Whose pain is it anyway?
Patient led health needs assessment and self
care resources
Frances Cole, Hospital Practitioner and GP
Pain Rehabilitation Programme
Bradford Teaching Hospitals NHS Foundation Trust
March 2007
Chronic pain
Chronic pain is very common, invisible and
incurable!!!
38% Adults over 18 yrs
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CLICK Survey W.Yorks 2001
Demoralises, taxes emotional resilience of sufferer and their
family and capacity to support sufferer.
Person centred model / cognitive behavioural approaches
enable pain survivors to improve health functioning despite
pain.
Biopsychosocial model of health
Health is a resource for everyday living

Role functioning how physical or emotional health affects work or other regular
daily activities e.g. cooking, cleaning, looking after children, play sports, organise
activities
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Social functioning in social activities with family, friends, neighbours or other
groups

Physical activities carry out basic physical tasks e.g. climbing stairs, walk to the
shops, bathing or dressing yourself
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Bodily Pain not feel bodily pain or have pain interfere with your normal daily life

Mental health feel peaceful and happy rather than down in the dumps, sad or
nervous
My prison bars by JG age 24 yrs
Mean scores of SF36 Health Status
107 pain sufferers before PMP compared to UK
population.
West Yorks. 1999
90
85
84
82
80
77
80
75
70
60
57
51
Before
50
General UK population
40
36
31
30
20
20
12
10
0
Physical health
Emotional
health
Social role
Bodily pain
Mental health
Physical
activities
Patient led Health Needs
Assessment (HNA) for pain
1.
2.
3.
Improves health functioning; it identifies crucial changeable
factors contributing to the person’s pain condition.
Involves professionals working with individual + carers to
focus on acceptable, feasible changes within available resources.
Helps target people with most to gain.
Health needs assessment tool
(HNA)
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Designed by a health needs process; HCP in pain services
and patients (collaborative)
Questionnaire contains key health issues affected by pain
(relevant)
Patient uses before assessment in all pain services +
follow ups to monitor change (timely)
Patient prioritise their needs (communicates)
Self care resources supported by PALS services (ownership
+ control)
CHANGING HOW THE PAIN AFFECTS
YOUR LIFE
(Health Needs Assessment tool)

Walking or moving about

Lack of fitness and energy

Balance / falls

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Side effects or other problems with
current pain medication e.g. tablets etc.
Pain relief
Understanding why longstanding pain
occurs
An unhelpful pattern of activity of doing
too much, getting more pain, then doing
too little
Disturbed sleep
Managing mood changes of depression,
anger, anxiety or worry

Relationship difficulties;
partner, family, work etc.
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Sex life
Remaining in work or returning to work
/ training

Financial / housing problems

Current legal claims
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Concerns about your carer/partner, their
health or other problems
Other difficulties that you feel are
important to change, e.g.
hobbies, leisure or social events or
visiting the church or mosque. Please
describe …………
HNA patient problems or difficulties
(n=79: 254 problems prioritised)
Pain Services Bradford Teaching Hospitals 2005
Patient problem or difficulty
59.5
Walking
Pain relief
Disturbed sleep
Lack of fitness
Managing moods
Unhelpful pacing
Understanding pain
Balance
Problem
Other difficulties
Meds side effects
Work issues
Relationships
Sex life
Financial
Current legal claim
Carers health
45.6
41.8
35.4
7.6
6.3
5.1
11.4
11.4
16.5
15.2
15.2
24.1
21.5
2.5
2.5
0
10
20
30
Percent
40
50
60
Did the HNA help patients with
chronic pain?
Focus on
impact of pain
Shared understanding of
needs by patient + HCP
Patients helped to take control
“Knowing the condition is
to be treated without
tablets”
“Bit of light amid
a lot of darkness”
Helped focus aspects of
life down to a minimum /
priority to discuss”
“Highlighted significant points
which could be missed during
consultation”
“I did not feel rushed or pressured, I could
explain in a bit more detail. Now I understand
that speaking to a specialist has helped me and
given me hope that people understand me”
“Nice to have
someone to listen”
“Made me realise
“He showed
the changes I have
Recommended
and explained”
to make, to make
alternative
things work better”
treatment”
Self care resources
Self care; the person takes responsibility for
their own health and well-being;
i.e.
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staying fit and healthy, both mentally + physically,
taking action to prevent illness + accidents,
better use of medicines,
managing minor illness
better care of long term conditions
Impact of pain experience and
resources
Pete Moore EPP 2005
Persistent pain
Time off work,
family and money
worries, no shower,
rundown estate
Inactivity and/or
overactive pacing
styles
Low mood &
negative thinking;
self, pain, future
Fatigue/ lack
of stamina
Anger/frustration
Guilt/depression
Weak muscles/
loss of fitness
Stress/anxiety/tension/ashamed
Did the self care leaflet help?
Feedback from 19 patients
Leaflet content
Changes in managing pain
 Helpful advice
 Pacing activities
 Pain cycle
 Regular exercise
 Acceptance
 Relaxation
 Support; groups,
 Setting goals
professionals, websites  Acceptance
 Clear layout
 Communicate with others
 Easy to reading
 Kept a pain diary
 Everything!!!!!!
 Realise no longer alone
It’s hard to keep smiling when your pain has made you
feel like this for over 30 years
The way forward ……..seeing
the person not the pain
Pain is everyone’s experience

HNA helps clarify the impact of chronic pain on
person’s health

Focuses on patient priorities
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Helps the person access self help resources to take control
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Self help information used through out pain services +
support by hospital PALS
My cloud has had a very colourful lining