Chronic pain is characterised as pain that has been on-going for 12 weeks or more despite the use of simple pain medication like ibuprofen and paracetamol and despite carrying out a course of exercise and physiotherapy.Chronic pain is a disease of the central nervous system and can be defined as pain that either persists beyond the point that healing would be expected to be complete or that occurs in disease processes in which healing does not take place. The pain may be continuous or intermittent and can typically present for 3-6 months before patients seek active treatment.Chronic back pain, 95% of which originates from the lower lumbar spine, can be very debilitating, with patients often predisposed to sleep loss, long periods of absence from work and, in some cases, patients can develop depression.Chronic back pain can manifest with pain on one or both sides of the lower back and the pain can extend to the buttocks or thighs but often not lower than the knee.
Classification by pain types includes:
Common painful disorders seen in our chronic pain service include but are not limited to:
Some of the procedures carried out in this Department are:
An epidural steroid injection (ESI) is a minimally invasive procedure that can help relieve neck, arm, back, and leg pain caused by inflamed spinal nerves. ESI may be performed to relieve pain caused by spinal stenosis, spondylolysis, or disc herniation.
A cervical or lumbar facet joint injection involves injecting a small amount of local anesthetic(numbing agent) and/or steroid medication, which can anesthetize the facet joints and block the pain.
Percuntaneous Electrical Nerve Stimulation (PENS) therapy is used to treat chronic nerve pain including areas of hypersensitivity, headache and chronic post-surgical pain. A PENS machine delivers low voltage electrical current to the peripheral nerves via a probe/s placed just under the skin. It works by altering the state of the nerves resulting in pain relief. It does not destroy the nerves but makes them less sensitive to pain.
An Autonomic Nerve Block is the interruption of sympathetic pathways, by local injection of an anesthetic agent. at any of four levels: peripheral nerve block, sympathetic ganglion block, extradural block, and subarachnoid block.
A sympathetic nerve block can be used to diagnose or treat pain involving the nerves of the sympathetic nervous system. Examples of conditions for which a sympathetic nerve block might be used include:Pain from spasms in the blood vessels,complex regional pain syndrome, previously called reflex sympathetic dystrophy and causalgia, some types of chronic stomach pain
Radiofrequency lesioning is a procedure in which special needles are used to create lesions along selected nerves. The needles heat the nerve to 80°C (about the temperature of hot, not boiling, water). When this heat is applied to the nerve for about 2-3 minutes, the nerve stops carrying pain signals.
A sacroiliac joint injection is designed to diagnose and treat pain and inflammation from sacroiliac joint dysfunction. Either too much or too little movement in one of the sacroiliac joints, which are located at the bottom of the spine on each side of the sacrum, can cause lower back pain and/or leg pain.
Selective nerve root block injection (SNRB) is an injection of a long-lasting steroid (cortisone) around the nerve root as it exits the spinal column.
The injection reduces the inflammation and pain caused by pressure on the nerve. It can also be used as a diagnostic tool to help doctors determine whether the nerve is irritated by “numbing” the nerve.
Spinal cord stimulation is a therapy that masks pain signals before they reach the brain. A small device, similar to a pacemaker, is implanted in the body to deliver electrical pulses to the spinal cord. It helps patients better manage their chronic pain symptoms and decrease the use of opioid medications. It may be an option if you suffer chronic back, leg or arm pain and have not found relief with other therapies.
Trigger point injection (TPI) may be an option for treating pain in some patients. TPI is a procedure used to treat painful areas of muscle that contain trigger points, or knots of muscle that form when muscles do not relax. Many times, such knots can be felt under the skin.
Dr Brendan Conroy is a Consultant Anaesthetist and Pain Specialist who completed his specialist training in St James’s Hospital Dublin, Beaumont Hospital Dublin, Mater Misericordia Hospital Dublin, Cork Regional Hospital and St Jame’s Hospital Dublin. He also received training in both Anaesthesia and Pain Management in the US and is board certified in both specialities. His teaching experience includes being an Associate Professor in both Anesthesia and Pain in the University of Texas and he currently holds the position of Vice Dean of the Faculty of Medicine, College of Anaesthesia Ireland.
Dr Conroy’s specialist interests include spinal pain and cancer pain. He has extensive experience in both chronic non-malignant and malignant pain.