The History of Pain Medicine in Roermond |
October 25, 2010
The Pain Department of the Laurentius Hospital in Roermond (the Netherlands) opened its doors on April 7, 1996. This was the starting point for structural treatment of chronic pain in Roermond. However pain has been prevalent throughout history and attempts were made at treating pain early on in the hospital's history.
In the hospital's oldest archives, a report of treatment of lumbago was registerd on December 13, 1944:
The treatment took place in the last winter of the 2nd World War. The city of Roermond had the misfortune of being at the front. Due to incessant bombing and shelling, hospital activities had moved to the cellar. The patient was described as suffering from lumbago. She had given her adres as being that of the hospital itself, which suggests that she was working at the hospital and living on the premises. The archives refer to an epidural sacral injection, which today, we would call a caudal block. The drug uses was referred to as 25cc 1% tuto. Tuto was discovered to be tutocain, a local anesthetic that is no longer in use. The treatment was repeated twice, the last time on Christmas day. There is no mention of the long-term results.
In the early 90's, the first radiofrequency lesions were performed not by an anesthesiologist, but by the radiologist, Dr. Kessing. The treatment was limited to the facet joint denervation. He made use of an early model of the Radionics series. The technique involves lesioning the medial branch of the dorsal ramus, that leads to the facet joint (also known as the zygapophyseal joint). Heat was produced by current that had a frequency comparable to radio waves, so that one could control the size of the lesion.
Pain was not treated systematically until the coming of a full fledged pain specialist in 1996. Peter de Jong, who had learned pain therapy at the Daniel den Hoed Cancer Centre in Rotterdam and continued with chronic non-cancer pain in the Merwede Hospital located in Dordrecht and Sliedrecht (The hospital is now known as the Albert Schweitzer Hospital). At the time he wa secretary of the pain section of the Netherlands Society for Anesthesiology.
The first consultations started in April 1996. Initially there was support from the secretaries of the Urology department located in the some wing, but two months later the department got it's own secretary, Corrie Bloemen. Treatments were initially done in Operating theater number 6, which had the advantage of a side door so that patients did not have to go by way of the main entrance of the OR.
Soon thereafter, the department got its own treatment table and its own Radiofrequency generator produced by Fischer (the N50) and delivered by Korst Medical Instruments. The Fischer firm has now been taken over by Stryker. The advantage of Fischer over Radionics, was that the apparatus was entirely digital. It was therefore possible to reprogram the apparatus for only 3000 guilders to make it suitable for pulsed-radiofrequency lesioning, without having to acquire new apparatus.
Pulsed radiofrequency lesioning has been in use at our hospital since 1999. It makes use of radio waves at temperatures of 42 degrees rather than the usual 80 degrees. This makes it possible to lesion small periferal nerves without resulting in painful post RF-lesioning pain.
On a different front the Pain Department worked on the treatment of painful extremities, the so-called Complex Regional Pain Syndrome (known previously as reflex sympathetic dystrophy). Previously, the syndrome had been treated by means of Regional Intravenous Sympathectomy. Studies , however, revealed that the treatment was not truly effective. The alternative treatment was iontophoresis. This method calls for bringing a drug in contact with the skin and passing a current through it. In this way the drug is transported through the surface of the skin into the tissues below. Initially, the most commond drugs applied were ketanserine for CRPS-1 and dexamethasone for arthritis, bursitis and painful scars. Later ketanserine was replaced by labetalol and S-ketamine. Initially the apparatus used was the Physionizer. More recently the EMPI has been used.
In 2006, the Radiofrequency Lesion Generator needed to be replaced. After careful consideration, we chose the Neurotherm NT1000. It had the advantage of have three channels so that double-sided lesion could be done in less time. Its grapphic display was a great improvement and it had the possibility for interfacing with other systems.
A coming and going of pain specialists.
Five years after the start of the pain department, Peter de Jong was joined by Nico Grupa. Nico Grupa had done his training as an anethesiologist in Maastricht (Prof. M. van Kleef). He continued to develop as a Pain Specialist in Roermond.
Some two years later (October 1, 2002) the group of Pain Specialists was joined by Raymond Frederiks. He had been trained as a anesthesiologist in Rotterdam (Prof.J. Klein) and supplementary training in Pain management by (Prof.) F. Huygen and R.van Seventer in Breda.
In 2004 Nico Grupa left Roermond for Heerlen and was replaced by Leon Ubags. He had been trained in Amsterdam (Prof. Trouwborst) and done supplementary training with J. Vranken. On January 1, 2008, Leon Ubags left the Laurentius Hospital to become a full time pain specialist in Sittard in Association with O. Rohof. He was replaced by J. Anderson.
I have been working at the Laurentius Hospital for 16 years. However, the hospital was unable to offer sufficient room for further expansion, so that it became necessary to start an independent Pain Clinic in association with 5 other such clinics. These clinics are part of the DC|group. The clinic was officially opened on October 1st 2011 under the name DC|Pijncentrum Roermond. This pain center is part of a franchise that incudes 6 pain centers throughout the country: Almer, Rotterdam, Alkmaar, Voorschoten and Amsterdam. About 7,5% of the pain treatments thruoughout the country are done by the DC group. The expectation is the this percentage will increase to 40%.