The people involved in establishing the in-patient pain management unit in Melbourne have all worked with chronic pain patients for several years. They have learned that the management of pain must involve a ‘multi-disciplinary’ approach to the patient with chronic pain.
In setting up such a clinic, the specialists had become convinced from experience that an in-patient facility was important in the assessment and management of chronic pain patients. They also believed that such a unit would operate best on a ‘behaviourial model’ based on principles of behaviour modification as set out by Dr W. Fordyce of Seattle.
This involves changing the behaviour of chronic pain patients and encouraging them to return to normal behaviour. In other words, patients must start managing or coping with their pain, and not allowing it to completely control their lives.
The programme’s aim is to improve the quality of life of patients with chronic pain. Accordingly, a programme of pain management was organised to minimise the length of stay in hospital.
The unit is staffed by:
• A clinical director who is a consultant psychiatrist, with experience in managing chronic pain patients.
• A full-time charge nurse and two other nurses.
• A clinical psychologist who acts as programme director.
• A part-time occupational therapist.
• A part-time physiotherapist.
• A part-time dietician.
• A unit physician.
• A social worker.
The programme usually runs for about four weeks. Under most circumstances, patients are initially admitted for a five-day assessment period which runs from Monday to Friday.
At the end of this time, the patient’s major areas of difficulty, both physical and psychological, are discussed and a contractual period of admission is agreed upon, with the specific aims being clearly defined.