Guidelines for observers
Manchester & Salford Pain Centre
MANCHESTER & SALFORD PAIN CENTRE
INDUCTION PACK
CONTENTS
Page No.
Introduction
2
Referrals
3
Team Profiles
4
Triage
6
Clinical Activity:
7
Point of First Contact Clinics
Review Clinics
Theatre Sessions
Acute Pain Ward Rounds
Specialised Treatments offered at MSPC:
12Spinal Cord StimulationPain Management Programmes
Guidelines for Observers
15
Patient Information Leaflets
17
General Information
19
INTRODUCTION
The Manchester and Salford Pain Centre is one of the country’s
leading clinics for the management of all forms of pain.
We are an interdisciplinary clinical team of doctors,
physiotherapists, psychologists and nurses who are expert in
managing all forms of pain ably supported by reception and
administration staff.
Referrals are received from General Practitioners and from
within the Trust. In addition we also encourage referral of
patients with complicated pain conditions from other pain clinics
for our more advanced treatment options such as intensive pain
management programmes and spinal cord stimulation.
Manchester & Salford Pain Centre
Salford Royal Hospital
Stott Lane
Salford
M6 8HD
Telephone: +44 (0) 161 206 4002
Fax:
+44 (0) 161 206 4169
E-Mail: [email protected]
REFERRALS
Patients can be referred to the Centre either by their GP or by
a Consultant from another specialty within the Trust. The letter of
referral should be sent to the Centre outlining the patient’s
clinical problem, investigations performed, past medical history
and current medications.
Referral letters are initially triaged via the nursing team
supported by the medical consultants. A decision is made with
regards to how urgently the patient needs to be seen. Patients with
chronic pain conditions are sent a questionnaire which includes
psychometric tests measuring depression, pain anxiety and
disability. The completed questionnaire enables the team to gain
more information about the patient’s pain and the impact it has on
their life. Once this questionnaire is returned the information is
triaged and the patient is given an appointment in the most
appropriate speciality clinic.
TEAM PROFILES
Nursing
The nursing team consists of six clinical nurse specialists in
pain management led by a consultant nurse. The nursing team work
across the Trust providing advice, support and intervention for
inpatients with acute pain. The team also provide an outpatient
based service for those with chronic pain in the form of joint new
patient clinics, medication review clinics and spinal cord
stimulator clinics. Their core duties include:
· Acute pain management within the hospital trust.
· Nurse led chronic pain clinics.
· Ongoing identification and improvement of patient pathways of
care.
· Education and Development of Trust staff, students and the
wider health care community in the management of pain.
· Clinical governance activities including clinical audit and
patient safety.
· Continuous service review and improvement.
Physiotherapy
The physiotherapy team consists of five WTE Physiotherapists who
specialise in the field of pain management. Physiotherapists are
involved at many different stages of the patient’s pain management
experience. Patients attending the MSPC may see a
Physiotherapist at their first appointment as the Physiotherapists
run regular assessment clinics both individually and in conjunction
with the pain Doctors (Consultants in Pain Management and
Anaesthesia) and Nurses. If after an initial assessment it is
thought that a patient may benefit from pain management
physiotherapy or a pain management programme they may go on to
attend further appointments with one of the Centre’s
Physiotherapists.
The physiotherapy team utilise a combination of exercise
therapy, education and advice on strategies such as pacing and goal
setting to help people with chronic pain work towards their
personal rehabilitation goals. The Physiotherapists work
within a cognitive behavioural approach and work closely with the
MSPC clinical psychology team providing multidisciplinary joint
treatment sessions and pain management programmes. Overall,
the MSPC Physiotherapists aim to enable people with chronic pain to
develop self-management strategies to improve their physical
function and quality of life despite their pain.
The physiotherapy team also provide training and educational
sessions for other healthcare professionals and local
universities.
Clinical Psychology
The clinical psychology team consists of two full time and two
part time Clinical Psychologists. Clinical Psychologists are highly
specialised practitioners in the assessment and treatment of
psychological distress. In addition to this a Clinical
Psychologist in a Pain Centre has specialised knowledge about the
impact of being diagnosed with a chronic pain condition, and the
bearing that this can have upon an individual’s quality of
life.
It is not that psychological distress triggers or causes the
onset of a chronic pain condition, but that chronic pain can
sometimes lead to low mood and heightened anxiety as it affects all
areas of an individual’s life.
Specifically, the Clinical Psychologists assess the impact of
chronic pain on people’s lives, particularly the effects on family
life, work, social activities and mood. They also help people to
learn new coping strategies to reduce the impact of pain in these
areas, so that people can gradually get back to doing the things
they have had to give up. The work isn’t aimed at reducing the pain
itself, but reducing the problems that are caused by the pain.
People often report that pain makes it much more difficult to
cope with other problems so a clinical psychologist may start off
by looking at stress management techniques such as breathing and
relaxation exercises. This helps people to remain calm and think
clearly in stressful situations. This also works well when combined
with the stretching exercises given by the
Physiotherapists.
Clinical Psychologists also help people to rebuild their
confidence by learning to recognise and challenge any negative
thoughts or unhelpful thinking styles. This helps people to feel
less frustrated, more realistic about dealing with problems and
more in control of their lives again.
Medical Consultants
The MSPC has a team of six medical consultants. Pain clinics
originally developed through procedures being performed by
anaesthetists for cancer pain. This role then expanded to include
chronic non-malignant pain culminating in the kind of
interdisciplinary working which we have here. The consultants in
the Pain Centre therefore have anaesthesia as their base speciality
(Dr Johnson however no longer practices as an anaesthetist).
The consultants are involved in assessing patients at point of
first contact clinics. The purpose of the medical review is to
exclude disease processes which may be more appropriately referred
to other specialists as well as instituting pharmacological therapy
for the management of pain. In addition patients are listed for
interventional pain procedures if suitable. We offer medical
support to the pain management programmes and also conduct acute
pain ward rounds.
Core duties include:
· Point of first contact clinics
· Review clinics
· Interventional Pain Procedures including Spinal Cord
Stimulation
· Acute Pain Ward Rounds
· Pain management Programmes
· Intrathecal Baclofen for the management of spasticity
TRIAGE
There is a daily triage of referrals by the Nursing or Advanced
Practitioner. The Physiotherapy team triage the referral letter,
completed patient questionnaires and analysis of psychometric
scores are reviewed. Using the criteria detailed below patient’s
are then triaged into the appropriate clinic. The criteria for each
of the clinics are detailed below:
This is intended as a guide only. Team discussion is
encouraged.
Dr Only (45 min apt) Score of 23 or below on PHQ-9 or where Q’s
have not been completed.
Non MSK pain e.g. headache, abdominal or pelvic pain, cancer,
PHN, undiagnosed facial pain
Complex medical history with significant comorbidities that
would present as a barrier to rehabilitation.
Patients wanting second opinion or where anger, resistance to
psychology, drug abuse, or iatrogenic distress is noted
Those patients who want to consider injections (Not AK) or
RFD(Specify MC/JR) & Q’s indicate this may be appropriate.
Patients who have outstanding investigations or are requesting
further investigations
Dr Complex (60 min apt) Score of 24 or more on PHQ-9
As for Dr only, but patients with higher/significant levels of
distress where questionnaires or psychiatric history (in the
absence of completed Q’s) indicate unlikely to benefit from
rehabilitation approach.
Documented indication of suicidal ideation in referral /
questionnaire
Evidence of personality disorder / longstanding mental health
issues
Dr Complex SCS (60 min apt) with either Prof Lalkhen or Dr
Chincholkar.
AGL/MC to check referrals first
For patients to be considered for spinal cord stimulation who
meet NICE guidance – Failed back surgery or CRPS.
Dr / Physio (60 min apt)
MSK pain +/- neuropathic pain +/- neurological symptoms. Specify
“Must see Dr” if necessary e.g. pure neurological condition or
visceral pain or those requiring medical reassurance/investigation
that may benefit from rehab’ approach
Typically scores 20 or above on PHQ-9 and hence be unsuitable
for Cons Nurse / Physio clinic. Referral specifically for PMP
should see a physio at PFC.
Physio Only (75 min apt)
MSK +/- neuropathic pain without indication of significant
medical/med’s issues. Bio-medical investigations completed.
Referral specifically for PMP +/- following assessment by
Rheumatologist/other pain service (eg. Trafford/CFS)
Typically these patients would score of < 20 on PHQ-9 to
avoid seeing severely depressed or iatrogenically distressed
patients in this clinic.
Advanced Practice Physiotherapist (75 min apt)
Typically MSK +/- neuropathic pain. Medically/pharmacologically
non-complex. Can see high distress (not off site). Not where GPs
have medication concerns. Complex physio only patients where ACP
input needed.
Cons Nurse / Physio (60 min apt)
Previously investigated MSK pain +/- neuropathic pain without
indication of significant medical issues but have clear indication
for pain medication review. Typically these patients would score of
< 20 on PHQ-9 to avoid seeing severely depressed or
iatrogenically distressed patients in this clinic. Referral
specifically for PMP should see a physio at PFC
Cons Nurse Only (60 min apt)
Previously investigated neuropathic, neurological,
post-surgical, and scar pain, DPN, PHN.
Patients who have ongoing medical treatment elsewhere and are
therefore not completely ready for an active self-management
approach. Abdominal pain, pelvic pain or headache. Cons Nurse only
cases need to be cleared with Cons Nurses before listing.
TGN joint with neurosurgery - (Pain Consultant + Neurosurgeon +
SB/NS, 30 min apt)
Suggestion of trigeminal neuralgia where surgical opinion is
required or is complex presentation. Other facial pain seen in Dr
Only/Nurse Cons only. Give all referrals to SB/NS to check
first.
CRPS Clinic (Medic and Physiotherapist, 60 min apt).
Diagnosis of CRPS or suggestion of this in Q’s
Pain/Neurology Clinic
Follow-up clinic for patients who have already been seen by
either a pain consultant or by Dr Cooper (neurologist)
Criteria for Priority of Appointment
Urgent (within 48 hours) Priority (within 4 weeks)
Routine
Cancer
Documented suicidal ideation/intent All remaining
Uncontrolled TGN
CRPS (less than 1yr duration)
NCA Staff member
Inference of imminent break-up of relationship
Patient’s job on line
CLINICAL ACTIVITY
The team at the MSPC are involved in varied clinical activity.
The clinic template is available on the P: drive. Trainees are
requested to book by adding their names against the clinic. A brief
description of each of the clinics can be found below alongside the
abbreviation it will correspond to on the template .A list of
initials and corresponding clinicians is also available.
NB - Please see guidelines regarding observation of clinics.
Point of First Contact Clinics
· Doctor (Dr Only)
The patient group triaged into this clinic have co-morbidities
which have to be evaluated prior to a decision being made with
regards to rehabilitation. These patients are often elderly or have
predominantly neuropathic pain.
· Doctor and Physiotherapist (Dr/Physio)
The patient group triaged into this clinic have predominantly
musculoskeletal problems and reduced quality of life which may be
amenable to a rehabilitation approach. There are often outstanding
concerns about diagnosis or options for interventional therapies.
They may have complex medication issues that require pain
consultant input.
· Doctor Complex
The patient group triaged into this clinic are typically highly
distressed (identified as a result of either heightened scores on
their psychometric measures or indications within the free text of
their referral questionnaires). These patients may also often have
long standing mental health difficulties.
· Advanced Practitioner Physiotherapist
The patient group triaged into this clinic are typically those
with musculoskeletal pain and a reduced quality of life, which may
be amenable to a rehabilitation approach, but are not so complex
that they require input from a pain consultant.
· Physio Only
The patients triaged into this clinic have predominantly
musculoskeletal problems which have been fully investigated and
disability and distress levels which indicate a need for
rehabilitation. They do not have co-morbidities which would require
medical assessment and /or medication issues which require
immediate attention. They may have been referred from other pain
clinics for a PMP assessment.
· Nurse only
The patients triaged into this clinic have predominantly pelvic,
abdominal or any other neuropathic pain management problems which
have been fully investigated and disability and distress levels
which may indicate a need for rehabilitation. Our clinic nurses are
non- medical prescribers which allows for the review of
medication.
· Nurse/Physio clinic The patients triaged into this clinic have
predominantly musculoskeletal problems which have been fully
investigated and disability and distress levels which indicate a
need for rehabilitation. The patients are assessed and examined by
both physio’s and nurses and identify any possible changes are made
following a review of their medication.
· Trigeminal Neuralgia MDT Clinic TGN)
This is an MDT clinic run by a neurosurgeon, a pain consultant
and either an advanced practice physiotherapist or a consultant
nurse. Patients are typically referred from Neurology/Neurosurgery
with refractory Trigeminal Neuralgia via the clinical pathway.
Patients are triaged via the standard clinical pathway but they
complete facial pain specific questionnaires. It is for patients
where an MDT opinion is required.
· Complex Regional Pain Syndrome (CRPS)
This specialist clinic runs once monthly and will see any
patients referred with a possible CRPS diagnosis. Assessment
documentation has been developed in conjunction with the national
CRPS clinical and research group. The pain clinic has partners in
rheumatology and specialist upper limb physiotherapy and
occupational therapy with a specialist interest in research and
clinical management of this patient group.
Review Clinics
Medic Led Follow up Clinics
· Medical Review Clinic
The purpose of the review clinic is broad and therefore offers
the learner the opportunity to see the effects of treatment.
Patients are reviewed after receiving therapeutic injections and
also to judge the efficacy of medication changes. Patients are also
brought back for repeat procedures (acupuncture, trigger point
injections) which do not require a theatre environment. Clinics
usually have in excess of 12 patients and there is therefore the
opportunity to be exposed to a range of conditions and their
ongoing management.
· Spinal Cord Stimulator Clinic
Spinal cord stimulation modifies the perception of pain by
stimulating the dorsal columns of the spinal cord and may relieve
pain of neuropathic origin. Patients who already have Spinal Cord
Stimulators in situ are reviewed in this clinic.
Physiotherapy Led Clinics
· Physiotherapy Pain Management Review Clinic (Physio PMR)
The aim of this clinic is to help the patient understand the
pain management approach and to engage them in this process. The
most appropriate treatment can then be offered with a view to
moving the patient forwards to a pain management programme if
possible.
· Physiotherapy Pre-Programme (Pre-Prog)
The aim of this clinic is to carry out a final assessment to
identify any barriers to a patient attending a pain management
programme. This assessment includes observation of physical
manoeuvres which the patient needs to be capable of in order to
manage the exercise and relaxation component of the programme. If
the patient is deemed suitable then a consent form will be signed
and the patient then listed for a programme.
Psychology Led Clinics
· Psychology Assessment Clinics (PMR/IPA)
As with the physiotherapy pain management review clinic, the aim
of these clinics is predominantly to identify a patient’s
suitability for some form of pain management intervention. This may
be either a pain management programme (patient will be seen in a
Psychology Pain Management Review Clinic (Psych PMR) or
individual/joint working/IMP (patient will be seen in an Individual
Psychology Assessment Clinic (Psych IPA). In addition to the
content covered in the physiotherapy pain management review clinic,
a brief psychosocial screening assessment is also completed as
patients seen in this clinic demonstrate higher levels of distress
(as indicated by their scores of the psychometric measures or
clinical judgement).
· Psychology Pre-Programme (Pre-Prog)
As with the physiotherapy pre-programme clinic, the aim of this
clinic is to carry out a final assessment to identify any barriers
to a patient attending a pain management programme. Rather than
assessing a patient’s physical suitability for a programme, this
clinic primary focuses on an assessment of psychological factors
which may impact on their suitability for a programme (including
mood, psychosocial history, other stressors, interpersonal issues,
goal areas etc). If the patient is deemed suitable then a consent
form will be signed and the patient listed for a programme.
· Spinal Cord Stimulator Assessment (SCS)
During this assessment clinic the psychologist will determine
whether there are any psychological contraindications for SCS.
Nurse Led Clinics
· Nurse Led Review
In this clinic patients are referred for medicines management
and /or education/ information regarding their pain management
plan. Medicines management in this clinic often involves titration
of medicines for neuropathic pain.
Patients discharged from hospital on complex medication regimes
will also be reviewed in this clinic prior to team assessment (as
indicated).
· SCS education
In this clinic patients are referred for information regarding
their SCS procedure, follow up and given advice on how to use the
kit once the SCS system has been implanted.
· SCS review
In this clinic patients are reviewed for follow up of their SCS
systems and troubleshooting of any programming issues. Patients can
be identified for rehab at this clinic and referred on for full
team assessment.
Theatre Sessions
The learner has the opportunity to observe commonly performed
therapeutic injections.
Monday
Theatre D Level 1 Weekly (am)
AGL SCS List
Monday
Theatre 10 Level 3 Week 2 (am) /Week 4 (pm) JR
Injections
Tuesday
Theatre 10
Level 3 Week 2 & 4 (pm)
RM Injections
Wednesday
Theatre E Level 1 Week 1
& 3 (am)
MC
SCS List
Thursday
Theatre 10 Level 3 Week 2 & 4 (am)
MC Injections
Thursday
Theatre
10 Level 3 Ad hoc
JT Injections /
Lumbar
Puncture
Acute Pain Ward Rounds
All Pain Consultants are allocated a week to cover 3 sessions of
Chronic Pain Ward Rounds. Details can be found via the secretaries
or on the Consultant Ward Round electronic diary.
AM ward rounds start at 8:30 a.m.
PM ward rounds start at around 13:00 – 13:30 p.m.
Palliative Care Ward Rounds
Palliative Care Office 2nd Floor CSB on Friday’s commencing at
8:30 a.m.
Contact: Dr Katie Hobson
Consultant in Palliative Medicine
Gillian (Secretary) – 206 0903
Direct Line – 206 1835
SPECIALISED TREATMENTS OFFERED AT THE MSPC
Spinal Cord Stimulation
Spinal Cord Stimulation was first used in 1967 and is a method
of providing pain relief. Here at the Manchester and Salford Pain
centre, patients have benefited from this technique since 1987 and
approximately 50 new patients each year have a spinal cord
stimulator implanted as part of their treatment.
Chronic Pain is a common condition and severely affects the
quality of life of those who suffer from this disease. Living with
an implanted stimulator may improve a patient’s quality of life and
demands a high level of commitment from the patient in order to
increase its chances of success.
This technique is not suitable for everybody and the decision to
provide this therapy involves a thorough multidisciplinary
assessment involving a number of professionals such as a Pain
Consultant, Psychologist, Specialist Nurse and Physiotherapist. The
National Institute of Clinical Excellence have advised that
patients who suffer from certain chronic pain conditions should be
considered for this type of pain relief technology.
Spinal cord stimulation involves the placement of a wire (called
a lead) in the space above the spinal cord. When activated by a
hand held programmer, the device sends mild electrical signals to
the spinal cord. These impulses mask the pain signals from reaching
the brain by producing a sensation of tingling at the place where
pain is normally felt or by stimulating inhibitory interneurons
using a high frequency current. After a trial period (if the
patient obtains 50% or more pain relief from the device) the spinal
cord stimulator is connected to a pacemaker-like device, which is
surgically implanted underneath the skin, usually in the
abdomen.
Patients may be referred to the Manchester and Salford Pain
Centre by their General Practitioner or Hospital Doctor .The
patient is assessed by the Spinal Cord Stimulator team at the
Salford Royal NHS Foundation Trust who also carry out the
procedure.
Pain Management Programmes
The Manchester and Salford Pain Centre is a National Centre for
Excellence in the delivery of interdisciplinary Pain Management
Programmes (PMPs). PMPs have been running in Salford since
1983 and are currently provided on a residential and out-patient
basis as part of the comprehensive pain management service at
Manchester and Salford Pain Centre (MSPC). The service
accepts referrals from throughout the UK.
The Pain Management Programme service at Manchester &
Salford Pain Centre complies with the current guidelines for PMPs
by the British Pain Society. PMPs are advocated by the British Pain
Society for the management of chronic pain.
What is a Pain Management Programme (PMP)?
A PMP is a group rehabilitation programme for patients who are
suffering from chronic pain. Usually 8 to 10 patients attend
each programme. The programme team is made up of a clinical
psychologist, physiotherapist and medical doctor all of whom
specialise in the management of chronic pain.
Chronic pain is pain that has lasted more than 6 months and
remains unresolved despite many different treatments. It can
often affect many areas of life including work, social life, home
life, mood and sleep.
Prior to attending a PMP a patient will undergo detailed and
comprehensive biomedical, functional and psychosocial
assessment. On the basis of their clinical assessment the
programme team will determine which programme the patient is likely
to gain most benefit from. If a PMP is not thought to be
suitable the reasons for this will be fully explained and other
recommendations will be made if possible.
Who is Suitable?
A patient may be suitable for a PMP if the following criteria
are fulfilled:
· Chronic pain causing significant disability and / or
distress.
· Over 18 years old.
· All appropriate investigations and treatments for pain have
been completed.
· No planned referrals to other specialities regarding the pain
problem.
· Other health problems should not be risk factors for active
rehabilitation (e.g. uncontrolled angina or asthma).
· Can manage basic activities of daily living and is
self-caring.
· No major substance misuse (including alcohol).
· No major psychiatric disorders of current significance.
· The patient is willing to participate in a group programme
involving psychological and activity-based interventions.
Types of Pain Management Programme
There are currently 2 types of pain management programme at
Manchester and Salford Pain Centre, the Intensive Programme and the
Foundation Programme.
The Intensive Programme
The intensive programme runs each day Monday to Friday (9.30am
to 4.30pm) over 3 consecutive weeks. For those patients who
live too far from the Centre to travel, local hotel accommodation
is provided for the duration of the programme (at no cost to the
patient).
The Standard Programme
The standard programme runs for 2 days per week (9.30am to
4.30pm) over 4 consecutive weeks.
For both PMPs, there are 2 half-day follow up sessions at
intervals of 1 month and 3 months after the programme. Six
months after attending the PMP, patients attend an individual
appointment for follow-up assessment and complete a questionnaire.
Twelve months after attending the PMP the patient is sent a
questionnaire by post to complete.
Aims of the PMP
Overall, the aim of the PMP is to help the patient focus on
self-management, helping them to address both the physical and
emotional impact of chronic pain on their life. The programme uses
well-established, evidence-based cognitive behavioural (CBT)
approaches throughout all sessions.
Programme Content
Activities include:
· Information and education about pain and pain management
· A structured graded exercise programme
· Activity management
· Goal planning
· Flare-up management
· Partner / friend / family member session
· Chronic pain and intimate relationships (optional session)
· Applied relaxation training
· Sleep management
· Stress management
· Problem solving training
· Maintaining change
· Medication review and advice
Efficacy
There is strong evidence for the efficacy of both outpatient and
inpatient cognitive-behavioural PMPs as a package, compared with
either no treatment or standard treatments. Analysis of
Manchester & Salford Pain Centre outcome PMP data demonstrates
statistically and clinically significant improvements across a
range of standardised measures. Patients attending either Intensive
or Standard PMPs can expect:
· Improvements in interpersonal relationships
· Reduced depression and anxiety
· Increased physical fitness
· Increased likelihood of work retention or readiness to return
to work
· Optimised medication use
· Reduction in health care use
GUIDELINES FOR OBSERVERS
Due to the unique nature of the Manchester and Salford Pain
Centre in terms of; clinicians, inter disciplinary working, varied
clinics and interventions offered it is likely that much of your
time spent with us will involve observation. This is in no way a
reflection on your capabilities but simply a chance for you to
observe, learn and make the most of the opportunities available to
you to gain insight into pain management.
The following guidelines will ensure that the team works
effectively and cohesively and avoids misunderstandings
developing:
Prior to observing any session(s) please request permission from
the clinician(s) involved. In certain circumstances it may not be
possible for you to observe a particular clinic/session e.g. if a
patient is particularly distressed or if there is already another
observer in the clinic. This also ensures that the clinician is
able to plan time in advance to spend with you explaining what will
be covered in the session and providing you with any necessary pre
session reading material to enhance your understanding. Please also
document your initials on the timetable in the Medical Consultants
office by the clinic you have been given permission to observe.
This ensures multiple observers are not attached to a clinic as
only one observer can be accommodated. Planning ahead also ensures
that you are able to meet your learning objectives.
1) The observer is to adhere to the following guidelines in line
with professional code of conduct
Punctuality
Confidentiality
Appropriate work attire
Mobiles/pagers switched off
2) The observer is to ‘observe’ only and not become actively
involved in discussion unless invited to do so by the lead
clinician. However observers are encouraged to remain passively and
thoughtfully involved. Clinicians will be happy to answer questions
following sessions.
3) The observer should be prepared to spend time pre and post
sessions with clinicians for explanation and discussion. This is an
opportunity to reflect upon the content of the session.
4) Please remain respectful of your professional colleagues;
physiotherapists, nurses and clinical psychologists. There may be
times when you feel that you are able or wish to offer your opinion
regarding a patient’s clinical care. However, in your role as an
observer you do not have responsibility for the patient’s care and
if a medical opinion is required the lead clinician will consult
the patient’s lead medic.
5) Finally, with specific reference to the observation of
clinical psychology led sessions, the psychologists will utilise a
Socratic dialogue to elicit clinical information in a systematic
process. During assessment sessions this may mean that sensitive
issues are brought up but are not explored in great depth as you
are not observing a therapeutic intervention.
Why can’t I observe rehabilitation intervention sessions, such
as individual physiotherapy/psychology appointments, or a joint
physiotherapy/psychology session?
It is not possible to observe the treatment/intervention
sessions run by the physiotherapists and/or clinical psychologists.
Effective interventions require trust and therapeutic rapport, this
is not conducive when observers are only able to “dip in and out”
of sessions. In addition, therapy is a process of both the content
of psychological therapy, but also the dynamic within the
therapeutic setting. When observers are present this can be
disruptive to this process and can potentially have negative
effects upon the efficacy of the patient’s treatment.
Unfortunately it may not be possible to observe the Pain
Management Programmes, due to priority of staff requiring training,
timing of programmes and the time commitment and requirement of
attendance of all sessions on the programme. However where possible
professional needs will be met and you are encouraged to seek out
observation opportunities pertinent to your particular
profession/interest whilst also gaining a broad knowledge of the
interdisciplinary team.
PATIENT INFORMATION LEAFLETS
The following leaflets have been produced by the Manchester and
Salford Pain Centre and are available in the clinic rooms for
distribution to patients. You are welcome to read and take away a
copy of any that you feel may be relevant to your learning
objectives.
Chronic Pain Information:
Explaining Pain
Drug Information:
Pregabalin
Oxcarbazepine
Gabapentin
Gabapentin Regime 1
Gabapentin Regime 2
Nortriptyline
Amitriptyline
Amitriptyline Regime 1
Amitriptyline Regime 2
Pain Management Programme Information:
Pain Management Programmes (flyer)
Pain Management Programmes-Information for Health Care
Professionals
Pain Management Programmes- Information for patients
Clinical Psychology Information
How Can Clinical Psychologists Help With Chronic Pain ?
The Good Sleep Guide
Chronic Pain and Stress
A Five Minute Guide for Employers
Attending Your Pain Management Appointments
Intervention Information:
Facet joint injections
SCS for chronic nerve pain
GENERAL INFORMATION
Practice of Pain Meeting (POP)
Meetings are held once a month (a list of dates can be obtained
from the secretaries). The format of the meeting is as follows: two
members of the service present a topic of interest and a third
member of the team chairs the meeting. The aim of the POP meeting
is to highlight service development and areas of specialist and
common interest.
Sickness and Absence
The Trust expects its staff to attend regularly for work and not
make minor unrelated ailments a regular cause of absence from
work.
Reporting Procedure
If you are unable to attend work for whatever reason, you must
personally (if possible) telephone your Line Manager/Educational
Supervisor or leave a message via Reception as soon as possible
0161 206 4002.
For the first three days no certificate is required. For the
following 3-7 days a self-certification note is required. For 7
days or more a medical certificate is required. Please keep your
Line Manager/Educational Supervisor informed of your progress.
Carers leave and compassionate leave days are at the discretion
of your Manager/Educational Supervisor.
On Your Return
You must notify your Line Manager/Educational Supervisor and
inform or leave a message with reception as soon as possible as to
the date and time of your return.
.
Catering Facilities
The restaurant is situated in the Atrium where there is also a
Marks & Spencer food outlet and coffee shops.
Catering facilities outside restaurant opening hours are
provided by vending machines throughout the hospital.
The Shopping Mall (Atrium)
The shopping mall is situated in the Atrium area. There is a
newsagent shop (Open 07.30 to 19.30 weekdays and 10.00 to 18.00
Sat-Sun) which sells sandwiches and cans of soft drinks. There is
also a coffee shop (Open 09.00 to 20.00 7 days a week) that sells
coffee, sandwiches, hot and cold meals, cakes etc. It also provides
a take away service. A cash machine is situated outside the
newsagent’s shop. There is also a Marks & Spencer Food
Outlet.
Information Systems/ Meetings
Clinical Governance Committee Meetings
Bi-monthly meetings are held in the Seminar Room, dates are
available on the Clinical Governance notice board in the staff
room; protected time is allocated to ensure you can attend these
meetings.
E-mail
If you are a salaried member of staff an email address will be
issued to you; this can be used as your first line of
communication.
Learning Resources Available
Departmental Library including pain related journals and
texts-(see attached recommended reading list)
Patient Information Leaflets-(see attached list of available
leaflets)
Main Library (located in the Mayo building)
Recommended journal articles- (see induction pack)
Documentation
All records to be in black ink
Anything you do must be documented
Records must be legible
Each entry must be clearly dated and signed, with name and
designation printed
FIRE SAFETY EMERGENCY NUMBER- 2222
Raising the alarm
Any member of staff discovering or suspecting a fire must raise
the alarm (permission not needed). Break the glass of the nearest
fire alarm call point. These are located at ward/department
entrances and at fire exit doors. The most common break glass call
point is the ' press' type which normally states 'press' or 'push'
hard on the glass. Press with your thumb firmly; the glass will
normally remain intact. The other type of call point is the 'smash'
type use something firm to smash the glass for example the heel of
your shoe or a bunch of keys. Sometimes it needs several strikes
before the glass breaks.
When the alarm is raised the fire alarm will normally sound with
a continuous tone (bells), this will inform other members of staff
in your fire zone area. The alarm can also be generated by a smoke
detector.
STAFF GENERATING THE ALARM SHOULD TELEPHONE SWITCHBOARD VIA 2222
TO CONFIRM THE RECEIPT OF THE ALARM AND THE LOCATION.
Fire Doors
Close fire doors this prevents the spread of smoke and toxic
fumes. Automatic fire doors linked to the fire alarm system will
close as a response to a fire alarm being generated or a power
failure.
DO NOT WEDGE ANY FIRE DOORS OPEN. DO NOT OPEN DOORS IF YOU SEE
SMOKE OR FIRE BEHIND OR THE DOOR FEELS HOT TO THE TOUCH
Evacuation
It is peculiar to hospitals and other health care buildings that
the last thing we would want to do is evacuate patients from ward
areas. A minority of staff on duty care for the majority of
patients in hospital at certain times of the day. Staff should
assess the situation for instance, is there a fire or smoke? If not
the movement of patients would be unnecessary. Obviously if staff
felt threatened by a fire situation they should start to move
patients from immediate danger. Staff should not wait for the
arrival of the fire service before evacuation commences.
There are three situations when an evacuation would take
place
Extreme Emergency
· Immediate threat to life.
· Fire impossible to extinguish.
· Immediate threat to patient and staff.
· Keep low and move fast.
· Move ambulant patients first then non-ambulant patients
next.
· Move horizontally i.e. corridor; to you're nearest safe
evacuation point.
· Use your visitors to assist and evacuate with you.
Emergency
Intermittent Alarm Sound
· No immediate threat to life but fire or smoke is likely to
spread from an adjacent area.
· Evacuate patients and staff safely.
· Move ambulant patients first then non-ambulant patients
next.
· Move horizontally i.e. corridor; to your nearest safe
evacuation point.
Precautionary
Intermittent Alarm Sound
· No immediate threat to life but fire is an adjoining area.
Follow information stated for emergency situation.
DO NOT USE LIFTS
N.B. The fire alarm is tested every Tuesday afternoon and can be
heard as an intermittent ring
Ensure as part of your induction process that you have made
yourself aware of the following in each clinical area.
Date
Inductee
Signature
Trainers
Signature
Emergency
Number
Alarm points
Fire doors/ extinguishers
and locations
When
to evacuate
Evacuation Route & point
Mandatory Training
(if applicable)
Staff members (plus initials for those on timetable)
Medical Team
TWJ
Dr Tim Johnson
AGL
Prof Abdul Lalkhen
RM
Dr Rick Makin
JT
Dr Justin Turner
MC
Dr Mahindra Chincholkar
JR
Dr Jonny Rajan
AK
Dr Ashwin Khanna
Pain Nursing team
SB
Sue Barnes
MH
Martin Howarth
AL
Angela Leonard
FM
Fionn Murison
KS
Kelly Savage
RW
Rob Wilding
Health Care Assistant
Heather Ellis
Carole McGreal
Psychology Team
KT
Karla Toye
RJ
Richard Johnson
SJB
Sarah Blackshaw
KG
Katherine Gerrard
Physiotherapy Team
AH
Andrea Hyde
HF
Helen Firth
LM
Lorraine Moores
NS
Naomi Smith
PB
Paul Briffa
SGB
Steve Barrett
Administration Team
Angela Smith
Outpatient Waiting List Co-ordinator
Julie Foster
Secretary to Dr Lalkhen & Alison Dwyer.
Karen Johnson
PMP Co-ordinator & Secretary to Dr Turner & Sue
Barnes/
Claire Jones
Secretary to Dr Tim Johnson.
Claire Lowe
Secretary to Dr Chincholkar & Dr Makin
Jayne Garside
Support Secretary to Dr Ashwin Khanna
Rebecca Hodgkiss
Support Secretary
Alex Gee
Support Secretary
Jennifer Redshaw
Support Manager
MANCHESTER & SALFORD PAIN CENTRE – STAFF TELEPHONE LIST
CENTRE NO. 0161 206 4002/4791 CENTRE FAX NO. 0161 206 1929
Medical Team
Extension
Bleep/Mobile/Pager
Justin Turner
6 2930
Tim Johnson
6 5696
Rick Makin
6 8259
07966 263187
Abdul Lalkhen
6 5927
07762 724774 (M)
Mahindra Chincholkar
6 0157
07896 672669
Jonny Rajan
6 6037
Ashwin Khanna
07988 869823
Pain Nursing Team
Acute Pain Bleep
84 5272 or 07623 623107
DCS Bleep
07623 610663
Angela Leonard
6 1923
Alison Dwyer
6 5939
07623 606680
Fionn Murison
6 4248
Howard Read
6 4168
Kelly Savage
6 4152
Martin Howarth
6 4169
Rob Wilding
6 4017
Sue Barnes
6 1256
Health Care Assistant
Heather Ellis and Carole McGreal
6 8425
Physiotherapy Team
Andrea Hyde
6 1919
Helen Firth / Paul Briffa
6 1917
Lorraine Moores
6 8260
Naomi Smith
6 7547
Steve Barrett
6 8261
Psychology Team
Karla Toye
6 1967
Katherine Gerrard
6 1968
Sarah Blackshaw
6 8996
Richard Johnson
6 8262
Administration Team
Outpatient Waiting List Co-Ordinator
6 4746
Claire Jones
6 1963
Claire Lowe
6 1941
Julie Foster
6 4103
Karen Johnson
6 4136
Jayne Garside
6 8410
Rebecca Hodgkiss
6 3121
Alex Gee
Jennifer Redshaw
6 0640
RECEPTION
6 4002
CLINIC ROOMS
Room 2
6 8276
Room 3
6 8275
Room 4
6 8271
Room 5
No Phone
Room 6
6 8278
Room 7
6 8274
Room 8
6 8273
Room 9
6 8272
Staff Room
6 8277
Cleaning Supervisor
6 3591 / 6 3018
Manchester and Salford Pain Centre’s Recommended Library
Resources
The following is a list of some of the resources available in
the MSPC library located on the 2nd floor. The access code is
C4136. Please document any books you borrow in the library loans
book located in the library. There are many other pain related
books and journals available in the Library which may be of
interest. There is also a PC and photocopier available for general
use.
AUTHOR
TITLE
ISBN No.
Publisher
MOSELEY, L
Explain Pain
097509100
Noigroup Publications
MOSELEY, L
Painful Yarns
GIFFORD, L
Topical Issues in Pain, books 1-5
RICE
Clinical Pain Management Books 1-4
9780340982808
Hodder Arnold
KEER, KEER & GRAHAME
Hypermobility Syndrome: Diagnosis and Management for
Physiotherapists
9781416038443
MAIN, SULLIVAN and WATSON
Pain Management
9780443100697
Churchill Livingstone
WADDELL, G
The Back Pain Revolution
0443072272
Churchill Livingstone
SHONE, N
Coping successfully with pain
0859698505
Sheldon Press
BIELING PJ, McCABE RE & ANTONY MM
Cognitive-behavioural Therapy in Groups
1593853254
Guilford Pub
WINTEROW, C BECK, AT & GRUENER D
Cognitive Therapy with Chronic Pain Patients
0826145957
Springer Publishing Co Inc
TAYLOR, RR
Cognitive behavioural therapy for chronic illness and
disability
0387253092
Springer
MELZACK and WALL (eds)
Textbook of Pain
BALLANTYNE
The Massachusetts general Hospital Handbook of Pain
management
9780781762243
BASBAUM
Science of Pain
9780123746252
COUSINS
Cousins and Bridenbaugh’s Neural Blockade in Clinical
Anaesthesia and Pain
9780781773881
MACINTYRE
Acute pain Management: A Practical Guide
9780702027703
RAJ
Interventional Pain management: Image Guided Procedures
9781416038443
RATHMELL
Atlas of image guided intervention in regional Anaesthesia and
pain Me
97080781751810
BENEDETTI, F
Placebo Effects: Understanding the mechanisms in health and
disease
ROSS, J
Occupational Therapy and Vocational Rehabilitation
HOLMES, J
Vocational rehabilitation
MOSKOWITZ, GP & GRANT, H
The Psychology of Goals
1606230298
Guilford Press
D'ZURILLA, TJ and NEZU, AM
Problem-solving Therapy: A Positive Approach to Clinical
Intervention
0826114881
Springer Publishing Co Inc
TURK, DC &
THORN, BE
Cognitive Therapy for Chronic Pain
1-57230-979-2
Guilford Publications
Website Resources
Manchester and Salford Pain
Centre-www.salfordpainmanagement.co.uk
The British Psychological Society-www.bps.org.uk
The British Pain Society-www.britishpainsociety.org
National Institute for Health and Clinical
Excellence-www.nice.org.uk
NURSING ROTA: WEEK COMMENCING: ………………………………………………………………
ACUTE PAIN
MONDAY
TUESDAY
WEDNESDAY
THURSDAY
FRIDAY
SAT
SUN
AM
PM
EVENING
ACUTE SHADOW
WARD ROUND
CONSULTANT SHADOW
TEACHING / MEETINGS
Martin Howarth
Angela Leonard
Fionn Murison
Rob Wilding
SCS
Kelly Savage
Support Assistant
Student Nurse Allocation
�
Manchester & Salford Pain Centre
INDUCTION PACK
�
MSPC Pathway
Team Triage
Doctor Only
Doctor / Physio
Nurse Cons Only
Medical Review
(+/- interventions)
Intensive Pain Management
30 Sessions (~ 75 therapy hours)
Follow up 1, 3 + 6 months
Pre-Prog Clinic
Standard Pain Management
16 Sessions (~ 40 therapy hours)
Follow up 1, 3 + 6 months
Psychology Pain
Management Review
PHQ9 > 17
Physio Pain
Management Review
PHQ9 <17
Individual Psychology
Individual Physiotherapy
Nurse Review
Physio Only
CRPS
Advanced
Practitioner
Point of first contact clinic assessments
Physio Review
Nurse / Physio
Introduction to Managing Pain (6 x 2hr sessions)
WEEK: 1
[Type text]
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Abdul Lalkhen/Misc/InductionBooklet/November 2015
