Dr Grahame Brown, Specialist Physician in MSK/SEM is presenting at the BASEM Spring Conference 2017
Dr Grahame Brown BSc MB MRCGP AFOM Dip Sports Med Dip HG FFSEM
After qualifying from Bristol University in 1979, Grahame’s first five years of medical practice were in the RAF where an interest in sport & exercise medicine (SEM) and occupational health (OH) developed. He then pursued a career in general practice with a special interest in SEM and OH, five years in Norwich and 6 years at the University of Birmingham student health service. In 1996 he left General Practice, invited to join the consultant surgical team at the Royal Orthopaedic Hospital NHS Trust in Birmingham as a specialist physician in Musculoskeletal, Sport & Exercise Medicine with consultant equivalent status. This was long before SEM became recognised as a specialty within the NHS. From this beginning, the service has grown to become The Centre for Musculoskeletal Medicine, with a team including 2.5 whole time equivalent MSK/SEM physicians, 9 ESPs, 3 podiatrists and a psychotherapist. Within this team Grahame specialises in combining psychological and behavioural treatment (both 1;1 and in group programmes) with physical exercise for persons with disability attributable to chronic regional pain problems. He was elected a foundation Fellow of the Faculty of Sport & Exercise Medicine Ireland in 2002 and UK in 2006. He was co-author of Liberate Yourself from Pain (Human Givens Publications) published in 2009, and Back to Life (Vermillion Press) published in 2016. He is author of the chapter Pain Management in the Oxford Textbook of Musculoskeletal Medicine published 2015.
Dr Brown is presenting "Lessons from the inter-disciplinary functional restoration programme for chronic back pain"
At the Royal Orhopaedic Hospital Grahame and physiotherapist Dave Rogers established a combined psychological, behavioral and exercise treatment programme we called the Functional Restoration Programme for persons with chronic (predominantly) back pain. The NICE guidelines recommended these programmes be 100 hours. We started with a ‘blank canvas’ and designed a group programme for up to 12 persons over 12 hours during 4 consecutive weeks. We have now had over 500 persons through the group programme. Results have been published that demonstrate that clinically meaningful results are achieved in this time that last beyond the completion of the programme. The team has grown from 2 clinicians in the early days to 10, and each programme has 4 clinicians comprising of a physiotherapist, a physician, a psychotherapist and a physiotherapy assistant. All of the clinicians are trained in cognitive behavioural principles.
The elements of the group programme include:
· Education about the neuro-physiology of pain: the sensitized nervous system and neuro-plasticity, ‘re-training the brain’.
· Education about the use and mis-use of commonly prescribed analgesic and neuro-modulating medication and how these quickly can become part of the problem not the solution.
· Coaching on stimulating the relaxation response, mindfulness based cognitive therapy, use of guided imagery.
· Goal setting and pacing activity: avoidance and boom-bust behaviours and how to change these.
· Supervised graded physical activity in the gymnasium based on a circuit of functional exercises reflecting activities of daily living.
· Education to manage flare-ups and set-backs
· Coaching on maintaining regular physical activity beyond the formal programme
· Education elements that are generic for all combined with individual based coaching as we identify needs and obstacles during the time together
· The clinicians work as an inter-disciplinary team and discuss patient’s progress before and after each session and plan how to respond to any obstacles identified.
Lessons learnt will be discussed during the talk.