Dr Doger has a special interest in Cancer Pain Management and pain management in dying patients. It is a cause that is very close to his heart.
The Cancer Pain Clinic at John Taylor Hospice he has introduced to Birmingham is an innovative concept and the first clinic of its kind in West Midlands. There are no similar clinics locally where terminal palliative patients are assessed and managed swiftly in a a structured, safe and effective manner.
The majority of palliative care patients have their pain well managed using conventional medications by mouth according to the WHO analgesic ladder. In 10-20% or more of patients, opioid doses are limited by intolerable side effects, including sedation, confusion, constipation, nausea, and pruritus.
It is recognized that the World Health Organization (WHO) analgesic ladder, whilst providing relief of cancer pain towards the end of life for many sufferers world-wide, may have limitations in the context of longer survival and increasing disease complexity.
About 10% of patients have pain that is more difficult to manage and sometimes benefit from more complex interventions. This includes a variety of nerve blocks and neurodestructive procedures.
Interventional pain management techniques can be highly effective. They may reduce the need for painkilling medications with associated side effects, for patients with cancer.
Unrelieved pain leads to increased morbidity through multiple mechanisms, such as decrease in functional status with increased sedentary-related complications (e.g. deep venous thrombosis and pneumonia); depression, anxiety, and an associated lack of compliance with recommended treatments, including in some cases the inability to complete treatment protocols; and other adverse sequelae.