1. Jeremy Weinbren January 2010 Pain Medicine at Hillingdon Hospital- An Overview

5. Who? Why? When? What? Questions for this evening...

6. 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

7. Pain Medicine at Hillingdon Two Consultants (6-8 sessions) –Damien Smith & Jeremy Weinbren

8. Pain Medicine at Hillingdon Two Consultants (6-8 sessions) Two Pain Specialist Nurses (1.7 WTE) –Eva Santiago & Sam Foo

9. Pain Medicine at Hillingdon Two Consultants (6-8 sessions) Two Pain Specialist Nurses (1.7 WTE) One Associate Specialist (1.5 sessions) –Pathma Rajah

10. 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

11. 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.

12. Pain Medicine at Hillingdon

13. 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

14. Chronic Pain Incidence 30% Lifetime Prevalence 80% Socioeconomic Costs £20 billion per year

15. Referral Pathways GPRMCPain GPRMCSDCPain GPRMCSDCProcedure

16. New Referrals

18. Referral Pathways GPRMCPain GPRMCSDCPain GPRMCSDCProcedure

19. New Referrals

20. Referrals to Spinal Surgeons (SDC)

21. New Referrals

22. Referral Pathways GPRMCPain GPRMCSDCPain GPRMCSDCProcedure

23. Onwards from Spinal Diagnostic : Pain Ortho PCS/PMP Xray Physio

25. Epidural Injections (Pain Medicine)

26. Epidural Injections (Orthopaedic)

27. Epidural Steroid Injections

28. Long term relief with Epidural Steroids

31. Facet Joint Injections

32. Increased Pain on: FACET DISC MUSCLE

33. Increased Pain on Lateral Flexion: FACET DISC MUSCLE

34. Increased Pain on Rotation: FACET DISC MUSCLE

36. 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)

40. Invasive Drug-based Others

41. Invasive Non-drug Treatments

42. Pain Medicine Follow-ups

43. Pain Medicine at Hillingdon

44. New Referrals

45. Clinical Guideline 88

46. So now you know..

47. More Consultants? Easier Access for GPs and Patients? Fewer patients? Community based sessions? More integration across the local health economy. The Future ?

48. Questions ? Jeremy.weinbren@thh.nhs.ukJeremy.weinbren@thh.nhs.uk 01895 279237