Welcome to the Alan Edwards Pain Management Unit

1. Welcome to the Alan Edwards Pain Management Unit Introductory session

2. About this unique session Aims: • Learn who we are • Review some information about chronic pain • Understand what treatments could be offered by us • Learn how our clinic works • Allow you to ask general questions in regard to your future therapy with us • Collect your completed white forms and review how we decide when your first appointment will be

3. About this session Please remember This session is not intended to answer personal medical questions!

4. About this session We will try to relieve some of the following concerns: • “I don’t know why I was sent here” • “I am here just for a block” • “I just need a medication” • “I have already heard all this before” • “When am I going to be seen?”

5. About us Different health professionals of multiple disciplines all specializing in chronic pain management: • Anesthetists • Family Doctors • Geriatrician • Neurosurgeon • Psychiatrist • Physiatrists • Rheumatologist • Psychologists • Nurses • Physiotherapists • Social Worker • Dentist

6. About us A multi-disciplinary Pain Management Unit • Working in collaborative harmony as a team • Many times decisions are made following a team discussion Mission • Decrease your pain • Improve your quality of life • Increase function

7. More about us…. • Academic Unit • Students of multiple disciplines • Residents and fellows • Psychology interns • Research Unit • Clinical pain research • You may be offered to participate in one of the studies

8. Pain education corner:true or false? It is necessary for all humans to feel pain TRUE!

9. We will not be able to survive without feeling pain!

10. What is pain? Pain = Perception + Verbal communication pain? pain?

11. There is a big difference between feeling acute pain and experiencing chronic pain

12. Acute vs. chronic pain

13. Pain evolution • Descarte – 17th century A simple cable from the injured site to the brain

14. Current knowledge Perception & modulation Spinal dorsal horn Transmission up & down Conduction Skin

15. The gate control theory of pain Our nervous system contains a gate that can partially control the amount and level of pain sensations we feel at any given time

16. The gate control theory of pain Factors that open the Gate: Physical inactivity Anxiety Depression Focusing on pain Boredom

17. The gate control theory of pain Factors that help close the gate: • Stimulation (e.g., massage) • Sleeping well • Positive emotions • Optimism, happiness • Concentration • Distraction • Reduced stress

18. True or False Pain is a purely physical problem FALSE!

19. The complexity of chronic pain

20. True or False Only medications can reduce chronic pain FALSE! Multiple approaches should be used

21. What treatments might we offer? • Medications

22. Medications

23. What treatments might we offer? • Medications • Invasive interventions

24. Invasive Interventions

25. What treatments might we offer? • Medications • Invasive interventions • Physiotherapy

26. Physiotherapy

27. Relieving fear of movement

28. What treatments might we offer? • Medications • Invasive interventions • Physiotherapy • Psychologicalevaluationand short-termtherapy

29. Psychological evaluation and therapy

30. What treatments might we offer? • Medications • Invasive Interventions • Physiotherapy • Psychologicalevaluation and short-termtherapy • Group therapy

31. Pain Management Group

32. Group sessions for families Pending

33. Our treatments are aimed to help you to: • Decrease your pain • Improve your sleep • Be more active • Feel lessdepressed , anxious or angry about your pain • Improve your quality of life

34. True or False Being actively involved in your care will help you to better manage your pain TRUE!

35. Be actively involved in your care • Attendall your appointments! • Think about what “I still can do” • Remain active, but pace your activities • This may include changing your life habits • You may not be able to do the same things you used to do before

36. Be actively involved in your care Collaborative relationship is crucial !

37. Our patients’ testimonials

40. Relevant clinic information 2018: Our average wait time for first appointment is approximately 5 months Wait times could vary between 1 month and 1 year 2013: Our average wait time for first appointment was up to 2 years

41. Relevant clinic information • Possible duration of your care with us • One appointment only • Up to several months • Varies between patients • Frequency of appointments • Depends on the individual patient and her/his needs

42. Relevant clinic information • Please bring all relevant medical information to your first clinical visit • List of medications, X-ray results, blood tests, etc. • Please ensure you have an up-to-date MGH (red) hospital card. If not, you must go to L6 130 at least 30 minutes before your appointment time to get an updated card. • We might decide to perform some tests (e.g., urine drug tests) at any point during therapy with us

43. Please remember • Once we have initiated your therapy you should avoid receiving other therapies elsewhere unless approved by us first • You must let us know at least one working day in advance if you cannot attend your scheduled appointment. We could then offer your slot to another patient.

44. You should know • We follow the McGill University Health Centre’s zero tolerance to violence, either physical or verbal • Violent behavior towards any of our staff members, including clerical staff, will result in your appointment(s) for that day being cancelled • Repeated violent behaviors will result in your immediate discharge from our clinic

45. You should also know • We try very hard to see you at your scheduled time • Some patients need more time with us than anticipated, resulting in possible slight delays • Nevertheless, you must be on time for your scheduled appointment • If you are more than 10 minutes late for your appointment, the front desk clerks are instructed to check if you can be seen • It is possible that your appointment will have to be re-scheduled

46. How do we evaluate your file? • We collect all your documents, including the medical questionnaire that you filled-in (today) 1) Questionnaire, 2) Agreement, 3) Familydoctorform • We triage your file and assign a medical priority • Within 2-4 weeks we send a letter to you, and your referring physician, indicating the approximate date of your first appointment with us

47. How do we determine your medical priority? Done by dedicated committee at the pain unit Combination of many factors Prioritization is unique for every individual patient

48. Available Resources • Québec Association of Chronic Pain • https://douleurchronique.org/?lang=en • Québec Pain Portal • http://portaildouleur.org/en/about-quebec-pain-portal • Canadian Pain Coalition • https://www.facebook.com/CanadianPainCoalition/ • Passeport Santé • Passeportsante.net • Alan Edwards Pain Management Unit • mcgill.ca/paincentre

49. Questions?

50. Thank you!