WHAT DOES THE PRECISION ASCEND PROGRAM INVOLVE?

Our Precision Ascend programs involve groups of 6-12 patients at a time working with a small team of highly trained and experienced staff.

Precision Ascend is a part time program which runs over 6 weeks (two and a half days per week). This is followed by a structured 4-week ‘home or work’, during which you will take your knowledge and skills back to your everyday life. Individual follow-up is provided as required.

Features of the Precision Ascend pain management program include:

• Medically supervised medication reduction and/or withdrawal. Our expert Pain Specialists play an integral role in making sure that this is done effectively and safely.
• Withdrawal of unnecessary aids, such as walking sticks and neck braces. These may do more harm than good, both physically and psychologically.
• An emphasis on functional improvement and physical conditioning. This is individually tailored, with expert input by our physiotherapists.
• Assistance with mood and sleep issues, with our health and clinical psychologists playing a key role.
• Family and partner involvement- rather than treating you as an isolated individual, we recognise the impact that your illness has on those around you, and also the role that your family can play in helping you to recover.
• Rehabilitation planning for return-to-work steps. Our team will work with your local doctor, rehabilitation provider, employer, and case manager to optimise your safe and sustained return to the workforce.

WHAT ARE THE MAIN COMPONENTS OF PRECISION ASCEND?

Precision Ascend is a multidisciplinary integrated pain management program which aims to offer something greater than the sum of its individual parts. To help you understand the mechanics of how Precision Ascend works, we can summarise the main components:

1. Medical component

   You will undergo a medical assessment by our Pain Specialist. This will include a review of your condition, treatment to date, and medication issues. In some cases, further investigations or treatment may be recommended, and your commencement of Precision Ascend may be deferred. If required, a strategy to safely reduce your medications will be developed, and this will be done under supervision.

2. Educational component

   Understanding your body, your condition, and the principles of treatment are a prerequisite to a successful outcome. We will explain the basics of human anatomy and movement, your diagnosis, and the keys to correcting posture and poor body mechanics. You will be taken through a personalised exercise program designed specifically for you and you will learn how to use exercise to improve your function and your quality of life. You will learn about pain itself, how normal pain can become dysfunctional and persistent and how this affects your whole life. You will be shown specific ways to modulate pain and reduce the impact it has on you.

3. Physical conditioning

   This involves daily physical exercises which do not require particularly special equipment, and which you can continue in the long term. Floor exercises, walking, core muscle stability exercises, and other activities will form the basis of a program of reconditioning of your body- a key strategy in your overall pain management and functional enhancement.

4. Psychological component

   Important components of the pain experience are: 1) The physical sensation of pain, 2) Automatic thoughts, 3) Uncomfortable emotional reactions, and 4) Self-defeating behaviours which often result. As pain becomes chronic (long-term), mood and motivation are usually affected, and the problem of the physical sensation of pain is amplified. By learning to separate the physical sensations from the emotional and psychological responses, stress levels and overall discomfort are reduced.

A cognitive behavioural strategy will challenge any negative thoughts and encourage changes in behaviour. Our Health and Clinical Psychologists will assist you, both in an individual and group therapy setting, with the following:

• Pain education
• Stress management
• Relaxation and distraction techniques
• Goal setting
• Problem solving
• Depression, anxiety and anger management
• Occupational therapy
  Occupational therapy is utilised in the following areas:
  • Posture
  • Basic ergonomics
  • Back support cushions and seating
  • Manual handling and lifting instructions
  • Work skills and workplace assessments
  • Job suitability

WHAT HAPPENS AFTER PRECISION ASCEND?

Our involvement in your care does not end with the 6 week program. Individuals are taught to apply the pain management strategies they learnt during the Precision Ascend program when they return home and to work after the program finishes. Those who do this achieve more robust and long-lasting gains.

All participants are assisted to develop a 4-week ‘home-plan’ at the end of the main program. These plans include a daily timetable of exercises and activities, as well as reminders of strategies to handle any pain flare-ups or other set-backs.

After the 4-week home-plan phase participants return to the Precision Ascend clinic to review their progress with our team. These reviews last a few hours and are extremely important. A similar review is also offered 6-months post-program.

For some, especially those with ongoing mood or other issues, we offer a series of individual sessions with one of the Precision Ascend staff, usually our health or clinical psychologist. Typically, no more than 5 individual sessions are required.

WHO IS SUITABLE FOR PRECISION ASCEND?

People suffering from chronic pain (lasting more than 3 months) may be suitable. Pain can result from a number of conditions including:

• Back pain
• Sciatica (leg pain)
• Neck pain
• Brachialgia (arm pain)
• Whiplash injuries
• Work-related injuries
• Arthritis
• Headaches
• Complex regional pain syndromes (CRPS) or neuropathic pain
• Facial pain
• Phantom limb pain
• Pain after surgery

The usual entry criteria into the Precision Ascend Program are:

• Pain for more than 3 months
• Failure to respond to medical or surgical treatments (and unsuitable for further treatments)
• Failure to progress in rehabilitation due to pain
• Reliance on medications to cope with pain
• Substantial distress due to pain
• Desire to get on with life and return to work or normal life despite ongoing pain

WHO IS UNSUITABLE FOR PRECISION ASCEND?

Unfortunately, some people are unlikely to be able to benefit from Precision Ascend. Our exclusion criteria include:

• Those not motivated or unwilling to participate
• Those unable to speak adequate English
• An active, major mental disorder (e.g. psychotic disorder, clear suicide risk)
• Those suitable for further medical or surgical treatment, or who require further investigations
• Pain present for less than 3 months
• A medication addiction or substance abuse problem

PRECISION ASCEND AND WORK RELATED INJURIES

Many back, neck and other conditions which result in chronic pain and disability result from injuries at work. Chronic pain commonly results in a loss of work capacity, and the longer that an individual is out of work, the less likely it is that they will get back into the workforce. A key goal of Precision Ascend is to enable injured workers to resume their place in the workforce in a safe and sustained fashion.

For those with long-term pain who are distressed and disabled, a number of studies have shown that intensive, cognitive-behavioural-based pain management programs can achieve significant gains in functional, mood, treatment costs, and return to work.

Guzman et al. [British Medical Journal 2001; 322: 1511-1516] provided evidence that multidisciplinary biopsychosocial rehabilitation with functional restoration reduces pain and improves function in those with chronic lower back pain.

Watson et al. [European Journal of Pain 2004; 8: 359-369] showed that over 60% of chronically unemployed individuals with back pain, who underwent a pain management rehabilitation program incorporating vocational focussing and advice, were able to return to the workforce in either a full-time or part-time capacity.

These results are supported by a more recent study published by Poulain et al. [European Spine Journal 2010; 19: 1153-1161] who examined the effectiveness of a functional restoration program for chronic lower back pain. 55% returned to work after mean follow-up time of 3.5 years (only 9% worked at the start of the program). Quality of life, functional capacity, psychological factors, and fear and avoidance beliefs were all significantly improved.