PAIN CLINIC: THE MELBOURNE EXPERIENCE
Over the past 11 years in Melbourne, a private pain clinic has been closely associated with university departments of psychiatry and also a private psychiatric clinic. During this time, about 800 patients a year have been assessed and treated as outpatients and another 120 to 130 a year in the four-week in-patient programme over the past four years.
About 70 per cent have been women with an average age of 35. The major conditions treated have been neck and back problems resulting from industrial and motor vehicle accidents. Other conditions treated included chronic headache, abdominal pain and repetitive strain injury.
In the early days, the link was established by the common interests within the University of Melbourne’s Department of Psychiatry and later by the involvement of a private psychiatric clinic.
A pilot programme was established to involve patients with chronic pain in a weekend pain management programme through the common interests of the various medical and para-medical people, such as psychiatrists, physiotherapists, general practitioners and psychologists involved in these areas.
From approximately 1979 until late in 1985, weekend pain programmes were held at the Melbourne Clinic on at least fifteen occasions. These have since been replaced by a longer, more involved programme. On each of these weekends, approximately ten patients would be admitted to the Melbourne clinic where they would be assessed by a multi-disciplinary team and given a virtual ‘smorgasbord’ of treatments over a two-day period.
These treatment methods included TENS therapy, laser acupuncture, hypnosis and biofeedback as well as orthodox physiotherapy. During this time, they were given lectures on the origin of pain, how pain affects the individual and how they could cope with their pain in the wider circle of their family, employers and friends.
The programme proved extremely helpful, with a large number of patients reaping rewards from relatively brief periods of hospitalisation. But it was recognised early on that there were deficiencies within the programme since there was little follow-up and patients often returned to country homes. In so doing, they lost the impetus they had gained from the programme.
In late 1985, the Melbourne Clinic established a ten-bed inpatient programme. This is now called the Pain Management Unit. Traditionally, chronic pain units have been established by anaesthetists, surgeons and physicians with the occasional clinical psychologist being involved.
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