Biopsychosocial Approach to Chronic

Pain Management: The Selayang

Hospital Experience
Overview
1. Chronic Pain
2. The Biopsychosocial Model of Pain
3. Pain Management at Pain Clinic Hospital
Selayang
4. MENANG Program
Pain
Acute Pain
Chronic Pain
Prevalence of Chronic Pain in Malaysia
A major healthcare problem worldwide,
especially Asia Pacific
1
Often neglected due to lack of awareness
1

Prevalence of chronic pain in Malaysia is about
7% with higher proportion in older age group
2

Age group >75 years 21.5% in average
Age group <75 years 2.5% in average




Challenge to pain management
Most Malaysian adhere to standard medical
model and depend on health care providers as
it was based on the Cartesian model of pain
2


However, the Cartesian model is unable to
explain many clinical and social observations
E.g. The presence of pain with the absence of
tissue damage


Pain defined
International Association of the Study of Pain
defined pain as:

An unpleasant sensory and emotional
disturbances, associated with actual or potential
tissue damage
Pain is always subjective
Many people report pan in the absence of tissue
damageit should be accepted as pain
3
Pain is not the only presenting issue
Chronic pain is a complicated condition
Is a major threat to on multiple levels:

o Physical
o Emotional
o Behavioral
o Relational
o Environmental

82% of patient with chronic pain patients reported
emotional, behavioral and social challenges interfered
with their daily activities
4
Quality of Life
The biopsychosocial model of pain
5
Pain
Nociception
Pain
Suffering
Pain
behavior
Pain Management at Pain Clinic,
Selayang Hospital
Employs a biopsychosocial approach to
chronic pain management for more than a
decade

The first multidisciplinary pain service in
Malaysia
Multidisciplinary team in Pain Clinic,
Hospital Selayang
Pain specialists

Physiotherapists

Clinical psychologists

Medical social worker

Pain nurses
Promote well-
being and
functioning of
patients with
chronic pain
In a holistic
manner
Management of chronic pain
Analgesics
Nerve blocks
Acupuncture
Physiotherapy
Cognitive Behavior Therapy
Clinical Hypnosis
Etc.
MENANG PROGRAM
2
Group-based pain management
10-days intensive program promoting self-
management in pain
Based on ADAPT Programmed at the Pain Management
Research Centre at the Royal North Shore Hospital in
Sydney

Emphasizes importance of physiotherapy and
psychological interventions
Deemphasize surgical interventions and roles of
medications





MENANG PROGRAM (2)
Patients selection are based on teams assessment and regular
multidisciplinary team meeting

Teaches patients to re-conceptualise pain:
o Education about pain
o Goal setting
o Relaxation and desensitisation training
o Identifying and challenging unhelpful cognitions
o Effective problem-solving
o Pacing and daily planning
o Programmed exercise and systematic encouragement of
activities that limit avoidance behaviours
o Medical withdrawal

Evaluation of MENANG program
2
Reconceptualizing pain
Complete pain relief is not necessary for
maintaining normal life style, given an active
pain management approach

It is important to have more training and
education for healthcare professionals and the
community on the role of self-management in
chronic pain
References
1 Malaysian Association of the Study of Pain (2010). Chronic
Pain Declaration. www.masp.org.my
2 Cardosa, M, S., Osman, Z, J., Nicholas, M., Tonkin, L.,
Williams, A., Aziz, K, A., Ali, R, M., & Dahari, N, M (2012).
Self-management of chronic pain in Malaysian patients:
Effectiveness Trial with 1-year follow up. TBM, 2, 30-37
3 Merskey, H. & Bogduk, N (1994). Classification of Chronic
Pain. International Association of the Study of Pain. United
States
4 Cardosa, M. S. (2006). Pain Management: Trends and
Challenges. Med Journal Malaysia, 61, 2.
5 Loeser, J. D. (1982). Concepts of Pain. Chronic Low Back Pain.
New York: Ravens


Thank you