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This section will deal
only briefly with some common pain disorders
Low Back Pain
and sciatica
Back pain is a very common problem. Up to 90% of population can
experience painful back at some stage of their life. In a majority of
cases, it will get better in a few weeks, however about 6% of patients
develop chronic disabling backache with significant impact on their
daily life and employment.
Below, you will find some but not all conditions associated with
backache, which often co-exist
‘Slipped’ intervertebral discs (they never actually ‘slip’ but can burst
or rupture) can cause irritation and pressure on a nerve root and cause
both back pain and sciatica.
Also see lumbar steroid epidural injection,
selective root block and
caudal steroid epidural injection
Lumbar spondylosis (wear or tear) or arthritis of the spine is very
common. This may include changes in intervertebral discs or
facet
joints. Pain arising from the inflamed arthritic
facet joints disease
accounts for 10-15% of mechanical back pain in young adults and up to
40% of cases in the elderly. Your main complain would be constant pain
in the lower back, frequently radiating to the buttocks, hip or groin.
It is worse on extending (bending backwards) your spine, prolonged
standing or walking. Not uncommonly, patients believe that the pain is
coming from their arthritic hip.
Also see facet joint injection,
facet joints, radiofrequency denervation of,
facet joints disease and
myofascial pain syndrome
Sacroiliac joint arthritis causes pain in buttocks and legs, difficulty
bending or twisting your low back, pain after sitting or standing for a
long time, low back and hip stiffness.
Also see sacroiliac joint injections and
sacroiliac joint,
radiofrequency denervation of
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Neck pain
Whiplash injury
Whiplash injury occurs when spine is stretched and strained after the
body is thrown in a sudden, forceful jerk. The injury most commonly
occurs in car crashes involving sudden deceleration, but the injury can
also occur after strenuous physical activities.
In simple cases only soft tissues in the neck are sprained and simple
pain killers and physiotherapy are all that are needed.
If your pain, however, persists for longer than six weeks it might be
that you have sustained more serious injury involving
intervertebral
discs or bony structures in the neck e.g. facet joints and more
aggressive treatment is needed.
Also see cervical (neck) facet joint injection or
Facet joints,
radiofrequency denervation of
Cervical spondylosis
It is a very common condition. It is almost inevitably seen on X-ray in
those over the age of 50, but the majority of people do not have any
pain. Those who have severe spondylosis often complain of neck stiffness
and pain radiating to the back of the head or shoulder.
Also see cervical steroid epidural injection,
cervical (neck) facet
joint injection, trigger point injection.
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Shoulder pain
Osteoarthritis of the shoulder is caused by the destruction of the
protective cartilage in the joint and accompanied by painful and
restricted shoulder movements.
Also see suprascapular nerve block and
Pulsed radiofrequency denervation
of suprascapular nerve.
Frozen shoulder
A condition where a shoulder becomes very painful and stiff. Movements
of the shoulder become reduced, sometimes completely 'frozen'. It is
thought to be due to scar-like tissue forming in the shoulder capsule.
Without treatment, symptoms usually go but this may take up to 2-3
years. Various treatments are used to ease pain and improve the movement
of the shoulder.
Many people are referred to a physiotherapist who can give expert advice
on the best exercises to use and suprascapular nerve block will
alleviate pain allowing patients to do a full range of exercises
achieving maximum benefits from physiotherapy.
Also see suprascapular nerve block
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Pain after
surgery
Approximately 3-5% of all surgical patients develop some degree of
chronic pain in the region of any surgical incision and about 20% of
patients attending chronic pain clinics implicate surgery as one of the
causes of their chronic pain.
There are usually two possible causes for persistent pain after surgery.
It could be either direct nerve damage or entrapment of the nerve in
scar tissue. A simple injection of a local anaesthetic and
steroids
around sensory nerve can dramatically reduce your pain immediately after
injection. If pain relief is short lived, then
Pulsed radiofrequency denervation of nerves in question or nerve roots is done in order to
achieve long lasting relief
Here are just few examples of chronic pain after surgery
Breast surgery
Postmastectomy pain syndrome (PMPS): chest wall or surgical scar pain
and tingling and pain down the arm. An estimated 30% to 60% of women
develop this chronic neuropathic pain syndrome after lumpectomy or
mastectomy. Other common complaints include numbness, shooting or
pricking pain, or unbearable itching. Postmastectomy pain is thought to
result from a physical injury to nerves supplying chest wall or an arm.
Pain after heart and lung surgery
May be either scar or chest wall pain caused by partial or complete
nerve injury.
Gallbladder surgery
Up to 56% of patients could suffer from deep or superficial abdominal
pain as a result of open or key-hole cholecystectomy
Pain after foot or hand surgery
One of the potential complications following surgery is the development
of chronic pain. The incidence of pain following orthopaedic surgery or
trauma that persists well beyond what might be expected (i.e. greater
than 3-6 months) can be alarmingly high. The exact incidence of
persistent postoperative pain remains controversial, but estimates
include
2.3% to 4% following arthroscopic (key-hole) knee surgery
2.1% to 5% following carpal tunnel surgery
13.6% following ankle surgery
0.8% to 13% following total knee arthroplasty
7% to 37% for wrist fractures
4.5% to 40% following fasciectomy for Dupuytren’s contracture
Also see Lumbar Sympathectomy and
Reflex Sympathetic Dystrophy or
Complex Regional Pain Syndrome (CRPS)
Caesarean section
Chronic pain after Caesarean section seems to be a significant problem
in at least 5.9% of patients and may result from the nerve entrapment in
the scar tissue
Hernia repair
Up to 11% of patients will suffer from persistent discomfort following
hernia repair. Pain may result from the direct nerve injury or too tight
a repair. A simple injection of a local anaesthetic and
steroids around
sensory nerve can dramatically reduce your pain immediately after
injection. If pain relief is short lived, then
Pulsed radiofrequency denervation of nerves in question or nerve roots is done in order to
achieve long lasting relief.
Also see neuralgia,
genitofemoral neuralgia
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Pain
after spinal surgery
Some people develop pain following spinal surgery as a result of scar
formation near the nerve roots causing gradual onset sciatica type pain.
In some cases, when discectomy was performed, there can be a recurrent
disc prolapse leading to a sudden recurrence of leg pain. Laminectomy
can also cause persistent back pain and so can vertebral fusion with
pain arising from facet joints just above the upper level of fusion.
Overall incidence of either leg or back pain following spinal surgery
may be as high as 30%. (http://www.pmrehab.com/fbss.htm)
Also see lumbar steroid epidural injection,
selective root block,
facet
joint injection and
pulsed radiofrequency denervation
Hip and knee
pain
Hip pain
Hip osteoarthritis is the most common joint disorder. The chronic
disease causes the cushioning (cartilage) between the bone joints to
wear away, leading to pain and stiffness. It can also cause new pieces
of bone, called bone spurs, to grow around the joints.
The symptoms of osteoarthritis usually appear in middle age and are
present in almost everyone by the age of 70. Before the age of 55, the
condition occurs equally in both sexes. However, after 55 it is more
common in women.
Hip osteoarthritis sometimes is perceived as back pain.
Also see hip injection,
lumbar plexus block,
meralgia paresthetica and
peritrochanteric bursitis
Knee pain
Osteoarthritis is the most common type of knee arthritis. Also called
wear-and-tear arthritis or degenerative joint disease, osteoarthritis is
characterized by progressive wearing away of the cartilage of the joint.
As the protective cartilage is worn away by knee arthritis, bare bone is
exposed within the joint. Knee arthritis typically affects patients over
50 years of age. It is more common in patients who are overweight, and
weight loss tends to reduce the symptoms associated with knee arthritis.
There is also a genetic predisposition of this condition, meaning knee
arthritis tends to run in families
Other painful knee conditions include
Ligament injuries
Patellar injuries
Meniscal tears
Patellar tendonitis
Some patients develop constant pain over the front of the knee after the
knee replacement surgery, arthroscopy or trauma. The diagnosis sometimes
is difficult to reach and one of the possible causes can be injury to
the small branches of the nerve that provides sensation to the front of
the knee (infrapatellar neuralgia)
Also see knee injection,
trigger points injection,
nerve block at the
knee and hyaluronic acid injection
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Pelvic pain
Chronic pelvic pain refers to any pain in your pelvic region — the area
below your bellybutton and between your hips — that lasts six months or
longer. If you were asked to locate your pain, you'd be more likely to
sweep your hand over that entire area rather than point to one spot.
Chronic pelvic pain can be a symptom of another disease, or it can be
diagnosed as a condition in its own right.
Pelvic pain is one of the most common problems affecting women of
reproductive age. The pain may vary from mildly irritating to
incapacitating.
Dysmenorrhoea and endometriosis are the two most common causes but other
reasons for your pain can be adhesions after surgery, nerve entrapment
in the abdominal wall, pelvic inflammatory disease (PID), an infection
of the uterus, fallopian tubes, and adjacent pelvic structures,
musculoskeletal disorders or something else.
You would have been seen already by a gynaecologist but you pain
persists despite optimal treatment
Also see Hypogastric plexus block,
Ganglion impar block,
Prostatitis
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Refractory
angina
Chronic stable angina that persists despite optimal medication and when
revascularisation is unfeasible or where the risks are unjustified. Some
people with coronary heart disease continue to suffer from recurrent
restricting angina even though they are taking the maximum amount of
medications. This is known as refractory or intractable angina.
The main goal of treatment of patients with refractory angina is
improving the quality of life through the alleviation of symptoms.
Stellate ganglion block (SGB) is a technique that has been used widely
by pain specialists for treating chronic pain syndromes for many years
and represents an important part of current ‘consensus’ evidence linked
treatment algorithm that has been commissioned by the United Kingdom
Pain Society and the British Cardiac Society and endorsed by the British
Cardiovascular Interventional Society.
Also see stellate ganglion block
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Cancer pain
In the management of cancer, 90% of patients would achieve reasonable
pain control with powerful pain killers alone. However, 10% of the
patients with cancer will still have a considerable amount of pain
despite maximum pain killers or develop intolerable side effects
preventing them from taking the effective dose of analgesia. This
category of patients may benefit from more advanced pain management
techniques such as chemical
neurolysis. This procedure is more complex
than a simple nerve block and in majority of cases should be preceded by
a diagnostic injection of a local anaesthetic.
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Hyperhidrosis
Hyperhidrosis is the excessive production of sweat. The areas most
frequently affected are the underarms, hands and feet. This condition is
often managed with Botulinum Toxin (Botox) injections. Prior to the
injections, a nerve block with a local anaesthetic is performed in order
to numb the skin and make the procedure painless.
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Nerve pain
Nerve pain caused by conditions where a part of nervous system is
affected by an injury, infection or any other disease. It can be pain
after a stroke or shingles infection (post herpetic neuralgia), painful
feet in diabetes or trigeminal neuralgia. Sciatica in fact is too nerve
pain as it is caused by an irritation of a nerve root. It is also
possible to have nerve pain after some types of surgery.
Also see Genitofemoral neuralgia,
Infrapatellar neuralgia,
Neuralgia, Neuropathic pain,
Reflex Sympathetic Dystrophy or Complex Regional Pain
Syndrome
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