Postgraduate Diploma in Interdisciplinary Pain Management

Purpose

The Postgraduate Diploma in Interdisciplinary Pain Management (PGDip in Interdisciplinary Pain Management) seeks to train evidence-informed health professionals to be able to implement contextually relevant patient-centred bio-psychosocial approaches in a comprehensive primary healthcare setting to manage complex pain conditions.

The healthcare professional graduating with the PGDip in Interdisciplinary Pain Management will be a Health Care Practitioner with the knowledge, skills and attitudes to provide quality, patient-centred services for people with pain at all levels of the health care system and to be able to contribute towards optimising health in the broadest sense of the word.

The graduate will be able to function effectively in four (4) domains in order to deliver effective evidence-informed health care to people with pain. The four domains are: The Multi-dimensional Nature of Pain, Assessment and Measurement of Pain and its effects, Comprehensive Pain Management and Evidence-informed Pain Management.

Rationale

The International Pain Summit of the International Association for the Study of Pain has found that a large number of patients seek medical attention to assist them with the management of pain. However, pain is often poorly managed by the very professionals from whom help has been sought and patients are frequently treated for a cause of pain without their suffering being attended to.

The Declaration of Montreal came into effect due to the recognition of the burden of pain and its under-management. The declaration states that unrelieved pain is a global problem as a consequence of inadequate access to treatment, deficits in health professionals' knowledge of pain, stigmatisation of chronic pain, a lack of policies relating to pain, lack of recognition of pain medicine as a specialisation, and restrictions on medications. Signatories of the declaration, including PainSA (the South African Chapter of the International Association for the Study of Pain (IASP)) stated that all patients have the right to access Pain Management including access to appropriate assessment and treatment of the pain by adequately trained health care professionals.

Pain Management is a growing field internationally which favours inter-disciplinary training. An inter-disciplinary team can be defined as a group of health care professionals from diverse fields who work in a coordinated fashion toward a common goal with and for the patient. Inter-disciplinary care consists of providing coordinated services in a comprehensive treatment programme with frequent communication among team members (health care professionals and the patient). The key ingredients for inter-disciplinary care are a common philosophy of rehabilitation, regular and structured communication among team members, and active patient involvement.

In South Africa there may be a far greater burden of pain than that reported in developed countries. The burden of these chronic pain conditions is exacerbated by the HIV/AIDS pandemic. Pain is the most common symptom in people living with HIV/AIDS and is frequently undertreated. Millions of South Africans have pain of sufficient severity to cause distress and pain which interferes with function and quality of life. In addition, there is a growing prevalence of chronic diseases of lifestyle including arthritis thus pain is a major burden on the health care system of the country.

Due to the size of the country and the diversity of the population, an appropriate Postgraduate qualification is designed to address the gap in knowledge and skills within the health care professions. In recognition of the complexity of pain, The International Association for the Study of Pain (IASP) recommends that training of health professionals occurs in inter-disciplinary qualifications and programmes to maximise the understanding of the role of different professions in managing pain and to optimise inter-disciplinary referral and communication in the management of patients.

This qualification targets the following health care professionals: Doctors, Nurses, Physiotherapists, Occupational Therapists and Psychologists.

Recognition of Prior Learning (RPL)

If learners do not have the required formal educational qualifications specified by the Degree believe that their age, work and life experiences have provided them with equivalent levels of learning, such learners can apply for admission through the Recognition of Prior Learning (RPL) process.

RPL may also be used to grant exemption for modules in the qualification.

Entry Requirements

To be eligible for admission an applicant shall be qualified as follows

• Doctors: Bachelor of Medicine, Bachelor of Surgery (MBChB), Level 8 or equivalent and registration with the Health Professions Council of South Africa (HPCSA).

Or

• Nurses: A Bachelor of Nursing, Level 8 or equivalent and registration with SANC.

Or

• Physiotherapists: A Bachelor of Science in Physiotherapy (BSc Physiotherapy), Level 8 Degree and registration with the HPCSA.

Or

• Occupational Therapists: A BSc (Occupational Therapy), Level 8 and registration with the HPCSA.

Or

• Psychologists: Registered as a Clinical or Counselling Psychologist with the HPCSA.

And

• Working in a setting which allows them to engage in the management of people with pain (acute or chronic).
• At least one year of experience working in a clinical health professional setting.

This qualification comprises compulsory modules at NQF Level 8, totalling 120 Credits.

• Introduction to Postgraduate studies, 10 Credits.
• Introduction to Clinical research method, 10 Credits.
• The multidimensional nature of pain, 25 Credits.
• Neuroanatomy and Neurophysiology of nociception and pain, 15 Credits.
• Assessment and measurement of pain and its effects, 15 Credits.
• Comprehensive Pain Management, 30 Credits.
• Pain Management in complex conditions, 15 Credits.

1. Develop a coherent and critical understanding of the principles and theories of pain including the science, nomenclature, experience of pain, and pain's impact on the individual and society with specific reference to the African context.
2. Plan and analyse interdisciplinary pain assessment and interdisciplinary Pain Management approaches using real world examples with evidence-based solutions and theory-driven arguments.
3. Communicate effectively with all members of the interdisciplinary team.

Associated Assessment Criteria for Exit Level Outcome 1

• Explain the complex, multi-dimensional and individual-specific nature of pain.
• Present theories for understanding pain.
• Use and understand terminology for describing pain and associated conditions.
• Describe the impact of pain on the individual and society.
• Explain how cultural, institutional, societal and regulatory influences affect assessment and management of pain.
• Demonstrate an understanding of the principles of human rights and social justice with specific relevance to the Declaration of Montreal, namely, "Access to pain management is a fundamental human right".
• Describe the unique pain management needs of special populations.
• Explain how to manage pain across settings and transitions of care with specific reference to systems at district, provincial and national level within the context of the national health policy and international guidelines.

Associated Assessment Criteria for Exit Level Outcome 2

• Demonstrate the ability to use knowledge and skills to integrate practice in both the assessment (input and evaluation from all members of the team) and management of pain
• Use collaborative approaches in decision making, selecting a diversity of treatment options, recognising the importance of patient agency, taking into account risk management and flexibility in care and treatment based on appropriate understanding of the clinical condition within context.
• Critically select and use valid and reliable tools for measuring pain and associated symptoms to assess and reassess related outcomes as appropriate for the clinical context and population.
• Critique patient, provider and system factors that can facilitate or interfere with effective pain assessment and management.
• Assess patient preferences and values to determine pain-related goals and priorities.
• Describe the unique pain assessment needs of special populations and critically select appropriate assessment methods based on evidence.
• Provide holistic evidence-informed care within an interdisciplinary team, collaborating with the patient and others, as appropriate, in the education and shared decision-making process for pain care.
• Monitor effects of Pain Management approaches to adjust the plan of care as needed.
• Access, understand, interpret, synthesise and critically apply evidence in the contextual management of people with pain.
• Explain how to assess pain across settings and transitions of care based on a critical understanding of literature and context.
• Identify and integrate evidence-based pain treatment options that can be accessed in a comprehensive Pain Management plan.
• Develop a holistic evidence-based Pain Treatment plan based on benefits and risks of available treatments.
• Develop an evidence-based treatment plan that takes into account the differences between acute pain, acute-on-chronic pain, chronic/persistent pain, and pain at the end of life.
• Critically examine published literature in the field of pain.
• Incorporate evidence and research into care, to guide evidence-informed clinical decision making.
• Critically evaluate an implemented individualised Pain Management plan that integrates the perspectives of patients, their social support systems and health care providers in the context of available resources.

Associated Assessment Criteria for Exit Level Outcome 3

• Demonstrate empathic and compassionate communication with patients during pain assessment.
• Communicate effectively, clearly and courteously, both verbally and in writing, with patients and their families and with other professionals.

Integrated Assessment

An assessment blueprint was developed for the qualification to ensure that assessment and learning outcomes were aligned and to inform teaching and learning activities. Assessments in the courses Introduction to Postgraduate studies"; "Introduction to Clinical Research Methods"; "The Multidimensional Nature of Pain"; "Comprehensive Pain Management"; "Measurement and Assessment of Pain and its effects" and "Pain management in Complex Conditions" will include short and long assignments using reflective writing to integrate theory with practice with both formative and summative assessments to guide learning. The short and long reflective assignments will be used as part of weekly teaching and learning activities which will prepare learners for the final assessments.

The modules "Neuroanatomy and Neurophysiology of Nociception and Pain" will use online tests to assess knowledge of Neuroanatomy and Physiology. The assessment for these modules will comprise six online assessments of knowledge and a written knowledge test in the final integrated assessment.

The final integrated assessment will include an oral exam on a case reflected on by the learner and an essay proposing an assessment and treatment plan for a case provided.