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What is Chronic Pain?

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.

 

Pain can be classified by the type of pain or by body region.

Classification by pain types includes:

  • Neuropathic pain: burning, stabbing, tingling, insect crawling, shooting, associated with allodynia, hypersensitivity or other sensory changes.
  • Nociceptive pain: aching, boring, worse on movement, anatomically defined, fluctuates in severity.
  • Mixed Pain: combination of both neuropathic & nociceptive pain symptoms.
  • Visceral pain: dull, diffuse, ill-defined.
  • Although chronic pain is often neuropathic, it can also arise from other types of pain and it is possible to classify chronic pain by the underlying condition or body region which is causing the pain.

 

Common painful disorders seen in our chronic pain service include but are not limited to:

  • Post Surgical Pain
  • Peripheral Neuropathy
  • Post-Herpetic Neuralgia
  • Peripheral Nerve Injuries, including Complex Regional Pain Syndrome
  • Myofascial Pain
  • Persistent Post-Surgical Pain
  • Musculoskeletal Disorders
  • Joint Pain
  • Cancer Pain

 

Some of the procedures carried out in this Department are:

  • Injections of the Cervical and Lumbar Facet Joints
  • Peripheral and Autonomic Nerve Blocks
  • Selective Nerve Root Injections
  • Epidural Steroid Injections
  • Trigger Point Injections
  • Sacro-iliac Joint Injections
  • Radiofrequency Lesioning
  • Spinal Cord Stimulation
  • Percutaneous Electrical Nerve Stimulation
  • Pharmacological Management

 

Appointments

  • Our service is currently available via outpatient appointment clinic and day case interventional procedure, each Wednesday
  • As this service is GP referral based, we request that a letter of referral along with all other relevant records be forwarded to your Consultant prior to the initial appointment. We recommend that prior to your appointment; you visit your family doctor to ensure you are on the right pain medication. Your GP may organise an MRI scan, a special type of x-ray that provides detailed imaging of the spine and the soft tissue, which in turn allows for a correct diagnosis of the cause. 
  • On the day of your procedure, please arrive no more than 20 minutes ahead of time. After registration, you will be directed to the Cath Lab, where the nurse will admit you for your procedure).

Service / Condition Treated

Epidural Steroid Injection

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.

Injections of the Cervical and Lumbar Facet Joints

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.

Percutaneous Electrical Nerve Stimulation

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.

Peripheral and Autonomic Nerve Block

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 

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.

Sacroiliac joint injection

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 injection

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

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

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.

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