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Pain Management
The Pain Management Teams deal with acute pain and chronic pain.
Acute pain is usually pain after surgery, an injury or trauma of some kind, is short acting and gets better with time.
Chronic pain is pain that can come on gradually and lasts longer than three months. It is treated with a multidisciplinary holistic approach and techniques.
Acute Pain
The Acute Pain Team exists to introduce, maintain and monitor modern methods of safely managing acute pain for patients on the wards. The Acute Pain Team consists of Debbie Hunter, Ruth Clayton, Anna Batman, and David Locker (Acute Pain Nursing Team), Dr T Madej, (Lead Consultant for Acute Pain), and the On-call Maternity anaesthetist, providing out of hours cover for the team.
The main current methods of pain relief used are:-
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Patient Controlled Analgesia (PCA)
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Epidural Analgesia (EIA)
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Single Dose Spinal Opioid Analgesia
Daily ward rounds take place of all patients on PCA and Epidural infusions, including weekends. Although nearly all of the patients are post-surgical, there are many other patients who benefit from close attention to pain relief and the Acute Pain Team is often involved in their pain management. During the ward rounds, assessment, evaluation, treatment and audit of pain management occurs and is recorded on ward documentation and CPD (Core Patient Database). Protocols have been developed by the Acute Pain Team for the care of these patients.
Education is a major part of the Acute Pain Team's role. Patient education is vital for the patients to gain full benefit from the type of analgesia used. Education of all trust staff involved with the care of Acute Pain patients is carried out on a regular basis. We also have visitors from other hospitals wanting to set up Acute Pain teams, this has included not only visitors from other trusts within the United Kingdom, but also medical staff from South Africa and Japan.
Research projects are undertaken by the Acute Pain Team, including studying outcomes resulting from the use of Non-Steroidal Anti-inflammatory drugs in post-operative pain relief and comparison of post-operative pain management techniques, following major surgery.
Chronic Pain
The Chronic Pain Team consists of three consultant anaesthetists: Dr Toomey, Dr Moss and Dr Hall. A multidisciplinary approach is used for these patients which includes 2 Clinical Psychologists, 2 Physiotherapists, 2 Occupational Therapists and 2 Senior Nurses. The pain management secretaries are Karen Thompson, Josie Taylor and Nicky Rice. Annette Calpin assists in the administration of the clinics. They provide a comprehensive chronic pain management service.
The treatment modalities include:-
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Regional blocks
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Implants
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Transcutaneous Electrical Nerve Stimulation
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Acupuncture
Patients are treated on an outpatient or day case basis. However, there are some patients treated as inpatients for implantable pain management techniques.
Research projects include the trial of Gabapentin and cannabis in pain management.
Pain Management Programme
The Pain Management Programme is designed for patients with chronic pain. The programme was initially a one year pilot project from May 1998 - May 1999. Funding has now been secured.
The staff include an Occupational Therapist, Senior Nurse, Physiotherapist, and Clinical Psychologist with secretarial support. The patients are invited to attend an information session prior to assessment for the programme.
The programme consists of 12 half day sessions, working in a group of 10-12 for 8 consecutive weeks and the subsequent sessions spread over a year.
The patients invited to attend the programme are patients with chronic pain. They have had treatment in the past to try and cure the pain, but despite all this, they still have the pain. At a certain stage, it is sensible to stop trying for a cure (or even a diagnosis) for the pain. The patient's pain experience is very much controlling the person, dominating every aspect of their life.
The philosophy of the Pain Management Programme
The programme aims to re-educate the patient and enable them to bring their life and pain under control
The programme aims to provide a very positive approach to all the problems associated with chronic pain in order to improve the coping skills of the patient with chronic pain. The team members facilitate and teach self management skills so the patients may find solutions to their problems and difficulties associated with chronic pain.
The programme covers the interaction of pain with the patients' behaviour, environment, mood, thoughts and physical aspects;
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Behaviour: any daily activities such as walking, sitting and standing
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Environment: people around you and the places you can go
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Mood: continuous pain can affect your mood and make you feel low
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Thoughts: worries and thoughts about the future, including feelings of frustration and anger
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Physical: gradual increase of exercise and activity levels
The patients are invited to attend an information session prior to assessment by the team for their suitability to attend the programme.
These areas do not exist in isolation, but affect each other. At the beginning of the programme the pain is in control of these areas. The programme is designed to enable the patient to achieve changes by giving them back control of their life and pain. This leads to a better quality of life for the individual and their families.
Brief Pain Management - the programme
This intervention forms a 4 week programme based on the same principles as the longer pain management programme delivered by the multidisciplinary team for people who have less impact from the pain.
Auditing and assessment of the programmes is being carried out.
The pain clinic has a patient pain support group holding regular meetings and providing support and information for those in pain. Further information is available on the Pain Management Support Group website.
