SlideShare a Scribd company logo
The University of Sydney
Non-pharmalogical
approaches to pain
management: The role
of clinician
communication
Claire Ashton-James, PhD
Associate Professor, Pain Management
University of Sydney School of Medicine
Page 2
The University of Sydney
• Injury/nociception is not sufficient to cause pain
• Pain is a bio-psycho-social phenomenon
What is pain?
Evaluation of
sensations as
unpleasant
Feelings of
distress
Construal of
actual or potential
harm
Page 3
The University of Sydney
Feelings of distress?
Dark Mofo Festival – Winter solstice nude swim
Page 4
The University of Sydney
Construal of harm?
Page 5
The University of Sydney
Managing pain involves managing feelings and
thoughts about pain
Evaluation of
sensations as
unpleasant
Feelings of
distress
Construal of
actual or potential
harm
What we say
matters
How we say
it matters
Page 6
The University of Sydney
Positive expectations
enhance analgesic
effectiveness
“I am going to give you a
powerful pain medication to
make you feel more
comfortable”
We must inform the patient
that we are providing pain
What we say matters: expectations shape
experiences
Open vs. hidden paradigm
Page 7
The University of Sydney
What we say matters: expectations shape
experiences
Amanzio, Pollo, Maggi, & Bennedetti, 2001
Analgesic dose needed to reduce pain by
50%
Time course of analgesic efficacy
Page 8
The University of Sydney
What we say matters: expectations shape
experiences
“We are going to give you a strong
painkiller now (morphine)”
“We are going to stop giving you the
strong painkiller now (morphine)”
Benedetti F, Maggi, Lopiano, Lanotte, Rainero, Vighetti & Pollo. 2003.
Page 9
The University of Sydney
What we say matters: expectations shape
experiences
Bingel U, Wanigasekera V, Wiech K, Mhuircheartaigh RN, Lee MC, Ploner M, Tracey I. 2011.
Remifentanil dose is constant after baseline
Page 10
The University of Sydney
Pre-surgery visit from anaesthetist:
– Informed about pain that patients typically
experience
– Reassured that having pain was normal after
abdominal surgery
– Informed that pain is not a sign of harm
– Informed that medications can be used to
help them to relax
What we say matters: expectations shape
experiences
Egbert et al 1964, NEJM
Page 11
The University of Sydney
How we say it matters: The role of empathy
• RCT of treatment for IBS
with three arms:
• waitlist
• placebo acupuncture
(limited interaction)
• placebo acupuncture
(augmented interaction)
• Augmented interaction
included:
• Warm and friendly manner
• Active listening
• Acknowledgement (“I can
understand how difficult IBS must
be for you”
• Thoughtful silence
• Communication of optimism and
positive treatment expectations (“I
have had many positive
Page 12
The University of Sydney
Outcomes at 3 weeks
Kaptchuk, Kelley, Conboy et
al. Bmj. 2008 May
1;336(7651):999-1003.
Page 13
The University of Sydney
Outcomes at 6 weeks
Kaptchuk, Kelley, Conboy et
al. Bmj. 2008 May
1;336(7651):999-1003.
Page 14
The University of Sydney
How we say it matters: The role of empathy
Schupp, Berbaum, Berbaum, &
Lang, 2005:
– 236 patients undergoing
vascular and renal
interventions
– All have access to PCA with
fentanyl and midazolam
– Randomized to 3 groups:
– Standard care
– Structured empathic
attention
– Self-hypnotic relaxation
Structured empathic interaction:
• matching patients’ verbal and
nonverbal communication patterns,
• attentive listening
• provision of perception of control
(eg, “let us know at any time what
we can do for you”)
• Encouragement (“you’re doing well”)
• emotionally neutral descriptions
(“what are you experiencing?”)
• avoidance of negative suggestions
(“you will feel a pinch or burning”).
Page 15
The University of Sydney
**significantly less pain medication requested and used by Empathy groups
Page 16
The University of Sydney
Managing pain involves managing feelings
and thoughts about pain
Evaluation of
sensations as
unpleasant
Feelings of
distress
Construal of
actual or potential
harm
What we say
matters
How we say
it matters
Page 17
The University of Sydney
Claire Ashton-James, PhD
Associate Professor, Pain Management
University of Sydney School of Medicine
CONTACT:
Email: Claire.ashton-james@sydney.edu.au
Twitter: @drashtonjames

More Related Content

Similar to The importance of communication in pain management

presentations_projects
presentations_projectspresentations_projects
presentations_projects
Andrew Bodine
 
article
articlearticle
article
Lin T
 
Pain management certification session 1
Pain management certification   session 1Pain management certification   session 1
Pain management certification session 1
tracymichellemorris
 
What do people know about pain isapm 2015 - dr. Mary S
What do people know about pain isapm 2015 -  dr. Mary SWhat do people know about pain isapm 2015 -  dr. Mary S
What do people know about pain isapm 2015 - dr. Mary S
Department of Anesthesiology, Faculty of Medicine Hasanuddin University
 
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
Heather Gilmartin
 
CapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative CareCapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative Care
Suzana Makowski, MD MMM FACP
 
Is your client in chronic pain?
Is your client in chronic pain?Is your client in chronic pain?
Is your client in chronic pain?
Louise Stanger Ed.D, LCSW, CDWF, CIP
 
Diagnosis and Management of Chronic pain associated with depression.pptx
Diagnosis and Management of Chronic pain associated with depression.pptxDiagnosis and Management of Chronic pain associated with depression.pptx
Diagnosis and Management of Chronic pain associated with depression.pptx
ssuser40df77
 
Women’s Objects of Hope and Benefit Finding at Cancer Recurrence
Women’s Objects of Hope and Benefit Finding at Cancer RecurrenceWomen’s Objects of Hope and Benefit Finding at Cancer Recurrence
Women’s Objects of Hope and Benefit Finding at Cancer Recurrence
ashleysandella
 
Daily Health Update 04-27-17 Rode Chiropractic Poway, CA
Daily Health Update  04-27-17 Rode Chiropractic Poway, CADaily Health Update  04-27-17 Rode Chiropractic Poway, CA
Daily Health Update 04-27-17 Rode Chiropractic Poway, CA
Rode Chiropractic of Poway, CA 92064 (858)-391-1372
 
Final tooth fairy presentation
Final tooth fairy presentationFinal tooth fairy presentation
Final tooth fairy presentation
James Coyne
 
How doctors-are-taught-to-deal-with-death
How doctors-are-taught-to-deal-with-deathHow doctors-are-taught-to-deal-with-death
How doctors-are-taught-to-deal-with-death
MiarizaAgcaoili
 
Internship powerpoint
Internship powerpoint Internship powerpoint
Internship powerpoint
lrburto
 
Values-based practice
Values-based practiceValues-based practice
Hah
HahHah
Agnesian HealthCare Know & Go Friday, January 2017: Integrative Health
Agnesian HealthCare Know & Go Friday, January 2017: Integrative HealthAgnesian HealthCare Know & Go Friday, January 2017: Integrative Health
Agnesian HealthCare Know & Go Friday, January 2017: Integrative Health
Agnesian HealthCare
 
Personalized Movement Therapy for Chronic Pain
Personalized Movement Therapy for Chronic PainPersonalized Movement Therapy for Chronic Pain
Personalized Movement Therapy for Chronic Pain
DrBonnie360
 
Ten Traits of Great Physicians_230228_085304.pdf
Ten Traits of Great Physicians_230228_085304.pdfTen Traits of Great Physicians_230228_085304.pdf
Ten Traits of Great Physicians_230228_085304.pdf
DR NTR UNIVERSITY OF HEALTH SCIENCES,VIJAYAWADA,ANDHRA PRADESH,INDIA
 

Similar to The importance of communication in pain management (18)

presentations_projects
presentations_projectspresentations_projects
presentations_projects
 
article
articlearticle
article
 
Pain management certification session 1
Pain management certification   session 1Pain management certification   session 1
Pain management certification session 1
 
What do people know about pain isapm 2015 - dr. Mary S
What do people know about pain isapm 2015 -  dr. Mary SWhat do people know about pain isapm 2015 -  dr. Mary S
What do people know about pain isapm 2015 - dr. Mary S
 
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?
 
CapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative CareCapeCodHospitalGrandRounds: Palliative Care
CapeCodHospitalGrandRounds: Palliative Care
 
Is your client in chronic pain?
Is your client in chronic pain?Is your client in chronic pain?
Is your client in chronic pain?
 
Diagnosis and Management of Chronic pain associated with depression.pptx
Diagnosis and Management of Chronic pain associated with depression.pptxDiagnosis and Management of Chronic pain associated with depression.pptx
Diagnosis and Management of Chronic pain associated with depression.pptx
 
Women’s Objects of Hope and Benefit Finding at Cancer Recurrence
Women’s Objects of Hope and Benefit Finding at Cancer RecurrenceWomen’s Objects of Hope and Benefit Finding at Cancer Recurrence
Women’s Objects of Hope and Benefit Finding at Cancer Recurrence
 
Daily Health Update 04-27-17 Rode Chiropractic Poway, CA
Daily Health Update  04-27-17 Rode Chiropractic Poway, CADaily Health Update  04-27-17 Rode Chiropractic Poway, CA
Daily Health Update 04-27-17 Rode Chiropractic Poway, CA
 
Final tooth fairy presentation
Final tooth fairy presentationFinal tooth fairy presentation
Final tooth fairy presentation
 
How doctors-are-taught-to-deal-with-death
How doctors-are-taught-to-deal-with-deathHow doctors-are-taught-to-deal-with-death
How doctors-are-taught-to-deal-with-death
 
Internship powerpoint
Internship powerpoint Internship powerpoint
Internship powerpoint
 
Values-based practice
Values-based practiceValues-based practice
Values-based practice
 
Hah
HahHah
Hah
 
Agnesian HealthCare Know & Go Friday, January 2017: Integrative Health
Agnesian HealthCare Know & Go Friday, January 2017: Integrative HealthAgnesian HealthCare Know & Go Friday, January 2017: Integrative Health
Agnesian HealthCare Know & Go Friday, January 2017: Integrative Health
 
Personalized Movement Therapy for Chronic Pain
Personalized Movement Therapy for Chronic PainPersonalized Movement Therapy for Chronic Pain
Personalized Movement Therapy for Chronic Pain
 
Ten Traits of Great Physicians_230228_085304.pdf
Ten Traits of Great Physicians_230228_085304.pdfTen Traits of Great Physicians_230228_085304.pdf
Ten Traits of Great Physicians_230228_085304.pdf
 

More from SMACC Conference

Precision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain InjuryPrecision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain Injury
SMACC Conference
 
CSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdfCSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdf
SMACC Conference
 
Subdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisationSubdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisation
SMACC Conference
 
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical careAndy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical care
SMACC Conference
 
The BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 MonitoringThe BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 Monitoring
SMACC Conference
 
Dilating the Dogma of Vasospasm
Dilating the Dogma of VasospasmDilating the Dogma of Vasospasm
Dilating the Dogma of Vasospasm
SMACC Conference
 
EVD Tips and Tricks
EVD Tips and TricksEVD Tips and Tricks
EVD Tips and Tricks
SMACC Conference
 
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew UdyThere is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
SMACC Conference
 
TBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories workTBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories work
SMACC Conference
 
TBI: when to stop and when to give time
TBI: when to stop and when to give timeTBI: when to stop and when to give time
TBI: when to stop and when to give time
SMACC Conference
 
Ketamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby JeffcoteKetamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby Jeffcote
SMACC Conference
 
Managing Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne LeeManaging Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne Lee
SMACC Conference
 
EEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania FarrarEEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania Farrar
SMACC Conference
 
Browne Neuro symposium.pptx
Browne Neuro symposium.pptxBrowne Neuro symposium.pptx
Browne Neuro symposium.pptx
SMACC Conference
 
Paediatric Stroke by Shree Basu
Paediatric Stroke by Shree BasuPaediatric Stroke by Shree Basu
Paediatric Stroke by Shree Basu
SMACC Conference
 
Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?
SMACC Conference
 
Optimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion PressureOptimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion Pressure
SMACC Conference
 
The Power of Words - Death and Language.ppt
The Power of Words - Death and Language.pptThe Power of Words - Death and Language.ppt
The Power of Words - Death and Language.ppt
SMACC Conference
 
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
SMACC Conference
 
Brain injury outcomes and predictors
Brain injury outcomes and predictorsBrain injury outcomes and predictors
Brain injury outcomes and predictors
SMACC Conference
 

More from SMACC Conference (20)

Precision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain InjuryPrecision Medicine in Acute Brain Injury
Precision Medicine in Acute Brain Injury
 
CSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdfCSD by Jeffcote Coda 22.pdf
CSD by Jeffcote Coda 22.pdf
 
Subdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisationSubdural Haemorrhage and MMA embolisation
Subdural Haemorrhage and MMA embolisation
 
Andy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical careAndy Neill - More neuroanatomy pearls for neurocritical care
Andy Neill - More neuroanatomy pearls for neurocritical care
 
The BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 MonitoringThe BONANZA Trial and PbTO2 Monitoring
The BONANZA Trial and PbTO2 Monitoring
 
Dilating the Dogma of Vasospasm
Dilating the Dogma of VasospasmDilating the Dogma of Vasospasm
Dilating the Dogma of Vasospasm
 
EVD Tips and Tricks
EVD Tips and TricksEVD Tips and Tricks
EVD Tips and Tricks
 
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew UdyThere is no such thing as mild, moderate and severe TBI - by Andrew Udy
There is no such thing as mild, moderate and severe TBI - by Andrew Udy
 
TBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories workTBI Debate - Mild, moderate and severe categories work
TBI Debate - Mild, moderate and severe categories work
 
TBI: when to stop and when to give time
TBI: when to stop and when to give timeTBI: when to stop and when to give time
TBI: when to stop and when to give time
 
Ketamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby JeffcoteKetamine in Brain Injury by Toby Jeffcote
Ketamine in Brain Injury by Toby Jeffcote
 
Managing Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne LeeManaging Complications of Chronic SCI by Bonne Lee
Managing Complications of Chronic SCI by Bonne Lee
 
EEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania FarrarEEG and Status Eplilepticus by Tania Farrar
EEG and Status Eplilepticus by Tania Farrar
 
Browne Neuro symposium.pptx
Browne Neuro symposium.pptxBrowne Neuro symposium.pptx
Browne Neuro symposium.pptx
 
Paediatric Stroke by Shree Basu
Paediatric Stroke by Shree BasuPaediatric Stroke by Shree Basu
Paediatric Stroke by Shree Basu
 
Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?Hypertensing Spinal Cord Injury - gold standard or wacky?
Hypertensing Spinal Cord Injury - gold standard or wacky?
 
Optimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion PressureOptimal Cerebral Perfusion Pressure
Optimal Cerebral Perfusion Pressure
 
The Power of Words - Death and Language.ppt
The Power of Words - Death and Language.pptThe Power of Words - Death and Language.ppt
The Power of Words - Death and Language.ppt
 
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same CoinSepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
Sepsis and Antimicrobial Stewardship - Two Sides of the Same Coin
 
Brain injury outcomes and predictors
Brain injury outcomes and predictorsBrain injury outcomes and predictors
Brain injury outcomes and predictors
 

Recently uploaded

Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
varun0kumar00
 
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in GoaCall Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
rajni kaurn06
 
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa AjmanLuxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...
rightmanforbloodline
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
dnee1
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
The Lifesciences Magazine
 
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair RejuvenationExosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Advancexo
 
Types of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatmentTypes of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatment
RioGrandeCancerSpeci
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
vattakandyrahoof8
 
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptxGORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
Rommel Luis III Israel
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
DrDevTaneja1
 
Movies as a mirror of a society, Introduction
Movies as a mirror of a society, IntroductionMovies as a mirror of a society, Introduction
Movies as a mirror of a society, Introduction
medicineseuge
 
COLD CREAM AND VANISHING CREAM, IP-I, PCI
COLD CREAM AND VANISHING CREAM, IP-I,  PCICOLD CREAM AND VANISHING CREAM, IP-I,  PCI
COLD CREAM AND VANISHING CREAM, IP-I, PCI
ssuser555edf
 
Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...
rightmanforbloodline
 
EXAMINATION OF HUMAN URINE AND FAECES.pdf
EXAMINATION OF HUMAN URINE AND FAECES.pdfEXAMINATION OF HUMAN URINE AND FAECES.pdf
EXAMINATION OF HUMAN URINE AND FAECES.pdf
Madhusmita Sahoo
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
CentiUP
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
Rommel Luis III Israel
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Malayali Kerala Spa Ajman
 
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
PsychoTech Services
 
Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...
SGRT Community
 

Recently uploaded (20)

Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 FaridkotFaridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
Faridkot ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 7742996321 ℂ𝕒𝕝𝕝 𝔾𝕚𝕣𝕝𝕤 Faridkot
 
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in GoaCall Girls Goa 7023059433 Celebrity Escorts Service in Goa
Call Girls Goa 7023059433 Celebrity Escorts Service in Goa
 
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa AjmanLuxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
Luxury Massage Experience at Affordable Rate - Malayali Kerala Spa Ajman
 
Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...Test bank advanced health assessment and differential diagnosis essentials fo...
Test bank advanced health assessment and differential diagnosis essentials fo...
 
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCWPRESSURE INJURY CARE AND MANAGEMENT FOR HCW
PRESSURE INJURY CARE AND MANAGEMENT FOR HCW
 
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
Cyclothymia Test: Diagnosing, Symptoms, Treatment, and Impact | The Lifescien...
 
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair RejuvenationExosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
Exosome Therapy’s Regenerative Effects on Skin and Hair Rejuvenation
 
Types of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatmentTypes of Cancer Treatments | Forms of cancer treatment
Types of Cancer Treatments | Forms of cancer treatment
 
CSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.pptCSE presentation 050804-nikhil tandon.ppt
CSE presentation 050804-nikhil tandon.ppt
 
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptxGORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
GORDON'S 11 FUNCTIONAL PATTERN-Health Assessment.pptx
 
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
Digital Health in India_Health Informatics Trained Manpower _DrDevTaneja_15.0...
 
Movies as a mirror of a society, Introduction
Movies as a mirror of a society, IntroductionMovies as a mirror of a society, Introduction
Movies as a mirror of a society, Introduction
 
COLD CREAM AND VANISHING CREAM, IP-I, PCI
COLD CREAM AND VANISHING CREAM, IP-I,  PCICOLD CREAM AND VANISHING CREAM, IP-I,  PCI
COLD CREAM AND VANISHING CREAM, IP-I, PCI
 
Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...Test bank clinical nursing skills a concept based approach 4e pearson educati...
Test bank clinical nursing skills a concept based approach 4e pearson educati...
 
EXAMINATION OF HUMAN URINE AND FAECES.pdf
EXAMINATION OF HUMAN URINE AND FAECES.pdfEXAMINATION OF HUMAN URINE AND FAECES.pdf
EXAMINATION OF HUMAN URINE AND FAECES.pdf
 
About CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdfAbout CentiUP - Product Information Slide.pdf
About CentiUP - Product Information Slide.pdf
 
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptxASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
ASSESSMENT OF THE SKIN, HAIR, AND NAILS.pptx
 
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa AjmanDiscover the Perfect Way to Relax - Malayali Kerala Spa Ajman
Discover the Perfect Way to Relax - Malayali Kerala Spa Ajman
 
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...Emotional and Behavioural Problems in Children - Counselling and Family Thera...
Emotional and Behavioural Problems in Children - Counselling and Family Thera...
 
Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...Correlation between surface motion and heart-breast distance for breast cance...
Correlation between surface motion and heart-breast distance for breast cance...
 

The importance of communication in pain management

  • 1. The University of Sydney Non-pharmalogical approaches to pain management: The role of clinician communication Claire Ashton-James, PhD Associate Professor, Pain Management University of Sydney School of Medicine
  • 2. Page 2 The University of Sydney • Injury/nociception is not sufficient to cause pain • Pain is a bio-psycho-social phenomenon What is pain? Evaluation of sensations as unpleasant Feelings of distress Construal of actual or potential harm
  • 3. Page 3 The University of Sydney Feelings of distress? Dark Mofo Festival – Winter solstice nude swim
  • 4. Page 4 The University of Sydney Construal of harm?
  • 5. Page 5 The University of Sydney Managing pain involves managing feelings and thoughts about pain Evaluation of sensations as unpleasant Feelings of distress Construal of actual or potential harm What we say matters How we say it matters
  • 6. Page 6 The University of Sydney Positive expectations enhance analgesic effectiveness “I am going to give you a powerful pain medication to make you feel more comfortable” We must inform the patient that we are providing pain What we say matters: expectations shape experiences Open vs. hidden paradigm
  • 7. Page 7 The University of Sydney What we say matters: expectations shape experiences Amanzio, Pollo, Maggi, & Bennedetti, 2001 Analgesic dose needed to reduce pain by 50% Time course of analgesic efficacy
  • 8. Page 8 The University of Sydney What we say matters: expectations shape experiences “We are going to give you a strong painkiller now (morphine)” “We are going to stop giving you the strong painkiller now (morphine)” Benedetti F, Maggi, Lopiano, Lanotte, Rainero, Vighetti & Pollo. 2003.
  • 9. Page 9 The University of Sydney What we say matters: expectations shape experiences Bingel U, Wanigasekera V, Wiech K, Mhuircheartaigh RN, Lee MC, Ploner M, Tracey I. 2011. Remifentanil dose is constant after baseline
  • 10. Page 10 The University of Sydney Pre-surgery visit from anaesthetist: – Informed about pain that patients typically experience – Reassured that having pain was normal after abdominal surgery – Informed that pain is not a sign of harm – Informed that medications can be used to help them to relax What we say matters: expectations shape experiences Egbert et al 1964, NEJM
  • 11. Page 11 The University of Sydney How we say it matters: The role of empathy • RCT of treatment for IBS with three arms: • waitlist • placebo acupuncture (limited interaction) • placebo acupuncture (augmented interaction) • Augmented interaction included: • Warm and friendly manner • Active listening • Acknowledgement (“I can understand how difficult IBS must be for you” • Thoughtful silence • Communication of optimism and positive treatment expectations (“I have had many positive
  • 12. Page 12 The University of Sydney Outcomes at 3 weeks Kaptchuk, Kelley, Conboy et al. Bmj. 2008 May 1;336(7651):999-1003.
  • 13. Page 13 The University of Sydney Outcomes at 6 weeks Kaptchuk, Kelley, Conboy et al. Bmj. 2008 May 1;336(7651):999-1003.
  • 14. Page 14 The University of Sydney How we say it matters: The role of empathy Schupp, Berbaum, Berbaum, & Lang, 2005: – 236 patients undergoing vascular and renal interventions – All have access to PCA with fentanyl and midazolam – Randomized to 3 groups: – Standard care – Structured empathic attention – Self-hypnotic relaxation Structured empathic interaction: • matching patients’ verbal and nonverbal communication patterns, • attentive listening • provision of perception of control (eg, “let us know at any time what we can do for you”) • Encouragement (“you’re doing well”) • emotionally neutral descriptions (“what are you experiencing?”) • avoidance of negative suggestions (“you will feel a pinch or burning”).
  • 15. Page 15 The University of Sydney **significantly less pain medication requested and used by Empathy groups
  • 16. Page 16 The University of Sydney Managing pain involves managing feelings and thoughts about pain Evaluation of sensations as unpleasant Feelings of distress Construal of actual or potential harm What we say matters How we say it matters
  • 17. Page 17 The University of Sydney Claire Ashton-James, PhD Associate Professor, Pain Management University of Sydney School of Medicine CONTACT: Email: Claire.ashton-james@sydney.edu.au Twitter: @drashtonjames

Editor's Notes

  1. relapse of pain happened faster and pain intensity was greater when patients were told morphine was being stopped than when treatment interruption was hidden; this suggests that hidden interruption prolonged the analgesia. The faster relapse of pain after the open compared with the hidden interruption could be attributed to a “nocebo” effect, in which knowledge that the treatment has been stopped leads to an increase in anxiety. In other words, the fear of pain relapse (because analgesics are no longer provided) might have a hyperalgesic effect.
  2. relapse of pain happened faster and pain intensity was greater when patients were told morphine was being stopped than when treatment interruption was hidden; this suggests that hidden interruption prolonged the analgesia. The faster relapse of pain after the open compared with the hidden interruption could be attributed to a “nocebo” effect, in which knowledge that the treatment has been stopped leads to an increase in anxiety. In other words, the fear of pain relapse (because analgesics are no longer provided) might have a hyperalgesic effect.
  3. The "special-care" group consisted of 46 patients who were told about postoperative pain. They were informed where they would feel pain, how severe it would be and how long it would last and reassured that having pain was normal after abdominal operations. Finally, they were told that at first they would find it difficult to relax completely. If they could not achieve a reasonable level of comfort, they should request medication During the afternoon after operation (day zero) the anesthetist visited his patients receiving special care. He reiterated what he had taught the patients the night before and reassured them that the pain they were experiencing was normal; they were again told to request pain medication whenever they could not make themselves tolerably comfortable. The independent observer recorded that the special-care patients appeared to be more comfortable and in better physical and emotional condition than the control group. This was emphasized by the surgeons, who, although unaware of the care each patient received, sent the special-care patients home an average of two and seven-tenths days earlier than the control group (p less than 0.01)
  4. a warm, friendly manner; active listening (such as repeating patient’s words, asking for clarifications); empathy (such as saying “I can understand how difficult IBS must be for you”); 20 seconds of thoughtful silence while feeling the pulse or pondering the treatment plan; and communication of confidence and positive expectation (“I have had much positive experience treating IBS and look forward to demon- strating that acupuncture is a valuable treatment in this trial”).
  5. a warm, friendly manner; active listening (such as repeating patient’s words, asking for clarifications); empathy (such as saying “I can understand how difficult IBS must be for you”); 20 seconds of thoughtful silence while feeling the pulse or pondering the treatment plan; and communication of confidence and positive expectation (“I have had much positive experience treating IBS and look forward to demon- strating that acupuncture is a valuable treatment in this trial”).
  6. a warm, friendly manner; active listening (such as repeating patient’s words, asking for clarifications); empathy (such as saying “I can understand how difficult IBS must be for you”); 20 seconds of thoughtful silence while feeling the pulse or pondering the treatment plan; and communication of confidence and positive expectation (“I have had much positive experience treating IBS and look forward to demon- strating that acupuncture is a valuable treatment in this trial”).