PAIN711 2023 Introduction to Pain Management Assignment 2: Information Resource 50% of final grade Due: Monday 16th October 2023
Purpose:
This assessment is designed to give you an opportunity to investigate a new/emerging treatment for pain, and to practice translating your knowledge of the evidence-based management of pain for patients. In this assessment, you will produce a resource that you may be able to use in your clinical practice/situation.
Brief:
You have been asked to create a Patient Information Resource about a new/emerging treatment for pain (of your choice) for use in your clinical practice setting. You have creative license as to what format this resource will take, but it needs to contain enough information for a patient to give informed consent.
Instructions:
Select a new/emerging pain management approach/treatment for either acute or chronic pain (eg: deep brain stimulation, virtual reality, ‘medicinal cannabis’). There are no hard rules about how ‘new’ a treatment must be, but as a guide, your treatment should not be available in the majority of clinics within New Zealand. Feel free to get in touch with Mark with queries.
Create a Patient Resource describing this intervention/treatment in enough detail that someone could give informed Consent. Your resource can take any format you see fit but should be easy to understand, engaging and appropriate for a lay audience.
You should consider including information about:
a) Description of the treatment: What the treatment involves, what the patient can expect both during and after treatment, where the treatment is available, who can offer it, how long it takes, costs etc.
b) Scientific basis: How the treatment works (or is proposed to work), the theoretic basis or proposed mechanism(s) etc.
c) Evidence of effectiveness: How well the treatment works, what the potential benefits/outcomes are and how likely these are (ie: the evidence base) etc.
d) Safety considerations: Indications (for whom and when it might be best) and contraindications (who not, when not, drug interactions), any potential side effects or adverse events and the likelihood of these etc.
e) Alternatives: What the alternative or complementary treatment options are etc.
For a refresher on Informed Consent see the following resource provided on Blackboard: ? Information-choice-of-treatment-and-informed-consent.pdf
You need to consider who your resource is for and use appropriate language for your target audience.
For help with designing and writing your resource, see the ‘Helpful Resources’ provided on Blackboard
Your resource MUST include references to the literature. For the purposes of this assignment, if you prefer, you may use an alternative referencing system other than APA 7th (eg: a numbered system such as Vancouver or Chicago might be better and more patient friendly).
For help with referencing styles, see the following resources provided on Blackboard: ? Otago Libraries Subject Guide on ‘Referencing/Citation Styles’
Submit your Patient Resource via the Assessment Submission Portal on Blackboard by the end of the day on Monday 16th October 2023. Please note: Unless a late submission request has been approved by the Paper Coordinator, a 5% penalty for late submission of Assignments will be applied.
If your resource is in a format other than .PDF or .DOC please email mark.overton@otago.ac.nz before the due date to arrange an alternative way of submitting.
This assessment will be marked out of 50 marks using the Marking Rubric below and is worth 50% of your final grade.
Help:
• Help with your assessment is available via the main Discussion Board Forum on Blackboard. Please ask any questions here so that everyone can benefit from the reply.
• An example of an Information Resource by a previous student is available on Blackboard as an example.
• Review the marking rubric below for areas you should focus on.
• Many organisations create patient information resources, do an online search and see what you find.
PAIN711 2023 Assignment 2: Information Resource – Marking Rubric
Marks 15 – 12 11 – 10 9 – 8 7 – 0
Use of literature
15 marks
Has selected and synthesised a wide range of appropriate, high-quality sources, developing a coherent rationale for the selected treatment. Has presented an up-to-date and balanced view creatively by applying peripheral literature when needed.
Has selected and applied a range of quality sources, developing a clear rationale for the selected treatment. Attempts to present an up-to-date and balanced view.
Appropriate literature has been selected but is either presented uncritically or used in a descriptive way. Does not present a clear rationale for the selected treatment.
Literature either not consulted, irrelevant to assessment or of poor quality.
15 – 12 11 – 10 9 – 8 7 – 0
Presentation
15 marks
Summary is well-structured and appealing. Presents information succinctly in an easily useable way for target audience.
Summary is clearly structured. Presents information in a usable way for target audience.
Summary is somewhat unclear or not well structured Information is not presented in a usable way for target audience. Presentation of summary is inappropriate for target audience.
15 – 12 11 – 10 9 – 8 7 – 0
Content
15 marks
Resource provides a comprehensive overview of treatment from the patient perspective and contains more than adequate information needed for patient to give Informed Consent.
Resource provides an overview of treatment from the patient perspective and contains adequate information needed for patient to give Informed Consent.
Resource attempts to provide an overview of treatment but may not contain adequate information for patient to give Informed Consent.
Resource does not contain adequate information for patient to give Informed Consent.
5 4 3 2 – 0
Referencing
5 marks
Citations are clearly presented using a consistent referencing style, allowing the reader to source references.
Citations are presented using a mostly consistent referencing style allowing the reader to source references.
Citations are presented but are inconsistent, the reader may not be able to source all references.
Citations are not presented at all or are presented in a way that does not allow the reader to source references.
_________________________
Patient information resource on transcranial magnetic stimulation (TMS) for treatment-resistant depression:
Transcranial magnetic stimulation (TMS) is an emerging non-invasive brain stimulation technique that is being used to treat depression in patients who have not responded adequately to antidepressant medications. TMS uses magnetic pulses to stimulate targeted areas of the brain and modulate neuronal activity without the need for surgery (Lefaucheur et al., 2014). Over the past two decades, research has demonstrated TMS to be a generally safe and effective treatment option for treatment-resistant depression. This resource aims to provide information about TMS to help patients considering this treatment make an informed decision.
What is TMS treatment?
During a TMS treatment session, a magnetic coil is placed against the scalp near the forehead. Brief magnetic pulses are then delivered through the coil to stimulate regions of the brain involved in mood regulation, such as the prefrontal cortex (Lefaucheur et al., 2014). Treatment usually involves daily sessions, with each session lasting around 30 minutes, over 4-6 weeks (O’Reardon et al., 2007). Patients remain awake and alert during treatment and can return to normal activities immediately after.
How does TMS work?
TMS is thought to work by modulating activity in brain circuits that regulate mood. Repeated magnetic stimulation of the prefrontal cortex is believed to induce neuroplastic changes that may help “reset” abnormal patterns of brain activity associated with depression (Lisanby, 2007). Specifically, TMS may enhance activity in brain regions with reduced activity in depression and inhibit overactive regions (Lefaucheur et al., 2014). By modulating activity across widespread brain networks, TMS may help relieve depressive symptoms.
Evidence of effectiveness
Over 30 randomized controlled trials have evaluated TMS for treatment-resistant depression (Schutter, 2009). A meta-analysis of these studies found that approximately one third of patients experienced a significant reduction in depressive symptoms after a course of TMS (Schutter, 2009). Several large multi-site trials have also demonstrated TMS to be significantly more effective than sham treatment (O’Reardon et al., 2007). While not all patients respond, TMS offers an alternative for individuals who have not benefited from antidepressant medications. The antidepressant effects of TMS appear to last for several months in responders (Lisanby, 2007).
Safety of TMS
TMS has an excellent safety profile and is generally well tolerated. Common side effects may include mild headaches or scalp discomfort during or after treatment in some patients (Lisanby, 2007). Serious adverse events are rare. TMS should not be used in patients with metallic objects in the head, a history of seizures, or unstable cardiac or neurological conditions (Lisanby, 2007). As TMS does not involve surgery or anesthesia, it avoids risks associated with more invasive procedures. However, as with any medical treatment, patients should discuss any health concerns with their doctor before starting TMS.
Alternatives to TMS
For treatment-resistant depression, alternatives to TMS include trying different antidepressant medications, augmentation with other psychiatric medications, electroconvulsive therapy (ECT), or participation in psychotherapy or counseling. Deep brain stimulation is another emerging neuromodulation option, but TMS has advantages over surgery in being non-invasive (Lisanby, 2007). TMS may also be used in combination with antidepressant medications or psychotherapy for some patients.
Availability and costs
TMS is currently available at some specialized psychiatric and neurology clinics throughout New Zealand. An initial course of treatment usually involves daily sessions, 5 days a week, for 4-6 weeks. The total cost of a full course of TMS is approximately $5000-6000 depending on the clinic (Health Navigator NZ, 2023). Some health insurance policies may cover part of the cost. Ongoing “maintenance” TMS sessions may also be recommended for relapse prevention after an initial positive response.
Making an informed choice
In summary, TMS offers a non-invasive treatment option for depression without the side effects of medications. While not all patients respond significantly, research shows TMS to be a generally safe and effective alternative for treatment-resistant cases. Patients considering TMS should discuss their individual circumstances and treatment history with their doctor to determine if TMS may help their depression. An open discussion of potential risks, benefits, costs, and alternative options can help patients provide fully informed consent for this treatment.
References
Health Navigator New Zealand. (2023). Transcranial magnetic stimulation for depression. https://www.healthnavigator.org.nz/health-a-z/t/transcranial-magnetic-stimulation-for-depression/
Lefaucheur, J., André-Obadia, N., Antal, A., Ayache, S. S., Baeken, C., Benninger, D. H., … & Garcia-Larrea, L. (2014). Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS). Clinical Neurophysiology, 125(11), 2150-2206. Research essay writing service.
Lisanby, S. H. (2007). Electroconvulsive therapy for depression. New England Journal of Medicine, 357(19), 1939-1945.
O’Reardon, J. P., Solvason, H. B., Janicak, P. G., Sampson, S., Isenberg, K. E., Nahas, Z., … & Sackeim, H. A. (2007). Efficacy and safety of transcranial magnetic stimulation in the acute treatment of major depression: a multisite randomized controlled trial. Biological psychiatry, 62(11), 1208-1216.
Schutter, D. J. (2009). Antidepressant efficacy of high-frequency transcranial magnetic stimulation over the left dorsolateral prefrontal cortex in double-blind sham-controlled designs: a meta-analysis. Psychological medicine, 39(1), 65-75.
