Liverpool Course on Management of Chronic Pain:
A Practical Approach 5th– 7th July 2018 

Liverpool Waterfront 2018

 

Registration now open

This is an advanced practical and interactive course in clinical pain management for Pain Professionals and trainees who are aiming to develop their skills of assessing and treating complex chronic pain patients. The course will offer those who attend, the opportunity to develop an evidence based approach to assessment, examination and formulation of diagnosis, and how to design a comprehensive management plan. The course will be held at the Pain Relief Foundation (Clinical Sciences Centre) and the Pain Clinic (Walton Centre for Neurology and Neurosurgery).

Click here for a detailed programme of events

Who Should Attend:

Anaesthetic, Neurosurgery and Pain Trainees.  Pain Consultants, GPs with Special Interest in Pain Medicine, Advanced Nurse Practitioners and Senior Physiotherapists with Specialist Interest in the management of chronic pain.

Fee:  £350 for Early Bird registration (after 4th May, 2018, £450) 
(Early registration secures first choice of workshops on days 1 and 2)

For further information and registration please visit the Pain Relief Foundation at their website www.painrelieffoundation.org.uk

 

 



 

LIVERPOOL CHRONIC PAIN COURSE 2017

GOES FROM STRENGTH TO STRENGTH

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The 33rd  Liverpool Course Annual Pain Course on Management of Chronic Pain was held 6th – 8th July the course attended by a range of disciplines which included, Consultants, GP’s, Anaesthetists,  Nurses and Physiotherapists from both the UK and internationally.

The course was organised by Dr Sharma and Dr Rajiv Chawla both of whom are Consultants in Pain Medicine based at the Walton Centre, Liverpool with the support from the Pain Relief Foundation and Walton Centre.

Dr Sharama and Dr Chawla  would like to thank to thank the Pain Course faculty and all for making this course possible and for making it another success in 2017 and would like to share this success.

Dear Pain Course Faculty,

 Please click here to see the written course feedback from course delegates on the 33rd Annual pain course just completed. It will be only fair to share this with you all and  reflect your contribution alongside your existing NHS commitments. Feedback is really as best as we can have (probably).

 The mean feedback score for this course last year was 2.66/3.00 and this year it is 2.78/3.0. This is not a coincidence but reflection of what we have as an excellent pain service and unique practical multidisciplinary pain course.

 Course was very well supported in terms of logistics by The Walton Centre and by the Pain Service and other disciplines and support from our secretaries, PMP team, Radiology, Theatres, Jefferson ward, OPD in Sid Watkins AND  of course many patients who also took part. So this is a significant undertaking made only possible by your hard work and by those who are not even copied in this e mail. They will be thanked separately.

 Sam Lipton Lecture by Prof Sam Eldabe was also the highlight in the field of Neuromodulation in NHS and made the evening most educational and entertaining.

 This course reflects genuine cross organisation collaboration between Pain Relief Foundation and The Walton Centre and will like to thank Julie and her team at PRF in making it a great success. I wish this continues and reaches new heights.

 Kind Regards

 Manohar Sharma and Rajiv Chawla
 On behalf of Organising Committees July Pain Course,
Pain Relief Foundation and The Walton centre

PLEASE CLICK HERE TO SEE THE CLASS OF 2017 

 

 



LIVERPOOL CANCER PAIN STUDY DAY

10th NOVEMBER 2017

 Clinical Sciences Centre, University Hospital Aintree, Lower Lane, Liverpool, L9 7AL

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Aim of this study day is to promote awareness and education regarding management of cancer related pain which is otherwise very difficult to treat with conventional means. This study day will help the attendees understand when a patient may be considered for interventional pain management techniques including neuromodulation and neuroablative techniques.

There have been many significant advances in this field in particular over the last 5 years and this study day will provide ample opportunity for discussion and also includes an interactive workshop on a case study on cancer related pain and patients journey.

Click here to see a detailed programme of events.

Who Should Attend:

Anaesthetic, Palliative Medicine, Neurosurgery, orthopaedics and Pain Trainees. GPs with Special Interest in Pain Medicine, Advanced Nurse Practitioners, McMillan Nurses and Physiotherapists with Specialist Interest in the management of chronic pain

Fee:      £50 – Consultants, GPs

              £25 – Trainee doctors

             Free – Nurses, Physiotherapists

 

For further information and registration please visit the Pain Relief Foundation at their website www.painrelieffoundation.org.uk



9TH ANNUAL NORTH ENGLAND PAIN MEDICINE GROUP MEETING

ANOTHER RESOUNDING SUCCESS

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 The North of England Pain Medicine Group (NEPMG), founded 8 years ago by Drs Sanjeeva Gupta and Manohar Sharma, is a supraregional Pain Medicine group established to cater specifically for the unique educational and networking needs of Pain Physicians in the locality of the North of England. The Group aims to foster closer collaboration between Pain Physicians to promote areas of good practice. It encourages and supports speakers and delegates drawn primarily from the region, contributing to an annual one day meeting of the highest quality.

This year’s meeting was held in the usual location of Huddersfield and again has proved to be a resounding success proving why this meeting has fast become a most important date in the annual pain conference calendar. Topics from this year’s programme included, ‘Legal Updates- consent and other issues’, ‘Interagency Team’s reflection on Management of patients with combined chronic pain and substance misuse problem.’ and ‘6 honest serving men Spinal cord stimulation – the Salford experience’ to name but a few. Listed below are feedback comments received from attendees

‘Good topics – variety – discussion’

‘Very good all day thanks’

‘Neurostimulation   The 6 honest serving men. SCS legal updates.  Very informative and interesting’

‘Legal updates very interesting. Teams reflections’

‘Different perspectives from different consultants’

‘Great venue’

‘Well organised, and variety of topics’

‘Good location, food and lecture content and video presentations’

‘Interaction and small group format’

‘Enjoyed the variety of the sessions’

For further information regarding the North England Pain Medicine Group please visit their website at www.north-england-pain-medicine-group.co.uk/

 



cedar court

9th Annual North England Pain Medicine Group Meeting

Friday 19th May 2017

Venue: Cedar Court Hotel,Lindley Moor Road,Elland, Huddersfield, HD3 3RH,

Phone: 01422 375431

Off M62 – Junction 24

This years  programme has been organised by Dr.R.Krishnamoorthy covering many topical and highly relevant areas in the current practice of Pain Medicine.

For a detailed programme click here

To download  and print a registration form click here

To visit the North England Pain Medicine Group website click here

 



 

Spinal Cord Stimulation for Chronic Pain

(SPINAL IMPLANTS FOR CHRONIC PAIN)

 Purpose of this article

The purpose is to raise the awareness regarding available treatments for chronic and intractable pain which otherwise may be poorly controlled or managed with usual medical treatments including medications. There have been many advances in the field of spinal implants to control chronic pain and when applied in conjunction with other supportive treatment including education and rehabilitation based approaches to support self-management, many patients can expect improvement in quality of life. This treatment is considered cost effective and is available on NHS and supported by NICE (National Institute for Health and Care Excellence, London).

Introduction to chronic pain

Chronic pain is highly prevalent. It is estimated that 14 million people live with chronic pain in England alone. In 2011, 31% of men and 37% of women reported persistent pain. Of these, one in four (3.5 million) said that their pain had kept them from usual activities (including work) on at least 14 days in previous three months. A person living with pain will have a very poor quality of life – much worse than other conditions, and as bad as significant neurological diseases such as Parkinson’s.

Chronic pain is a complex long-term medical condition. Chronic pain has huge impact on daily activities, disrupts family life and impacts on ability to work. Chronic pain is not only a physical condition but also a disease in itself. The pain can be localised in a small part of body or diffuse. The severe unremitting chronic pain affects social functioning, workplace roles and drains mental performance to such an extent that patients can feel depressed and isolated. Patients can become suicidal with the burden of their symptoms. Severe chronic pain has an impact on life expectancy. The 2008 Chief Medical Officer report states that 25% of pain sufferers lose their jobs; 16% of sufferers feel their chronic pain is so bad that they sometimes want to die.

Treatment of chronic pain

There are teams of trained Pain Specialist present in primary, secondary, and tertiary care pain centres for helping people with chronic pain to support managing their pain and offer pain relief. There is immense background knowledge about prevalence of chronic pain and impacts of pain relief technology available that could reduce burden and suffering from chronic pain. In particular, pain related to altered nerve function or dysfunction or damage to nerves (neuropathic pain) can be successfully controlled with spinal implants especially when patients do not derive benefit from existing usual medical treatments. Various examples of neuropathic pain include persistent pain control following spinal surgery for sciatica or disc related pain, complex regional pain syndrome, trauma or surgery leading to nerve damage, post amputation stump pain, pain following spinal cord injury, post herpetic neuralgia and peripheral neuropathy. These types of pain are typically poorly responsive to usual painkillers including nerve pain killing medications (antiepileptic, antidepressants and morphine based pain killers) and some of the patients while having some pain relief gets significant side effects. This means there is unmet need for relief of patient with chronic pain.

Spinal Cord stimulation (SCS)

Spinal cord stimulation (spinal implant to control neuropathic pain) is a way to control nerve injury related pain (neuropathic pain). Norman Sheily attempted this first in 1967. He placed a wire (lead) with electrical contact (with ability to pass electrical pulses through spinal cord in a much localised area to control pain) in spinal cord in a patient suffering from cancer related pain and patient had pain relief lasting a couple of days. This technique has since been significantly refined and improved. There is as well better understanding as how this treatment works in patients with nerve injury related pain (neuropathic pain).

There have been a variety of leads and batteries available on the market for control of neuropathic pain. It essentially means implantation of fine wires with ability to pass electrical pulses into the spinal cord to interfere with pain signals from painful area passing to the brain. This interference means that patient is not able to feel the pain. These wires are connected to a battery, which powers the SCS (Spinal Cord Stimulation). This is controlled with hand held remote device from outside. None of the components are visible from the outside apart from the remote control to communicate with the device. Over the last ten years there has been significant advance in understanding of mechanisms as how SCS helps and also with improved hardware and software i.e. type of electrical pulses, many more patients are now in a position to receive good pain relief.

Advances have been made not only with spinal cord stimulation leads but also with the batteries. In the past SCS was powered using radio frequency coupling mechanism and now with the improvement of battery, it means battery carrying a charge can be implanted with out need for charging from outside. These may need replacing after 5-7 years depending on use. Batteries now have been further improved and these can be charged from outside meaning that these can now last more than 10 years and hence avoiding need of an operation to replace a flat battery. There is also improvement with the battery software, such that with change in posture batteries will automatically adjust electrical pulses and there is minimal postural variation in electrical pulses or surges felt by patients (sharp pain or loss of treatment effect) and hence improving patient’s experience.

 New advances in technology

Another advance in the field of SCS has been the ability to target stimulation (tingling sensation) in areas otherwise difficult to target with conventional SCS. It has been realised that with conventional spinal cord stimulation it is difficult to pass pleasant electrical pulses to control pain in the foot, groin, or in very localised area of chest or abdomen. The new technology includes dorsal root ganglion stimulation i.e. spinal cord stimulation of the dorsal root ganglion and is now established and successful. This means patients, who could not be offered this treatment 4-5 years ago, now are able to access treatment with possibility of pain relief and improved quality of life.

Further advance in this field has been i.e. High frequency spinal cord stimulation which passes electrical pulses at 10 kHz frequency and patients typically do not feel any paraesthesia or tingling sensation, but only pain relief. This treatment modality has also been studied in a rigorous scientific and controlled manner and pain relief is not only comparable but seems superior to existing SCS technology.  This was shown in randomised controlled trial in nearly 200 patients, and study data is now available lasting over 18months and showing good pain relief as well as safety of the device. Many device manufactures are introducing further improved electrical waveforms with potential for improved quality of pain relief.

Another advance in this field is to use wireless technology to minimise the amount of SCS hard ware being implanted (SCS device without a battery) and hence minimising the extent of surgery and surgery related side effects. This study is due to start soon to see if this holds promise for future.

There is significant potential to be involved with and lead exciting research in this field at Pain Relief Foundation and The Walton centre Pain Service.

Summary

There have been significant improvements and understanding of spinal cord stimulation and impact of this treatment on neuropathic pain. There have also been significant improvement and refinement to hardware as well as stimulation paradigms (software) i.e. the characteristics of electrical pulses used to treat chronic nerve pain. This essentially means that patients can now be offered better pain relief compared to recent past. This field is likely to expand and improve further because of significant interest and research in this field and this is exciting time to support research in this filed.



33rd Liverpool Course on Management of Chronic Pain:
A Practical Approach 6th– 8th July 2017 

Registration now open

This is an advanced practical and interactive course in clinical pain management for Pain Professionals and trainees who are aiming to develop their skills of assessing and treating complex chronic pain patients. The course will offer those who attend, the opportunity to develop an evidence based approach to assessment, examination and formulation of diagnosis, and how to design a comprehensive management plan. The course will be held at the Pain Relief Foundation (Clinical Sciences Centre) and the Pain Clinic (Walton Centre for Neurology and Neurosurgery).

Click here for further information and registration

 

 

 



 

 

The European Pain Federation EFIC® – Winter Cancer Pain School, Liverpool 2016

 

The European Pain Federation EFIC® – Winter Cancer Pain School, Liverpool was held 11th – 14th October the course was fully booked with a waiting list and was attended by 20 doctors from across Europe and 12 doctors from the UK.

The course was organised by myself Dr Sharma, along with Dr Kate Marley, Consultant in Palliative Medicine, University Hospital Aintree,Liverpool and Dr Chris Wells a Pain Physician, Rodney Street, Liverpool and current president of EFIC. I would like to thank would like to thank the Pain Course faculty and all for making this course possible and for making it another success in 2016

Dear EFIC Cancer Pain Course Faculty,

It was immense pleasure to have your company in Liverpool and share your experience in this field which has been very well received and appreciated by the course delegates. I have had a quick look at the feedback and am delighted to say that it is excellent and reflects your valuable contribution and support without which it is not possible. 

This school was very well supported by Dr Chris Wells (EFIC President), Faculty from EFIC, Dr Marley from Aintree Palliative Medicine (Woodland’s Hospice), Walton Centre colleagues and faculty from UK.  

It is a rare and unique opportunity to share knowledge and experience in this field in such detail (lectures, case discussions, live case presentations on recently treated cases, pain in cancer survivors, group work etc).  

I am sure this will make positive impact on those who attended, to further help patients with cancer related pain in UK and Europe.  

Pain relief foundation (Julie and Brenda) and Walton centre has provided immense support and motivation towards this and it is really appreciated

 Again many thanks for your contribution in making this a great success!

Regards

Dr Manohar Sharma

Click here to read feedback comments

Click here to see photos