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.
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.
These different treatment procedures are applied specifically in the treatment of disorders such as:
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.
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.
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.
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)
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 .
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.
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.
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.
Ricardo González Durán
Ignacio Javier Hernández Ferreras.
Dr Cristina Álvarez Zapatero.
Dr Javier de Andrés Ares.
Dr Carlos Arias Laverde.
Dr Francisco Leal Quiñones
Dr Sonia Ortiz.
Pedro Antonio Bravo Flores.
As well as all these professionals, the unit has works in close collaboration with the departments of:
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