Free Health Dissertations - Advanced Pain Management Techniques For Palliative Care Specified By The
Advanced pain management techniques for palliative care specified by the Department of Health as in adult cancer pain include opioid infusion, drug delivery systems, drug weaning techniques, neuromodulatory techniques and neurodestructive procedures. Some of these techniques may be relatively ‘low technology’ but are performed fairly infrequently, and are therefore included as specialised services. Specialised services requires the right equipments and access to inpatient beds where an appropriate level of care can be provided to enable advanced pain management techniques to be undertaken such as spinal infusion of opioids. Appropriate supporting facilities and advanced imaging techniques such as computer tomography (CT) scanning for invasive procedures, and magnetic resonance imaging (MRI) are also required (DH, 2002).
For assessment and management of patients with intractable non-malignant pain, the DH suggests that for the assessment and management of specific conditions, including intractable angina, complex neurological disease, spinal cord injury, brachial plexus injury, urogenital pain syndromes and pain in drug dependency, patients need to be assessed in specified pain management clinics where they should be supported by multidisciplinary teams who have specific training and skills to deal with pain management. Techniques such as Quantitative Sensory Testing (QST) are used for describing sensory abnormalities and to monitor effects of pain investigation infusions and pain management interventions.
The Neuromodulatory techniques specified by the department of health may include various types of peripheral, central and brain stimulation techniques. Examples include:
peripheral nerve stimulation
paravertebral nerve stimulation
spinal cord stimulation
deep brain stimulation
thalamic stimulation
motor cortex stimulation
Sometimes trial neuromodulation techniques may be necessary before any permanent implantation. (Source: DH, 2002)
Intensive Interdisciplinary Cognitive Behavioural therapy is often used in pain management programmes endorsed by the Department of Health. Cognitive Behavioural Therapy or CBT is a core service given by primary care trusts and is delivered on an outpatient basis as standard management technique within all pain clinics in the UK. However, a quite a few patients are considered inappropriate for an outpatient programme of CBT as they may be more severe cases and require more intensive therapy over a three or four week period in a residential or inpatient setting (DH 2002; Jensen, 2005). These patients are usually characterised by having high levels of pain-related depression and anxiety, high dependency on care providers and medicine, and a high level of disability (Department of Health, 2002).
Dissertations - Free Health Dissertations
