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Treatments available
Choosing the right medication for your pain
You are probably already taking some pain killers like Paracetamol,
Codeine or Neurofen which may be either of little help or could be
associated with some side effects (e.g. stomach upset on Ibuprofen or
dizziness, nausea and constipation in case of Codeine based
medications).
Although, it is the right thing to start treating any pain with simple
pain killers, it is important to realise that some painful conditions
respond better to the different types of medications (e.g.
Antidepressants or Anticonvulsants for the nerve pain)even if these are
not generally regarded as ‘pain killers’.
Some patients would require much stronger medications for their pain,
e.g. Opioids which can be prescribed in a form of tablets, capsules or
skin patches applied once or twice a week.
Optimising your pain relief medications may be the first and, sometimes,
the only step needed and this should constitute an essential part of
your overall pain management strategy.
We shall discuss most issues regarding your medications during your
appointment but meanwhile you might consider going to
http://www.theacpa.org/documents/ACPA%20Meds%202007%20Final.pdf
which is ‘Medications & Chronic Pain 2007 Supplement’ of the American
Chronic Pain Association.
This is a quite large volume of information and most medications are
accompanied by their American brand names; however, it is very
comprehensive and it answers virtually any question about chronic pain
medication.
You can also find some answers regarding opioid (Morphine like) pain
killers on the British Pain Society website
http://www.britishpainsociety.org/book_opioid_patient.pdf
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Diagnostic nerve blocks
When the clinical examination and tests are not sufficient to identify
the cause of pain a diagnostic nerve block can be performed. It will
allow the doctor to test nerves that he believes may be related to the
pain. The test involves injecting a small amount of local anaesthetic
near the nerve to determine if the pain subsides. In general, the pain
needs to be confined to a certain area of the body, e.g. a limb, the
lower back or neck, shoulder, groin, head, etc. If the test offers
short-term pain relief, it will help the physician choose an effective
treatment for longer control. It is usually done during your
appointment.
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Steroid injections
A steroid (cortisone) is a medicine reducing inflammation and swelling.
It can reduce pain caused by these mechanisms, e.g. in inflamed joints
and their capsules or swollen connective tissue irritating nerves
passing through e.g. back or neck, shoulder and hip or knee joint. The
effect can sometimes take days to weeks to materialise and will usually
last for several months. Most of the substance will stay at the site of
injection and is not absorbed into the rest of the body. Therefore,
there are hardly any of the side effects feared from steroid tablets
although; quite often patients suffering from diabetes will have high
blood sugar for a few days after the injection.
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Radiofrequency lesioning
Radiofrequency lesioning is a procedure used to bring a long term pain
relief to those who had good but short lived response to a local
anaesthetic injection. An electrical current produced by a radio wave is
used to heat up a small area of nerve tissue, thereby decreasing pain
signals conducted by a sensory nerve. Sometimes, pulsed
radiofrequency
modulation is used which would not destroy a nerve and instead it would
rather modify its function in terms of stopping pain impulses through
it.
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Neurolytic procedures
Injections of chemical agents to destroy nerves and interrupt pain
pathways. The results of such injections are essentially the same as
nerve sectioning, although the effect is usually seen for only 3 to 6
months. Neurolysis is indicated in patients with severe, intractable
pain in whom less aggressive approaches are ineffective or intolerable
because of either poor physical condition or the development of side
effects.
Another consideration is that the painful area has responded to
diagnostic blockade with a local anaesthetic.
This procedure is usually reserved for the patients with cancer pain
although some patients with non-cancer conditions, who responded well to
a diagnostic blockade with a local anaesthetic, may obtain a long term
pain relief.
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Vertebroplasty
Vertebroplasty is an X-ray guided, minimally invasive, non-surgical
therapy used to strengthen a broken vertebra (spinal bone) that has been
weakened by osteoporosis, trauma or, less commonly, cancer.
Vertebroplasty can increase the patient's functional abilities, allow a
return to the previous level of activity, and prevent further vertebral
collapse. It is quite successful at alleviating the pain caused by a
compression fracture. Often performed as a day case procedure,
vertebroplasty is accomplished by injecting an orthopaedic cement
mixture through a needle into the fractured bone.
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Epiduroscopy
Epiduroscopy or spinal endoscopy is a key-hole procedure when a tiny
camera (endoscope) is inserted into your lower back (epidural space) in
order to see what might be causing your pain. It is also used to divide
adhesions and deliver medications exactly where they are needed.
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Botox for pain or excessive sweating
Botulinum toxin (Botox), a muscle poison much in the news as a cosmetic
treatment for wrinkles, has actually been used in many areas of medicine
for some time, such as in the treatment of muscle spasms, and certain
types of headaches. Its latest medical niche is the treatment of
excessive sweating and muscle pain. It works by interrupting connections
between nerves and muscles relieving spasm and leading to a pain relief
as a result. It also disrupts nerve signals to the sweat glands thus
reducing excessive sweating; although, the effect is temporary and
usually lasts for eight to ten months but occasionally longer.
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