Background: In response to COVID-19, the authors used clinical psychology resources from their ho... more Background: In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas. Aims: The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated. Methods: A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention. Findings: Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback. Conclusion: Establishing a supportive service that included psychology benefited both staff ...
The coronavirus disease 2019 (COVID-19) pandemic has mandated telehealth adaptations. Communicati... more The coronavirus disease 2019 (COVID-19) pandemic has mandated telehealth adaptations. Communication in the pain consultation is a complex interplay of nonverbal visual cues and behaviors. The crucial "therapeutic alliance" can be difficult to establish with telehealth. 1 Although telehealth offers a viable alternative, there are concerns over accessibility, clinical limitations, 2 and benefit. 3 Our secondary care service for chronic pain established a remote telehealth follow-up clinic in response to the first wave. We set out to retrospectively evaluate the service according to the Faculty of Pain Medicine 4 Standards of Good Consultation. Themes were quality of communication, feeling listened to, self-help advice, and understanding. 4
Mid-facial segment pain is a common reason for referral to an otolaryngologist, frequently misdia... more Mid-facial segment pain is a common reason for referral to an otolaryngologist, frequently misdiagnosed as sinusitis. This is a distinct group of patients with facial neuralgia having characteristics of tension-type headache, except that it affects the mid-face. • Studies have shown that quality of life tools such as the Sino-Nasal Outcome Test in patients with mid-facial segment pain have comparable scores to those suffering with chronic rhinosinusitis but have normal endoscopy and CT sinus scans. • This study shows that the prevalence of sinonasal anatomic variants in a cohort of patients suffering with mid-facial segment pain is not significantly dissimilar to those without this condition. • This study did not find any evidence to support traditional causes often attributed to headache in the cohorts studied such as transient vacuum process secondary to blocked osteomeatal complex. • The authors suggest care should be exercised when interpreting sinus CT scans, acknowledging the low evidence base for sinonasal surgery in non-sinugenic facial pain.
Background: The purpose of this study was to qualitatively characterise patients with midfacial s... more Background: The purpose of this study was to qualitatively characterise patients with midfacial segment pain (MSP) using the Sino-Nasal Outcome Test (SNOT). The data will provide a detailed overview of the physical and psychological impact on patients' well-being, and how it compares with the normal, healthy population. Methods: Suitable patients were prospectively identified from the Multidisciplinary Facial Pain Clinic at the Royal Liverpool University Hospital, based on the diagnostic criteria for MSP. The pre-treatment SNOT-22 of these patients were also compared to patients with chronic rhinosinusitis and normal healthy volunteers. Results: Twenty-nine consecutive patients with a diagnosis of MSP were identified, and compared with 30 CRS patients and 34 healthy volunteers. The average SNOT-22 scores of MSP and CRS patients were higher than normal healthy volunteers. Patients with CRS had the highest rhinological subscale SNOT scores compared to normal healthy volunteers and MSP. Conversely, the reported ear and facial symptoms of MSP patients were most unfavourable. A similar trend was observed in reported sleep function where MSP patients recorded higher subscale scores than the other two cohorts. The subscale mean score for psychological function of MSP patients was not significant when compared to the mean score of patients diagnosed with CRS. Conclusion: MSP has an adverse impact on both physical and psychological well-being. The subtle differences in the SNOT subscores between MSP and CRS have provided greater insight into the character and disease impact of MSP. We propose that the SNOT may be suitably utilised in MSP to document disease severity and measure response to treatment.
Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is ... more Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is used in the management of refractory angina at several UK centres. Although patients frequently report significant reduction in symptoms, efficacy has not been established by double-blind, randomised placebo-controlled trial (RCT). To investigate the efficacy of the procedure for the first time by a double-blind RCT. Consecutive patients referred to the authors' National Health Service (NHS) angina centre who were candidates for temporary sympathectomy were invited to participate in a trial. A total of 65 patients were randomised to receive either bupivacaine or saline injections. Identical syringes were prepared remotely, blinding patients and staff from randomisation. Cardiac autonomic function was measured 3 hours pre- and post-injection using new heart rate variability (HRV) analyses. Angina episodes were recorded contemporaneously by patients in study diaries in the 7-day period...
Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined t... more Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion fo...
Methods: 344 trainees were identified and a postal questionnaire sent to each. 214 were returned ... more Methods: 344 trainees were identified and a postal questionnaire sent to each. 214 were returned by stamped addressed envelope. This methodology was identical to that in 2004. Results: Head and Neck surgery was the most popular (30%), followed by Otology (22%). This varies from 2004, where Otology was the most popular (28%) followed by Head and Neck (17%). General ENT became more popular (17%) compared to 2004 (12%). 33% selected multiple subspecialties, compared to 2004 (18%). Attitudes towards RCS-approved fellowships were more favourable than in 2004. Conclusions: Head and neck is currently the most popular subspecialty, correlating well with the current growth in this service. Trainees are more open to the prospect of competition for fellowships, which supports further fellowships, similar to the head and neck interface fellowships, being offered in other subspecialties.
Introduction: The purpose of this study was to assess the strength of correlation between the Sin... more Introduction: The purpose of this study was to assess the strength of correlation between the Sino-Nasal Outcome Test (SNOT) subdomains to determine which bore the greatest disease burden so that it could be used as a suitable measure of clinical response. Methods: Prospective clinical audit of patients attending the Liverpool Multi-Disciplinary Facial Pain Clinic. The Brief Pain Inventory–Facial (BPI-F) was used as a comparator and surrogate measure of quality of life. Results: Fifty patients (38 female) were reviewed, of whom 66% had midfacial segment pain. The total SNOT score was highly correlated with the BPI-F. Both the sleep function and psychological issues were the most highly correlated SNOT subdomains with the BPI-F, followed by ear-facial symptoms. The rhinologic symptom subdomain had a weak correlation with the BPI-F. The total SNOT score was most significantly correlated with the sleep function and psychological issues subdomains. Conclusion: This study supports the ut...
One aim of the student elective during medical training is to see different cultural and social a... more One aim of the student elective during medical training is to see different cultural and social aspects of practice. This article concerns a student visit from the University of Wales College of Medicine to the Imperial City of Xi'an in China, which offers a medical school with teaching in both traditional Chinese medicine and Western medicine. The visiting student can learn of the traditional theories and methods of diagnosis and have a chance to see and use treatment techniques such as acupuncture, moxibustion, cupping, herbal medicine, Chinese massage and qigong. The Chinese people in general use both Western and traditional medicine, trying one and switching to the other if the first is ineffective, and Chinese traditional doctors make use of Western diagnostic techniques when necessary.
Background: In response to COVID-19, the authors used clinical psychology resources from their ho... more Background: In response to COVID-19, the authors used clinical psychology resources from their hospital's Pain Medicine Department to provide direct support to critical areas. Aims: The degree to which the service met the needs of staff and managers between March and August 2020 was evaluated. Methods: A total of 51 staff were referred. Most were nurses (43%), followed by theatre practitioners (36%), healthcare assistants (9%), consultants (8%), administrative (2%) and support staff (2%). Working status, reason for referral and presenting difficulties at first appointment and outcome were recorded. Staff were sent an anonymous survey following intervention. Findings: Staff reported high rates of burnout, anxiety and low mood, with 22% experiencing exacerbation of pre-existing mental health problems. All staff reported benefit from the intervention and managers provided positive feedback. Conclusion: Establishing a supportive service that included psychology benefited both staff ...
The coronavirus disease 2019 (COVID-19) pandemic has mandated telehealth adaptations. Communicati... more The coronavirus disease 2019 (COVID-19) pandemic has mandated telehealth adaptations. Communication in the pain consultation is a complex interplay of nonverbal visual cues and behaviors. The crucial "therapeutic alliance" can be difficult to establish with telehealth. 1 Although telehealth offers a viable alternative, there are concerns over accessibility, clinical limitations, 2 and benefit. 3 Our secondary care service for chronic pain established a remote telehealth follow-up clinic in response to the first wave. We set out to retrospectively evaluate the service according to the Faculty of Pain Medicine 4 Standards of Good Consultation. Themes were quality of communication, feeling listened to, self-help advice, and understanding. 4
Mid-facial segment pain is a common reason for referral to an otolaryngologist, frequently misdia... more Mid-facial segment pain is a common reason for referral to an otolaryngologist, frequently misdiagnosed as sinusitis. This is a distinct group of patients with facial neuralgia having characteristics of tension-type headache, except that it affects the mid-face. • Studies have shown that quality of life tools such as the Sino-Nasal Outcome Test in patients with mid-facial segment pain have comparable scores to those suffering with chronic rhinosinusitis but have normal endoscopy and CT sinus scans. • This study shows that the prevalence of sinonasal anatomic variants in a cohort of patients suffering with mid-facial segment pain is not significantly dissimilar to those without this condition. • This study did not find any evidence to support traditional causes often attributed to headache in the cohorts studied such as transient vacuum process secondary to blocked osteomeatal complex. • The authors suggest care should be exercised when interpreting sinus CT scans, acknowledging the low evidence base for sinonasal surgery in non-sinugenic facial pain.
Background: The purpose of this study was to qualitatively characterise patients with midfacial s... more Background: The purpose of this study was to qualitatively characterise patients with midfacial segment pain (MSP) using the Sino-Nasal Outcome Test (SNOT). The data will provide a detailed overview of the physical and psychological impact on patients' well-being, and how it compares with the normal, healthy population. Methods: Suitable patients were prospectively identified from the Multidisciplinary Facial Pain Clinic at the Royal Liverpool University Hospital, based on the diagnostic criteria for MSP. The pre-treatment SNOT-22 of these patients were also compared to patients with chronic rhinosinusitis and normal healthy volunteers. Results: Twenty-nine consecutive patients with a diagnosis of MSP were identified, and compared with 30 CRS patients and 34 healthy volunteers. The average SNOT-22 scores of MSP and CRS patients were higher than normal healthy volunteers. Patients with CRS had the highest rhinological subscale SNOT scores compared to normal healthy volunteers and MSP. Conversely, the reported ear and facial symptoms of MSP patients were most unfavourable. A similar trend was observed in reported sleep function where MSP patients recorded higher subscale scores than the other two cohorts. The subscale mean score for psychological function of MSP patients was not significant when compared to the mean score of patients diagnosed with CRS. Conclusion: MSP has an adverse impact on both physical and psychological well-being. The subtle differences in the SNOT subscores between MSP and CRS have provided greater insight into the character and disease impact of MSP. We propose that the SNOT may be suitably utilised in MSP to document disease severity and measure response to treatment.
Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is ... more Temporary sympathectomy by injection of bupivacaine at the site of the left stellate ganglion is used in the management of refractory angina at several UK centres. Although patients frequently report significant reduction in symptoms, efficacy has not been established by double-blind, randomised placebo-controlled trial (RCT). To investigate the efficacy of the procedure for the first time by a double-blind RCT. Consecutive patients referred to the authors' National Health Service (NHS) angina centre who were candidates for temporary sympathectomy were invited to participate in a trial. A total of 65 patients were randomised to receive either bupivacaine or saline injections. Identical syringes were prepared remotely, blinding patients and staff from randomisation. Cardiac autonomic function was measured 3 hours pre- and post-injection using new heart rate variability (HRV) analyses. Angina episodes were recorded contemporaneously by patients in study diaries in the 7-day period...
Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined t... more Midfacial segment pain (MSP) has the characteristics of tension-type headache which is confined to the midface cor- responding to the second division of the trigeminal nerve. This review presents treatment outcomes of MSP patients managed at the Multi-disciplinary Team (MDT) Facial Pain Clinic in Liverpool. Prospective clinical outcome performed in a tertiary referral centre for complex facial pain syndromes. Sino-Nasal Outcome Test (SNOT). Clinical "success" was defined as an improvement in total SNOT score of >9 points and a reduction of the ear-facial symptoms sub-domain score by ≥50% from baseline. The average age of the cohort was 49 years, with an average follow-up of 12 months. The overall pre-treatment total SNOT-22 score was 59.5 which improved significantly to 42 at latest follow-up. Although the average scores of all sub-domains improved, only the ear-facial symptoms and psychological issues sub-domains achieved statistical significance. When the criterion fo...
Methods: 344 trainees were identified and a postal questionnaire sent to each. 214 were returned ... more Methods: 344 trainees were identified and a postal questionnaire sent to each. 214 were returned by stamped addressed envelope. This methodology was identical to that in 2004. Results: Head and Neck surgery was the most popular (30%), followed by Otology (22%). This varies from 2004, where Otology was the most popular (28%) followed by Head and Neck (17%). General ENT became more popular (17%) compared to 2004 (12%). 33% selected multiple subspecialties, compared to 2004 (18%). Attitudes towards RCS-approved fellowships were more favourable than in 2004. Conclusions: Head and neck is currently the most popular subspecialty, correlating well with the current growth in this service. Trainees are more open to the prospect of competition for fellowships, which supports further fellowships, similar to the head and neck interface fellowships, being offered in other subspecialties.
Introduction: The purpose of this study was to assess the strength of correlation between the Sin... more Introduction: The purpose of this study was to assess the strength of correlation between the Sino-Nasal Outcome Test (SNOT) subdomains to determine which bore the greatest disease burden so that it could be used as a suitable measure of clinical response. Methods: Prospective clinical audit of patients attending the Liverpool Multi-Disciplinary Facial Pain Clinic. The Brief Pain Inventory–Facial (BPI-F) was used as a comparator and surrogate measure of quality of life. Results: Fifty patients (38 female) were reviewed, of whom 66% had midfacial segment pain. The total SNOT score was highly correlated with the BPI-F. Both the sleep function and psychological issues were the most highly correlated SNOT subdomains with the BPI-F, followed by ear-facial symptoms. The rhinologic symptom subdomain had a weak correlation with the BPI-F. The total SNOT score was most significantly correlated with the sleep function and psychological issues subdomains. Conclusion: This study supports the ut...
One aim of the student elective during medical training is to see different cultural and social a... more One aim of the student elective during medical training is to see different cultural and social aspects of practice. This article concerns a student visit from the University of Wales College of Medicine to the Imperial City of Xi'an in China, which offers a medical school with teaching in both traditional Chinese medicine and Western medicine. The visiting student can learn of the traditional theories and methods of diagnosis and have a chance to see and use treatment techniques such as acupuncture, moxibustion, cupping, herbal medicine, Chinese massage and qigong. The Chinese people in general use both Western and traditional medicine, trying one and switching to the other if the first is ineffective, and Chinese traditional doctors make use of Western diagnostic techniques when necessary.
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