Pain And Palliative Medicine

The department of pain and palliative medicine at Amrita Hospital focuses on the active total care of the person suffering from advanced and non-responsive diseases as well as their families. It is concerned with quality of life and addresses physical, psychological, social and spiritual aspects of suffering. The department seeks to provide total care for people suffering from cancer and chronic non-cancerous ailments.

• Post herpetic neuralgia
• Diabetic neuropathy
• Trigeminal neuralgia
• Myofascial pain syndrome
• Fibromyalgia
• Chronic migraine
• Central pain syndromes
• Chronic back pain
• Cancer pain and symptoms
• HIV infection and related issues
• Failed back syndrome
• Cervical spondylosis
• Peripheral vascular disease
• Lymphoedema
• Advanced systemic diseases
• Post-operative pain
• Pancreatic pain
• Procedure related pain
• Paediatric pain

• Improving quality of life
• Rehabilitation for the patients and their relatives
• Offer support to other members in the family
• Chronic cancer pain management
• Chronic pain management

Utilising a team of committed palliative care physicians, nurses, social workers and office staff, we aim at improving quality of life with the available resources. We treat the person as a whole and not just the disease.We provide care to patients with:

• Cancer: pain, symptom and supportive management.
• Chronic pain: includes patients mainly with chronic pain (pancreatitis, peripheral vascular disease, low backache, fibromyalgia, myofascial pain syndromes, post-herpetic neuralgia etc.)
• Lymphoedema: both cancerous and non-cancerous origin
• Advanced, non-responsive and debilitating diseases like chronic cerebrovascular accidents, HIV infection, end-stage systemic diseases (heart diseases, renal disease, liver disease), etc.

Dedicated Multidisciplinary Team: Our team of compassionate palliative care physicians, nurses, social workers, and office staff collaborates to improve the quality of life for our patients. We treat individuals, emphasizing personalized care beyond the disease itself.

Comprehensive Services: Whether dealing with cancer-related pain, chronic pain, lymphoedema, or advanced debilitating diseases, we offer a range of services to manage symptoms effectively. Our commitment extends to providing end-of-life care, ensuring a peaceful transition for patients of all specialties.

Home Care with a Difference: Our innovative home care program delivers active total care to patients and their families, enhancing their quality of life within the comfort of their homes.

Expertise in Lymphoedema Care: Our specially trained palliative care nurses excel in providing tailored care for lymphoedema, a condition that can significantly impact patients both physically and emotionally.

Advanced Interventional Pain Management: Our department excels in high-tech interventions for pain relief. From nerve blocks to epidural neurolysis, we employ a range of techniques to manage pain effectively, ensuring personalized and cutting-edge solutions for our patients.

We are committed in providing comprehensive care for individuals facing advanced and non-responsive diseases, ensuring their holistic well-being along with support for their families. We focus on enhancing the quality of life by addressing physical, psychological, social, and spiritual aspects of suffering. Our services encompass outpatient care, in-patient services, home care, and interventional pain management.

In-Patient Care

• In-patient care is provided for patients when symptoms like pain, nausea, vomiting, constipation, intestinal obstruction, breathlessness, insomnia, delirium, convulsions, bedsores, etc., that are difficult to control on out-patient basis.
• Empowerment of the family members in various aspects of patient care like skin care, mouth care, bedsore care, etc., is undertaken to make them self-reliant and confident. We encourage them to be actively involved in the care for their loved ones.
• In-patient service includes end of life care, one of the components of palliative care. Our palliative medicine department liaisons with the intensive care units to provide better end of life care to provide ‘A Good Death’ in the presence of their loved ones. This facility is extended to patients of all specialties, who are terminally ill.

Home Care

The very word ‘home care’ signifies the active total care provided at home to the patients and their families, who cannot approach the hospital for their treatment. Home care service is provided free of cost to all the deserving patients. Objectives are:

• To provide active total care to the patient and family at home
• To improve quality of life for the patients and their families
• To set forth a team effort (by empowering the family) in the care of patients
• To provide rehabilitation for the patients and their relatives
• To help patients live and die with the highest possible quality at home
• To provide bereavement support to the family after the death of the patient

The concept of home care was adopted by Amrita Hospital in January 2001. It is provided for deserving patients who reside within a radial distance of forty kilometres from the hospital.

Minor procedures like ascitic tapping, urinary catheterization and bladder wash, wound debridement, nasogastric intubation, enemas and rectal evacuation, sponge bath, skin care, mouth care, bowel care, tracheostomy care, intravenous and subcutaneous infusions and injections, bedsore management, lymphoedema management, trigger point injections, etc. are done by the team at home.

Beneficiaries

Those patients who require care at home and those who cannot travel, which includes both cancer and non-cancer patients (mainly geriatric patients).

Lymphoedema is a notoriously debilitating progressive condition with no known cure. Worldwide, 140-250 million cases of lymphoedema are estimated to exist, with filariasis being the most common cause. Kerala has a high incidence. Because lymphoedema is disfiguring and sometimes painful and disabling, it can create mental, physical, and sexual problems.

We have specially trained palliative care nurses to provide patient tailored lymphoedema care. The majority of patients can be treated successfully with conservative measures.

Interventional Pain Management

The majority of pain types can be managed with pain medicines alone. A minority of pain cases may require hi-tech interventions for which this department is well equipped and is a leader in such services in the country. The interventions available for pain relief include:

• Stellate ganglion block
• Coeliac plexus block
• Hypogastric nerve block
• Chemical lumbar sympathectomy
• Intercostal nerve block
• Continuous epidural analgesia
• Epidural neurolysis
• Epidural steroid injections
• Trans-cutaneous nerve stimulation
• Trigger point injections
• Facet joint injections
• Sacro-iliac joint infiltration
• Post-operative epidural analgesia
• Splanchnic nerve block
• Spinal subarachanoid neurolysis
• Single nerve block
• Paravertebral nerve block
• Intra articular steroids
• Ascitic fluid tapping
• Pleural fluid tapping
• IV Morphine trial
• IV Lignocaine trial

Post-Operative Pain Relief

This concept has been introduced in this institution with the objective of providing a pain free surgical experience to our patients. This venture is in line with the goal of achieving a ‘Pain Free Hospital’ status for this institution by 2020.
We work in partnership with surgical departments for the management of postoperative pain. Post operatively the patient stays pain free, comfortable and satisfied with the overall hospital experience.

Additionally

• Wound healing is faster
• Patients are able to get back to their normal lives earlier
• The postoperative hospital stay has been reduced to nearly half
• Ensured better bed utilization and faster turn over
• Enables the patients to get mobilized early

At Amrita Hospital, Kochi we believe in fostering a compassionate and patient-centric approach to healthcare. We treat the individual, not just the disease, providing comprehensive care that considers physical, psychological, social, and spiritual well-being. We empower families by involving them actively in the care of their loved ones, providing education and support to enhance their self-reliance and confidence.

1. Seminars
2. Journal clubs
3. Case presentation
4. Hospital Grand rounds
5. MDT – Mult-disciplinary team meetings
6. Case discussions
7. Super specialty PG posting for 2 weeks
8. Regular Interns posting for 5 days each
9. IAPC course – Part B - 10 days posting

1. Out-patient services
2. Day care services
3. In-patient services
4. Home care

IAPC Certificate Course in Essentials of Palliative Care
Duration –8 weeks
Eligibility- Nurses with Diploma in Nursing/ BSc   Nursing/MBBS
 

1. First PG Diploma in Palliative Medicine (2-year Course) in India, started in the year 2004 recognised by Amrita University. Discontinued after four courses
2. First MD Palliative Medicine Program recognised by NMC (National Medical Commission) in Kerala started in the year 2022
3. Several publications over the years by different faculty members best paper and poster prizes over the years
4. Eg: Indications and Outcomes of Nefopam administration in Palliative Care patients – An Observational Study – IAPCON 2022, Best paper award

• Pain Clinic– Daily
• Palliative Care Clinic – Daily
• Lymphoedema Clinic – Daily
• Home Care – Five days a week (Monday to Friday)

• Teaching faculty were panellists for Community cancer palliative care
• conference conducted by the Department of Community Medicine at 
• AIMS, Kochi
• Teaching faculty of the department participated as skill station faculty for 
• Palliative care in non – malignant diseases 
• conducted by Department of
• Pulmonology AIMS Kochi and Ernakulam chapter of Indian Association of 
• Palliative Care at IMA Kochi
• Teaching faculty of the department are regularly invited faculty for national and state wide programmes in palliative care

• Lymphoedema
• Advanced systemic diseases
• Post-operative pain
• Pancreatic pain
• Procedure related pain
• Paediatric pain
• Central pain syndromes
• Chronic back pain
• Cancer pain and symptoms

Phone: 0484 - 2853012, 0484 – 6683012

8am – 5 pm – 7994999313

Email: palliation@aims.amrita.edu