jeremy weinbren january 2010 pain medicine at hillingdon hospital- an overview
TRANSCRIPT
Jeremy WeinbrenJanuary 2010
Pain Medicine at Hillingdon Hospital-
An Overview
•Who?•Why?•When?•What?
Questions for this evening...
• 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
Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)
– Damien Smith & Jeremy Weinbren
Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)
– Eva Santiago & Sam Foo
Pain Medicine at Hillingdon• Two Consultants (6-8 sessions)• Two Pain Specialist Nurses (1.7 WTE)• One Associate Specialist (1.5
sessions)– Pathma Rajah
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
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.
Pain Medicine at Hillingdon
• 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
Chronic Pain
Incidence
30%
Lifetime Prevalence
80%
Socioeconomic Costs
£20 billion per year
Referral Pathways
New Referrals
Referral Pathways
New Referrals
Referrals to Spinal Surgeons (SDC)
New Referrals
Referral Pathways
Onwards from Spinal Diagnostic :
Epidural Injections (Pain Medicine)
Epidural Injections (Orthopaedic)
Epidural Steroid Injections
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
Facet Joint Injections
Increased Pain on:
FACETDISC MUSCLE
Increased Pain on Lateral Flexion:
FACET
DISC
MUSCLE
Increased Pain on Rotation:
FACET
DISC
MUSCLE
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)
Invasive Drug-based
Others
Invasive Non-drug Treatments
Pain Medicine Follow-ups
Pain Medicine at Hillingdon
New Referrals
Clinical Guideline
88
So now you know..
• More Consultants?• Easier Access for GPs and Patients?• Fewer patients?• Community based sessions?• More integration across the local
health economy.
The Future ?
