REPORT FROM SPRINGSCIENTIFIC MEETING- “NEEDLES AND PINS”- FRIDAY 7/5/04
Dr Peter McKenzie from the SouthernGeneral Hospital in Glasgow expertly chairedthe morning session.Dr Adam Zemen, Consultant Neurologistand Senior Lecturer at the Edinburgh Instituteof Neuro-Sciences gave the first lecture. Heis married (to another Neurologist) and hasthree children. Of note, he completed a degreein philosophy prior to entering medical school.He is a prominent figure in the world of neurology and has been invited to give radioManagement Clinic who has continued to provide secretarial support to the NBPA andCouncil particularly in the organisation of meetings.
Research Group:
Mick Serpell presenteda report on behalf of the Research Groupwhich comprises of Ian Comrie, Mike Basler,Denis Martin and Ian Power. There is now aresearch database of NBPA members.Research activity is being encouraged. Fundsare available for primary research projects.Submissions for the NBPA essay competitioncould include original research.
IT Sub-Group:
Dr Robin McKinlay madea presentation on behalf of this group.Members include Andrea Harvey and JonathanBannister. The subgroup suggests that the NBPA be clearly seen as the professional voiceof pain management. The idea is to encouragemeaningful data collection across the NorthBritish Pain Association region, which isrequired for Clinical Governance. The hopeis to perform an initial survey to record the present set-up. Different methods of achievingdata collection and audit will be assessed.Funding sources will be addressed and the plan will be to work towards a minimumdataset. Constructive comments are requested.
Financial Report:
outgoing Treasurer, Dr Alan Semple, presented this. The bank balance in January 2004 stood at £41,141.21.
Secretarial Report:
Fourteen newmembers across the disciplines have beenaccepted and two members have moved outof the area and terminated their membership.
Prize Essay:
Four entries have beenreceived this year. The judging panel was Dr Nicola Stuckey, Professor Ian Power andDennis Martin. The winner of the prize for the year is Stephen Feltbower, a MedicalStudent at Edinburgh University. He will beinvited to present his work at the forthcomingWinter Scientific Meeting.asking if they can have this new wonder treatment.Brian reviewed the indications for spinalcord stimulation and the conditions for whichit is most likely to be successful. Goodindications seem to be neuropathic leg or arm pain following lumbar or cervical spinesurgery, complex regional pain syndrome,neuropathic pain secondary to peripheralnerve damage, pain associated with peripheralvascular disease and refractory angina. Poor results have been found with phantom limb pain, facial pain, spinal cord injury pain, perineal pain and genital pain. Spinal cordstimulation is expensive and there is a driveto obtain evidence of effectiveness.A small number of studies have been performed. Six on critical limb ischaemia, four on refractory angina and one each on failed back syndrome, complex regional pain anddiabetic neuropathy.interviews on several occasions. The title of his lecture was “What is consciousness”He started by asking, “How can millionsof neurones produce experience andconsciousness?” He pointed out how difficultit is, even now, to define consciousness. Thereare scientific and philosophical perspectives.Consciousness includes wakefulness,awareness and experience. The areas of the brain associated with consciousness are thethalamus and the upper brain stem. A surveyof medical students revealed that a sizeablenumber believed that the mind and soul wereseparate from the brain and there was a belief in life after death. This is startling consideringtheir scientific teaching. Brain function can be monitored with an EEG. During sleep,different patterns occur during different stagesof sleep and also during Random EyeMovement (REM) sleep. Normally duringREM sleep, the body is paralysed. There can,however, be an overlap with either sleepwalking (still asleep but able to move)or sleep paralysis (awake but unable to move).One of the most fascinating and illuminatingareas in the research of consciousness isfollowing brain injury. This sad event can givean insight into the role of the damaged areaof the brain. Different states are producedfollowing brain injury including coma,vegetative state, brain death and ‘being lockedin’. As technology advances, there is interestin the possibility of using functional MRI or PET scanning to more accurately locate theareas of brain associated with consciousness.Self-consciousness is a concept within theidea of consciousness. It is the awareness of being aware. To have knowledge about oneself and awareness of stimuli impinging on your own body. It is the basis of uneasiness in socialsituations.This was a very thought provoking start tothe day. The next lecture was equally thought provoking but on a completely different topic.Dr Brian Simpson, a Consultant Neurosurgeon from the University Hospital of Wales in Cardiff, gave the next lecture. Dr Simpson, a graduate of Cambridge University,qualified at the Royal London Hospital. Heis married, has two daughters and a passionfor motor racing.His lecture was on spinal cord stimulation,which has received an increasing profilerecently. Many a patient has arrived in theclinic clutching an article from the Daily Mail
Dr. Pete MacKenzie and Mr. Brian Simpson Dr. Kim Jobst and Dr. Adam Zeman
There are obvious blinding issues withthese studies and difficulty eliminating the placebo effect. Many studies use 50% painrelief as an endpoint, which many wouldargue, is too strict. Many treatments for chronic pain do not achieve this degree of painrelief. Dr. Simpson argued that simple painscores do not give the whole picture. Chronic pain is poorly remembered and also promptsthe memory of previous pain. There isvariability in the time of a patient’s pain andsnapshot assessments may give the wrongimpression.One method of trying to eliminate some of these problems is to switch off the stimulator for a period of time, perform pain scores, thenrecommence stimulation and repeat the scores.Pain relief in the order of 10% - 15% is mostcommonly reported.Coffee was followed by a talk from Dr KimJobst, Consultant Physician and MedicalHomeopath based in Hereford. His talk “Integrated Medicine: The Road Forward” was passionate, reflective and personal. Hereviewed how mainstream and alternativehealthcare is provided today in the UnitedKingdom.Kim firmly believes that the integration of complementary and alternative practice intomainstream medicine is the only way forward.There are a large number of complementaryand alternative medicines available and the public spend a vast amount of money on it.Why is this? Many factors are involved butdissatisfaction with the medical establishmentis one of the main causes. A common perception is that doctors will simply promotethe use of drugs and surgery against patient’swishes. Doctors have also been under attack in the media. In 1998, JAMA published a paper reporting serious adverse drug reactionsin routine hospital practice in the USA. Theyfound that iatrogenic causes were between thefourth and sixth commonest cause of death inhospital. This study was well publicised.In America, 629,000,000 visits were madeto complementary and alternative medicine in1997 compared with 427,000,000 visits in
THE 2005 PRIZE ESSAY COMPETITION
The 2005 Prize Essay Competition will beannounced at the Winter Scientific Meeting.Entrants must write an essay on the topic “TheFar Side of Pain”. The prize is £2000 to funda trip to the IASP World Congress in Sydneywith £1000 as a runner up prize for themeeting. The closing date will be 31
st
January2005. Watch out for more information on thewebsite. Flyers will be circulated. Entries will be judged by a panel who will decide if theentries are of a high enough standard to awardthe prize.
NBPA East of Scotland Team photo
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