Pain Clinic
Professional in charge: Dr. Salvat Fernando
* 1. Introduction
* 2. Definition
* 3. Objectives
* 4. Scope
* 5. Members
* 6. Diagnoses
* 7. Treatment
* 8. Operational features
1) Introduction
Pain is an affliction common to the human being that produces suffering and disability. It affects a third of the general population and is one of most frequent reasons for consultation in medical practice.
Pain is an unpleasant subjective experience that not only modifies and harms the quality of life of those who suffers it but also affects their social, labour, family and economic environment.
Pain causes serious economic losses to society due to the raised use of sanitary resources and because it generates disability and labour absenteeism.
In the past, pain was treated by the family doctor or referred by the latter to a generalist, to a neurologist or to an orthopaedic surgeon.
Currently, pain clinics comprise multidisciplinary teams including neurologists, anaesthesiologists, traumatologists, psychologists, psychiatrists and kinesiologists specialised in pain.
Our mission is to offer the patient who suffers pain a treatment with a wide and comprehensive focus in order to diminish or to alleviate pain, optimising health resources, functional autonomy and improving the quality of life.
2) Definition Return
The Pain Clinic is a multidisciplinary team made up by diverse specialists devoted to the study, diagnosis and treatment of pain, whose goal is to improve the patient's quality of life.
3) Objectives Return
* Objectives of the Pain Clinic (PC)
A. Research and diagnosis: studying the causes of pain in all patients admitted for treatment.
B. Relief of pain which leads to an increase in quality of life indices.
C. Socio-labour reinsertion:
1. Fast insertion to the socio-labour and family media.
2. Education in the use of analgesics reducing the appearance of adverse effects.
3. Decrease in exaggerated pharmacy expenses by rationalisation of analgesic intake.
4. Reduction in lost working hours.
4) Scope Return
* Patients with benign chronic pain (non-oncological):
They are those who present pain for over 3 months or exceed the habitual period of recovery.
Patients with pain to be attended at the FLENI Pain Clinic (CD) present such painful pathologies as:
. Neck and back pain
. Neuralgias - (postherpetic, trigeminal, and others )
. Headaches
. Degenerative and muscular pain of the Spine, hip, knee, shoulder upper and lower limb
. Muscular Pain (myopathies)
. Neuropathic and central pain (painful neuropathies, traumatic nerve and spinal cord injuries)
* Patient with malignant chronic pain or pain due to cancer:
Pain control in patients for cancer should be of high priority to improve the quality of life and to avoid suffering, the sensation of resignation, impotence, anxiety and depression. Chronic pain can induce patients to reject programmes of active treatment and when the pain is more severe can induce them to commit suicide.
At the time of cancer diagnosis and in intermediate stages, 30 to 45% of patients experience moderate to severe pain. On the average, nearly 75% of patients with advanced cancer present pain.
Pain secondary to cancer may be due to: tumorous progression and related pathology, surgeries or other invasive therapeutic or diagnostic procedures, toxicity of chemotherapy, infection or muscular pain caused by associated limited physical activity.
5) Members Return
1) Neurosurgeons
2) Neurologists
3) Traumatologists
4) Anaesthesiologists
5) Physiatrists
6) Clinical physicians
7) Nurses
8) Psychologists
9) Nutritionists
10) Kinesiologists
11) Occupational therapists
12) Social assistants
6) Diagnosis Return
To contribute to perform an accurate diagnosis, FLENI possesses the necessary equipment of high technology for the study and diagnosis of patients with pain:
* Simple X-ray - Radioscopy
* Electromyogram
* Evoked potentials
* Echography / Doppler
* Computed tomography
* Digital image intensifier
* Nuclear Magnetic Resonance
* Neuronavigator
* Gamma Knife
7) Treatment Return
- Treatments are implemented for such pain as:
1) Multidisciplinary pain programme of Recovery and Therapeutic Education of Spine.
A multidisciplinary programme of recovery from a painful affliction of the Spine seeks to decrease its impact on patient's life and not merely the disappearance of pain. The main objective is to increase the patient's functionality and quality of life, also providing relief from pain.
2) Combined pharmacological treatments.
3) Physical therapy and postural correction techniques.
4) Drug infusion: opioid and anaesthetics test; peripheral blockades: somatic (muscular, articulate) or of peripheral nerve.
5) Neurostimulation: intramuscular stimulation by means of acupuncture, auriculotherapy and transcutaneous techniques (TENS).
6) Blockades: epidural, spinal or subarachnoid, ganglionar, plexual and sympathetic.
7) Selective blockade: under radioscopic control.
8) Catheter placement: epidural or spinal subarachnoid.
9) Biofeedback
10) Surgical procedures of orthopaedics surgeons (Spine, knee, hip, and upper and lower limb surgery) and neurosurgery (lumbar Spine and head surgery) and neurosurgical procedures for pain such as: placement of epidural electrodes
and drug infusion pumps, percutaneous thermolesion by radiofrequency, rhizotomies, treatment with Gamma Knife.
8) Operational features Return
- Patients with pain are admitted by a physician specialist in pain in charge of carrying out the clinical history and planning the diagnostic strategy and therapy. When necessary, he/she will refer the patient to a member of the pain team.
After the initial visit and examination, a treatment schedule is planned. Some patients require later research or hospitalisation but most will be able to receive ambulatory assistance.
If the patient presents a concomitant illness, he/she must be treated specifically. In these cases, the PC physician will be able to guide the patient or to his/her attending physician, maintaining permanent contact.
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