Early intervention pathway for major trauma patients at risk of developing persistent pain

Structure of interventions Inpatient education comprising of a short message about recovery from trauma delivered by a healthcare professional in audio format. It will introduce themes outlined below. Four x 1 hour 1:1 consultations with a psychologist with specialist pain medicine physician support and review that occur every other week for four sessions (6 weeks total) Inpatient education will address: • Basic pain physiology, including pain as danger detector / protector • Difference between acute and persistent pain and structural and non-structural pain • Danger/Safety framework and role of attentional system • Drivers of danger include – unclear diagnosis, fear about pain and its trajectory, compensation stress, perceptions of injustice, hx of trauma • Drivers of safety include – understanding of pain and diagnosis, feeling supported, recovery pathway including optimisation and facilitation of claim • Introduction/rationale for understanding pain, activity pacing, gentle movement, relaxation and mindfulness • Introduction to strategies to manage pain including opioids, anti-inflammatories and nerve modulating medications 5-10-minute video outlining practical aspects of injury/trauma recovery: • Role of pain medicine, rehabilitation medicine, co-ordinating GP • What to expect re health processes: specialist appointments, need for certificates • Compensable systems including Transport Accident Commission (TAC), Worksafe (WCA) claim processes, contacts, supports, troubleshooting Interventional content – in person or telehealth Session 1 - Psychology or Physiotherapy lead • Assessment session (physiotherapy or psychology lead) with brief medical review including diagnosis, stage of recovery, consolidation and ensuring shared understanding of presenting issues and treatment rationale • Ascertain key targets for intervention and SMART goals Session 2 - Psychology lead • Review TAC claim process/coordination of care • Introduction to Window of Tolerance – for understanding mind/body stress response and emotional regulation • Noticing and responding to catastrophic /fear cognitions • Skill building: somatic-tracking + grounding i.e. tuning into / tolerating unpleasant sensations • Homework practice: Mindfulness exercise: “when pain grabs your attention” Session 3 - Physiotherapy lead • Mindful movement – encouraging safety in the body • Activity pacing • Homework practice: Completing valued activity applying mindfulness and pacing principles Session 4 – Psychology or Physiotherapy lead • Review of progress and sessions to date • Review of claims process • Post-discharge medical/nursing summary, goal setting w community links, follow-up plans • Relapse prevention/planning - Adherence will be monitored through patient attendance to sessions - Adherence may also be monitored through recollection of themes checked by psychologist at beginning of each session - Adherence may also be monitored through web-portal analytics for engagement in disseminated communication and filling in PROMs in a timely fashion if able to do so.