The Chronic Pain Management Service is popularly known as the ‘Pain Clinic’. This is a Specialised Clinic at Mater Dei Hospital, run by Trained Pain Specialist Consultants with the co-operation of a multidisciplinary team.

Location

The Pain Clinic Offices can be found at Mater Dei Hospital, Outpatients Department, Level 1 (near the Outpatient Administration Office).

An Outpatient Pain Clinic is held every day at Mater Dei Outpatient Department (specifically at OOP, MOP1, MOP3 or MOP4).

An Oncology Outpatient Pain Clinic is held weekly at the Oncology Hospital on Wednesday mornings and an Outpatient Pain Clinic is held once every month at Gozo General Hospital (Tel. +356 23446730).

Making an appointment with the pain clinic

The patient’s Family doctor, Primary Health doctor or another Consultant needs to complete and send a Ticket of Referral or Consultation note.

Referrals are received at the Mater Dei Hospital Main reception desks. All referrals are received through the booking office and are first vetted by the Pain Specialists before the appointments are given out and sent by post to the referred patients.

Important: There is a waiting list for first outpatient visit, for procedures and for follow up appointments. If you are unable to attend your outpatient visit or your procedure/intervention kindly contact our offices on the numbers provided as soon as possible, so that we can use the appointment for someone else.

Outpatient Visit

The patient is assessed by the Consultant Pain Specialist who will take the patient’s history, perform physical examination, evaluate investigations, establish diagnosis and treatment plan.

It is important for the patient to:

• Bring a list of any current medication
• Bring all results and medical reports of treatment done outside MDH
• Inform the doctor of any drug allergies
• Inform the Doctor or Nurse if he/she is taking anticoagulants (e.g. Aspirin, Warfarin)
• If there is any possibility of pregnancy the patient should inform the doctor or nurse
• Be accompanied by a next of kin or close friend

The Pain Management Team

The Pain Clinic Multi-disciplinary team consists of three Consultant Anaesthetists specialising in pain management and one visiting Consultant, a Practice Nurse Pain, Deputy Charge Nurse, Staff Nurse, Clerk, Nurse Aide, Two Physiotherapists, Psychotherapy Nurse, and with the co-operation of Radiographers, Theatre Anaesthetic Nurses and Day-care nurses for procedures.

Chronic Pain Conditions

The Pain Management Team offers Pain management for a variety of chronic painful conditions including:

• Chronic Low Back Pain
• Shoulder and Neck Pain
• Hip and Knee Pain
• Post-Amputation Pain
• Phantom Limb Pain
• Post Herpetic Neuralgia
• Diabetic Neuropathies
• Trigeminal Neuralgia
• Complex Regional Pain Syndromes
• Cancer Pain
• Fibromyalgia

How can the pain service help?

Chronic Pain Patients are referred as outpatients to the Pain Clinic, after experiencing pain for a prolonged period of time and the pain is having a negative impact on his/her quality of life. We define this pain as chronic pain when it has persists for longer than three months. Persistent pain is at times difficult to understand and is challenging to treat.

The doctor and other health professionals, work together with the patient to enable the latter to manage his/her pain and symptoms more effectively and to reduce the impact that pain can have on life, both physiologically and psychologically.

What can we offer to help manage a chronic pain condition?

Interventional Pain Therapy

A range of procedures are carried out at the theatre and the patient is admitted as a day case at the Day Surgery Unit (Day Care Unit).

The decision whether the condition can be helped by an interventional therapy will be taken by the pain specialist during or after the first clinic visit. Interventional therapy requires patient’s signed consent.

The pain specialist will give the patient details of the type of infiltrations or interventional treatment required and the patient will be placed on a waiting list depending on the urgency of condition.

There are various procedures that may be necessary and some may need to be repeated or followed up by other interventions at a later date.

The doctors and nurses will be more than happy to give patients the details they require and answer any questions regarding the particular treatment proposed.

Not every patient can benefit from interventional pain therapy.

Drug Therapy

As well as conventional painkillers there are other drugs that may alter the pain experience. Patients may need to be on drug therapy for several months if not for life, but the long term aim is to help patients to take fewer medications.

Transcutaneous Electrical Nerve Stimulation (T.E.N.S.)

This is a small battery-operated portable devise that aims to reduce pain by blocking pain signals. This works by passing a mild electric current through adhesive pads placed on the skin.

If TENS is felt to be appropriate for the patient, he/she is shown how to operate the devise and the machine is loaned for a four week period. If the patient finds it beneficial he/she may then wish to purchase and own a TENS machine for long term use.

On the other hand P.E.N.S. or Percutaneous Electrical Nerve Stimulation bypasses the resistance of the cutaneous barrier and delivers the electrical stimulus in closer proximity to the nerve endings. The latter, however, is a procedure that is carried out in theatre.

Physiotherapy

Physiotherapy promotes mobility, functional activity, quality of life and movement potential. The referred patient is assessed by a physiotherapist who will design a treatment plan according to patient’s needs. This involves range of passive and active exercises and movements which are evidence based to manage and improve pain.

In general terms, an active exercise program may be needed when the patient is experiencing persistent (chronic) pain. This program is individually designed for the patient by the physiotherapist and entails specific exercises which the patient can complete in his/her own time.

The physiotherapist will assess the present physical function and adapt the exercises to the patient’s personal level of attainment and overall physical health.

The Physiotherapists liaise with other members of the Pain Management Team where appropriate. The Physiotherapist may be present during the patient’s first Out-patient visit and will thereafter inform the Consultant if he/she needs to return for a visit after the Physiotherapy sessions

When the patient has persistent pain, it may hurt to exercise but it may hurt a lot more if they don’t. It only takes one week in bed for muscles to begin wasting and joints to stiffen so a stretching and strengthening exercise program can help build fitness which in turn helps to cope with persistent pain.

Physiotherapy sessions are carried out at the Physiotherapy Department in St. Luke’s Hospital, G’Mangia.

Psychotherapy

Living with pain can be very debilitating and it can be difficult to come to terms with the way it prevents someone from living their life in the way they are accustomed. Having someone professional may be enormously useful in adjusting to a different pace and pattern of lifestyle.

For this reason your Pain Specialist may refer the patient for individual psychotherapy if necessary.

Pain Management Education

The doctors and nurse give practical advice on managing life with chronic pain. Together with the patient they explore the things that the patient can do for him/herself using strategies and techniques to give more control over the pain.

Staff Training

Mater Dei Hospital is a teaching hospital and we are therefore committed to the training of staff. Anaesthetic Registrars, Physiotherapists, Pharmacists, Psychotherapists, Radiographers and Nursing Students are at times based with the Pain Team and are present during the Outpatient Clinics and Theatre Sessions as part of their training programme.