Attachment 2. Suggested actions for general practitioners Early intervention 4-12 weeks post injury Chronic phase Within 3 weeks post-injury Detailed review and modify treatment Rethink, reassess Consider multidisciplinary approach Use brief screeners like Orebro, K10 and pain intensity to Reassess and consider the specific risks test with: To identify and treat persistent pain issues, gain insight into the worker’s: Pain Catastrophising Scale re-administer DASS/K10, pain self-efficacy Function Pain Self Efficacy Q’re (coping with pain) Refer to pain psychologist and or Global prediction of RTW K10 for distress multidisciplinary team for detailed risk Fear/avoidance behaviour assessment assessments Fears of re-injury Risk Review physiotherapy treatment Refer to physiotherapist for active treatment and Review role of physiotherapy treatment Refer to mobile case manager, RTW consultant or monitor progress Assess and impact of deactivation coordinator for workplace issues Listen, reassure, foster self-management, extend Review and treat if sleep difficulties For clinical signs of low mood, high anxiety, depression activity levels to be despite pain’ Refer to multi-disciplinary team of ‘active consider referral to pain psychologist Educate pain e.g. it does equate to severity of experienced clinicians Reassess patient’s understanding of their conditions response injury Coordinate with all parties Work Capacity Certificate to reflect functional abilities Clinical Now consider Now consider beyond pain Expand treatment options Cognitive behaviour techniques (CBT) for persistent pain Cognitive behaviour techniques to counter: medication and reducing the worker’s hours of work addressing: Distress, depression, anxiety Fear avoidance/behaviour at work Self-perceived disability to address broader pain beliefs and anxiety issues High pain focus and distress Pain management techniques management Refer to: (a) return to work coordinator to manage Re-activation strategy Review impact of CBT to identify specific workplace problems e.g. suitable duties, Pain management techniques using: ongoing difficulties and modify management relationships; or (b) mobile case manager to arrange clinical Pain education including pain education approach mediation/relationship management Physical exercise regime Coaching/motivational techniques Additional
Attachment 2. Suggested actions for general practitioners Early intervention Within 3 weeks post-injury 4-12 weeks post injury Detailed review and modify treatment Chronic phase Rethink, reassess Consider multidisciplinary approach Risk assessments Use brief screeners like Orebro, K10 and pain intensity to gain insight into the worker’s: Function Global prediction of RTW Fear/avoidance behaviour Fears of re-injury Reassess and consider the specific risks test with: Pain Catastrophising Scale Pain Self Efficacy Q’re (coping with pain) K10 for distress To identify and treat persistent pain issues, re-administer DASS/K10, pain self-efficacy Refer to pain psychologist and or multidisciplinary team for detailed risk assessment Clinical response Refer to physiotherapist for active treatment and monitor progress Listen, reassure, foster self-management, extend activity levels to be ‘active despite pain’ Educate pain e.g. it does equate to severity of injury Review physiotherapy treatment Refer to mobile case manager, RTW consultant or coordinator for workplace issues For clinical signs of low mood, high anxiety, depression consider referral to pain psychologist Reassess patient’s understanding of their conditions Work Capacity Certificate to reflect functional abilities Review role of physiotherapy treatment Assess and impact of deactivation Review and treat if sleep difficulties Refer to multi-disciplinary team of experienced clinicians Coordinate with all parties Additional clinical management Expand treatment options beyond pain medication and reducing the worker’s hours of work to address broader pain beliefs and anxiety issues Refer to: (a) return to work coordinator to manage workplace problems e.g. suitable duties, relationships; or (b) mobile case manager to arrange mediation/relationship management Now consider Cognitive behaviour techniques (CBT) for persistent pain addressing: Fear avoidance/behaviour at work High pain focus and distress Re-activation strategy Pain management techniques using: Pain education Physical exercise regime Coaching/motivational techniques Now consider Cognitive behaviour techniques to counter: Distress, depression, anxiety Self-perceived disability Pain management techniques Review impact of CBT to identify specific ongoing difficulties and modify management including pain education approach
Outcomes-of-early-psychosocial-screening.docx