Pain Management - Information for Health Professionals
Acute Pain Management
Care for inpatients who experience severe acute pain related to medical (e.g. sickle cell crisis), traumatic and post-surgical conditions. Ward rounds are conducted daily with after-hours cover.
We use a range of analgesic modalities such as nerve blocks, patient controlled analgesia (PCA), opioid infusions, epidural infusions and peripheral nerve infusions, and other adjunctive pharmacological interventions.
We also assist with the early recognition and management of neuropathic pain states / Complex Regional Pain Syndromes and strategies to reduce risk of subacute pain conditions from becoming persistent.
We provide training and education for other health professionals such as nurses and junior medical staff on pain management practices. Ward nurses are also accredited in the care of patients requiring advanced analgesic modalities
Interventional Cancer Pain Management
We provide support and advice to the Palliative Care, Medical and Radiation Oncology teams for their patients whose pain is not controlled by standard treatments. Where appropriate, we may help with the use of local anaesthetic and neurolytic blocks, spinal analgesic therapy and other interventions. Local anaesthetic nerve blocks involve the injection of an anaesthetic, a corticosteroid and other agents near a nerve, for pain relief. For longer term relief, interruption of nerve conduction can be done either by use of chemicals (e.g. alcohol, phenol) to produce neurolysis or application of heat (radiofrequency neurotomy).
Chronic Pain Management in our Pain Clinic
We assess patients with complex persistent pain in a Multidisciplinary Pain Management clinic. Patients at this clinic will see the pain medicine physician, physiotherapist and psychologist who will then discuss and make recommendations on the best options for managing someone’s pain.
Patients with apparent straightforward persistent pain are also assessed by the pain medicine physician with further referral to the Multidisciplinary Pain Management Clinic if necessary.
We have also established a clinic for the older person with pain and multiple comorbidities which can address their complex medical issues and provide a multidisciplinary focus.
A subacute clinic has been established to deliver pain treatment early in the patient’s medical or surgical condition. The clinic aims to reduce the risk of long term pain with its associated multidimensional comorbidities. We also endeavor to reduce the risk of polypharmacy and development of drug dependence.
We also conduct inpatient consultations for patients with severe pre-existing or uncontrolled pain or if requested by other specialist teams.
If needed patients may be referred to see our psychiatrist, addiction medicine specialist or social worker or occupational therapist.
A wide range of interventional management strategies are used to elucidate the cause and manage pain including:
- Diagnostic nerve blocks.
- Diagnostic infusions for the evaluation of pain.
- Therapeutic nerve blocks including radiofrequency neurotomy and neurolytic blocks.
- Intraspinal infusions of analgesics.
- Neuromodulation techniques including transcutaneous electrical nerve stimulation (TENS), transcranial direct current stimulation (tDCS), transmagnetic stimulation (TMS), epidural spinal cord stimulation, dorsal root ganglion stimulation, peripheral nerve field stimulation and intraspinal analgesic infusion.
- Implantation of intrathecal baclofen pumps for the management of intractable spasticity.
Following a comprehensive assessment by our team, patients could be offered any of the following:
- Regular land based group exercise program.
- Specific tailored physiotherapy such as soft tissue techniques, joint mobilisation and muscle stretching/strengthening.
- Psychological pain management strategies such as cognitive-behavioural therapy, relaxation techniques and pain education.
- Pain Management Program - Conducted in a group setting utilising a combination of cognitive behavioural therapy and physical activation.
- Occupational therapy program involving support for work-related issues, functional assessment and pacing of activities.
- Mindfulness meditation in a group setting.
- Social work interventions and counselling.
We have access to teleconferencing facilities which link us to and help support the Port Kembla and Shoalhaven Hospital pain clinics. We use these facilities to meet with other specialists to discuss complicated pain problems.
Clinic days are Monday, Tuesday, Wednesday and Friday.
A/Prof Kok Eng Khor
Dr Teik Tay
Dr Chimene Bhar
Dr David Gorman
Dr Sachin Shetty
Dr Benjamin Teo
Dr Candice Wallman
Dr Swapnil Sharma
A/Prof Apo Demirkol
Other health professionals
Nursing: David Begley, Bernadette Bugeja, James Tekiko, Rebecca Mallam and Rose Faisca
Clinical Psychologists: Tony Hollins and Josephine Wan
Physiotherapist: Skye Sadokierski and Edel O'Hagan
Occupational Therapist: Melissa Leong