(精选)REDUCING REFERRALS TO THE CHRONIC PAIN CLINIC教学课件.pptVIP

REDUCING REFERRALS TO THE CHRONIC PAIN CLINIC Dr Damien Smith FRCA, FFPMRCA Consultant Anaesthesia Pain Management Hillingdon NHS Trust RECENT NATIONAL PAPERS REPORTS Report by Chief Medical Officer 2009 Nice guidelines for management of lower back pain Review of chronic pain services (Wales) HEALTH SECRETARY AND CMO CMO REPORT 2009PAIN : BREAKING THROUGH THE BARRIER  United Kingdom : Pain in numbers 7.8 million people live with chronic pain NHS spent ￡584 million on 67 million prescriptions for analgesia 1 million women suffer with chronic pelvic pain 1.6 million adults suffer with chronic LBP 49% adults with CP experience depression 25% of sufferers lose their jobs 500 pain specialists in the UK Roughly 1 specialist per 250,000 people (1 specialist per 32,000 sufferers????) CMO REPORT When pain becomes chronic, normal damping mechanisms stop working Biological, psychological and social factors combine to exacerbate symptoms Modern pain management should address all these elements with an “Integrated Approach” Treatments involve activity, rehab, drug therapy, psychological therapy, TENS, acupuncture and interventions Key is to ensure all aspects are INTEGRATED and joined up rather than instigated in isolation IDEAL MODEL CMO REPORT : IDEAL MODEL? WAYS TO REDUCE REFERRALS More level 3 services in the community? Educational programme for GP’s Prescribing guidelines Pharmacy teaching of community pharmacists EXERCISE PROGRAMMES EXERCISE PROGRAMMES 8 sessions over 12 weeks Groups of 10 Aerobic activity Muscle Strengthening Posture Control Stretching MANUAL THERAPY MANUAL THERAPY SPINAL MANIPULATION!! MANUAL THERAPY Spinal manipulation Spinal mobilisation Massage MAY be performed by osteopaths and chiropractors 9 sessions over 12 weeks ACUPUNCTURE ACUPUNCTURE Advises 10 sessions over 12 weeks Does not advise injection of therapeutic substances into the back COMBINED WITH PSYCHOLOGY PROBLEMS WITH THE GUIDELINES NICE summary: we recommend acupuncture and ma