Introduction

At Pain Medicine Unit, Teaching Hospital, Peradeniya, we are dedicated to providing compassionate, comprehensive care for individuals suffering from acute and chronic pain. Our mission is to help you reclaim your life by managing and reducing every patient’s pain through personalized and effective treatment plans.

Our clinic brings together a team of experienced Anesthetists, nurses, counselors, physical therapists, and other healthcare professionals who are all committed to understanding every patient’s unique needs.

We believe in treating the whole person, not just the symptoms. That’s why our approach includes not only medical interventions but also supportive therapies that address the emotional and psychological aspects of living with chronic pain. Our goal is to empower, patients with the resources and knowledge needed to achieve a better quality of life.

Members of the staff Pain Medicine Unit

 

In-charge Consultant

  • Dr. Ashani Ratnayake
    • MBBS (Peradeniya), MD Anaesthesiology (Colombo), FRCA (UK), Accreditation in Focused Intensive Care ECHO by Intensive Care Society-UK.
    • Consultant Anaesthetist- Teaching Hospital – Peradeniya.

Other Consultants

  • Prof. Vasanthi Pinto
    • Faculty of Medicine, University of Peradeniya.
    • MBBS(Peradeniya), MD Anaesthesiology, FRCA (UK), FCARCSI(Ire)
  • Prof. P.S.K. Nanayakkara
    • Head of Department of Anaesthesiology and Critical Care, Faculty of Medicine, University of Peradeniya.
    • MBBS (Peradeniya), MD Anaesthesiology, Member of Acupuncture Foundation of Sri Lanka, Postgraduate Diploma in Sociology.
  • Dr. Anura Abeysundara
    • Senior lecturer at Faculty of Medicine, University of Peradeniya.
    • MBBS, MD Anaesthesiology, FRCA (UK).
  • Dr. Senani Samarasinghe
    • MBBS, MD Anaesthesiology, Postgraduate Diploma in applied statistics

Other Doctors

Medical Officer, Pain Medicine Unit:

  • Dr. Vijaya Thangavadivale (MBBS)

Counselling:

  • Dr. Senani Egodage (MBBS, Higher diploma in counseling)

Nursing officers

  • We have two nursing officers in the pain management unit.

In-charge Nursing officer

  • Mrs. H.H.P.D. Thilakarathna
    • Diploma in Nursing ( NTS – Kandana), Bachelor’s Degree in Nursing(OUSL), Master’s Degree in Nursing (Central South University, China), and Advanced certificate in psychology and counseling (Peradeniya).

Nursing officer

  • Mrs. H.E. Yenitha
    • Diploma in Nursing, Undergraduate Nursing, Pain management training.

Other Contributing Staff

Research Assistant

  • Dr Chandima Rathnayake (MBBS)

Health Care Assistant

  • Mrs. K.D.R.D. Kulathilaka

 

History and operation details

Pain management service was first established in Teaching Hospital Peradeniya in 2014 under the supervision of Prof Vasanthi Pinto. The pain service was further improved by Prof Saman Nanayakkara with a functioning clinic established in 2019 at the premises of the Gynaecology unit.

The current Pain Medicine Unit of Teaching Hospital Peradeniya was established on May 18 th May 2023.

Our unit provides both acute and chronic pain management services and is open around the clock for acute pain management services. Pain clinic is conducted every Monday and Wednesday, except for the public holidays, from 8.00 am to 1:00 PM for acute and chronic pain services and other procedures. For patients with chronic pain, the unit is under operation for pain procedures on Tuesday, Thursday, and Friday from 8.00 am to 12.00 noon.

The acute Pain Management services are extended to Dental Hospital – Peradeniya, a specialized hospital that has a high volume of sophisticated OMF surgeries.

Admission Policy

Since 2024 January, the unit has been recognized as a day admission unit. The admission, clinic visits, and records are managed through the system of hospital data management. Patients have their unique identity number given by the hospital.

Admission card with barcode

Services provided by our unit

A wide range of pain management services are provided by our unit.

Acute pain management

The service is provided for both Teaching Hospital – Peradeniya and Dental Hospital- Peradeniya.

Manage patients with

  • Post-operative pain- including OMF patients
  • Chronic pain conditions in inpatients
  • Trauma patients at ETU
  • Pain management methods used
  • PCA – The unit currently has 21 pumps
  • PCEA
  • Nerve blocks
  • TENS
  • Routine pain medical treatment

Chronic Pain Management

We provide pain management for patients with chronic pain as our patients.

  • Drug therapy
    • Eg: Opioids, Gabapentin
  • Injection therapy
    • Trigger point injections
  • Physical therapy
  • Transcutaneous electrical nerve stimulation ( TENS)
  • Targeted exercise
  • Mind-body therapy – Mindfulness
  • Massage
  • Occupational therapy
    • We refer patients for Ergonomics, CBT, Activity grading and simplification, Prioritising Daily activities, and Activity Modification to improve quality of life.
  • Dietary approaches
    • We provide dietary supplements and dietary advices
  • Meditation techniques

Labour pain management

For labour pain relief, our widely used practices are Analgesic injections (Pethidine), Inhalational analgesia (Entonox), Epidural analgesia, TENS, Aromatherapy, and Relaxation techniques.

The staff educates the patients in antenatal clinics and antenatal wards.

  • Mirror box therapy

Providing mirror therapy to patients

  • Peripheral nerve block

  • Art therapy

Clinic Facilities and Equipment

Our unit has a dedicated pain clinic area in an easily accessible place. It has a wheelchair-accessible entrance.

Dedicated Area size: 348″x 108″ (261 Square feet)

Equipment Available :

  • PCA machines
  • Transcutaneous electrical nerve stimulation machines
  • Mirror box therapy

Statistics

Patient volume

The PMU conducts a meeting every 3 months and the statistics and problems are analysed. The last meeting was held in June 2024.

Total clinic registrations by June 2024 are 714 patients.

From April to June 2024 there were 84 new clinic visits and 332 subsequent clinic visits. For the past three months 70 Epidural Infusions, 62 Epidural catheter removal, 36 PCA, 12 Clinic nerve blocks, and 7 regional blocks in the ward were performed by our unit. In addition to those procedures, we have conducted 1800 ward rounds and 105 counseling sessions during the last three months.

We have performed a total of 29 Nerve blocks during last year and in this year we have performed 19 Nerve blocks up to now. There were 69 patients who had PCA for pain relief during last year.

Educational and Research Activities

Educational programs

  • The unit provides both educational and training programs for a wide variety of people including patients, healthcare staff, and medical students.

Patient education programs

  • Conducted every 2-3 months

Essential pain management workshops for healthcare staff

2 consultants, 2 medical officers, and 2 nurses attached to the Pain Medicine Unit – Peradeniya are trainers in the essential pain management program (EPM ) conducted by the College of Anaesthesiologists and Intensivists of Sri Lanka. The team is responsible for conducting EPM in the central province. The team has conducted 8 EPM programs for doctors, nurses, and pharmacists. Dr. Sidarshi Kiriwaththuduwa (CA- National Hospital Kandy, Dr. Roshana Mallawaracchi also contributed as resource persons

Ward classes for medical students

The pain Medicine unit conducts regular ward classes for Medical students

Nurses teaching programs

These are conducted regularly as small groups and large groups in addition to EPM

Nurses program on 21: 05:2023

Small group training for nurses

Postgraduate training

PMU is not recognized for pain teaching for Anaesthesia post-graduates. However, the registrars get the opportunity to provide pain management care for patients attending PMU

Registrars getting hands-on training on peripheral nerve blocks

Medical officer training

PMU was involved in training 28 doctors attached to RDHS on Pain Management which was arranged by RDHS Kandy. This was a quality improvement project by RDHS to improve pain services in Kandy district in 2022 and 2023.

Research and audits

Published research

Abstracts presented at conference proceedings

  • Herath A, Ekanayake N, Ratnayake A, Nanayakkara PSK, Abeysundara AB, Samarasinghe S, Bandara H MMCD, Morel NS, Sandaru GLG: Insights into chronic pain management: A retrospective audit on demographics, pain characteristics, and treatment strategies in a pain management unit at a Tertiary care hospital. Presented at the proceedings of the annual academic congress at Sri Lanka Medical Association. August 2024 – Colombo Sri Lanka
  • Sachini Weddagala, Punsara Liyadipita, Vasanthi Pinto, Anura Abeysundara, Ashani Ratnayake, Senani Samarasinghe, Tharanga Wijethilake, Indumathie Nanayakkara, Saman Nanayakkara: Effect of reassurance on reducing pain related to cannulation in patients undergoing venous cannulation: Presented at the proceedings of Annual Academic sessions of Faculty of Pain Medicine. October 2023, Virtual event
  • Gayan Wijekoon, Punsara Liyadipita, Piumi Nakandala, Indumathie Nanayakkara, Saman Nanayakkara Prevalence of chronic pain among elders residing in elders’ homes in Kandy district, Sri Lanka. Presented at the proceedings of Annual Academic sessions of the Faculty of Pain Medicine. October 2023, Virtual event
  • Shanika Ranasinghe, Punsara Liyadipita, Vasanthi Pinto, Anura Abeysundara, Ashani Ratnayake, Senani Samarasinghe, Tharanga Wijethilake, Indumathie Nanayakkara, Saman Nanayakkara . Comparison of pain perception between dominant hand and non-dominant hand of patients during intravenous cannulation, who are awaiting anesthesia. Presented at the proceedings of Annual Academic sessions of the Faculty of Pain Medicine. October 2023, Virtual event
  • Lalantha Kavisekara, Samadhi Madugalle, Punsara Liyadipita, Vasanthi Pinto, Anura Abeysundara, Ashani Ratnayake, Senani Samarasinghe, Tharanga Wijethilake, Indumathie Nanayakkara, Saman Nanayakkara. Assessment of prevalence of pain and the change in the severity of pain during procedures in the ICU of teaching hospital Peradeniya using the Cpot scale Presented at the proceedings of Annual Academic sessions of Faculty of Pain Medicine. October 2023, Virtual event

Ongoing research activity

Full papers submitted to peer-reviewed journals

  • H.G.R.B.L. Hewawasam, M.P.C.Sumithraarachchi , Ashani Ratnayake, Sajitha Weerasinghe , Senani Samarasinghe, Saman Nanayakkara. Post dural puncture headache and its potential to obscure sinister pathologies: A case report under review
  • Ashani Ratnayake, Sampath Gananrathne, Saman Nanayakkara, Githmini Sandaru Allodynia in episiotomy scar: An unusual cause for dyspareunia – Under review

Other

  • Factors affecting shoulder tip pain in Laparoscopic Gynaecological Surgery: A population-based prospective study – Awaiting ethical clearance

leaflets

The PMU distributes various kinds of patient education leaflets

  1. Duloxetine for pain relief – Sinhala version
  2. Duloxetine for pain relief – English version
  3. Pain relief with Amitriptyline- Sinhala version
  4. Pain relief with Amitriptyline – English version
  5. Intravenous regional anaesthesia – Sinhala version
  6. Intravenous regional anaesthesia – English version
  7. Trigger point injection – English
  8. Epidural steroid injection – Sinhala
  9. Epidural steroid – English
  10. Pain relief with Gabapentin

Visual aids

Guide to oral pain medications displayed at unit

Guide to WHO pain ladder with use of medications – Used in patient explanation

Educational videos

The unit uses educational videos to educate patients and Medical officers.

Video 1: How to set up PCA pump – Guide for doctors and nurses

Video 2: Labour pain relief – Guide to patients

Video 3: How to set up elasto-metric pump – Guide to healthcare staff

Video 4: How to set up PCEA and epidural infusion – Guide to doctors