Choice Case Studies Database

1.Choice and long-term conditions:

Patient with complex regional pain syndrome affecting right (dominant) hand and arm, with swelling, severe pain and significantly reduced function.
Patient from a PCT where local pain clinic had closed, offered option of two other clinics several miles away. Attended one in West London.
Several injections, sympathetic blocks and physiotherapy failed to resolve. No NHS neuro-rehabilitation unit available, therefore offered private neuro-rehab in private hospital, paid for by NHS.
Now fully recovered after 3 weeks in rehab unit with specialised hand function physiotherapy and medications.

Where there are no appropriate NHS facilities, patient should be offered wider choice of attending appropriate unit even when private.

2. End-of-life care.

Patient dying from carcinomatosis, referred to local pain unit. Severe pain due to secondary tumours growing on nerve roots in spinal cord. Pain resistant to high doses of opioids, which caused sedation. Local Pain team placed an intra-thecal catheter direct into the fluid around the spinal cord and commenced an infusion of diamorpine and other drugs. Pain completely relieved and patient anxious to go home. transferred to local hospice, where community team trained in the management of intra-thecal infusions, then transferred home. Died comfortably some two months later.

Wider choice of access to more complex pain management than possible through palliative care alone enabled patient to return home, managed by local team, enabled to sort out end of life issues.