Essential Pain Management UK

What is EPM UK?
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. In 2013, the EPM UK Advisory Group was established, with the purpose of running EPM courses across Africa. 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 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 (previously known as EPM Lite) as a project in 2014, and the first UK EPM UK course was held in Bristol in September that year.
The course helps students understand classifications of pain, why pain should be treated, and 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. 
 

Why EPM 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 EPM UK is to expand the level of pain management knowledge taught at undergraduate and postgraduate level.

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 centred 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.  To access handbooks, slide sets and references for trainers and students, please click on the relevant box below.

 

Information on EPM UK at Aberdeen Medical School
Information on EPM UK at Birmingham Medical School
Information on EPM UK at Bristol Medical School
Information on EPM UK at Cardiff University
Information on EPM UK at Dundee Medical School
Information on EPM UK at Edinburgh Medical School
Information on EPM UK Manchester
Information on EPM UK at Newcastle Medical School
Information on EPM UK at Newcastle Medical School
Information on EPM UK at Oxford Medical School
Information on EPM UK at Plymouth Medical School
Information on EPM UK at St Andrew's Medical School
Here you will find a list of all medical schools involved with the EPM UK project
Advice from facilitators
A list of references for EPM UK