ADAPT - being active with pain

What is ADAPT?

For more generally disabled, distressed and/or medication-dependent patients, one of our intensive cognitive-behavioural, multidisciplinary treatment programs may be recommended after comprehensive assessment.

These programs involve groups of 8-10 patients at a time working with a small team of staff. It is our experience that there are significant functional benefits for this group of patients to attend the more intensive program if they meet the entry criteria.

Details available from ADAPT office (phone (02) 9463-1500 or email ).

Two group programs are available:

INTERVENE

For those who are working (but either on extended restricted hours/duties or taking frequent time off due to pain), taking minimal medication, but struggling to manage.

  • INTERVENE takes 3-weeks: 5 days in week 1, 2 days in week 2, and 2½ days in week 3

  • Patients are expected to attend work (as relevant) on the other days in weeks 2 and 3.

  • Close liaison with the workplace and treatment team is essential.

Follow-up reviews at the PMRI are strongly recommended.



ADAPT

For the more seriously disabled, distressed, or medication-reliant patients. Generally, they are longer-term patients (more than 6-months post-injury).

ADAPT is an intensive 3-week program (9 am – 5 pm, Monday to Friday), with structured 4-week ‘home or work’ phase and individual follow-up as required.

Features include:

  • medically supervised medication rationalisation/withdrawal,
  • withdrawal of unnecessary aids (sticks, braces, etc.),
  • functional upgrading (individually-tailored),
  • help with mood and sleep disturbances,
  • family/partner involvement and
  • rehabilitation planning for return-to-work steps (linked to local doctor and rehabilitation provider/employer as appropriate)

See also ADAPT for work related pain

Follow-up

All patients attending either ADAPT or INTERVENE are expected to apply the pain management strategies they learn on the programs when they return home or to work after the programs.

Our outcome data clearly show that those who do this achieve much stronger and more lasting gains.

  • In order to help those attending the programs to achieve good maintenance effects all patients are helped to work out a 4-week ‘home-plan’ at the end of the hospital phase of the program.
  • These plans include a timetable for each day on activities and exercises, as well as reminders of strategies for dealing with any flare-ups in pain or other set-backs that can occur.
  • After this 4-week phase all patients are expected to return to the PMRI to review their progress with the ADAPT (or INTERVENE) staff. These reviews usually last from 9.00 am to about 12.00 noon. A similar review is also offered 6-months post-program as well.
  • In some cases, especially those with ongoing mood disturbance, adjustment or management problems, ADAPT offers an opportunity to attend (by appointment) a series of individual sessions with one of the ADAPT staff (usually, but not always, the clinical psychologist).
  • Typically, we find that no more than 5 individual sessions are needed (but some do need more). For patients who have been funded by an insurance company to attend ADAPT the first 5 individual sessions are free of charge. For all other patients the sessions are free of charge as well.

Admission criteria

ADAPT is for people who:

  • have had pain for more than 3-months
  • have not responded to (evidence-based) medical or surgical treatments (and not suitable for further treatments)
  • have not progressed in rehabilitation due to pain
  • have become reliant on medication to cope with their pain
  • have become distressed due to their pain
  • and are prepared to try to get on with their lives and return to work(or normal life) despite their continuing pain.

Exclusion criteria

  • Not motivated or unwilling to participate in the Program
  • Unable to speak adequate English
  • Presence of active, major mental disorder (e.g. psychotic disorder, clear suicide risk)
  • Suitable for further medical/surgical treatment or investigations
  • Pain less than 3-months
  • Primary addiction problem

Staff

Staff at the Pain Management and Reasearch Centre are highly dedicated, experienced and work collaboratively to give each patient the best possible outcomes.

  • ADAPT is conducted by a multidisciplinary staff. These include a clinical psychologist, physiotherapist, nurse, a pain medicine specialist and a rehabilitation advisor.
  • All staff have extensive experience and training in pain management and they work closely in a collaborative manner.
  • During the program the clinical psychologist, physiotherapist and nurse have the most contact with participants on a daily basis while the other staff see the participants on an individual basis at different stages of the program.
  • The staff meet for two formal reviews of each participant’s progress each week and daily brief meetings are held as necessary.
  • All staff involved in the program contribute to the preparation of the reports that are sent out to referring doctors and other agencies at the end of the program.

How does ADAPT differ from other programs?

ADAPT is more than:

  • An intensive course of exercises (or work conditioning)

  • An intensive education about pain

  • A way of adjusting to persisting pain

  • A way of reducing reliance on medication and aids

  • A fitness and weight loss program

  • An activity-upgrading program

  • A mood management program

  • A sleep management program

  • A return-to-work program

  • A multidisciplinary treatment for persisting pain


ADAPT is all of these, and more…

A person in persisting pain can do any of these individually with a health professional of one type or another.

But to do all of them simultaneously takes:

  • preparation,
  • planning,
  • coordination,
  • clear communication and
  • preparedness to provide long-term support.

It also takeshighly specialized and skilled multidisciplinary staff; staff with extensive experience in pain management.

All these factors make ADAPT more than any single program element.

ADAPT helps patients make sense of complex pain problems.

This diagram describes how many of the problems faced by people in persisting (or chronic) pain develop over time.

How chronic pain leads to excessive suffering

Social and medical conditions relating to pain from a patient's perspective.

One thing tends to lead to another and over many months and years the person suffering from this pain ends up not only having ongoing pain but also the other burdens identified here.

When no effective or curative treatments are available the person in pain needs to shift their focus from seeking pain-relieving treatments to things they can do something about, despite ongoing pain.

These include increased activities, physical fitness, strength, mood, sleep, reducing reliance on unhelpful medication, developing useful coping strategies, improving relationships at home, getting back to suitable work, etc.

This requires that the person in pain has a good understanding of their pain and accepts the idea of living a normal life despite ongoing pain.

No one will achieve these overnight, but ADAPT can help with making the first steps and showing how to go further than many think possible.