Background Pain is one of the most frequently encountered symptoms in palliative care patients, and poorly controlled pain is debilitating. Two-thirds of terminally ill cancer patients report moderate to severe pain (van den Beuken-van Everdingen, Hochstenbach, Joosten, et al. J Pain Symptom Manage. 2016; 51(6): 1070 – 1090). Up to 10% of patients fail to gain adequate analgesia with oral medication, and many are troubled by significant side effects (Bhaskar. Postgrad Med. 2020;132(S3):13–16). Despite National Institute of Clinical Excellence (NICE) guidance in 2004 advocating for each regional Cancer Network to have a ‘named specialist for advanced pain management techniques’ (NICE: Improving supportive and palliative care for adults with cancer. Cancer service guide [CSG4]), joint consultations with palliative care were rare in 2007 (Kay, Husbands, Antrobus, et al. Palliat Med. 2007;21(4): 279–284) and remain so still (Bhaskar. 2020).
Aim To evaluate the impact of a combined monthly complex pain management multi-disciplinary team (MDT) meeting, spanning hospital and community palliative care services.
Method Beginning in July 2021 monthly meetings were set up using Microsoft Teams to facilitate remote access, and invites sent to community and hospital palliative care teams along with colleagues in the acute and chronic pain teams. In mid-2022 this expanded to include colleagues from paediatric pain management. Patients are informed in advance that their case will be discussed by the MDT, and consent is obtained for information to be shared via the ‘Combined Health Information Exchange’ in Hampshire.
Results 15 meetings were held over 21 months. 53 patients in total were discussed, meaning there were three or four patients each time (range two – seven). Nine interventional procedures followed directly from these discussions, most of which were carried out in a hospice setting. These included two fascia-iliaca blocks, three erector-spinae blocks (two accompanied by serratus anterior blocks), a greater occipital nerve block, a para-sternal intercostal block, and a supra-scapular block. All the procedures produced some short-term benefit, with no immediate or subsequent adverse consequences.
Conclusion Establishment of a combined complex pain management MDT involving palliative and pain specialists has improved patient access to interventional pain management procedures. It has also provided an opportunity to network with colleagues across boundaries and share ideas promoting best practice.
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