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Hospital Universitario La Zarzuela Madrid

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MULTIDISCIPLINARY UNITS

Pain Management Unit

The Multidisciplinary Pain Management Unit is a medical super-specialism made up of a multidisciplinary team dedicated to the diagnosis and treatment of disorders that cause pain, particularly chronic pain (evolution of more than 90 days).

It is not a palliative care unit or a unit solely dedicated to the management of pain caused by cancer. Although it also treats patients with cancer pain, it is not a palliative care unit, occasionally serving as a support to said home care units for the management of pain not controlled thereby. In practice, the origin of the pain of the majority of the patients we treat is not cancer-related.

The patients are referred by other specialist doctors, after their diagnosis or therapeutic interventions indicate the possibility that the pain symptom needs to be diagnosed and treated by acting on the neurophysiological cause producing the pain.

The treatment of chronic pain is based on a clinical diagnosis of the causes of pain, on the level of the ing of the nervous tracts which are part of its production, and is focused on procedures whose purpose is to cure the pain through interventions regularising the pain transmission systems.

To achieve this permanent or lasting modulation, minimally invasive techniques whose result is a prolonged or permanent reduction of pain, which can be based on nerve blocks, radiofrequency, drugs, etc., are used. Additionally, the treatments of pain are supported by the lifestyle, care and maintenance of physical and psychological health indications specifically present in each case.

 

SERVICES

The unit's activity consists of diagnostic consultations, assessment by protocol of different types of pain, assessment of the psychological aspects that may play a role in the generation and maintenance of pain. Inpatients under the care of other departments are also cared for, when requested through reports. The consultations are by appointment.

No Patient can turn up spontaneously or request an appointment directly without having previously been referred by their specialist doctor.

In the case of the initial consultations, the patient has to be referred by another specialist; the prior diagnostic tests that patients have undergone are requested, together with their respective reports, as well as the medical reports on prior diagnoses or surgeries.

Additionally, adapting to the needs of each patient, treatments with drugs which act on the causes of the pain, treatments with nerve blocks in the painful areas, treatments with radiofrequency procedures which modulate the activity of the sensory areas, denervation procedures, systems for the administration of drugs through iontophoresis, infusion pumps and electronic stimulation systems (electrodes, TENS, interferential current stimulation, ozone therapy) are used.

We have the most advanced devices, which we are constantly updating, to be able to use the most adequate one for each pathology.

The treatments are performed in consultations, recovery rooms, outpatient operating theatres and/or central operating theatres depending on the needs of each patient. The majority of the treatments are through the outpatients clinic.

After the treatments, consultations are held to monitor and control the patient's development over time spans which vary according to the healing, improvement and evolution of the patients, with the intention of avoiding relapses and adapting the evolution.

 

PATHOLOGIES

These different treatment procedures are applied specifically in the treatment of disorders such as:

The majority of patients referred to our Pain Unit come mainly from the traumatology and neurosurgery departments, with spinal problems.

Lumbago, lumbo-sciatica, cervicalgia, post-surgery spinal syndromes and vertebral compression fractures are some of the most frequent conditions cared for in our multidisciplinary-approach Spinal Unit. We have specialist and advanced minimally invasive techniques that are usually applied through the outpatient clinic, such as: epiduroscopy, epidurolysis, radiofrequency, vertebroplasties and ive epidural or root nerve blocks. The effectiveness of these procedures is based on a correct diagnosis and prolonged care and monitoring by the whole care team.
Today, fibromyalgia constitutes an as-yet-unresolved problem in the pathology of chronic muscle problems.

In this disease, assessment and treatment among many of the unit's professionals constitutes the best guarantee of relief in this type of patient. Scientific advances in neurophysiological processes that develop this pathology and the discovery of new therapeutic targets constitute the basis of the interdisciplinary sessions for the application of the most modern and effective treatments of fibromyalgia.

The pain localised in different muscular areas is treated by ultrasound-guided approach, under complementary localisation of stimulation and radiology, with the most modern methods, following a diagnosis based essentially on the medical history, prior examination of the patient and imaging tests.

The intensity of the pain in some facial neuralgia such as trigeminal neuralgia, and the high incidence and difficulty in the diagnosis of headaches make it necessary to have a unit specialising in the treatment of cranial pain.

A team made up of doctors of from the unit, psychologists, neurologists, neurophysiologists and brain imaging specialists, with cutting-edge equipment, forms the unit specialising in the modern treatment of headaches.

JOINT PAIN:

Quite frequently, elderly patients cannot benefit from orthopaedic t ment surgery (prosthesis) or other types of surgery, given their advanced age and physical conditions. In these cases, the use of intraarticular pulsed radiofrequency, by the introduction of small electrodes on the t, or intraarticular ozone therapy can provide prolonged relief for these patients and allow them to recover the mobility and quality of life they have lost.

NEUROPATHIC PAIN:

Some viral diseases such as herpes zoster, metabolic diseases such as diabetes, drug addiction, post-traumatic diseases and those of unknown origin cause lesions in the nervous system that provoke chronic, high-intensity neuropathic pain.

Their treatment is essentially based on the neuromodulation (ment of normal nerve ) in nerve lesions, which cause spontaneous pain (ectopic foci). *To neuromodulate we have several procedures, including pharmacological, inhibiting nerve stimulation (TENS, PENS, epidural stimulation) and pulsed radiofrequency procedures, procedures through administration by means of anaesthetic patches, etc. Electrical stimulation of the nervous system by means of small electrodes fitted percutaneously in the outpatient clinic to treat desperate cases of pain that do not respond to any other treatment, such as the effects of spinal surgery, peripheral neuropathies, ischaemic lower extremity pain (it can prevent the amputation of the limb due to its vasodilator effects), angina pain or migraines.

POST-SURGICAL PAIN:

After some interventions, essentially performed on the spine for its stabilisation, despite the perfection of the surgical technique, lesions occur in the area thereof due to the formation of fibroses (scars within the spinal cord). This pathology is known as post-laminectomy syndrome or failed back syndrome.

The introduction of a system with a camera into the epidural space (the space between the spinal cord) with radiofrequency devices that can debride these scars and perform neuromodulation on the affected nerves is known as an EPIDUROSCOPY. This procedure, which is performed under sedation/anaesthesia, constitutes one of the most significant advances in many patients who were previously destined to wear a permanent stimulation system with electrodes fitted in the epidural space. (VIDEO)

VISCERAL PAIN:

Patients with visceral diseases which are difficult to treat, such as chronic pancreatitis, endometriosis, etc., are treated in our unit using visceral sensitivity interruption procedures (denervation) through imaging-guided blocks in the sensitive centres of the affected organs, without deterioration of their normal .

VASCULAR PAIN:

Ischaemic pain (lack of blood flow) can be treated using radiofrequency and neurolytic techniques on the sympathetic nervous system to improve the blood flow and pain.

CANCER-RELATED PAIN:

Our unit has a close working relationship with the Oncology and Internal medicine departments in order tly to treat pain in these patients. There are patients who do not respond to conventional treatment on whom we use specific techniques such as the fitting of spinal catheters and subcutaneous pumps for administration of analgesic and anaesthetic drugs to mitigate the most severe cases of pain.

PSYCHOGENIC PAIN:

The t treatment between the medical team, psychologists and psychiatrists allows the treatments established thereby, both cognitive-behavioural and pharmacological therapies, to give relief to these patients in our unit.

MULTIDISCIPLINARY TEAM

Ricardo González Durán

  • Graduate of Medicine and Surgery. Specialism in Anaesthesiology.
  • Founder of the Pain Clinic of the Ciudad Sanitaria "Vall D'Hebron" (Vall D'Hebron Healthcare City). Barcelona. (the 2nd largest pain unit in Spain).
  • Founder and head of the Multidisciplinary Pain Management Unit at the Hospital Ramón y Cajal in Madrid (until 1992) and the Hospital Universitario Sanitas La Zarzuela.
  • Founding member of the Spanish Society of Pain. Member of the Spanish Society of Anaesthesiology, Recovery and Pain Management. Member of the IASP (International Association for the Study of Pain). Member of the Pain Forum.

Ignacio Javier Hernández Ferreras.

  • Graduate of Medicine and Surgery.
  • University specialist in "Occupational Rehabilitation: Assessment of Medical Disabilities" and "Expert Assessment and Social Rehabilitation". Master's in Disability Assessment.
  • Master's in Pain Management.
  • Master's in Palliative Care.
  • Accredited by the Spanish Society of Pain (SED) in Basic-and Advanced-Level Radiofrequency Techniques.
  • Member of the Spanish Society of Pain. Member of the Madrid Society of Pain.
  • Associate doctor of the Pain Unit at the Hospital Universitario Sanitas La Zarzuela since 1998.

Dr Cristina Álvarez Zapatero.

  • Graduate of Medicine and Surgery.
  • Master's in Pain Management.
  • Member of the Spanish Society of Pain.

 

Dr Javier de Andrés Ares.

  • Graduate of Medicine and Surgery.
  • Specialist in Anaesthesiology, Recovery and Pain Therapy.
  • Fellow of International Pain Practice (WORLD INSTITUTE OF PAIN).
  • Coordinator of the Radiofrequency Group of the SED.

 

Dr Carlos Arias Laverde.

  • Graduate of Medicine and Surgery.
  • Specialist in Anaesthesiology, Recovery and Pain Therapy.
  • Accredited by the Spanish Society of Pain (SED) in Basic-Level Radiofrequency Techniques.

 

Dr Francisco Leal Quiñones

  • Graduate of Medicine and Surgery.
  • Specialist in Anaesthesiology, Recovery and Pain Therapy.
  • Member of the Spanish Society of Pain.
  • Professor on the Master's in Pain at the Universidad Rey Juan Carlos.
  • Collaborator teacher at the Universidad Europea de Madrid.

 

Dr Sonia Ortiz.

  • Graduate of Medicine and Surgery.
  • Specialist in Anaesthesiology, Recovery and Pain Therapy.
  • Member of the Spanish Society of Pain.

Pedro Antonio Bravo Flores.

  • Graduate of Psychology. Master's in Experimental Conduct Analysis. Foreign psychology fellow in the Multidisciplinary Pain Management Unit at the Hospital Ramón y Cajal. Courses of the training programme of the Spanish Society of Psychosomatic Medicine and Medical Psychology.
  • Associate professor of Psychology U.N.A.M. 1985-1994. Senior researcher, Hospital General de México, 1990-1993.
  • Member of the Spanish Society of Pain. Member of the Pain Forum. Psychotherapist member of the Federation of Psychotherapist Associations (FEAP), Spanish Society of Psychosomatic Medicine and Medical Psychology.
Mercedes Valero de Bernabé Herraiz.
The unit has two secretaries of its own.

As well as all these professionals, the unit has works in close collaboration with the departments of:

  • Neurology and Neurophysiology.
  • Traumatology.
  • Neurosurgery.
  • Rehabilitation.
  • Psychiatry.
  • Internal Medicine.
  • Oncology.
  • Angiology and Vascular Surgery.
  • Rheumatology.

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