Context and philosophy

CONTEXT AND PHILOSOPHY

Pan-European studies have demonstrated that approximately 7% of the population of Northern and Western Europe suffer from chronic pain of such intensity that a consultation with a pain specialist is warranted. This translates to about 560.000 patients in Switzerland. A single pain specialist working according to standards laid down by scientific organizations would have a capacity of approximately 300 new chronic pain patients per year. This is why a large majority of patients have to be taken care of by physicians with limited training or none.


The real problem is that pain therapy provided is limited by the knowledge and experience of the doctor the patient is consulting, it is unlikely to be based on a specific and detailed understanding of the pathology causing his pain, which most commonly remains unknown. If the patient has consulted doctors of several specialties, it is common that different therapies will have been suggested for one and the same pathology causing their pain. This explains why many patients do not report any improvement after a multitude of therapeutic efforts including spinal surgery. Our statistics, collected prospectively over several decades, show that only about 20% of patients referred to the Pain Clinic in Lausannehave a correct diagnosis explaining their pain condition at their first consultation. This number has not improved over time.


A firm belief in the general population and among doctors, not least among radiologists, is that X-rays identify the source of pain. This is almost always incorrect, a fact that has been recognised in the medical literature for more than half a century. This has not improved much with the introduction of sophisticated techniques, such as CT and MRI. The diagnostic precision in identifying the source of back pain based on a combination of the patient's medical history, clinical examination and MRI findings varies between 5% and 75%, depending on which precise pathology is the cause of the pain. The result is that a high proportion of patients with chronic low back pain derive no benefit from therapies proposed on the basis of MRI findings.


Our statistics show that close to 80% of patients consult us for pain from the spine including pain after unsuccessful spinal surgery, 15% suffer from pain from the peripheral or central nervous system, and 5% have pain from other sources. Our priority is to establish the anatomical origin of pain, or if not possible, the mechanism of pain (musculoskeletal or neurological). High precision nerve blocks done with potent long acting local anesthetic agents under fluoroscopic control, provocation testing and pharmacological techniques are used to obtain the most precise information possible. These methods allow us to obtain a reliable diagnosis for the exact origin of pain in 75 to 80% of patients referred to our Clinic.


A large majority of patients with pain from the nervous system (neuropathic pain) have pathologies produced by surgery or by a disc hernia. Sometimes, there is direct trauma to a nerve via a fracture. All new pain not resolving spontaneously within 6-8 weeks after surgery or trauma should always be suspected to be neuropathic.


The Pain Clinic in Lausanne has since its start in 1999 collaborated with other medical specialists according to an interdisciplinary model. Spine surgeons, neurosurgeons, microsurgeons, rehabilitation physicians, neurologists, and oncologists are our most frequent discussion partners at our monthly conferences. Well-known international pain physicians, also serving as teachers at our specialist training courses, may be consulted for patients with particularly complex pain conditions.


Below you will find the most common of the pain conditions we investigate in the Pain Clinic in Lausanne as well as the results of the various therapies:


To obtain further information or to make an appointment please contact us via phone or e-mail. Don’t forget to inform your family doctor and bring all medical documents, including x-rays, concerning your pain condition to your 1st consultation.