The Eric Angel Pain Management Centre

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The Eric Angel Pain Management CentreA Service update : 

The Eric Angel Pain Management CentreA Service update Dr R Sawyer

History : 

History Established in 1950s by Dr Eric Angel at Freedom Fields Hospital Moved to Derriford Hospital in 1980’s Gradually expanded in consultant numbers: 1984= 3 1994=4 1997=5 2007=6

Current staffing levels : 

Current staffing levels 6 Consultants. part time pain management, part time anaesthetists (about to decrease to 5 consultants) 1 part time associate specialist 1 x 8a nurse specialist 1 x 8a extended scope physiotherapist 1 x psychologist (2nd to start Oct 2010) 2 band 6 nurses, 1 band 5 in clinic 2 x HCAs Directorate and Support manager Admin staff (In patient acute pain team)

Services provided : 

Services provided Out-patient chronic pain service Cancer pain management service at St Luke’s Hospice Chronic pain research Chronic pain training to medical students, junior doctors and GPs. (In patient acute pain service)

Out patient pain service : 

Out patient pain service Comprehensive biopsychosocial pain assessment Analgesic drug advice and optimisation Pain psychology management Individual Pain education to patients Pain management programme Interventional pain procedures Multi disciplinary team case discussions (Traditionally) consultant lead service Patient led chronic pain self help group

What we do: : 

What we do: Chronic musculoskeletal pain conditions Cervical/Lumbar/thoracic spondylosis and trauma OA/RA Shoulders Fibromyalgia Chronic neuropathic pain conditions: Radiculopathy Neuralgias: trigemminal, occipital, PHN, Diabetic, idiopathic peripheral FBSS Chronic cancer pain conditions Chronic Spasm: Multiple sclerosis, cerebral palsy, post stroke Refugees/Victims of torture/abuse patients

What we don’t do: : 

What we don’t do: Chronic Headaches Rheumatological chronic pain Formal Paediatric chronic pain service Chronic Fatigue Service Mental health Drug rehabilitation service – refer to Harbour centre Sports injuries

N/P Referral Numbers : 

N/P Referral Numbers Capacity plan 2010/11 = 2400 Capacity plan 2009/10 = 2173 Actual referrals 2009/10 = 2994 Actual News seen = 2644 DNA rate 5% New to follow up ratio 1:1.7 (national 1:2.5)

Referral numbers : 

Referral numbers

Interventional pain procedures provided : 

Interventional pain procedures provided TNS training clinic Acupuncture (limited to 6 sessions) Trigemminal dennervations Spinal Cord Stimulators Intra-thecal Drug Delivery “Controversial”: Epidurals Facet joint injections Radiofrequency dennervations Epidural adhesiolysis / spinal endoscopy Intra-discal procedures

Outcomes : 

Outcomes Interventional Procedures Pain Management Programme Psychology service Neuro-modulation

Service provision problems (1) : 

Service provision problems (1) Battling to meet RTT targets Ever increasing referral rate Unrealistic patient expectations Inappropriate referrals Recent audit results “Revolving door” patients Loss of a consultant.

Service provision (2) : 

Service provision (2) Prolonged follow up (trust wide): Nurse follow up In hospital facilities Holes in service: Occupational therapists CBT therapists Chronic pain Physiotherapists Paediatric service Flare up clinic Specific PMP

Service Solutions: : 

Service Solutions: Demand Management (change in culture) Community based (Tavistock, Devonport, Liskeard etc) New In Hospital accommodation Teams of Nurse / physio assessment and treatment of new patients. (?) GP Referral proforma and guidelines

GP Referral Proforma : 

GP Referral Proforma Pain History (including duration of pain) Past Medical History Past Psychiatric History Relevant Social History (including litigation) Current Medication / Allergies List of previous treatments (please circle) Medication: Physio: Yes No Epidurals: Date____________ No Other interventions: Type____________ No Pain Clinic Acupuncture: Yes No Pain Management Programme Yes No Relevant Investigations / Other Medical Referrals

Service solutions : 

Service solutions Partnership with GPs: stop re referrals. Pain management guidelines for primary care: Back pain Neuropathic pain Opioid guidelines Package of care Improved education GPwSI (training is available) Better use of website: www.pain-medicine.co.uk

Questions? : 

Questions?