A pain management programme in the health service

A PAINMANAGEMEXT PROGRAMMEIN THE HEALTHSERVICE. J C D Wells,E J Chadiali*, J J Tapper*and P A J Hardy,Centrefor Pain Relief,WaltonHospital,Liverpool, UK. AIM OF INVESTIGATION: Many treatment programmes for chronicpain have Abs No 624 beenescribedin the UnitedStates,enablingsomepatients ____^ to._.. copewith have - theirpain,whateverthe cause. Informalprogranuaes exlsteain hurope,but no formal,continuousprogrammeexistedby 1983 in Europe,possibly becauseof the high costsof an in-patient prograrmne. Consequently an out-patient programne was set UP in OUT Pain Unit in June 1983, and has continuedsince then. Six hundredand forty-eight patientshave enteredthe progrsmmeand the resultsof theirtreatment have been assessed. METHODS:The treatmentprogrammelasts for 4 weeks,with patientsattendingdaily for 5 days a week. Treatmentis based upon gradedincreasein exerciseand activity,relaxation trainingand cognitivebehaviouraltreatment. Patientsare assessedprior to attendance, upon completion,at 3 months and 1 year. Note is taken of pain (VAS),medicationand activities, includingpaid occupation. RESULTS:Over 89 per cent of patientscompletedthe 4-week programme. A 50 per cent remin pain was reportedin 58 per cent of patientsat 4 weeks,but only 36 per cent at 1 year. The usage of opiate and opiate derivativemedicationwas 74 per cent prior to recruitment,and had dropped to 32 per cent at 1 year. Activitieshad increased significantly in 84 per cent of patientsat 4 weeks,but thishad droppedto 61 per cent by 3 monthsand 47 per cent at 1 year. Twentyfourper cent of patientsthoughtto be employable had gainedand maintainedpaid employment at 1 year. CONCLUSION: The programneoffereda significant advancein managementof chronicpain sufferers.The cost-effectiveness is seen in returnto activityand in reductionin sickness benefits,drugs and relianceon SocialServices. Increasedactivityenhancesthe lifestyle of both patientsand often their long-suffering families. Other CentresthroughoutEurope are now settingup treatmentprogrammes, some basedupon our experience.Most patientsfeel the programneis useful;therapistsfind a multi-disciplinary approachstimulating and more effectivethanworkingalone.

HYPNOTIC ANALGESIA: A BEHAVIOURAL AND COGNITIVE ANALYSIS. Poster 85 R.A.Bryant* (SPON: R.Garofali), Pain Clinic, '?/estmead GREEN Th-Fri Hospital, Westmead, NSW, Australia. Exhibit Hall i AIM OF INVESTIGATION: Two experiments investigated Abs No 625 i behavioural and cognitive factors of hypnotic analgesia in II_ chronic lower back pain patients. Experiment 1 was designed to compare the efficacy of hypnotic analgesia, relaxation, and a control condition in pain management. Experiment 2 investigated cognitive factors associated with hypnotic analgesia. METHODS: In Experiment 1, patients' pain, anxiety, depression, anti medication use were monitored during a two-week course of either audiotaped self-hypnosis (n = 20), relaxation training (n = 20), or control condition (n = 20). The influence of hypnotizability, absorption, attitudes to hypnosis, and pain coping styles was assessed. In Experiment 2, patients (n = 40) completed a one-week course of self-hypnosis, then viewed a videotape of their self-hypnosis, and commented on their cognitive, affective, and motivational experiences during self-hypnosis. RESULTS: MnCiings from Experiment 1 indicated that self-hypnosis, relaxation, and control conditions were associated with differences in pain and affective response. Findings from Experiment 2 indicated that hypnotic analgesia was associated with the active use of cognitive strategies, and with aptitude for cognitive absorption. CONCLUSIONS: Hypnotic analgesia is an effective pain management tool for patients who possess specific cognitive skills, and respond to hypnotic suggestion in an active, problem-solving manner. These finoings are discussed in terms of the development of more effective hypnotic management of chronic pain.