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ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence ZISOP The concept of the Centre for interdisciplinary.

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Presentation on theme: "ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence ZISOP The concept of the Centre for interdisciplinary."— Presentation transcript:

1 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence ZISOP The concept of the Centre for interdisciplinary pain therapy, oncology and palliative medicine Univ.Prof. Dr. Rudolf Likar Pain Clinic, General Hospital Klagenfurt Klagenfurt, Austria IINTERDISCIPLINARY PAIN CLINIC KLAGENFURT GENERAL HOSPITAL

2 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Development and implementation  1992 Establishment of interdisciplinary Outpatient Pain Department (anaesthesiology, neurosurgery, neurology, orthopaedics, radiology) at Klagenfurt General Hospital  1992 Introduction of postoperative pain service and regional anaesthesiological procedures  1993 – 2005 Organisation (planning, concept, implementation) of the international pain congresses in Carinthia  1999, 2002, 2003 Co-Organisation of the Austrian Pain Congress  1996 Introduction of and cooperation in establishing the Outpatient Pain Department at Graz University Clinic for Anaesthesiology and Intensive Medicine IINTERDISCIPLINARY PAIN CLINIC KLAGENFURT GENERAL HOSPITAL

3 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Interdisciplinary Outpatient Pain Department Purpose interdisciplinary cooperation for optimal management of inpatients and outpatients at Klagenfurt General HospitalPain: Symptom of many different diseases, interdisciplinary approach essential IINTERDISCIPLINARY PAIN CLINIC KLAGENFURT GENERAL HOSPITAL

4 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Fields of activity:  chronic pain therapy and palliative medical management of outpatients and inpatients  postoperative pain therapy  preoperative regional anaesthesia techniques  postoperative pain therapy in recovery room (evaluation – patient survey 2000 in Austria) concept “painless hospital”

5 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Pain Measurement  Pain on rest/on movement  VAS/NRS/VRS/KUSS and SMILEY  Twice daily  Documented on a chart

6 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Treatment of the following diseases/symptoms  Postoperative pain  Cancer pain  Chronic forms of headache and facial pain (migraine, tension headache, cluster headache etc.)  Neuropathic pain (trigeminal neuralgia, post-zoster neuralgia, phantom pain, central pain syndromes etc.)  ischemic pain (DST [Dynamic Sequential Thermography] III bis IV)  CRPS (Complex Regional Pain Syndrome = sympathetic reflex dystrophy and causalgia)  Chronic spinal pain syndromes  Spasticity associated pain  Pain due to central nervous disorders  Psychogenic pain

7 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Use of the following forms of therapy Use of the following forms of therapy  Oral and transdermal pharmacological treatments with analgesics and other agents used for chronic pain syndromes (anticonvulsants, psychotropics etc.)  Nerve blocks: a) reversible blocks (CT-guided, under fluoroscopic control) b) neurolytic blocks (chemical and thermal)  Radiofrequency cryotherapy (in cooperation with neurosurgery department): gasserian ganglion, peripheral nerves, facet joint denervation  Subcutaneous and intravenous administration of opioids with pain pumps

8 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence  Spinal opioid analgesia (in cooperation with neurosurgery department) a) Trial use with bolus injections, catheter with a port b) Implantation of medication pumps (volume flow controlled gas-pressure pumps, electronically programmable pumps)  Spinal cord stimulation (in cooperation with Neurosurgery Department) a) Implantation of epidural test electrodes in the screening phase b) Implantation of pulse generators  Implantation of medication pumps for intrathecal baclofen administration in spasticity (in cooperation with neurosurgery department)  TENS  Acupuncture  Provision of psychotherapeutic support (pain-coping training, behavioural therapy) and learning of relaxation methods (biofeedback, Jacobson)

9 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Pain Therapy Pain Therapy Symptomatic Treatment Options Pharmacological pain treatment Physicaltherapy TENSAcupuncture Psychological therapy therapy Physiotherapy Invasiveprocedures

10 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Year 1998200120042007 Outpatients 587 804 1.750 2.150 Follow-up examination of an outpatient 2.386 4.047 5.9276.630 Consultation activities for inpatients: 5.529 6.490 7.019 9.190 2001: total 19.074 services 2002: total 21.895 services 2004: total 21.562 services 2007: total 22.323 services

11 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence CT-guided blocks: 424 / 2001 964 / 2004 982 / 2007 Invasive procedures: 1,284 / 2001 1,950 / 2004 2.037 / 2007 (One-day surgical interventions). 25 to 30 SCS* (114.000 performance-oriented hospital financing points). * Spinal cord stimulations 10 to 15 pain pumps (220,000 performance-oriented hospital financing points). (hospital admission – Neurosurgery, Neurology, Orthopaedics and other wards).

12 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence CT-guided blockade epidurale blockade epidurale blockade

13 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence CT-guided nerve-blockade

14 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence CT-gezielte Blockadebehandlung

15 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Shim JK, Moon JC, Yoon KB, Kim WO,Yoon DM. Ultrasound-Guided Lumbar Medial-Branch Block: A Clinical Study With Fluoroscopy Control. Regional Anesthesia and Pain Medicine 2006; Vol. 31 No. 5 September – October 2006 Ultrasonographic cross-axis view with the needle at the groove of the transverse process adjacent to the superior articular process. SP, spinous process; TP,trans-verse process; AP, articular process; Lat,lateral; Med, medial

16 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Ultrasonographic longitudinal paravertebral view with the needle at the cephalad margin of the transverse process. TP, transverse process. Shim JK, Moon JC, Yoon KB, Kim WO,Yoon DM. Ultrasound-Guided Lumbar Medial-Branch Block: A Clinical Study With Fluoroscopy Control. Regional Anesthesia and Pain Medicine 2006; Vol. 31 No. 5 September – October 2006

17 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence HLST_CodeType of Activity20072008 IBL_7832CONSULTATION WITH AN IN-PATIENT10.17411.417 IBL_7803CLINICAL FOLLOW-UP EXAMINATION OF AN OUT-PATIENT9.42611.500 RZI_4774Pain-pump check postop.2.5694.335 IBL_7425AUTOMATIC MEDICATION APPLICATION4.0692.638 IBL_4550PDA PER DAY postop.3.1172.801 IBL_3496STANDARD MONITORING/epidural blocks,sympathetic blocks2.3083.046 IBL_8612Acupunture1.3721.978 IBL_7782First consultation with an out patient1.4001.069 IBL_8617Lumbar nerve blockade CT guided716811 IBL_7825Consultation with an out-patient917599 UNF_205INFILTRATION4741.032 IBL_3490PLEXUS ANASTHESIA806233 IBL_8614INTRADERMAL434554 IBL_8613TENS per day309470 IBL_8615Cervical nerve blockade CT guided134203 RZI_5304Facet blockade US guided79242 total40.46543.918

18 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Interdisciplinary OUTPATIENT PAIN DEPARTMENT CONSULTING ACTIVITIES Chronic- 80 % cancer pain patients pain- 20 % chronic non-cancer pain syndromes OUTPATIENT - 30 % cancer pain patients - 70 % chronic non-cancer pain syndromes Acute pain postoperative pain therapy 2 rounds daily Outpatients Referred by GP Referred from other general hospital outpatient department former inpatients

19 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Interdisciplinary OUTPATIENT PAIN DEPARTMENT INTERDISCIPLINARY OUTPATIENT PAIN DEPARTMENT PATIENTGENERAL PRACTITIONER HOME CARE PAIN CONFERENCES (intramural and district advanced training for physicians and nursing personnel) TRAINING OF NURSING PERSONNEL AND PHYSICIANS International and national CONGRESSES

20 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Interdisciplinary centre for pain therapy and palliative medicine (ZISOP) Centre of Excellence (Austrian Pain Society) Klagenfurt General Hospital Anesthesia and intensive medicine Neurosurgery Neurology Orthopaedics Radiology Physical medicine, clinical psychology, oncology, surgery, radiotherapy, nuclear medicine Outpatient department times: MO – FR 7 a.m. – 2 p.m. Tel. ++43 463 538 23720 Fax. ++43 463 538 23722 IINTERDISCIPLINARY PAIN CLINIC KLAGENFURT GENERAL HOSPITAL

21 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Palliative ward „local competence Team“ (14 Beds) Out-patients Family physician Hospice Service Out-patient home - care Daytime hospice Palliative Team

22 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence PALLIATIVE CARE DEFINITIONS Palliative care is the active, holistic care of patients with advanced, progressive illness. Management of pain and other symptoms and provision of psychological, social and spiritual support is paramount. The goal of palliative care is achievement of the best quality of life for patients and their families. Many aspects of palliative care are also applicable earlier in the course of the illness in conjunction with other treatments.

23 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Change of paradigm in palliative care Palliative Care cannot only be defined by the stage of disease but by the actual needs of the patient and his family

24 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Number of Patients – palliative care unit 295 322410

25 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Diagnosis (in %)

26 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Reason for admittance (in %)

27 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Average hospital stay in days

28 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Type of discharge (in %)

29 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence 3 mobile palliative care teams –Interprofessional (physician, nurse, psychologist) –Support of general practicioners and nurses, when palliative patients are at home or in nursing-home –„bridge“ between palliative care unit and home care –Project of Carinthian government, free of charge

30 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Institutions of Palliative Medicine in Carinthia

31 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence The terminal patient may stay at home in the last weeks of life Palliative care is available around the clock He may die without pain in the family circle

32 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence

33 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Course: Decompressive laminectomy Th 7 and placing of fixateur interneDecompressive laminectomy Th 7 and placing of fixateur interne complete transection at Th 7complete transection at Th 7 weakness of the upper extremities following possibly old injuryweakness of the upper extremities following possibly old injury Patient, male, 62 years old

34 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence  Intensive care 10.09.04 – 10.03.05 Reason for hospitalization: The patient felt tingling in both legs for several hours and increasing pain in the mid thoracic vertebral region. The patient felt tingling in both legs for several hours and increasing pain in the mid thoracic vertebral region.Diagnoses: compression fracture Th6 and Th7 with severe compression on vertebra Th7 and compression of the myelon, slightly less compression on Th6compression fracture Th6 and Th7 with severe compression on vertebra Th7 and compression of the myelon, slightly less compression on Th6 marked COPDmarked COPD osteoporosis associated with long-term cortisone therapyosteoporosis associated with long-term cortisone therapy Patient, male, 62 years old

35 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Admittance with acute respiratory insufficiency Local infection at the operative site - removal and reimplantation of material Difficulties in mobilization - Decubitus sacralis (attempt at plastic covering only moderately successful) Difficulties in establishing feeding - PEG tube implantation Delay in withdrawal of artificial ventilation, repeated episodes of pneumonia and atelectasis - tracheostomy, weaning up to adjustment to home respirator

36 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence  Admittance to palliative ward 10.3. – 25-03. 2005 stabilization of general conditionstabilization of general condition induction of future careinduction of future care organization of home help for the patient and organization of antidecubitus mattressorganization of home help for the patient and organization of antidecubitus mattress organization of home respirator and oxygen supply serviceorganization of home respirator and oxygen supply service introduction of the management by mobile palliative teamintroduction of the management by mobile palliative team

37 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence

38 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence 10 inpatient beds: partially implemented for two patients with back pain, two patients with headache, two patients with neuropathic pain, two patients with articular or myofacial pain, two patients with lower abdominal pain (networking with obstetrics and gynecology) 5 part-time inpatient treatment places (interdisciplinary pain day-clinic) 14 beds for palliative ward (networking with interdisciplinary pain centre / oncology) Night duty up to 10 p.m. Area of responsibility: chronic pain therapy, palliative, acute postoperative pain therapy

39 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence Mission statement – ZISOP  We are a multiprofessional interdisciplinary team located in Klagenfurt General Hospital – specialists under one roof.  We offer our patients individualised holistic care with curative and palliative intention with the aim of maintaining / improving quality of life.  We care for people with acute /chronic pain, malignant diseases and neurological illnesses.  Our research and teaching focus on improving people’s quality of life.  We are a team characterised by medical and human competence, openness, reliability, flexibility, tolerance and willingness to continuously learn and develop.  We aim at achieving high efficiency combined with the careful use of available resources.

40 ZISOP - Zentrum für interdisziplinäre Schmerztherapie, Onkologie und Palliativmedizin, Center of excellence THANK YOU FOR YOUR ATTENTION! If you have any questions to this presentation please contact me per e-mail: tamara.kreuter@kabeg.at


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