Page 182 - HA Convention 2016 [Full Version]

HOSPITAL AUTHORITY CONVENTION 2016 Special Topics

T18.2 Collaborative Service Programmes in Allied Health 14:30 Room 423 & 424

Multidisciplinary Pain Management Programme for Complex Non-cancer Pain Patients in Alice Ho Miu Ling

Nethersole Hospital
Cheung CT 1, Lau CW 2, Siu SY 3, Chan CM 4, Lee YC 5, Ma ML 5, Hui PL 6, Chu MC 7, Chen PP 5, Lau WK1
1Department of Physiotherapy, 2Department of Clinical Psychology, 3Department of Medical Social Work, Alice Ho Miu Ling
Nethersole Hospital, 4Department of Occupational Therapy, Prince of Wales Hospital/Alice Ho Miu Ling Nethersole Hospital,
5Department of Anaesthesiology and Operating Services, Alice Ho Miu Ling Nethersole Hospital, 6Spiritual Care Services:
Hospital Chaplaincy, 7Department of Anaesthesia, Pamela Youde Nethersole Eastern Hospital, Hong Kong

Wednesday, 4 May Introduction

Since 2002, the Comprehensive Outpatient Pain Engagement Pogramme” (COPE), a structured six-week (14 whole days) has
been introduced with multidisciplinary input from pain specialist, clinical psychologist, nursing specialist, physiotherapist,
occupational therapist, medical social worker and chaplain for managing complex chronic non-cancer pain patients at Alice
Ho Miu Ling Nethersole Hospital (AHNH).

Objective

This study evaluates the effectiveness of a multidisciplinary pain management programe in handling complex chronic non-
cancer pain patients.

Design

A prospective cohort study.

Methods

Data of 158 chronic non-cancer pain patients who had joined the COPE programme from
2002 to 2012 were analysed.

During the six-week programme, different disciplines closely worked together to implement rehabilitation plan for the
patients. The team adopted cognitive behavioural approach. Core elements included pain pathophysiology education,
medication titration, goal setting, counseling and behavioural activation. The team used cognitive restructuring, relaxation
exercise, activity pacing, communication skill training, graded exercise, functional training, and life style modification to help
patients get out of chronic pain spiral. At weekly case conferences, the team reviewed patients’ progress on their capacity to
cope with chronic pain to achieve better daily activities and functions.

Physical outcome measures included tolerance to sitting and standing. Psychological constructs such as mood,
catastrophisation, self-efficacy, quality of life, and perceived performance in activities of daily living were measured. Return-
to-work rate, hospital admissions, and outpatient visits were also analysed. All outcome measures were taken before and one
year after the programme.

Results

There was significant improvement (p<0.05) in all psychosocial measures, physical tolerance in sitting and standing, and
reduction in medical utilisation despite similar pain intensity. There was also significant increase in return-to-work rate one
year after commencement of the programe (35% after vs 17% before the programme; odds ratio=3.01). Logistic regression
analysis showed that pain intensity, psychological distress and history of work-related injuries were not related to the
likelihood of return to work. But shorter duration of pain and higher physical functioning score in 36-item Short-form Health
Survey were prognostic indicators.

Conclusion

Patients with chronic pain who joined the integrated multidisciplinary COPE Pain Management Programme at AHNH showed
significant improvement in physical and psychological functions, and return-to-work rate despite their long history of pain.

180