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Organization and management of a multidisciplinary pain clinic
s103
CAPSAICIN AND ANALGESIA. G. Jansco (Chairman), Dept. of Physiology, School, Szeged, Hungary
University
Medica
Participants: F. Cervero, Dept. of Physiology, Univ. of Bristol, UK H.O. Handwerker, Dept. of Physiology, Univ. of Erlangen, Republic of Germany
Federal
In recent years, the use of capsaicin as a specific neurotoxin for a morphologically well defined population of primary sensory neurones has been greatly exploited in somatosensory research. Administration of this compound to newborn animals produces a profound, permanent attenuation of nociSimilarly, local treatment of peripheral nerves with fensor responses. capsaicin results in a specific and apparently irreversible regional analgesia as does administration of capsaicin into the subarachnoid space. The actions of capsaicin on peripheral nociceptors are: excitation, temporary block, permanent block and permanent alteration of the nociceptor units. Capsaicin may influence, rather selectively, particular classes of afferent nerve fibres when applied topically or close-arterially to nociceptive nerve endings or topically to nerve trunks. Treatment of newborn animals with capsaicin results in a permanent loss of unmyelinated afferent fibres and produces functional alterations in spinal cord somatosensory systems. These changes are expressed as increases in the size of cutaneous receptive fields, reduction in the levels of tonic descending inhibition and altered somatotopic organization of the second order neurones. In addition, visceral and somatic reflexes are also affected. The possible mechanisms of action of capsaicin at peripheral and central levels and the potential use of capsaicin in pain therapy will be discussed.
ORGANIZATION AND MANAGEMENT OF A MULTIDISCIPLINARY PAIN CLINIC. John D. Loeser (Chairman), Pain Clinic, Univ. of Washington, Seattle, WA, USA Participants: Joel Seres, Northwest Pain Center, Hans Gerbershagen, Schmerz-Zentrum,
Portland, OR, USA Mainz, Federal Republic
1 of Germany
This seminar will address the key issues in the organization and management of a multidisciplinary pain clinic by drawing upon the experiences of three different multidisciplinary pain centers. Emphasis will be placed upon how to maintain and integrate the services of a wide variety of health care providers so as to conduct an effective and efficient program which is aimed at restoring chronically disabled patients to gainful activities, both at home and at the workplace. It is essential that clearcut goals for each patient be established as part of the initial evaluation. The skills of each of the health care providers must be integrated so as to produce the desired outcome. Issues such as burn-out in the health care providers, the identification of disruptive strategies and individuals, and effective leadership will be addressed. This seminar will not delve into the issues of effective treatment programs but will, instead, focus upon the selection of effective members of the treatment team, the maintenance of a group effort and the preservation of individual creativity in order to provide the best chance of success for the patient and job satisfaction for the team members.
CAPSAICIN AND ANALGESIA. G. Jansco (Chairman), Dept. of Physiology, School, Szeged, Hungary
University
Medica
Participants: F. Cervero, Dept. of Physiology, Univ. of Bristol, UK H.O. Handwerker, Dept. of Physiology, Univ. of Erlangen, Republic of Germany
Federal
In recent years, the use of capsaicin as a specific neurotoxin for a morphologically well defined population of primary sensory neurones has been greatly exploited in somatosensory research. Administration of this compound to newborn animals produces a profound, permanent attenuation of nociSimilarly, local treatment of peripheral nerves with fensor responses. capsaicin results in a specific and apparently irreversible regional analgesia as does administration of capsaicin into the subarachnoid space. The actions of capsaicin on peripheral nociceptors are: excitation, temporary block, permanent block and permanent alteration of the nociceptor units. Capsaicin may influence, rather selectively, particular classes of afferent nerve fibres when applied topically or close-arterially to nociceptive nerve endings or topically to nerve trunks. Treatment of newborn animals with capsaicin results in a permanent loss of unmyelinated afferent fibres and produces functional alterations in spinal cord somatosensory systems. These changes are expressed as increases in the size of cutaneous receptive fields, reduction in the levels of tonic descending inhibition and altered somatotopic organization of the second order neurones. In addition, visceral and somatic reflexes are also affected. The possible mechanisms of action of capsaicin at peripheral and central levels and the potential use of capsaicin in pain therapy will be discussed.
ORGANIZATION AND MANAGEMENT OF A MULTIDISCIPLINARY PAIN CLINIC. John D. Loeser (Chairman), Pain Clinic, Univ. of Washington, Seattle, WA, USA Participants: Joel Seres, Northwest Pain Center, Hans Gerbershagen, Schmerz-Zentrum,
Portland, OR, USA Mainz, Federal Republic
1 of Germany
This seminar will address the key issues in the organization and management of a multidisciplinary pain clinic by drawing upon the experiences of three different multidisciplinary pain centers. Emphasis will be placed upon how to maintain and integrate the services of a wide variety of health care providers so as to conduct an effective and efficient program which is aimed at restoring chronically disabled patients to gainful activities, both at home and at the workplace. It is essential that clearcut goals for each patient be established as part of the initial evaluation. The skills of each of the health care providers must be integrated so as to produce the desired outcome. Issues such as burn-out in the health care providers, the identification of disruptive strategies and individuals, and effective leadership will be addressed. This seminar will not delve into the issues of effective treatment programs but will, instead, focus upon the selection of effective members of the treatment team, the maintenance of a group effort and the preservation of individual creativity in order to provide the best chance of success for the patient and job satisfaction for the team members.