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Dr Naomi Bowers has spent a number of years working in the chronic pain area. She began as a senior medical officer at a hospital persistent pain clinic, and continues as a GP with a special interest in chronic pain. Here, she shares her top tips to help you assess, treat and manage such patients.

Chronic pain assessment tips

With one in five Australians aged 45 and over suffering from chronic pain, Naomi says it’s important registrars work on developing their assessment and treatment skills.

  1. Listen carefully

“If it’s the first time you’re seeing a chronic pain patient, make sure you listen to their story because there’s therapeutic value in that too. It will often take me two or three visits to complete my initial assessment, as this gives the patient adequate time to share their experiences and feel like I’ve really understood them.”

  1. Do a hands-on examination

“Always examine these patients. Even if a patient has had chronic lower back pain for decades, feel for yourself to make sure nothing has been missed. I’ve had such patients say to me, ‘No one’s actually examined me for 20 years.’ This serves to build trust too, as it clearly shows you’re taking their pain seriously.”

  1. Review their examination history and repeat if necessary

“By the time I see most chronic pain patients, they’ve had extensive investigations and even surgery, but nothing has helped. They’re at the point where they just want to find a way to live their life despite the chronic pain. While you should track down and review their previous investigations, I also would recommend you repeat them – especially if it’s been a long time – to ensure you don’t miss anything physical.”

  1. Take a social history

“Do an extensive social history. Ask whether they grew up in a safe household, or were ever in a relationship classed as domestic violence. I’ve had patients I’ve seen for a very long time as their regular GP, but they haven’t spoken to me directly about their pain. But when they do and I ask those specific questions, it turns out they were abused in childhood, or that they left a relationship after their husband tried to kill them. These things can make a huge difference to their ongoing treatment.”

  1. Equip them with resources

“I encourage my patients to visit the MindSpot website, as they have excellent chronic pain education and an online pain management program. I also highly recommend they watch Lorimer Moseley’s TEDx Talk ‘Why do we hurt?’ as he’s very good at explaining what happens when you have a heightened nervous system and secondary trauma.”

  1. Involve the team

“Once you’ve really engaged with your patient, you can then move onto getting your multidisciplinary team on board. Look for a psychologist experienced with chronic pain, and a physiotherapist with the same.”

  1. Give it time

“Helping chronic pain patients takes a long time, and it’s often five steps forward, four steps back. But that’s okay. Keep the focus on setting very small goals and work towards them. For instance, I set a goal for a recent patient to sit in her garden for 10 minutes, three times a week for the next two months. While the progress is incremental, these patients will make real improvements in their quality of life. When you manage to get a patient who hasn’t been leaving the house to a point where they can do their own shopping, that’s immensely rewarding.”