The role of injection procedures in a multidisciplinary chronic pain clinic

Background and aims
Chronic pain is an increasing health burden in society, and multidisciplinary (MDT) clinics are the recommended approach to patient management (1). A National survey of UK pain clinics in 2015 (2) showed the composition of MDTs are variable and injection rates are high, with >61% of clinics injecting >25% of patients. There is limited evidence for success rates for injection procedures and how these may be beneficial in chronic pain.
 
This study presents the results from 8 months of data from a multidisciplinary pain clinic in a UK District General Hospital, measuring injection referral and success rates. Our pain clinic comprises physiotherapy, psychology and pain consultants. The team discusses every patient, and appropriateness for injection is agreed. If indicated, patients are referred for physiotherapy following injections. 

Methods
A database of all patients seen in the MDT pain clinic was analysed from January to August 2018. For each month we measured total patients seen in clinic, patients referred for injection, procedures undertaken and outcome. 

Results
A total of 371 patients were included, 50 were referred for injection, giving a 13% rate of referral. A total of 56 injection procedures were undertaken, with a successful outcome in 41 procedures, giving a success rate of 73%.

Conclusions
Our Pain Clinic has a low referral rate for injection, with high success rates for patients undergoing injections. This is facilitated by the MDT input, careful patient selection, and appropriate timing of physiotherapy following injection. The data show that injections have an important role within MDT clinics, in carefully selected patients.


(1) NHS England: Specialised Services for Pain Management (Adult)
(2) British Journal of Pain 2018, Vol 12(1) 47 - 57

4 - The role of injection procedures in a multi-disciplinary chronic pain clinic