Preceptorship program for community physicians
The aim of the preceptorship program is to:
- Provide physicians in the community with an opportunity to update their knowledge of pain medicine
- Help physicians better understand the role of the MUHC - Alan Edwards Pain Management Unit in the management of chronic pain patients
- Help us learn about the physician's work with patients in the community who suffer from pain
- Foster future collaborations in the care of pain patients.
Information sent to doctors expressing interest
We would like to welcome you for your preceptorship day at the MUHC - Alan Edwards Pain Management Unit (AEPMU). We believe it will be a great opportunity for us to learn more about the needs of pain patients in the community, and for you to better understand the role of tertiary Pain Centres in treating pain. We hope to enrich your knowledge in the field of pain treatment, and we will try to tailor the tutorship to your needs.
You will spend one full day with us (although there are possibilities for further preceptorship days). During the day you are here we would like you to become, as much as possible, a part of our pain team, and to get involved in our multi-disciplinary activities. These activities include:
- Evaluation of patients by the multidisciplinary team, including physicians, psychologists, physiotherapists and nurses
- The physical examination of the pain patient
- Diagnostic procedures
- Treatment modalities, including physical modalities, medications and interventional procedures (a special emphasis will be placed on the subject of opioids in chronic pain patients)
- Group discussions on individual patients
- Clinical research at the AEPMU with an emphasis on possible future collaboration
To better prepare the tutorship, we enclose a short introduction about chronic pain and our Unit, as well as a short questionnaire. We suggest you prioritize your needs and expectations by filling out this questionnaire and faxing it to us before your arrival. We will try to adjust our activities to meet your learning needs.
The MUHC - Alan Edwards Pain Management Unit team
Pain preceptorship: Pre-visit assessment of aims
Please fax us the completed questionnaire at 514-934-8096.
Pain that persists beyond the normal time of healing (generally >6 months), despite adequate treatment, is considered chronic. Chronic pain is not several days of acute pain strung together but must involve physical and neurochemical changes in CNS pathways. In Canada, nearly one third of the population over age 15 have chronic pain. At least 70% of these patients have moderate to severe pain that interferes with their daily life. Over 20% of primary care patients suffer almost unrelenting pain for at least six months at a time. Finally, chronic pain is the most common cause of disability.
Chronic pain typically creates a cluster of related problems affecting physical, psychological and social well-being. These problems include sleep disturbance, fatigue, excessive rest, mood disorder, withdrawal from activity, and compromised immune function. These in turn often interact with other patient factors, such as disease, mental disorders, affective distress, personality traits, and personal beliefs, to interfere with treatment. Consequently, several key factors must be considered in order to improve treatment outcomes, including the somatic source of pain, prior pain experiences, emotional and personality status and family and cultural factors.
Pain pathophysiology (pain type) may affect treatment options:
Nociceptive pain: This pain results from direct stimulation of peripheral nociceptors and is often associated with tissue damage and inflammation. The most common forms are:
- Deep somatic pain which is generally aching and involves receptors in bone, joints, ligaments and muscle such as arthritic pain, degenerative disc disease, and osteomyelitis
- Visceral pain which involves receptors in the peritoneum, pleural cavity or viscera such as pain resulting from chronic pancreatitis, Crohn’s disease and endometriosis
Neuropathic pain: This pain is caused by an injury to the central or peripheral nervous system, or by sensitization of central pain processing. It includes:
- Peripheral mononeuropathy such as carpal tunnel syndrome, disk herniation, and post-herpetic neuralgia.
- Polyneuropathy such as diabetic- and HIV-associated pain.
- Central deafferentation such as phantom limb and post-stroke pain.
- Chronic syndromes such as post-traumatic causalgia and complex regional pain syndrome
Single modalities of treatment are unlikely to be effective in the treatment of chronic pain. It has been demonstrated in the literature that combination treatments in multidisciplinary Pain Centres are superior to unimodal treatments.
During the one-day Preceptorship, the physician will acquire the knowledge to enable him/her to:
- Conduct a pain assessment
- Distinguish different types of pain
- Know which medications or combination of medications to use for different types of pain
- Be aware of non-medication treatment modalities and their use
- Assess the role of psychological factors in the pain problem
- Be aware of "red flags" (addiction, secondary monetary gain perpetuating pain, serious psychological problems masquerading as pain)
- Avoid over-medicalizing when treatments do not help
The one-day preceptorship program teams the community physician with the multidisciplinary staff of the AEPMU and includes:
- Half-hour introduction to the work of the AEPMU
- Assessment & examination of the pain patient
- Psychological assessment of the pain patient
- Observation of invasive pain-relieving interventions
- Summary discussion at the end of the day
- Package of readings on pain treatment
After you have completed the Preceptorship, staff at the MUHC - Alan Edwards Pain Management Unit will continue to be available for consultation or to answer any further questions.