The MNH Chronic Pain Clinic
TABLE OF CONTENTS
I. Introduction...... 2
II. Chronic pain...... 4
III. Team members • Neurosurgeon...... 7 • Neurologist...... 7 • Anesthesiologist...... 7 • Clinical Nurse Specialist (CNS)...... 8 • Nurse Clinician...... 8 • Psychologist...... 8 • Physiotherapist (PT)...... 9
IV. Chronic Pain Clinic • Your visit to the clinic...... 10 • Directions, access, public transport...... 10
VII. Additional resources and information...... 12
1 I. Introduction This brochure describes the services offered at the Montreal Neurological Hospital (MNH) Chronic Pain Clinic. It also answers questions you may have when coming to the clinic.
At our clinic we treat chronic pain related mainly to neu- rological diseases*. We treat many of these problems with neuromodulation. This is when we insert a device in your body to ease pain, spasms and stiffness. One device is called a neurostimulator. This is a machine that sends tiny electrical pulses to your nerves or spinal cord. These pulses block the pain message from getting to your brain.
Another kind of neuromodulation is an intrathecal pump. This pump is inserted in the abdomen and it infuses small amounts of pain medication into your spinal fluid.
We also use medicine taken by mouth or by injections to treat the pain. In some cases we use a nerve block, which is a treatment for a specific painful area.
If you would like to be treated at the Pain Clinic you will need a referral from your doctor.
The clinic is located on the 2nd floor of the Montreal Neurological Hospital, room 201. The hours are Thursdays from 8 a.m. to 4 p.m. and Fridays from 8:30 a.m. to 11:30 a.m.
The MNH Chronic Pain Clinic is associated with the MUHC Pain Centre located at the Montreal General Hospital. The two teams work closely together.
*Neurological diseases: dysfunction or injury to the peripheral or central nervous system
2 How to contact us The administrative secretary of the MNH Chronic Pain Clinic can be reached Monday to Friday from 8 a.m. - 4 p.m.
By phone: 514-398-5976
By fax: 514-398-2304
3 II. Chronic Pain Pain is an uncomfortable feeling that tells you that something may be wrong in your body. Pain that lasts for a short time (like after surgery) is called acute pain.
Chronic pain is when pain lasts longer than the expected time for healing. This usually means more than three (3) months. It could be caused by an injury, surgery, or an illness such as arthritis or cancer. Sometimes the cause of the pain is not known. Chronic pain is considered a disease in itself.
Chronic pain can last for years and can affect your quality of life. It can cause sleeping difficulty, mood changes, depres- sion, and other problems.
There are many types of chronic pain. At the MNH pain clinic we focus on neuropathic pain conditions. This is pain that comes from the nervous system. It may be caused by injury or disease or the cause may not be known.
4 Pain measurement Only one person knows how much it hurts and this person is you. The only way we can measure your pain is by what you tell us. We use a rating scale to try to measure the pain you are feeling. We can then see how helpful our treatments are for you.
We use a scale of 0-10, with 0=no pain, and 10= pain as bad as you can imagine.
Pain Intensity Scale 0 1 2 3 4 5 6 7 8 9 10 No pain Pain as bad as you can imagine
5 Pain treatment At the MNH Pain Clinic we have many ways of treating pain:
¥ Medicine taken by mouth.
¥ Treatments, such as: • Nerve blocks • Intravenous infusions (slowly dripping medicine into a vein) • Trigger point injections (inserting medicine into tight, painful areas of muscle).
¥ Neuromodulation methods, such as: • Neurostimulation (a device that sends tiny electrical pulses to your nerves or spinal cord) • Implanted pain medication pumps
¥ Other methods, such as: • Breathing exercises • Relaxation • Distraction • Use of heat and cold • Learning ways to cope with pain
¥ Surgery
6 III. Team Members Our Chronic Pain Clinic has a large team to treat your chronic pain. The team includes an anesthesiologist, a neurologist, a neurosurgeon, nurses, a psychologist and a physiotherapist. At our clinic you might be seen by one or more of these team members according to your condition.
Neurosurgeon Neurosurgeons are doctors who specialize in surgery of the brain, spine and other parts of the nervous system. In the Chronic Pain Clinic, the neurosurgeons specialize in the treatment of neuropathic pain using surgery. They may use implanted devices such as neurostimulators or pain control medication pumps.
Neurologist Neurologists are doctors who examine the nervous system, make a diagnosis and a treatment plan. Neurologists in our clinic have special training in neuropathic pain.
Anesthesiologist Anesthesiologists are doctors who specialize in pain medicine. They provide this care to patients before, during and after surgery. They treat pain by using medicine taken by mouth, nerve blocks, spinal injections and other methods.
7 Psychologist During your treatment at our clinic, you may meet with a psychologist. This is to see if a pain control implant is a good choice for you. The psychologist will also assess how well you can control your pain and may suggest methods or programs that can help you.
Clinical Nurse Specialist The Clinical Nurse Specialist (CNS) coordinates clinic activi- ties. This nurse will see you at the clinic, ask you questions about your pain situation and explain what are the treat- ments that can be offered at the clinic. The Clinical Nurse Specialist is a resource person for you and your family who can provide you with information about drug therapies, surgery options and community resources.
Nurse Clinician During your visit to our clinic, the Nurse Clinician (NC) will ask how you are doing on a daily basis and how you are managing your pain overall. She will also ask about any side effects of your medi- cine. She will want to know if you can do activities, how you are sleeping and about your mood. She acts as an important link between you and the other members of the team. For patients with an implanted device, the nurse clinician will check the batteries and make sure it is working well. She will refill the pump as prescribed by the doctor.
8 Physiotherapist During your treatment at our clinic, you will meet with a physiotherapist. First, the physiotherapist will find out what move- ments you can and cannot do, how well you can walk and test your balance. The physiotherapist may recommend walking aids, such as a cane or walker, help set up an exercise program from your home or refer you to a program in your community.
9 IV. The Chronic Pain Clinic
Your visit to the clinic You will need a medical referral to be seen in the MNH Chronic Pain Clinic. Please send or bring to the clinic com- plete information about your health history. Bring a list of the medicine you are taking now and have taken in the past. You can get a list from your pharmacy. Bring the results of any test, like X-rays and MRI. The administrative secretary will contact you to set up a first appointment as soon as possible.
Directions: How to get to the MNH Chronic Pain Clinic? Parking Parking near the hospital is limited. Some metered parking is available on University Street. Handicapped entrances are north of the main entrance on University Street, or through the ambulance entrance at the rear of the hospital. There is a parking lot on University Street above the main entrance to the hospital. There is a fee for this parking.
10 By Metro The nearest metro station is McGill on the green line. This is located at the corner of University Street and de Maisonneuve Boulevard. The McGill metro will allow you to get out on University Street. There is a 10 to 15 minute walk up a hill to get to the hospi- tal. If you have difficulty walking, you may want to take a taxi up the hill.
If you take the 144 bus from the Atwater or Sherbrooke metro stations it will stop at University and Pine. This is much closer to the hospital.
By Bus • #144 at Pine Avenue and University Street • #107 at Pine Avenue and Doctor Penfield Street. • For the most direct route, contact the STM (Société de transport de Montréal) Tel: 514 288-6287 (A-U-T-O-B-U-S)
Website: www.stm.info
11 Additional resources and information The Neuro-Patient Resource Centre of the Montreal Neurological Institute and Hospital offers the following services: • Books, pamphlets and articles about your condition • Research by a medical librarian to answer your questions • Community resources • Computers with Internet access for your needs
All our services are free and confidential We invite patients and their families to come and visit us!
Montreal Neurological Hospital (room 354) 3801 University Street, Montreal, H3A 2B4 Tel: 514 398-5358 Fax: 514 398-5275 Email: [email protected] http://www.infoneuro.mcgill.ca
12 Internet Resources Canadian Pain Society: www.canadianpainsociety.ca
www.Canadianpaincoalition.ca
International Association for the Study of Pain; www.iasp-pain.org
Paincare.org
Pain.com
Partnersagainstpain.com
La société québécoise de la douleur: www.sqd.ca
Douleurchronique.org
www.douleurexpliquee.ca
13 Authors Claire Nehmé, Clinical Nurse Specialist, MNH Pain Program/Clinic Catherine Ciaravola, Nurse Clinician, MNH Pain Clinic
Consultants Cheryl Gauvin, Nurse Clinician, MNH Pain Clinic Barbara Taugher, Nurse Clinician, MNH Pain Clinic Dr Line Jacques, Neurosurgeon, MNH Pain Clinic Dr Bobbi Popovec, Anesthesiologist, MNH Pain Program/Clinic Dr Angela Genge, Neurologist, MNH Pain Clinic Eileen Beany Peterson and Julia Asselstines, Neuro-Patient Resource Center.
Produced by the Neuro-Patient Resource Centre 2009
14