Gwent Healthcare NHS Trust
The Polyneuropathy Pain Clinic was established in May 2004 to correctly diagnose and treat pain improving the mobility and wellbeing for people with diabetic neuropathies. The clinic operates in conjunction with the Diabetes Foot Clinic in order to prevent ulcerations and amputations.
To reduce pain and improve the mobility and wellbeing of people with diabetes experiencing neuropathy
A one monthly multidisciplinary clinic is held, led by a consultant in pain medicine. The team includes a clinical nurse specialist and clinical psychologist. People with diabetes are referred from the diabetes service or the diabetes foot clinic and are seen within eight weeks of referral. Four people with diabetes are seen at each clinic session.
During the session the following are assessed:
- Mobility score (using the Get up and Go test)
- Identification of pain syndromes
- Domiciliary arrangements for a safe environment
- A view is gained of the persons emotional and psychological well being and family relations
A physiotherapy and occupational therapy questionnaire is also used.
People are offered comprehensive treatment involving correction of medication to more appropriately cover the newly diagnosed types of pain, invasive interventions with local anaesthetic peripheral blocks, spinal nerve injections, spinal joints and intra-articular injections, individual physiotherapy and psychology if needed. Some people have also been referred to Occupational therapy departments for domiciliary assessment.
An educational programme of two/ annual seminar(s) has also been developed to help boost motivation and support self management for people with diabetes attending the clinic and their family and offers an opportunity for people to meet and talk with one another.
The seminars consisted of: formal lectures on - weight management, diet for people with diabetes, appropriate shoe wear, as well as a relaxation class and group exercise class
A lecture on diabetes related neuropathy – what it is and what can be done about it
There is a session entitled: “ask your pain consultant, ask your diabetologist, ask your pain nurse, ask your dietician, ask your pharmacist”
Advice on medicines concordance
Demonstrations of ankle exercises to help improve mobility
A hand out with information is also given to participants.
Participants also produce artwork of what they want to do and where they want to be, discussed personal experience with management of their neuropathy and their achievements in getting back to motivation and self management.
Participants are then given a quiz to complete within a month of attending the seminar and are also asked to write a 150 word essay on diabetes related foot complications.
People are given a printout of the exercise programme to take home.
In diagnosing the patient’s pain we have been able to identify previously undiagnosed neuropathies, as well as musculo-skeletal pain.
With an average duration of treatment of 6 months our patients report 50% reduction of pain on average, have achieved 15% improvement in mobility score, with no ulcerations or amputations. Patients’ experiences were audited and 78% were very satisfied with the clinic and 50% were better after 18 months of treatment. Again here were no ulcerations or amputations.
The seminars have been highly appreciated by participants who wrote that they have found friends, feel motivated, and will try to follow the exercise programme.
The clinic is inexpensive to run:
The clinics needs 6 hours/month of consultant in pain medicine time,
5 hours/month of clinical nurse specialist time,
1 hour/month of clinical psychologist time.
At the moment the seminars are funded by private donations. There is no funding for domiciliary visits of the most disabled patients, no separate funding for individual physiotherapy, no funding for pharmacist’s review of medication and nurse follow-ups.
The essays were a moving account of peoples’ experiences.