Intended for healthcare professionals


BMJ Awards 2019: Clinical Leadership Team of the Year

BMJ 2019; 365 doi: (Published 15 April 2019) Cite this as: BMJ 2019;365:l1659
  1. Jacqui Wise, freelance journalist
  1. London, UK

Jacqui Wise meets the teams transforming clinical services and achieving better outcomes

A multidisciplinary team for trigeminal neuralgia

Trigeminal neuralgia is a rare chronic condition that causes agonising facial pain and is commonly triggered by light touch. “It’s like an electric shock going through half of your face,” says Joanna Zakrzewska, consultant in facial pain. Patients often can’t eat or drink and can become depressed or suicidal.

It takes, on average, two to three years before a patient gets a correct diagnosis, says Zakrzewska. The pain is often attributed to a dental disorder and, as a result, 17% of patients have irreversible and unnecessary dental treatment such as root canals or extractions.

When Zakrzewska moved to the Eastman Dental Hospital, part of the University College Hospitals NHS Trust, she saw an opportunity to do something different and developed a multidisciplinary team approach to managing the condition. Uniquely, patients are seen by both a facial pain physician and a neurosurgeon in a joint clinic which takes referrals from around the country. Then, patients who decide on surgery can be fast tracked as they have already been seen by the neurosurgeon.

A clinical nurse specialist offers a telephone service to support patients with medication problems. Psychologists and a physiotherapist designed a programme of cognitive behavioural therapy pain management. This helps patients cope with the fear, unpredictability, and isolation which can come with trigeminal neuralgia, says Zakrzewska.

A survey of patients showed very high satisfaction with the clinic. Patients reduced their consultations with GPs and two thirds said they felt more confident managing their pain.

A bespoke FGM service

Whipps Cross University Hospital in east London serves a large immigrant population with a high proportion coming from countries such as Somalia and Sudan where female genital mutilation (FGM) is practised. The traditional model for FGM services is midwifery led but Reeba Oliver, consultant …

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