Pain Management Program Case Study: Improving Outcomes with Multidisciplinary Collaboration
Of people living with chronic pain, 68% are of working age and 40% of people who retire early do so because of chronic pain (Treasury, 2022).
It is imperative that we come up with novel solutions to pain rehabilitation, so that we can improve the lives of people living with chronic pain, and give them the tools and support to be active and engaged participants in life, work, and the community. This can have positive economic benefits such as increased productivity, as well as relieving the pressure on an already overburdened hospital system.
Whatever it is, the way you tell your story online can make all the difference.
In 2023, Sunrise Well partnered with Pain Education and Management, an organisation with an innovative pain management program, to develop a comprehensive, informed educational presentation on sleep and lifestyle modifications. Initially this formed part of a pilot program bringing education and management out of the hospital setting and into the community, delivered by a multidisciplinary team of subject matter experts. This article looks at Sunrise Well’s involvement in the program and the challenges and successes experienced in the implementation of the program, and future directions.
The Context
Chronic pain affects approximately 3.6 million Australians, yet there are only 400 to 500 pain specialists available to assist, which places an enormous burden on the process of referral to specialists. There is a huge gap between what the GP can do to support someone with chronic pain, and what the public perceives a pain specialist can do to help. Recognising this gap, Pain Education and Management sought to bring education and treatment back into a community setting, aligning with federal initiatives aimed at enhancing primary healthcare for persistent pain.
Internationally, a multi-disciplinary approach is recognised as being the best-practice intervention for those with chronic pain, however, in the limited time frame available for GPs, this is increasingly more difficult to manage. The pain management program brought together elements of assessment, treatment, and education from an in-patient (hospital) setting, to a community-based setting. This involved collaboration and coordination with local GPs, clinicians, and subject matter experts, like Sunrise Well, to build and deliver the educational components of the program.
The Partnership
Sunrise Well partnered with Pain Education and Management to contribute to the educational component of the program. Sunrise Well was selected for our expertise in behavioural health education, particularly in the areas of sleep and lifestyle modifications for chronic pain management. The collaboration followed a co-design approach, allowing collaborators to leverage their professional expertise while adhering to established educational outcomes.
“ We wanted to engage with those that were subject matter experts… but we wanted to engage in almost a pseudo co-design type activity.”
Our Work
Initial discussions focussed on the program requirements, scope of work, and expectations regarding content and delivery dates. The main focus of our contribution to the program was on the topics of sleep and lifestyle factors that can assist in chronic pain management. As the Principal in this engagement, I wanted to develop a better understanding of the role chronic pain plays in sleep and lifestyle, and how these factors can help or hinder everyday life with chronic pain.
The collaborative effort focused on developing a presentation that addressed:
Sleep Hygiene: Educating participants on the importance of sleep and practical strategies to improve sleep quality.
Lifestyle Modifications: Providing actionable recommendations for relaxation techniques and therapeutic recreation that enhance functioning and life satisfaction.
My research found that there is a bi-directional relationship between chronic pain and sleep and lifestyle. For example, 68-88% of people with chronic pain suffer from sleep issues (Finan, et al., 2013), and yet poor sleep can increase sensitivity to pain (Sleep Foundation, 2023). In addition, there are biopsychosocial issues which can affect sleep and pain, such as sociodemographic factors, positive or negative affect, and brain dopamine systems (Finan, et al., 2013).
Alongside sleep, other lifestyle interventions, such as exercise and stress management, can improve daily functioning of people with chronic pain and, sometimes, alleviate the symptoms of chronic pain. This information is essential for those who have had debilitating outcomes from the pain they are suffering. The ability to increase self determination, and utilise non-invasive interventions in a completely autonomous way, empowers the individual to improve their quality of life, and, potentially gain the satisfaction of participating in and contributing more fully to their own lives and the community they live in. This is likely to increase participation in work activities and reduce avoidance of daily activities (Nijs, J., 2024).
Research such as this was utilised in creating the presentation, so that the content was evidence-based, useful, and provided guidance for the participants. In an iterative approach we consulted with Pain Education and Management to align the presentation with their own program outline.
In line with the overall program structure, we engaged with the participants, delivered the presentation, fielded relevant questions, and discussed and added to feedback on the program.
“The longer you have pain, the better your spinal cord gets at producing danger messages to the brain, even if there is no danger in the tissue.”
Outcomes
The program included a series of workshops, each evaluated through participant surveys to assess the relevance of the content and presenter quality.
Feedback for Sunrise Well’s presentation was overwhelmingly positive:
Relevance of Information: 100% of participants found the information covered to be very relevant to their personal experience.
Presenter Quality: 100% reported being very satisfied with the quality of the presentation.
Knowledge Gain: Participants noted a split in satisfaction regarding knowledge gain, with 50% reporting being very satisfied and the other 50% somewhat satisfied.
Additionally, the program achieved a perfect Net Promoter Score (NPS), indicating that all participants would recommend the workshop to others.
The pilot program not only succeeded in meeting its educational goals but also won the Pinnacle Pain award for the Best Multidisciplinary Care Program in Australia in its first year.
Key program outcomes included:
Improved Knowledge: Participants reported increased understanding of chronic pain management strategies.
Community Engagement: The program successfully bridged the gap between clinical care and community education.
Benchmarking Success: The initiative performed better than many established pain services, as evidenced by the EPOC (Electronic Persistent Pain Outcomes Collaboration) benchmarks. The program leader noted, “We beat five of the seven indicators across the country,” indicating an outstanding performance.
The positive participant feedback and measurable outcomes validate the program's approach. As the program manager concluded, “We’re very, very happy with the outcomes.”
Challenges
According to Pain Education and Management, the program faced various challenges, particularly in the coordination and integration of diverse therapeutic approaches into a comprehensive program. However, the iterative design process allowed for continuous improvement, focusing on participant needs and feedback. As expressed by program manager Dean Minchington, “We are always looking from a clinical governance point of view, always looking at what could improve.”
In terms of Sunrise Well’s project delivery, one of the key challenges was to ensure that the development of our content was both best practice in terms of international research and standards, and also fit within the expectations and parameters set out by the program manager. Given the program was already aligned with best practice standards, the main concern was to maintain open lines of communication, and a willingness to find flexibility within the project to ensure all parties were satisfied with the outcome.
Key Takeaways
Sunrise Well was a contributing component to the success of the pain education and management pilot program, however one of the key takeaways is that the success of the program very much depended on the contribution of many. Key learnings include:
Importance of Collaboration: Working alongside subject matter experts in a coordinated fashion allows our clients to gain much more than working alone.
Adaptability: The ability to pivot and adapt based on participant feedback and program requirements was essential for the program’s success and will be a key learning for Sunrise Well going forward.
Evidence-Based Practice: Continuing to use evidence-based content will always support effective and credible work.
Conclusion
The partnership between Sunrise Well and Pain Education and Management shows how a collaborative approach can provide innovative solutions for issues that are traditionally addressed in a singular way. In this case, pain education and management was taken out of the typical in-patient setting, brought into a community setting, and delivered using multidisciplinary subject matter experts, with positive outcomes for all.
Recommendation
We’re proud to say that when asked if he would recommend Sunrise Well to others, the program manager responded with, “I wouldn't have any reservations”.
The successful outcomes from this partnership demonstrate our commitment to creating impactful, evidence-based educational programs that meet the needs of both practitioners and patients.
Further Reading
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References
‘Working Together to Address Chronic Pain’, 2022, Pain Australia Budget Submission 2021 to 2022, <https://treasury.gov.au/sites/default/files/2021-05/171663_painaustralia_0.pdf>
Finan, P., Goodin, B., Smith, M., 2013, ‘The Association of Sleep and Pain: An Update and a Path Forward’, The Journal of Pain, Volume 14, Issue 12, 1539 - 1552.
Nijs J, Malfliet A, Roose E, Lahousse A, Van Bogaert W, Johansson E, Runge N, Goossens Z, Labie C, Bilterys T, Van Campenhout J, Polli A, Wyns A, Hendrix J, Xiong HY, Ahmed I, De Baets L, Huysmans E., 2024, ‘Personalized Multimodal Lifestyle Intervention as the Best-Evidenced Treatment for Chronic Pain: State-of-the-Art Clinical Perspective’, Journal of Clinical Medicine, Jan 23;13(3):644.