Chronic Pain Management Revolutionized

Uploaded by SunnybrookMedia on 09.10.2007

The procedures are
sort of interventional procedures for chronic pain management.
We concentrate more on the diagnostic part rather than treatment.
The importance of the diagnostic injections
is to figure out if the
future treatment may help or not.
We used to do diagnostic injections fluoroscopy,
which is x-ray,
the problems with x-rays
are many:
radiation exposure,
additional personnel,
so that usually patient needed to have
several trips to hospital
to have the procedure done with fluoroscopy.
With ultrasound
we can do
exactly the same
procedure with same quality but
just at the end of the appointment.
We do the appointment, its finished, have a treatment plan and a diagnostic plan and we
do procedure right away.
To our knowledge we are the first academic center in the country...
Just recently I came back from Europe and I had discussion with European group
ultrasound for chronic pain
people from Vienna and Bern.
According to all
we're only one centre in Canada
and the second centre in the USA. We started
approximately the same time
Sunnybrook and Cleveland Clinic Foundation
and we do slightly different things but the same area of chronic pain.
We plan now the research...
the major issues are standards of care.
So if we want to change standards of care we need to provide
first-line evidence based medicine
which means it's been
for a while that we used to use fluoroscopy for diagnostic injection for example neck joint.
To convince medical community that
we can do
the diagnostic
test with ultrasound
we should provide research.
Predominantly we see spinal pain,
chronic lower back, chronic neck pain,
We see the shoulder pain, chronic shoulder pain,
and less but more and more we see cancer pain.
So cancer pain is another venue for
ultrasound application for treatment.
First of all very obese patients
the current technology isn't perfect
to penetrate into the depth.
And patients with extremely degenerative changes of spine
I would prefer just to use fluoroscopy as a standard
rather than ultrasound,
because I cannot see the clear landscape of the bone
on the ultrasound when the degenerative changes are severe.
Many people now are more and more interested...
we do workshops for doctors here
and more global
planning is to get together all groups
from North America and Europe and South Korea
to discuss the education and research project of ultrasound in pain medicine.
Another very interesting development is 3D ultrasound so we know 3D ultrasound in gynaecology
we see the baby and face and everything is nice.
So now we do have
technology for chronic pain management.
It's coming, actually it's here.
but we still don't have knowledge of technology and picture
so one of the plans is to start to use 3D ultrasound
to see the landscape into the path of the nerve and see the progress of
the medicine around the nerve.
So it will be very
very interesting.
So they referral to our clinic is very simple as any other academic centre
through family doctor or any referral doctor, an orthopaedic surgeon, neurologist, neurosurgeon.
It goes through the process of selection
because our clinic is
predominately interventional pain management facility, we cannot see all patients
but the patients that we see
and select for specific procedures
we do these procedures
using different tools including ultrasound.
There's not much information unfortunately on the web
regarding ultrasound.
There's lots of information about
ultrasound and regional anesthesia. Not so much on pain.
Still you can find
at the site
ultrasound and regional anesthesia
with the nice pictures of ultrasound imaging
mostly for general anesthesia, some for pain.
But at least you get the impression what does it mean to see nerve
under ultrasound.