Dr Jane Trinca
MBBS, FANZCA FFPMANZCA, FANZCA MM (pain management), Graduate Certificate in Health Evaluation and Research
Director, Specialist in Pain Medicine
Jane has worked as part of the interdisciplinary team at the BWCPM since 1999 and became the Director in 2008. She has a particular interest in the improvement of the understanding of “pain mechanisms and modulation” by patients and health professionals.
She has a background in clinical anaesthesia and is an honorary senior lecturer in Department of Pharmacology at the University of Melbourne.
Research interests include: Pain knowledge and education in health professionals, Safety and monitoring acute pain services, Opioid misuse.
Our team include the following:
- Pain Medicine Specialists
- Pain Fellows
- Research Assistant
- Group Coordinator
After the initial assessment, a treatment plan will be developed according to the patient's individual needs. This might involve medical input (e.g., medication, further investigations required, other interventions), individual physiotherapy and/or individual psychology sessions. Some patients may also be offered appointments with other medical specialists within the clinic (i.e., Dental Consultant, Addiction Medicine, Rehabilitation Medicine, Consultant Psychiatrist) or outside the clinic if necessary. All patients must attend group Pain Education Program (PEP) before undertaking individual appointments.
The clinic has a range of group programs including hydrotherapy, PEP, START (a cognitive behavioural program - see below), and PACT (Physiotherapy Plus Acceptance Committee Therapy Program) for suitable patients (as assessed by the team).
Please note that the length of treatment that patients may receive at the clinic is determined by individual needs and progress.
The medical team as part of the multidisciplinary team include pain specialists with backgrounds in Anaesthesia, Rehabilitation Medicine, Dentistry, Addiction Medicine, and Psychiatry. Medical therapies offered include Pharmacotherapy, Interventional Procedures, and Education.
The role of a physiotherapist is to look at how pain is affecting a patient's physical condition and level of daily activity. This information will then be used to formulate an appropriate physiotherapy treatment plan.
This may include:
- Developing an exercise program to improve flexibility, strength, and fitness
- Advice on how to correct posture and walking pattern
- Learning how to upgrade level of daily activity or plan daily activity level to help manage pain
- Improving patient knowledge about chronic pain and how it affects the body's physical function.
The role of a psychologist in an assessment is to look at the way persistent pain has affected a patient's life. For example, a person may be unable to work and/or do their usual hobbies because of pain. Commonly, people with persistent pain become depressed, anxious and/or angry as a result of the changes to their life because of pain. Changes in a person's self esteem is also common.
A psychologist may be able to assist with:
- Reducing emotional distress (e.g., depression, anxiety, anger)
- Improving quality of sleep
- Develop strategies to help manage pain (e.g., pacing activities, meditation/relaxation strategies).
The role of the clinical nurse consultant primarily involves coordination of patient care and patient education.
All patients referred to the BWCPM are triaged by the nurse consultant and appointments are organized according to the information provided at the time of referral. The nursing staff monitor the patients' progress while attending the centre and ensure that all aspects of the management plan are implemented, the outcome is reviewed on a regular basis, and changes are made to the plan in accordance to patient response
Nursing staff can also provide patient education both individually and to groups. Education involves: mechanisms involved in chronic pain states, management of chronic pain using medications, and the use of cognitive behavioural therapy in the management of chronic pain.
START (Selected Targets of Activity ReTraining) program
1. What does it involve?
The START program is an intensive three-week pain management program. This program runs daily (Monday to Friday, 9am-5pm) at the centre. It is designed to help people deal with their persistent pain and is based on cognitive behavioural therapy (CBT) principles. The program is conducted by a team, including a psychologist, physiotherapist, nurse and doctor.
2. Who would it be appropriate for?
Some examples of types of patients who may be suitable include those who:
- Have not responded to medical or surgical treatments
- Have not progressed in rehabilitation due to pain
- Are reliant on medication to cope with pain, or
- Have become very distressed/disabled due to pain
- Wish to be free of analgesic medications.
3. What can patients expect?
- increased knowledge about persistent pain
- greater physical fitness, strength and endurance
- better mood
- more enjoyment of social activities
- improved ability to manage daily activities despite the pain
- increased confidence in their ability to manage persistent pain without medication and aids
- less need to visit other allied health professionals (e.g., physio, acupuncture, osteopath, chiropractor) for treatment of persistent pain
- returning to work/study/other duties, or a new focus on their work/study options.
4. What is the referral process?
The same referral process apply as per point 2 above. The patient will need to be assessed prior to being accepted into the program. This is to ensure that the patient has a good understanding of the nature of the program, has realistic goals and is willing to actively participate. We strongly recommend patients to read the book "Manage your pain" by Michael Nicholas (ABC Books) prior to a program.
Frequently Asked Questions
1. Who is eligible for the service?
- Anyone with persistent pain lasting more than 3 months or more may be referred.
- Refer to "Anaesthetic Department" on the St Vincent's Intranet for information about acute pain management.
- The service gives referrers advice about patients with complex acute pain on request.
2. What is the referral process?
- Ensure that there is sufficient detail on the referral to facilitate accurate triaging of referral (see point 3 below). This will ensure that the right type of assessment is booked (see point 4 below for details).
- Any doctor outside St Vincent's may refer patient to BWPMC.
3. What information is required on the referral form / letter?
- Detailed reason for referral
- Management to date and response to treatment
- Past medical history
- Current medications (& medication history if relevant)
- Relevant imaging and pathology reports.
- Note. If you believe that this patient should be seen urgently or fast tracked, please state the reason and it will be taken into consideration when triaged.
4. What happens after the referral?
- A set of questionnaires will be sent out to the patient, and an appointment made to attend a 'Gateway' information and triage clinic. This appointment is usually within 2 months of referral. At Gateway clinic, once completed questionnaires are received, patients are seen briefly by a team member who gathers more information.
- The information provided will determine the type of initial assessment.
5. What does the initial assessment involve?
- 3 types of assessments can be offered.
- A Multidisciplinary Assessment (MDA). An MDA includes appointments with a doctor, psychologist and physiotherapist, usually all on the same day. The patient typically gets feedback on the same day regarding a proposed treatment plan/options.
- A Doctor and Physiotherapist assessment (i.e. no psychology assessment).
- A Doctor Only assessment (e.g., this may apply for patients whose presenting problem is specifically medication related, or request for a procedure).
There are no costs to public patients as BWCPM is a public service. Workcover, TAC or Veteran Affairs patients will be billed accordingly.
Referral Forms and Guidelines
For referrals to the Pain Clinic for Older Persons please use the Aged Care and Community Services Referral Form
The BWCPM also offers a consultation service for patients who are currently in hospital (at St Vincent's). For an acute post-operative pain issue, please contact the 'Pain Registrar' (refer to 'Anaesthetics Department' on the Intranet) via St V's Switchboard. Please fax all referrals to 9231 4660.
Alternatively, if it is a chronic or cancer pain issue, please direct referrals to our Pain Fellow (via FAX: 9231 4660). Note that the standard referral process still apply.