Sarah Lewis CNS in Pain Management Defence Medical Rehabilitation Centre - Headley Court Defence Medical Rehabilitation Centre
Introduction of a bespoke, Nurse-led Pain Management Service Defence Medical Rehabilitation Centre
DMRC – Headley Court ‘ Working together to deliver excellence in rehabilitation ’ Defence Medical Rehabilitation Centre
Rehabilitation provided for: Complex Trauma Neurological Rehab RTA Battle Injuries Force Generation • Spines Rehab • Lower Limbs rehab • Upper Limbs Neurological Musculoskeletal • Specialist Medical Injury Injuries Rehab Defence Medical Rehabilitation Centre
Treatment of Neuropathic and Pain Management Algorithm - Persistent Pain Treatment Aims • Develop plan of care and set goals using the biopsychosocial model • Physical rehabilitation with functional goals Evidence Grid • Psychosocial management with functional goals • Development of Self Care plan References Neuropathic pain Outcome Measures Disease-specific Symptom Management measures • Tighter glucose control in diabetes DMRC Rehab Teams Specialist Referral • Use of disease- modifying agents in MS • Surgery, chemotherapy, or Pain Management/ Physiotherapy Occupational Exercise DMRC Medical Mental Medicals / COPE radiation therapy for Intervention Clinic/ Therapy Therapy Team Health and Referral nerve decompression Psychology Pain Nurse • Infection control (e.g. in HIV infection, herpes zoster, Lyme's • TENS • Education on • Range of • Referral to CPN disease) Management Intervention • Acupuncture chronic pain motion Prof Birch or Psychologist • Pain Education • Sympathetic • Manipulation • CBT • Hypnosis exercises Plastics Review blocks • Electrotherapy • Self Management • Graded • See analgesic • EMDR • Pain Medication • Epidural/ • Heat & Cold • CBT strategy formation Exercise guidelines Review intratheacal • Myofascial • Education on • Education • See • Mindfullness • Onward referral blocks • Guided release Posture Neuropathic • Selective nerve for Neuro • Trigger point • Ergonomics Guidelines imagery stimulation (SCS, root blocks • Referral SOP release & advice and • Radiofrequency DBS) Pressure prescription • Referral SOP nerve root • Graded Motor • Desensitisation ablations • Mirror Therapy Imagery • Mirror Therapy • Graded Motor • Hydrotherapy Imagery • Education • Splinting • Exercise • Assistive Therapy equipment • Kinesiotaping provision Additional Guidelines on management of Phantom Limb Pain, Sleep, Headache Guidelines The modalities used by each profession will be determined by clinical need Defence Medical Rehabilitation Centre
Aim of the Pain Management Service To deliver effective pain management to facilitate rehabilitation in order to achieve optimal health and fitness within the Services or transition to civilian life. Defence Medical Rehabilitation Centre
Framework S taff and A udit R esearch E ducation C linical Service Development Defence Medical Rehabilitation Centre
Defence Medical Rehabilitation Centre
Defence Medical Rehabilitation Centre
Defence Medical Rehabilitation Centre
Defence Medical Rehabilitation Centre
Defence Medical Rehabilitation Centre
Challenges Defence Medical Rehabilitation Centre
Aim of the pain management service within DMRC: to optimise pain management to facilitate rehabilitation, in order to achieve optimal health and fitness within service life or transition to civilian life. This is achieved by the Consultant Led IDT approach with support from the CNS Pain Management through the bespoke nurse-led pain management service Defence Medical Rehabilitation Centre
“So many of our Servicemen and women have made the ultimate sacrifice; so many lives have been lost and so many changed forever by the wounds they have suffered in the course of their duties. For these selfless people, it is after the guns have fallen silent, the din of the battle quietened, that the real fight begins – a fight that may last for the rest of their lives” HRH Prince Harry - May 2012 Defence Medical Rehabilitation Centre
Thank you Defence Medical Rehabilitation Centre
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