PainSA is a chapter of the International Association for the Study of Pain. Our mission is to improve all aspects of pain management in Southern Africa.

EPM Newsletter – July 2024

No.1, July 2024

Welcome to the July 2024 Essential Pain Management Newsletter

At the World Congress we held our regular Essential Pain Management workshop. We were delighted that over 100 participants attended the 90 minute session. There were several short presentations:

Dr Juan Carlos Duarte on the rapid progress on delivery of EPM in Central and South America, along with the increasing uptake of the Spanish version of EPM online.

Professor Sean Chetty gave a progress report on how EPM is being used in South African Universities for teaching undergraduates. Professor Chetty reported that there is an evaluation on the use and value of EPM as an undergraduate program underway and we look forward to seeing the results.

Dr Angela Yeo a paediatric anaesthesiologist is working with the International Association for the Study of Pain special interest group on paediatric pain management to modify EPM for paediatric use.

Dr Clare Roques, the retiring chair of the WFSA pain management committee reviewed the place of EPM in the United Kingdom.

Dr Roger Goucke discussed the importance of evaluating EPM on patient care and how patient reported outcome measures (PROMS) could be collected to show changes at a patient level.

There were a range of discussions including the use of specific case discussion studies for pain in dementia, pain in aged care, pain and sickle cell disease and pain in leprosy. Hopefully we will be able to develop these resources over the next 6 to 12 months.

Also during the World Congress, Papua New Guinea anaesthetist Dr Gertrude Marun was honoured with the World Federation of Societies of Anaesthesiologists’ (WFSA) Distinguished Service Award. 

Dr Roger Goucke discussed the importance of evaluating EPM on patient care and how patient reported outcome measures (PROMS) could be collected to show changes at a patient level.

There were a range of discussions including the use of specific case discussion studies for pain in dementia, pain in aged care, pain and sickle cell disease and pain in leprosy. Hopefully we will be able to develop these resources over the next 6 to 12 months.

Also during the World Congress, Papua New Guinea anaesthetist Dr Gertrude Marun was honoured with the World Federation of Societies of Anaesthesiologists’ (WFSA) Distinguished Service Award.

In 2010 Dr Marun and colleagues pioneered the development and then the introduction of EPM courses into PNG and has been a long term champion of EPM.

We were also delighted to hear that Dr Mary Cardosa, another champion of EPM, has become the President-elect of the IASP.

International Association for the Study of Pain – African Pain Camp

IASP will host its first African Pain Camp, from 23 – 26 February 2025 in Nairobi, Kenya. Learn more about the camp’s program, and application requirements on the IASP website. All healthcare professionals working in Sub-Saharan Africa, and who have excellent English skills, are encouraged to apply by 31 July:

EPM in Hong Kong, Dr Fiona Tsui writes:

The Hong Kong EPM community has been thriving since EPM’s inception in 2017. We’ve adopted the half day version of EPM (EPM Lite) which fits in well into the busy schedule of Hong Kong healthcare workers. Currently we run 16-20 EPM Lite workshops every year for all frontline healthcare workers within the public health system. Analysis from 1120 participants during 2017-19 showed positive feedback, with over 99 percent of participants agreeing that EPM provided basic and essential pain management training relevant to their work. 98 percent of them felt more confident and competent when managing patients with pain after the workshop.

During the COVID pandemic, we continued to deliver EPM online and developed e-learning modules to address the training need. Module 1 covers the Recognise and Assess, with Module 2 focusing on Treatment. Both modules contain case demonstration videos and interactive Q&A to enhance the learner’s experience. Currently we are using module 1 as pre-workshop reading so that we will have more time for interactive discussions during the workshop.

EPM reports from around the world

Below are some EPM reports from our colleagues around the world. You will see from these reports that EPM is now being delivered in many ways from in person face-to-face to hybrid models to entirely virtual.

EPM in Benin, December 2023

Mercy Ships sponsored an EPM training programme in Benin, West Africa in December 2023. A team comprising a Mercy Ships project manager, a UK pain doctor, two local surgeons and an administrator, facilitated courses over an eight day period.

This was the third time Mercy Ships have organised EPM in Benin, with previous courses delivered in 2016 and 2021. Dr Odry Agbessi, a Benin plastic surgeon, was an attendee for the first course in 2016 and since then has gained significant experience by teaching the EPM course in multiple locations around West Africa. Dr Agbessi has remained committed to raising the standard of pain management across the healthcare system in Benin, with a desire to ensure that the learning is spread equitably around the country. She was able to identify suitable participants and advertise the course through local contacts.

Training was delivered to clinicians working across the country, thereby supporting the development of a national trainer network. Two locations for delivery, Cotonou and Abomey, were chosen due to geography and transport links. Mercy Ships supported these courses.

A mixture of doctors, midwives and nurses from a range of specialties attended the EPM courses. Some also trained as trainers, practising their new skills by teaching the course on subsequent days, in keeping with the standard EPM global format. Trainers came from hospitals distributed around the country, with the expectation that they will provide ongoing courses throughout Benin.

During the course, clinicians were encouraged to discuss beliefs and concerns about pain management. One midwife shared that when a patient in labour asked for pain medication, she offered them prayers and told them they needed to feel the pain. One anaesthetist said he has always been hesitant to administer Morphine because of the risk of addiction. EPM provided ample opportunity to address misconceptions and was universally well received, with feedback demonstrating appreciation of the content, structured format and teaching style.

Some participants chose to add their details to a WhatsApp group, which has been used to support delivery of subsequent courses, to share experience and celebrate success.

The support from Mercy Ships and Dr Odry Agbessi’s ongoing commitment to the EPM trainer network highlights the benefit of facilitating local leadership to provide sustainable training in pain management. 

Hybrid EPM in the Philippines – January 2024. Prof Jocelyn Que writes:

In January this year, the Center for Pain Medicine of the University of Santo Tomas (UST) Faculty of Medicine and Surgery ran the first hybrid EPM course in Bacolod City, Philippines. This was followed by two more hybrid workshops, with a total of 96 healthcare professionals in attendance, including doctors, nurses, and physiotherapists. The link to the online EPM video was shared with the participants a week before the face-to-face session to allow them ample time to watch and study the video at their own pace. Participants were then required to submit their certificates of completion obtained after finishing the online video. prior to the face-to-face session. The three hour face-to-face session consisted of brief lectures on three selected topics from the EPM module to highlight and reinforce the key principles of EPM and the case discussions to demonstrate the application of these principles.

Overall, the participants were very satisfied and excited to apply the R-A-T approach to their patients. They enjoyed the video and appreciated the face-to-face session where they were able to see and interact with the other participants and the EPM faculty and ask questions directly with immediate responses. Most of them preferred the hybrid EPM course to the purely online EPM. The EPM faculty recommended the hybrid over the online and onsite delivery, citing less time required of both the faculty and participants, while being able to maintain the advantages of physical direct interaction.

Association of Southeast Asian Pain Societies virtual EPM instructor course – February 2024

In February 2024 due to increasing demand we ran an online EPM instructors course for Southeast Asia and beyond. We were assisted throughout the process with strong support from the council of the Association of Southeast Asian Pain Societies.

We were able to offer this activity as a continuing professional development activity for both participants and instructors and provided a certificate on completion. The program ran for just over four and a half hours with a 15 minute break.

Delivering an online instructor course where the focus is on course delivery rather than EPM content can be challenging for both instructors and participants! We were able to use Zoom with breakout rooms, and were pleased that participants rapidly adapted to the Zoom chat facility to ask questions, respond to informal polls and brainstorming in general. 

The internet connections were good and quite adequate even when, during practice lectures and case discussions, cameras were required to be on. We did have a few disconnects but reconnection was quite speedy due to Dr Jimmy Barus’ overall Zoom management skills.

There were 37 participants, including doctors, (psychiatry, anaesthesiology, neurology, rehabilitation), nurses, physiotherapists and psychologists. Participants came from ASEAPs countries from Malaysia, Myanmar, Philippines, Singapore, and Thailand. We were also joined by participants from Laos, Vietnam, Bhutan, Timor Leste, Papua New Guinea and Pakistan. Using the English language worked well. Participants were required to have completed either a face-to-face EPM program, or the online program prior to the course.

In the final section of the course there was a discussion on Zoom tips and running hybrid courses. Hybrid course may become the EPM course delivery of choice. Because of both time constraints and the requirement to travel, either in country or between countries this style of course delivery appears to be practical. Hybrid courses can consist of taking the online course then participation in a facilitated group discussion which can be either online or face-to-face.

Post course evaluation showed a significant number of participants self-reported an increase in confidence to either moderately confident or very confident in either giving a lecture or running a case discussion group.

A Virtual Train the Trainer Program in Sri Lanka – May 2024

In May 2024 we were delighted to assist the Faculty of Pain Medicine , College of Anaesthesiologists and Intensivists of Sri Lanka to run a further online virtual EPM trainer course.

Sri Lanka has a good network for delivering EPM throughout the country with several regional trainers and so increasing the number of individuals who feel confident to deliver EPM should improve delivery further.

22 participants including junior and senior anaesthesiologists and two nurses attended. We were fortunate to have a recently graduated doctor Nirmitha Morel who was very confident with the Zoom technology so that the breakout groups worked seamlessly.

The main contact in Sri Lanka was Dr Ashani Ratnayake and Dr Roshana Mallawaarachchi. Dr Jess Lim from Sydney, Professor Jocelyn Que from Manila and Dr Roger Goucke from Perth ran the program. As English is widely spoken in Sri Lanka this made for good interaction both verbally and in the Zoom chat function.

The program ran over four and half hours with a fifteen minute break with two 45 minute breakout sessions to practice giving a lecture and running a discussion group. While this was somewhat threatening to participants they took the challenge and gave positive feedback. We acknowledged that running lectures or discussion groups virtually is quite different to face to face delivery but similar techniques can be used with practice.

EMP Online

Both the English and Spanish Version of EPM Online are available through the Praxhub website.

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ANZCA: The Australian and New Zealand College of Anaesthetists (ANZCA) is the professional medical body in Australia and New Zealand that conducts the education, training, and continuing professional development of anaesthetists and specialist pain medicine physicians.

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