Welcome to the website of the DC|Pain Centre in Roermond
DC Klinieken Roermond (The Netherlands)
www.pijnpolikliniek.info October 4, 2011
At this website, one can find general information about pain and specific information on pain syndromes and pain treatments as practiced in our department.
Anesthesiological pain management, usually implies invasive pain treatments (needle-stick treatments), Although anesthesiologists initially became involved in pain mamangement because of their knowledge of regional anesthesia, modern pain treatment is by no means limited to such techniques. To manage pain adequately, a physician must have broad knowledge of the underlying causes of pain, including the social and psychological factors involved. Also, many patients are better off with non-invasive treatments, both physical and medicinal. One can find information on a wide variety of treatments on this website.
Our way of thinking on the subject of pain was influenced to a large degree, by the French philosopher, Rene Descartes, who was living in Amsterdam at the time. At the end of the eighteenth century, he developed a theory by which pain was explained as a simple signal that was transferred from the skin, and other structures, to the brain. Pain was seen as a sign of structural tissue damage, that required an adequate response, in order to prevent further damage. This so-called Cartesian Pain Model influenced our way of thinking until well into the sixties. The scientific community has long since abandoned the Cartesian Model, but non-scientists still tend to explain pain in terms of this model.
The French philosopher Rene Descartes was to first to propose a theory on pain
in the late 18th century.
In reality, the situation is far more complex. The old model cannot explain many of the phenomena that we commonly observe in chronic pain patients. Besides signals that originate in the skin, bones and organs to the brain stem, there are ather signals that run from the brain back down to the spinal cord. In the dorsal horn of the spinal cord, there is an important processing center. According to the theory first proposed by Melzack and Wall in the sixties – the so-called Gate-control Theory – pain signals that enter the spinal cord can be transferred to the brain or not, depending on whether or not the gate is open or closed. The result is that sometimes minor tissue damage can result in severe pain, whereas severe tissue damage is sometimes painless.
It is becoming increasingly clear that chronic pain is not merely a symptom of some underlying disease, but is often a disease in its own right. The expectation that someday, chronic pain would be a thing of the past, because of the effectiveness of invasive nerve blocks, proved to be an illusion. Although a major proportion of chronic pain patients, can find relief in this way, many patients will continue to experience pain in spite of such treatments.
The diagnosis and treatment of pain are not the exclusive terrain of the anesthesioligist. Adequate treatment of pain requires collaboration with neurologists, orthopaedic surgeons, psychologists, psychiatrists, oncologists, rheumatologists, physical therapists, social workers, rehabilitation medicine, and pain nurses.
The most important pain syndromes are:
- chronic low back pain
- neck pain and whiplash
- thoracic pain
- complex regional pain syndrome type 1
- cancer pain
- chronic postoperative pain
- neuropathic pain
- facial pain
Treatment can consist of medication, injections, radiofrequency lesioning, pulse radiofrequency lesioning, nerve stimulation (TENS) or iontophoresis (transferring drugs through the skin with the help of electric current). Some patients are presented in a multidisciplinary pain commission. Sometimes patients may be referred elsewhere for further treatment.
Corticosteroid injections and radiofrequency lesions make up the groep called invasive pain treatments. These are generally done as day-case procedures. Admission generally lasts abou two to three hours. Patients in day-case treatment are requested to take along a bath robe and slippers. They are taken to the treatment room by wheelchair. Iontophoresis is done on an out-patient basis.
Many of the invasive procedures can be quite painful. In most patients, local anesthesia and reassurance, can make the procedure acceptable. However, for some patients no amount of reassurance will placate them. For those being treated by Dr. de Jong, sedation can be provided in accordance with national guidelines, regarding sedation. Sedation results in a reduced consciousness, to a point that makes the treatment acceptable.
The results of pain treatments are not unequivocally positive. The majority of patients experience a significant prolonged reduction in pain. Although some patients are pain free after treatments, others must settle for minor pain relief or no pain relief at all. It is important not to raise one’s expectations too high, in order to avoid disappointment..
On this website, one can find information on various pain syndromes and their treatment. Ther are also links to various professional sites as well as patient societies. There is also information on the treatment of postoperative pain and labor pain, although these are not strictly chronic pain syndromes.
Patients requiring sedation are also screened in advance, to optimize safety. An anesthesia nurse is responsible for monitoring the patient.
Pain signals enter the spinal cord by way of the dorsal horn.
This is where the "gate" is located.
This website is the intellectual property of P.C. de Jong. He is the author of all the information posted on the site. The domain name is owned by the webhost. Information is intended for patients en health care providers provide free of charge. However, reproducing this information for commercial or other purposes should be done only with the author's permission and reporting of the source.
The New DC|Pijncentrum Roermond opened its doors on October 1, 2011. In the first three months of operation, more than 600 patients have been seen. This is a phenomenal amount of patients for such a clinic. It was only with the greatest effort, tht we were able to prevent the waiting time for treatmenst from becoming unacceptably long. Starting in2012, we will expand, by admitting new colleague to our clinic. Dirk Peek, who also practises in nearby Weert, works with us two days a week. On Tuesdays he holds consultations in Maastricht and on Fridays in Roermond. This increases our capacity to treat patients by 50%, and improves the continuity of care by making a liason with the Hospital at Weert.
Our clinic is of course multidisciplinary by nature. We have our own Physiotherapist, Koen Overdijk, and a neurologist. Further support from a psychologist will come from the Buro van Rosmaalen. These are conditions for a multidisciplinary approach to difficult pain conditions.
Snce October 2013, we are collaborating with the Rughuis, which specializes in physical therapy, kinematics and psychology. Patients who we treat in common, are discussed once a month.