. This includes, person-centred, holistic assessment, regular reviews, patient education and support with medication optimisation, in conjunction with primary care clinicians and other community services.

Providing early intervention through a biopsychosocial approach, the service will provide patients with early support and appropriate care, reducing the risk of developing persistent pain and unnecessary referrals for imaging and interventions, while giving patients self-management skills and structured plans to improve the quality of their lives.

The practitioner will develop this new model of care so that it may be scaled and spread further across Wales, through the production of a CPD pack.  This work will involve bridging the divide between services by working closely with primary and community colleagues to educate, refine and develop pathways, and provide a point of contact for services within primary care.

The service will provide improved access to appropriate and quality care for patients, supporting their recovery and well-being. We would anticipate savings in GP time through the availability of the pain management practitioner and a paradigm shift in the management and prescribing habits of opioid medications. There will also be a benefit across organisations from improved partnership working, with follow-up and combined management, reducing the amount of recovery time and risk-or relapse after discharge from services.

Early Project Outcomes:

The project is already reporting positive outcomes. Based on a feedback questionnaire that patients were asked to complete:

  • 93% of patients were very satisfied with the service.
  • 70% of patients found positive changes in their mood and emotions.
  • 95% of patients found that their knowledge and understanding of the condition has improved.
  • 80% of patients found that their quality of life has improved and 20% didn’t notice any changes.
  • 78% would contact the service again in the future if the need arises.

Please see below for comments from clinicians and patients on their experience of the service:

Patient Story:

When I turn in bed, I wake in pain, so I get up because I’m fully awake regardless of if I’ve only been sleeping for 45 mins or a couple of hours. I sit up in bed and I get shooting pains. My cheeks flush with anger and I curse and swear at the pain as if it’s a living entity. I hesitate before I move as I know it’s going to hurt like hell. I count in my head 1.2.3 {insert curse word here} as almost every motion has its own personal “hurt”. My neck, both shoulders, both knees & lower back all in varying degrees of pain and all have various swear words associated, from the mildest for my left shoulder, to the vilest for my back. I get up, make a cup of tea, and stay up, generally all night until I feel absolutely exhausted and go back to bed.

It’s exhausting, depressing, hopeless, frustrating, makes me feel completely inadequate because I can’t do the simplest of tasks. The worse it gets, the less I do & the less I do, the worse it gets. I psych myself up for days sometimes, just to go to the shop for essentials, often running out of milk, bread etc. but I manage without until I can go. Mental health plays a big part in this too, so it’s not just the pain preventing me from doing things. I dread going out because I know before I get home, I’ll be in awful pain. Some of the pain is sharp enough to sicken me, some is minor, some medium, but all combined is almost too much to put up with. I have massive walls to climb before I manage a moderate exercise regime and start losing weight, which I’m almost certain will help with at least some of the pain. I am trying to control the pain rather than letting it control me, but I’m losing the fight at the moment.

Does M and the service make a difference? When we 1st spoke, I was very guarded and wary of M, thinking this was just another do gooder, nosey busybody trying to save the NHS money and leave me in pain with no meds. Well, I soon realised that I couldn’t have been more wrong. It takes a long time for me to trust someone, especially someone I have never met. But I knew very quickly that the practitioner had my very best interests at heart, and she was going to help. Not only does she make sure I am on the right medication and proper dosage for my physical issues, but she also takes the time to talk in general and to ensure I’m in the best place mentally.

I cannot stress how important the service and help that M gives to me is. We are working together to try and reduce my medication currently, and also improving my mental health. Through M’s persuasion I started speaking to MIND and I’m trying to change & improve my way of life. I hardly leave my home at the moment because of pain and mental health, but I am making small changes to improve things. This is all thanks to the service.