A Multidisciplinary Approach to Pain Management

4 Mar 2018

It can provide great reassurance to a claimant, or indeed when defending a claim, to know that the Expert providing an opinion is experienced in treating all types of chronic pain and is regularly diagnosing and treating patients with a range of chronic pain conditions in their every day clinical practice.

Dr Christopher Jenner and Dr Ivan Ramos-Galvez are highly regarded as the “go to clinicians” for chronic pain conditions that are complex and challenging to diagnose and treat.  We discuss their approach to treating chronic pain in this short article.

Treatment for chronic pain is a continuous process and needs to be tailored towards the individual patient’s specific symptoms. The key to effective pain management is to break the cycle of pain long enough to provide treatment that can begin to target the underlying cause of the symptoms. Patients who are treated by Dr Jenner and Dr Ramos-Galvez will be provided with a variety of approaches from different medical disciplines, in order provide effective relief.

Conservative Treatment to Break the Cycle of Pain

Conservative treatment, which generally includes analgesic medication and physiotherapy-based rehabilitation, is always the first avenue of approach. The aim of medication is to break the cycle of pain to provide patients with a pain-free window that is long enough to be able to participate in gentle physiotherapy, which increases their range of movement, strength and flexibility. This gives confidence to the patient and helps them to get back on their feet. Medication can vary depending on the severity of the symptoms and whether they have a musculoskeletal or neuropathic source, from anti-inflammatory, to anti-neuropathic and opioid analgesics.

Clinical Pain Pscyhology

The physical and mental components of chronic pain are intimately linked. It is often impossible to manage chronic pain without addressing both the physical source of the pain and the psychological relationship the patient has with their pain. Clinical pain psychology sessions with a Psychologist, alongside conservative treatment approaches, provide techniques for the patient to master and empower their own symptoms.  Common techniques include cognitive behavioral therapy (CBT), psychoanalysis and the increasing use of relaxation techniques such as mindfulness.

Pain Management Procedures

If conservative treatment has been fully adopted and it has not been possible to control the patient’s chronic pain, a variety of specialist pain management procedures are available. These are broadly split into two groups, minimally invasive pain management techniques, which are usually administered during a clinical appointment as a day-case, or advanced pain management procedures, where there is a surgical element to the treatment, which often includes the surgical implantation of a device to help modulate the pain.

Minimally Invasive Techniques

Most minimally invasive pain management procedures can be performed while the patient is awake under local anaesthesia. Treatment for musculoskeletal pain composes of epidurals, facet joint injections and nerve blocks.  Therapeutic injections are used  for neuropathic pain and the targeting of specific nerves, such as the lumbar sympathetic chain, stellate ganglion or occipital nerve.

Radiofrequency technology can also be used to ‘switch-off’ the local pain mediating nerve through a process of denervation or used in pulses to reduce the nerve’s activation threshold and its amount of spontaneous activity.

These techniques have an approximately 65% chance of success in reducing the patient’s pain by 30-40% for 6 months, making them very effective at breaking the cycle of pain for long enough to administer other treatment options or providing ongoing relief if found effective and used on an ongoing basis.

Spinal Cord Stimulation

Finally, spinal cord stimulation is an advanced pain management technique that requires the surgical implantation of electrodes from a spinal cord stimulator. Electrodes from the stimulator are placed adjacent to the area of pain on the spinal cord to provide targeted relief. This procedure requires regular maintenance by a specialist and we provide referral to the top experts in the UK in this field. For more information, visit our article on spinal cord stimulation.

Dr Jenner and Dr Ramos-Galvez are both highly regarded Experts and Consultants in Pain Management.  They accept instructions on Personal Injury Claims and Clinical Negligence Claims from screening reports to condition and prognosis reports, causation and joint instructions.  They work for both claimants and defendants and offer consultations within 7 days and a full report within 3-4 weeks.

If you have a question or would like to instruct them please call us on 020 7118 0650 or email us on info@medicolegal-associates.com.