jeremy weinbren january 2010 pain medicine at hillingdon hospital- an overview
TRANSCRIPT
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Jeremy WeinbrenJanuary 2010
Pain Medicine at Hillingdon Hospital-
An Overview
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•Who?•Why?•When?•What?
Questions for this evening...
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• Jeremy Weinbren– Who we are and what we do
• Damien Smith– What you can do instead
• Simon Dupont– What the patient can be helped to do.
• Questions
Menu
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Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)
– Damien Smith & Jeremy Weinbren
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Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)
– Eva Santiago & Sam Foo
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Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)• One Associate Specialist (1.5
sessions)– Pathma Rajah
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Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)• One Associate Specialist (1.5
sessions)• Two Acupuncturist Physiotherapists
(3 sessions)• One TENS Clinic Physiotherapist (2
sessions)
• One Administrator (Betty Parkes)• One Secretary
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Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)• One Associate Specialist (1.5 sessions)• Two Acupuncturist Physiotherapists (3
sessions)• One TENS Clinic Physiotherapist (2
sessions)
• One Administrator• One Secretary
• One Advanced Pain Trainee – a 15-month training post.
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Pain Medicine at Hillingdon
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• Patients with musculo-skeletal pain• Patients with neuropathic pain• Patients with specific pain syndromes• Patients needing medication advice• Cancer Pain patients• Patients for Interventional Pain
Procedures
Referrals
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Chronic Pain
Incidence
30%
Lifetime Prevalence
80%
Socioeconomic Costs
£20 billion per year
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Referral Pathways
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New Referrals
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Referral Pathways
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New Referrals
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Referrals to Spinal Surgeons (SDC)
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New Referrals
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Referral Pathways
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Onwards from Spinal Diagnostic :
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Epidural Injections (Pain Medicine)
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Epidural Injections (Orthopaedic)
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Epidural Steroid Injections
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Long term relief with Epidural Steroids
83
77
69
67
53
51
40
36
0 20 40 60 80 100
PercentLong-TermRelief
Normal CT scan
Osteophytes
Spondylolisthesis
Previous Back Surgery
Disc space narrowing
Facet joint inflammation
Spinal stenosis
Disc prot. + root imp
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Facet Joint Injections
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Increased Pain on:
FACETDISC MUSCLE
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Increased Pain on Lateral Flexion:
FACET
DISC
MUSCLE
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Increased Pain on Rotation:
FACET
DISC
MUSCLE
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Facet Joint Syndrome• Back pain radiating down
a segmental nerve root• May follow an injury or
lifting• Worse on extension or
lateral flexion• Paravertebral tenderness• May be associated with
disc disease – (mixed signs)
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Invasive Drug-based
Others
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Invasive Non-drug Treatments
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Pain Medicine Follow-ups
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Pain Medicine at Hillingdon
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New Referrals
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Clinical Guideline
88
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So now you know..
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• More Consultants?• Easier Access for GPs and Patients?• Fewer patients?• Community based sessions?• More integration across the local
health economy.
The Future ?