EPM UK

Essential Pain Management UK

"It's good to have a simple system to approach pain management"

What is Essential Pain Management UK?

A survey of pain education (Briggs et al) within undergraduate healthcare studies estimated that ‘the identification, assessment and treatment of pain represent less than 1% of the university-based teaching for healthcare professionals’. The aim of Essential Pain  Management UK (EPM UK) is to expand the level of pain management knowledge taught at undergraduate and postgraduate level.The Essential Pain Management Programme (EPM) was originally developed in Australia and New Zealand by Roger Goucke and Wayne Morriss as an educational tool for health care workers in low and middle-income countries.  The first course was held in Papua New Guinea in April 2010. EPM UK is a scaled-down version of the full EPM course and is designed to be delivered to medical undergraduates in half a day. It was developed with the additional help of Dr Linda Huggins, a UK pain medicine trained anaesthetist now working as a Palliative Medicine Specialist in New Zealand. The UK Faculty of Pain Medicine took on introducing EPM UK as a project in 2014, and the first UK EPM UK course was held in Bristol in September that year.  The EPM UK team feed into the EPM Advisory Group (EPMAG).  The team is relatively small and is run with the help of the FPM administration. 

The team is as follows:

  • Dr Helen Makins - Clinical Lead, EPM UK
  • Dr Mike O'Connor - Deputy Clinical Lead
  • Daniel Waeland - Head of  Faculties
  • Caitlin McAnulty - Professional Affairs Manager, FPM
  • Claire Driver - Training and Membership Administrator, FPM

The EPM UK course helps students understand classifications of pain, why pain should be treated, and with an overview of different drug and non-drug treatments. The half day course is flexible as the content and timings can be amended to suit group size and level of teaching.  Increasing experience has shown that the basic structure is very usefully enhanced by highlighting particular areas for deeper exploration. This has provided a great opportunity to facilitate discussions around areas such as the use of opioids in chronic pain, illustrated with challenging case discussions.  Each course is adapted by the local teaching team, according to the experience and needs of the course attendees.  Over the last year, we have expanded our remit, to extend teaching of the course to postgraduate and undergraduate medical and allied health professionals. 

 

Regional Leads

Due the success and expansion of EPM UK a number of  Regional Leads have been appointed to cover the geographical area of their medical school.  In most cases it is hoped that there will be several EPM Regional Leads working within the boundaries of a local Regional Advisor in Pain Medicine.  Currently there are 8 Regional Leads who have been recruited, with a plan to appoint more leads in the near future.  Please click on the following link to view a list of leads and locations:

Please see below for a list of Regional Leads by region:

Region                Regional Lead   
Aberdeen            Dr Naomi Scott
Birmingham       Dr William Rea
Bristol                 Dr Helen Makins
Liverpool            Dr Hoo Kee Tsang
London               Dr Alan Fayaz
Manchester        Dr Jonathan Rajan
Milton Keynes    Dr Venkat Hariharan
Newcastle           Dr Sailesh Mishra
Plymouth            Dr Karen Gilmore

 

Medical Schools

EPM has been endorsed by the new RCoA undergraduate curriculum, released in November 2017, recommending EPM UK as a framework for teaching medical students.  In addition, the BMA publication “Chronic pain: supporting safer prescribing of analgesics”, highlights EPM as an effective course for teaching medical undergraduates.  Our programme continues to flourish and receive excellent feedback, with at least 14 medical schools incorporating the teaching so far.  At a local level, anaesthetic enthusiasts are consolidating EPM effectively by teaching it within their own departments.

Colleagues in medical schools have now run EPM in a variety of guises, for groups of up to 240 students in a single session.  It has been used as a mini version for hour-long weekly medical student seminars, for small group teaching in year 2 and 3, in the fourth year during the students’ Anaesthesia Specialty Study Modules, and on a Final Year ‘survival’ course in preparation for taking up FY1 posts.

 

Postgraduate doctors and allied healthcare professionals

We recognise that the benefits of teaching medical students a new structure for approaching patients with pain could be short-lived if other more senior clinicians and allied healthcare professionals are not using the same approach.  With this in mind, we have extended training to postgraduates and other healthcare workers.
In order to gather momentum, we ran our inaugural UK Train the Trainers course in March 2017 and a second course in September 2017.  These have been attended by a variety of professionals, including physiotherapists, nurses, anaesthetists (trainee and consultant) and psychologists from a variety of Trusts in the UK.  The course includes familiarisation of course content, personal tips from previous experience and feedback, discussion of teaching techniques, and development of adaptations to ensure relevance for those attending courses.  Following this, a variety of professionals have received EPM training around the country, including student nurses, qualified nurses, physiotherapists, recovery staff and GP trainees.  In this way, we aspire to expand the number of healthcare professionals using the RAT approach, thereby standardising language with the aim of improving inter-professional communication and patient management.  More Train the Trainers courses are anticipated in 2018.

 

Feedback and Outcome Data

Currently, we evaluate EPM by collating a wide range of information, from details of previous pain training received by participants, to MCQ scores and free text feedback, using a spreadsheet, to tabulate the pertinent information.  The data gathered has been invaluable in developing the course on an on-going basis.  In particular we have shown the need for the course, with very few participants stating that they have received previous training, yet overwhelmingly feeling that this would be useful both personally and for their colleagues.

 

How is EPM UK delivered?

EPM UK is centered on a three-letter acronym, ‘RAT’ (Recognise, Assess, Treat). This is designed to allow rapid recall of a logical, stepwise system for pain management, akin to the Airway, Breathing, Circulation approach used in Advanced Life Support training. This structure provides the basis for an evidence-based, standardised and reproducible training session in pain medicine, with its own handbooks for both trainers and students, slide sets and references.  Recognising pain involves a multimodal approach, including looking for verbal, behavioural, physical and physiological signs, and then communicating the findings to the wider team.
Assessment focuses on a logical classification including severity, type, cause and mechanism. A variety of scoring systems are discussed, alongside benefits and potential disadvantages. Students are encouraged to classify the pain by duration (acute, chronic, acute on chronic), cause (cancer, non-cancer) and mechanism (nociceptive, neuropathic, mixed). Each area is explained in terms of pathophysiology and common descriptors for symptoms. Use of a biopsychosocial   approach is encouraged, with reference to additional factors which may affect the perception of pain in a particular individual.

The students are taught to treat patients in an individual way and to avoid using a ‘one size fits all’ model. Nonpharmacological therapies, including physical and psychological techniques, are discussed. Whilst pharmacological management includes the World Health Organisation Pain Ladder, there is an emphasis on tailoring this to the individual, particularly with respect to use of appropriate anti-neuropathic agents and de-prescribing pain medication after the acute phase. Opioids are promoted for use in acute, severe non-cancer pain, such as in the postoperative period and following trauma, and also when treating cancer pain. There is room for discussion of their use and side-effects in chronic non-cancer pain.  The format of the course is short lectures, punctuated with small group discussion sessions covering all elements of the RAT approach, and culminating in a wide series of case based discussions.  

Date Piloted: 5th October 2015

Student Year: 5

Facilitator: Dr Saravana Kanakarjan

The course was delivered four times during the 2015/2016 academic year to small groups of 8 participants each time.

A further four courses approved for the 2016/2017 academic year

Feedback from students:

'Good to have simple system to approach pain management'

'Good that parts are short and use different speakers'

'Reiteration and simple message drives take home message'

'Very helpful workshop'

Date Piloted: 5th December 2016
 

Student Year: 4
 

Facilitators: Dr William Rea

EPM UK was piloted at the University of Birmingham in 2016. The course was initially piloted to 20 fourth year students and then to 400 Year 4 students on 16th January 2017. 

Date Piloted: 24th September 2014

Student Year: 3 and 4

Facilitators: Dr Helen Makins (Regional Lead) and Ben Howes

University of Bristol was the first medical school to have piloted EPM UK back in 2014 and it was delivered to a total of 240 fourth year medical students over four sessions. In the 2015/2016 academic year it was delivered to the entire year group of third year medical students on a single half day session! University of Bristol now teaches EPM UK on a regular basis.

Feedback from students:

'Overall learnt some useful info re pain, drug pathway/non-drug methods''

'Very helpful and well-structured'

'Good group vibe'

'Learnt a lot - MCQ easier at the end'

'Liked small groups'

'Good to talk to clinicians' 

Date piloted: 19 September 2017

Faciliator: Dr Venkat Hariharan

EPM was piloted at MKU in September 2017.  It was run again in January 2018 and September 2018, and is now part of the curriculum.  Feedback from the workshops has been extremely positive. 

What students liked:

  • Case discussions
  • Variety of speakers
  • short concise lectures
  • Interactive nature of the sessions

EPM UK contiues to be a success at MKUH with more courses planned for the future.

Date piloted: 2016 with plans to run it again in February 2018.

Facilitators: Dr Athanasios Hassoulas and Dr Ann Taylor.

Students receive two lectures in year one that cover the basic physiology and psychology (nociception and pain), as well as working through an e-resource (virtual patient case).

In year two students further explore acute pain management and focus on pharmacological as well as non-pharmacological options during support sessions that look at low back pain specifically, with another e-resource (workbook) focusing on the biopsychosocial model and application thereof to pain management.

In year two students also have an EPM UK half-day which involves revision of physiology and acute pain, as well as an intro to chronic pain and management, through three lectures that are delivered and workshops that run during the second part of the half-day, with case scenarios that facilitators guide students though.

In year three students receive a lecture on chronic pain, and in year four they work through an e-resource ocusing on fibromyalgia during their Chronic Disease 2 placements, which is overseen by the clinical teams when they are doing the rheumatology component of that block.

The next, and final, phase or rolling out our changes to the teaching of pain medicine and management is focusing on prescribing in year 5 along with building on what has previously been covered in relation to management and palliative care.

Date Piloted: November 2016


Student Year: 4


Facilitators: Dr Phil Lacoux and Dr Gail Gillespie

EPM UK was piloted at University of Dundee, School of Medicine in November 2016. 

Date Piloted: October 2016


Student Year: 6 (Final Year)


Facilitators: Dr Ivan Marples

EPM UK was piloted at the University of Edinburgh in 2016. Four tutorials are delivered to a quarter of the year each time. The tutorial takes cases from the EPM UK materials and other real life examples to illustrate the EPM UK principles and discussion is promoted in groups. 

The first clinical year lecture to Year 4 students was piloted in December 2016; this will set out the EPM UK approach in a more didactic manner.

 

Student Years: 4 and 5
 

Facilitator: Dr Jonathan  Rajan

A pilot course has been developed. Facilitator training is underway and the aim is to roll out the course for years four and five at The University Hospital of South Manchester, Lancashire teaching hospitals trust (Preston), Salford Royal and Manchester Royal infirmary. The course will be modified to include prescribing elements and an interactive content.  Manchester are also hoping to develop an education research aspect.

Date Piloted: April 2016

Student Year: 3

Facilitators: Dr Ashish Gulve and Dr John Hughes

Date Piloted: 22nd June 2015


Student Year: First and Final years


Facilitators: Dr Peter Cole and Dr Tim McCormick

EPM UK was piloted at the University of Oxford in 2015. The course was delivered to 120 students in two lectures. EPM UK was also delivered to over 100 students in the First Year Survival Course which is an annual event attended by those in preparation for taking up FY1 posts. Dr Cole and Dr McCormick have adapted an ' extra lite' version of EPM UK for the hour long weekly medical student seminars that take place in the Pain Relief Unit; these seminars are attended by 8-10 final year medical students each week. This means that nearly all pain medicine students will be taught by EPM UK.

Date Piloted: April 2015
Student Year: 2
Facilitators: Dr Anthony Davies

Date Piloted: September 2015


Student Year: 3


Facilitators: Dr Stephen Gilbert

EPM UK was piloted at St Andrew's in 2015. The course was taught in small groups of 4 students as well as lectures and is delivered to around 110 students in two semesters. The three hour course is split into 1 - 1.5 hours seeing & discussing a patient, and followed by 1.5 – 2 hours small group based on EPM UK.