Pain Clinics
Introduction
Pain clinics are a modern concept of pain management characterized by multiple specialists’ services and patient convenience.
People with chronic pain are now able to attend a specialist pain clinic for assessments and possible pain management, together with advice on living a fuller life, even in presence of pain.
Recent research shows that pain clinics provide a range of therapies which patients are unlikely to receive elsewhere.
The Concept
Pain clinics generally vary in their method of functioning as well as in the range of treatments offered. While some hospitals have specific pain clinics of their own, others will usually refer you to another pain clinic.
There are three basic aims of a pain clinic:
- To decrease the level of pain and suffering
- To enable the patient to return to the maximum level of functioning and independence
- To help the patient restore the quality of life
At times, pain clinics do not prescribe or provide medication, except in emergency situations. Patients are instructed to bring with them an adequate supply to cover their stay time at the clinic.
Normally, the team of specialists at a pain clinic will include the following:
- Doctors
- Psychologists
- Nurses
- Physiotherapists
- Occupational therapists
The Procedure
The procedure for joining a pain clinic generally follows certain specific steps. Here we list the main steps usually followed.
His /her doctor or the GP refers the patient. The patient is then required to come in for a medical screening and assessment. If there are constraints like distance, there can be a telephone consultation amongst the physician and the patient. Once done, a report is sent to the referring physician. If the patient is found suitable, an appropriate schedule is designed for the patient. If required, patients are offered additional services like familiarization and induction into the program, prior to the commencement.
Conditions and Facilities
The conditions treated at the pain clinics often vary according to the requirement and medical facilities available. However, most of the pain clinics offer treatments for relief from a vast series of common medical conditions. The most prominent amongst these are:
Post herpetic neuralgia Back pain and radiculopathy Neuralgias (trigeminal and others) Peripheral nerve injuries Painful peripheral neuropathy Cancer pain Facial pains Headaches/Migraines Central pain syndromes Phantom limb pain Chronic pelvic pain Myofascial pain syndromes Fibromyalgias
Recent Advancements
The technology and concept of pain clinics have undergone a major metamorphosis in the recent years.
From the modernization of scientific techniques to the availability of skilled expertise, these pain clinics are the definitive new face of the world of the medicine.
In this section, we’ve briefly discussed what is it that gives this latest concept an advantage over other forms of treatment.
The most prominent development is that of the availability of interventional pain specialists. These specialists basically rely on evidence-based practice with modern techniques for precision in locating the cause of pain and its subsequent treatment. Fluoroscopy is a mandatory technique applied in the pain clinics. This enables the specialist to accurately pinpoint the nerve blocks, thus avoiding destruction of nerves that occur as a result of blind techniques. The use of nonionic radioopaque dye under fluoroscopy ensures that the injection is pointed at the right location. Identifying nerve inflammation points and injecting a slow-release medicine (steroid) enables the relief to last for 2 to 3 months, enabling the nerve to heal. Techniques like radiofrequency for denervation produce much safer and efficient results than neurolytic agents such as phenol and alcohol. Availability of a variety of treatments including psychotropic drugs (like antidepressants, anticonvulsants), nerve blocks and stimulation have made the treatment process highly result-oriented and efficient. Implants, such as spinal cord stimulators for treating painful conditions like chronic back ache, refractory angina and failed back surgery enable patients to live a much more comfortable and productive life. Use of intrathecal pumps for cancer pain and other chronic pain makes the related conditions much easier to handle in such patients. Techniques such as discography enable the accurate pinpointing of intervertebral disc to be removed, thus reducing chances of a failed back surgery. Needle procedures such as IDET (intra discal electro thermal annuloplasty) and Nucleoplasty can almost always replace the need for a major invasive back surgery.
The Pre-Requisites
To set up a pain clinic, there are certain pre-requisites that are important to be fulfilled. Here we briefly list the requirements that need to be taken care of before an independent pain clinic is set-up.
Adequate funds and resources Licenses for medication Equipment, tools and machinery Referrals and contacts Skilled staff and technicians Alliance with an institution (if required) Recognition from a regulating authority Sufficient reference and study materials Credibility and good reputation
