A multi-disciplinary spinal pain unit

The Multidisciplinary Spinal Pain Unit in Townsville, North Queensland, Australia is the result of years of negotiations between the Vice-Chancellor of James Cook University of North Queensland, and the then Townsville General Hospital and Northern Regional Health Authority.

TOWNSVILLE, AUSTRALIA – The Multidisciplinary Spinal Pain Unit in Townsville, North Queensland, Australia is the result of years of negotiations between the Vice-Chancellor of James Cook University of North Queensland, and the then Townsville General Hospital and Northern Regional Health Authority. The Unit opened on 3 July 1995 with a clinical diagnosis and treatment staff of one general medical practitioner, one medical acupuncturist, two chiropractors, and one nurse/receptionist.

Essentially, the Unit is a diagnostic and patient management facility for patients suffering from acute and chronic spinal pain syndromes. While collecting clinical information from patients, data are collected to ascertain which form of therapy – acupuncture, chiropractic spinal manipulation, or medical treatment – is most beneficial.

his investigation is of great significance to the Australian community, as spinal pain syndromes cost the community several billion dollars per annum. The research protocol was originally circulated to an international body of academic multidisciplinary clinicians for their input. These individuals are from the disciplines of chiropractic, neurosurgery, orthopaedics, physiotherapy, psychiatry, radiology, and rheumatology.

The university’s foresight in perceiving the necessity for such a specialised spinal pain unit in Townsville has been rewarded by an extremely positive response from patients and medical practitioners. More than 200 medical practitioners refer patients to the Unit. The Unit opened on Monday Wednesday and Friday afternoons in the Townsville General Hospital from 3 July 1995 to 10 October 2001. When the hospital closed and relocated to another campus, the Multidisciplinary Spinal Pain Unit was relocated to the Townsville Health Service District’s Kirwan Campus where the same hours are observed.

Analysis of data regarding the three treatment modalities is about to begin. It is too early to know which, if any of the three treatment modalities will be most successful. However, it is very clear that the multidisciplinary team approach is benefiting the Unit’s patients, many of whom say ‘It is wonderful to find a group of different types of doctors working together who are interested in me.’ Another frequent comment is “I no longer need medication to help my pain, so I no longer have stomach pain”. This highlights the importance of the Unit where patients are seen by a multidisciplinary team, members of which have expertise in different areas of health care. The clinical team is unique in that the prime objective of each member is the well-being of the patient; politics simply are not even considered.

Patients from the Townsville and Thuringowa communities benefit from the multidisciplinary team approach because of three gentlemen who had the foresight and courage to support the establishment of the Unit. Without the support and determination of Professor Ray Golding, who was Vice-Chancellor of James Cook University when the Unit was established, the Director of Medical Services at Townsville General Hospital, and the Professor of Psychiatry, of whom took considerable professional risks in enabling the Unit to be established, the Unit would not exist to provide a specialised diagnosis followed by management of complex pain syndromes.

Patients undergo a very thorough physical examination followed by plain x-ray, CT, MRI or bone scan studies and blood and urinalysis laboratory work as indicated. Because of the number of new patients, the Unit also uses private radiological clinics where the radiologists go out of their way to provide the Unit’s clinical staff with specialised technology such as CT reconstruction images of regions of the spine.

The advantage of having a multidisciplinary team in a hospital setting so that patients may be easily referred to specialists within the hospital has been lost to some extent now that the unit has been relocated to a community health campus. However, the Unit has been managed and operated by The University of Queensland since an Agreement was drawn up on 19 March 1999 between The University of Queensland and the Townsville District Health Service Townsville General Hospital ‘for the services provided to its patients’ by the Multidisciplinary Spinal Pain Unit; patient demand for the specialised Multidisciplinary Spinal Pain Unit is as strong as ever.

The Multidisciplinary Spinal Pain Unit is funded by Queensland Health until 31 December 2002. Because of the demand for such a specialised Unit, the Director has asked both Queensland Health and the Federal Government to provide ongoing funding to prevent the Unit from closing on 31 December 2002.

For anyone interested in looking into the history and issues relating to patient satisfaction regarding this specialised Multidisciplinary Spinal Pain Unit, please note reference (2,3,4, and 9) from the following list of publications.

1. Giles L.G.F., Crawford C.M. (1997) Shadows of the truth in patients with spinal pain: A Review. Canadian Journal of Psychiatry 42: 44-48.
2. Giles L.G.F., Baker P.G. (1998) A Multidisciplinary specialised spinal pain syndrome unit. Chiropractic Journal of Australia 28(1): 2-6.
3. Giles L.G.F., Muller R. (1999) Chronic spinal pain syndromes: A clinical pilot trial comparing acupuncture, a non-steroidal anti-inflammatory drug and spinal manipulation. J Manipulative Physiol Ther, 22(6): 376-381.
4. Baker P.G., Giles L.G.F. (1999) Is excess weight related to chronic spinal pain? Chiropractic Journal of Australia, 29:51-54
5. Watson A, Giles L.G.F. (1999) Is this back pain real? Australian Family Physician, 28(3): 268 & 270.
6. Giles L.G.F. (2000) Mechanisms of neurovascular compression within the spinal and intervertebral canals. J Manipulative Physiol Ther. 23(2): 107-111.
7. Giles LGF (2001) The multidisciplinary specialised Spinal Pain Unit at Townsville General Hospital. Chiropractic Journal of Australia 31: 53-57.
8. Giles L.G.F., Yamada S. (2001) Urinary bladder dysfunction and adult tethered cord syndrome. Australian Family Physician, 30(8): 767-769.
9. Giles L.G.F. (2001) Medicolegal reporting for spinal injuries. Plaintiff 44: 21-23.

Book Chapter – Giles L.G.F (2001) Pathophysiology of the posterior zygapophyseal (facet) joints. In Principles and Practice of Chiropractic (S Haldeman (ed)) 3rd edition, McGraw-Hill, in press.

Book publications showing affiliation between the Unit and Townsville General Hospital (Butterworth-Heinemann)

1. Clinical Anatomy and Management of Low Back Pain, 1997 (411 pages), Giles L.G.F and Singer K.P (eds).
2. Clinical Anatomy and Management of Cervical Spine Pain, 1998 (214 pages), Giles L.G.F and Singer K.P (eds).
3. Clinical Anatomy and Management of Thoracic Spine Pain, 2000 (303 pages), Giles L.G.F and Singer K.P (eds).
4. 50 Challenging Spinal Pain Syndrome Cases, Giles L.G.F, in press.