Patient Case Study: Chronic Pain Clinic Consultations
Chronic Pain Clinic Consultations, between a Chronic Pain Consultant and a female patient with abdominal pain
Dr Steven Allen, is a Locum Consultant in Pain Management at Churchill Hospital, Oxford, Oxford Radcliffe Hospitals NHS Trust. This Patient Case Study video is made up of four parts and is based on series of chronic pain clinic consultations with a female patient (actor) with abdominal pain (no current diagnosis). The history so far is that her pain is very difficult to manage. She was referred by her GP.
Part1 (00.00 - 25.32)
In the first consultation the patient is very angry, defensive and unhappy with her management to date. It shows how Dr Allen approached the situation to assess her and to start building a better patient:doctor relationship. He identifies that in addition to the abdominal pain, she has neuropathic scar pain and makes some changes to her pain management. He asks her to start reducing her opioid and adds in a local anaesthetic patch.
Part 2 (25.32 - 35.09)
In the second part of the video, she returns to clinic for the next consultation. She is much calmer and there is a better rapport between them. She has introduced and continued to apply the local anaesthetic patch. It has reduced the scar pain, but the abdominal pain and poor sleep are still a problem. He now introduces an adjuvant analgesic - an anti-convulsant. He also mentions the role of a Psychologist in helping patients with chronic pain and the role of ‘pacing’.
Part 3 (35.09 - 41.10)
In this part, the patient returns for a fifth and final appointment. She has stopped applying her patch, as she found them a ‘problem’ to use, but has been taking the anti-convulsant. She feels a bit better and the scar pain has reduced.
Part 4 (41.10-50.03)
Finally, Dr Allen reflects on the patient with the pain clinic nurse, in terms of the progress made and some other treatment options that may have been appropriate.
Key message
The patient:healthcare professional relationship can be affected in patients with long terms conditions. It is important to undertake your own assessment of the patient, their understanding of the pain and its impact. This allows opportunities to correct any myths and misconceptions they may have about their pain and its management and how different forms of treatment and different types of healthcare professionals can help.
Key words
Abdominal Pain
Chronic Pain
Angry Patient
Chronic Pain Clinic
Chronic Pain Consultation
Patient / doctor interaction
Psychosocial
Scar pain
Neuropathic Pain
Opioids
Anti-depressants
Anti-convulsants
