Teamwork! An exciting new approach to pain self-management

Pain can be a lonely experience, but people should not have to manage it alone. Effective pain management is a team effort. Friends and family are usually key team members as sources of support, but it cannot be left to them alone. They may not feel equipped to offer the correct support and can often bear the brunt of their loved one’s suffering.

In healthcare the importance of a team approach to addressing persistent pain is recognised by the combination of health professionals – doctors, nurses, physiotherapists, clinical psychologists, occupational therapists, increasingly social prescribers and expert patients too – who together deliver pain management programmes.

While such programmes are invaluable, people living with persistent pain still live most of their lives without the support of a pain management team. This is where a team approach to ongoing support can be vital in ensuring the skills learnt are embedded in daily life. But what is Team-based Learning (TBL) and how might it add value to the supported self-management of pain?

TBL: the flipped classroom

TBL is a form of flipped classroom where learners are provided the learning materials to engage with before attending class. This ‘pre-reading’ might include, for example, podcasts, online videos as well as written material. What would traditionally be ‘taught’ in the classroom therefore becomes ‘homework’, prepared before the sessions. This is then followed up by a variety of activities designed to review and consolidate learning as well as identify any gaps in knowledge or misunderstandings. This then leads to team exercises designed to encourage the application of this new knowledge to real word situations.

The TBL approach therefore aims, in summary, to:

• Promote independent learning and maximise time in the classroom to help individuals with whatever they are finding difficult;

• Elevate the status of the learner. For pain education this acknowledges that patients, rather than health professionals, are experts in their own pain and must feel validated when sharing their experiences;

• Shift the emphasis from the healthcare professional being the expert imparting knowledge to one of facilitating patients’ learning;

• Access the social benefits of learning together, not only for deepening learning but promoting the formation of social networks that might provide ongoing support in the community.

Seeking the views of people with persistent pain

Since TBL is likely to be unfamiliar to many people, especially in the healthcare context, a project designed by myself and colleagues to explore patients’ views began with an online consultation involving representatives from the Patient Involvement in Education and Research (PIER) Group, Bournemouth University, the Patient Voice Committees of the British Pain Society and the Royal College of Chiropractors.

All had lived experience with persistent pain, and liked the idea of TBL. They provided excellent insights and advice and were also very clear that the word ‘quiz’ should be used, and not ‘test’ (regarded as off-putting for many)! This led to the development of new TBL learning materials used with those attending a pain café in Somerset run by a social prescriber and a health coach.

Again, feedback was positive with one participant saying of the application exercises: “This is me; this is the sort of situation I have been in.” Both the online consultation and engagement with the pain café gave us confidence to proceed with running a TBL pain education course in NHS Somerset.

Team-based Learning in a clinical setting

In a musculoskeletal outpatient’s setting in NHS Somerset, ten patients with persistent pain attended a five-week TBL pain education course. Topics included pain and the brain, sleep, emotions and managing relationships with others. This was delivered, after initial training, by musculoskeletal physiotherapist Joe Barry and Susanna Edwards ran a group discussion at the end of the course to find out what patients thought of the approach.

Responses were hugely encouraging. Recognising the benefits of the social environment created through TBL one patient said, “I think it’s quite nice to be in a group where it’s safe to talk about your pain.” Another patient contrasted their experience with that of previous pain management programmes they had attended: “I’ve been to other pain clinics and there hasn’t been this group thing and I’ve got a lot more out of this one than from the previous ones. I actually felt quite isolated when it was just everyone sitting around in a circle, I felt quite alone. With this one I’ve felt like I’ve made some friends, and it felt comfortable coming here.”

There were negative comments too but not regarding TBL. These were generally related to the pain itself being an ongoing problem, reinforcing the need for ongoing support in the community.

What next for Team-based Learning pain education?

The research team are delighted with the positive feedback gained from the initial consultations with people with persistent pain plus feedback from patients who experienced the TBL pain education course. Next steps are to further develop and refine the TBL pain education course with additional input from expert patients and professionals involved in pain management.

A wider perspective will help us to consider such questions as how to maximise inclusivity, including considerations of how to appeal to traditionally underserved groups such as those from ethnic minorities or those with learning differences. The possibility of online courses for those who cannot attend in person needs consideration, as do the outcomes used to measure the impact a TBL approach is having.

All this will take time to find out. In the meantime, the research team is encouraged to keep pushing forward when they hear quotes like this: “Everyone was made to feel welcome and not only included but heard. Those of us living with chronic pain do not often feel heard and it was a refreshing change.”

Dr Jonny Branney is Principal Academic in Nursing and Clinical Sciences and Programme Leader for the PGDip/MSc Advanced Clinical Practice and MSc Advanced Clinical Practice apprenticeship, Bournemouth University.

If you have any questions or feedback about this project, or if you’d like to get involved, the project lead, Dr Jonny Branney would love to hear from you. You can email him at jbranney@bournemouth.ac.uk