At the 2018 American Academy of Pain Management Annual meeting, a panel discussed how you approach patients after they have completed an interdisciplinary pain management program. The panel included:
- James Atchison, DO – Shirley Ryan Ability Lab
- Ravi Prasad, PhD – Stanford University School of Medicine
- Patricia Cole, PhD – Shirley Ryan Ability Lab
- Elizabeth Gaffron, MOTR/L – Shirley Ryan AbilityLab
- Sharon Hsu, PhD – Swedish Medical Center
- Felix Lavsky, MS – Shirley Ryan Ability Lab
- Kristin Lucas, PT, DPT – Swedish Medical Group
- Hannah Nilles, PT, DPT – Shirley Ryan Ability Lab
The speakers talked about the importance of follow up on an outpatient basis for a period of time, continuing to address psychological counseling, and occupational therapy. The intensive program usually lasts four weeks. Some presenters follow that up immediately with a four week step down program, while others want the patient to self-care for four weeks then return for evaluation. It is important that self care is emphasized so the patient does not become dependent on the therapist and the program for continued care.
Connecting patients with peer support groups is also useful for the follow up care as this helps the patient better understand how they need to restructure their lives to be successful with their new pain management techniques.
From an occupational therapy perspective, you need to follow up to ensure they are actually putting the training into practice. This may involve a home visit to make sure they are taking care of their house, practicing good nutrition, and good self care. The nutrition component cannot be overlooked as this can help patients maintain proper weight and have a healthy diet. Many OT programs actually involve taking the patient shopping for groceries and preparing food to reinforce this learning. Meal preparation is an important part of returning to a state of feeling normal for many patients.
Sometimes patients are harder on themselves with post treatment self assessments than needed, focused on the negatives instead of positives. The therapist can help them refocus on what has been successful to celebrate those successes while at the same time taking corrective action to address the deficiencies.
If there are elements of the formal program the patient really liked, there are community programs available which could allow them to continue to participate in these activities in a group setting. This is especially true with things like yoga, tai-chi and meditation programs.
In terms of medications, usually after the program is completed the patient is on some form of mild sleep aid to ensure they are getting proper rest. They stay on these for at least 8 weeks and sometimes longer. Medications impacting anxiety are also usually continued. Some opioids can be part of the post-treatment program if they are only used occasionally and only for an increase in activity level. They try to encourage the patients that the relaxation techniques work faster than the medications, with the goal being that the patients eventually stop using all medications. If the patient was taking both opioids and benzos, the tapering of the benzos can take much longer.
Wearables can also play a role in post-treatment monitoring. Activity monitoring bracelets are used frequently in younger patients to monitor daily step goals as well as sleeping patterns. There are also apps out there that are support groups for chronic pain patients that features online resources as well as peer networking.
It’s very important to know the patient as some of these apps and wearables can make the patient overly competitive and lose focus on their actual treatment goals.