Chronic pain is complex and can significantly impact your quality of life. Primary care physicians are on the front line of your care and play an important role in helping you manage your pain and referring you to a pain specialist when necessary.
Assessing your pain: Your GP will assess the duration and nature of your pain, any underlying medical conditions that may be contributing to your pain and the impact this is having on your daily life, emotional wellbeing and functionality.
Conservative treatment: Your GP may initially introduce approaches, such as physical therapy, simple pain relief medications and advice on lifestyle modifications.
Referral to a pain specialist: Your GP may refer you to a pain specialist if the pain is severe, not responding to conservative management or there are indications of complex pain conditions.
A Pain Specialist may look at further medications management or interventional pain procedures such as: Nerve Blocks, Epidural Treatments, Facet Joint Injections/Medial Branch Blocks, Radiofrequency Nerve Ablations, Dorsal Root Ganglion Treatments, Spinal Cord Stimulations, Intrathecal Pumps and Platelet-rich plasma (PRP).
A nerve block is a minimally invasive interventional pain management procedure that involves injecting a local anaesthetic and sometimes a corticosteroid medication near a nerve or group of nerves to temporarily block pain signals.
Facet joint injections involve the injection of a local anaesthetic and a corticosteroid medication into the facet joint, which is a small joint located between the vertebrae of the spine. This injection is typically performed under the guidance of advanced imaging technique to ensure accurate placement of the medication. The injection can help to reduce inflammation and relieve pain caused by conditions such as facet joint arthritis.
Medial branch blocks involve the injection of a local anaesthetic medication targeting the medial branch nerves, which are small nerves that transmit pain signals from the facet joints to the brain. This injection is also typically performed under the guidance of advanced imaging technique to ensure accurate placement. The injection can help to block pain signals and can be used as a diagnostic tool to determine if the facet joints are the source of the patient’s pain.
Sacroiliac joint injection is a minimally invasive interventional pain management procedure used to diagnose and treat pain originating from the sacroiliac joint, which is located in the lower back where the spine meets the pelvis.
During the procedure, a local anaesthetic and a corticosteroid medication are injected into the sacroiliac joint under the guidance of advanced imaging techniques. The injection can help to reduce inflammation and relieve pain caused by conditions such as sacroiliac joint dysfunction, sacroiliitis, or arthritis.
Radiofrequency Neurotomy, also known as radiofrequency nerve ablation or RFA, is a minimally invasive procedure used to relieve chronic pain by disrupting nerve conduction in the affected area. There are different types of RFAs: Conventional thermal RFA, Pulsed RFA, Cooled RFA).
During an RFA procedure, a specialized needle is inserted through the skin and directed toward the nerves responsible for transmitting pain signals. Once the needle is in place, a small electrical current is used to heat and disrupt a small section of the nerve, interrupting its ability to send pain signals to the brain.
RFA is typically used to treat chronic pain conditions such as back pain, neck pain, shoulder, hip and knee pain that have not responded to other treatments such as medication or physical therapy. In other instances, they can also be used in specific peripheral nerve pain.
Epidural treatment is a minimally invasive procedure used to relieve pain by delivering medication directly into the epidural space surrounding the spinal cord and nerve rootlets.
During an epidural procedure, a needle is inserted through the skin and into the epidural space (area surrounding the spinal cord and the nerves that transmit pain signals) under the guidance of advanced imaging techniques. Once the needle is in place, medication such as a steroid or anaesthetic is injected into the epidural space, where it can help to reduce inflammation and block pain signals.
Epidural treatment is often used to treat chronic pain conditions such as back pain, neck pain, and leg pain, frequently caused by herniated discs or nerve irritation.
Neurostimulation, can be categorised into Spinal Cord Stimulation and Peripheral Nerve Stimulation, is a minimally invasive interventional pain management procedure that involves implanting small electrical leads (electrodes) near the spinal cord to deliver impulses and create electrical fields that can interrupt pain signals to the brain.
The device consists of a small battery-powered generator and thin wires with electrodes at the end. The electrodes are placed near the spinal cord via an epidural technique, and deliver electrical impulses that can help alleviate chronic pain caused by conditions such as failed back surgery syndrome, complex regional pain syndrome, or neuropathic pain.
The device is usually programmed to deliver electrical impulses at a frequency and intensity that is tailored to the individual’s specific pain needs. Patients can also adjust the settings of the device using a handheld remote control.
Neurostimulation is generally considered safe and effective for managing chronic pain that has not responded to other treatments. Your Pain Specialist can discuss the benefits and risks of this procedure with you and help determine if it is an appropriate treatment option for your specific condition.
An intrathecal pump, also known as a spinal drug delivery system, is a minimally invasive interventional pain management procedure that involves implanting a small device under the skin of the abdomen that delivers medication directly to the spinal cord.
The pump contains a small reservoir that can be filled with medication such as opioids, local anaesthetics, or other pain-relieving medications. The medication is delivered through a catheter that is inserted into the spinal fluid space, allowing for targeted delivery of medication to the affected area.
Intrathecal pumps are often used to manage chronic pain that has not responded to other treatments or for patients who cannot tolerate oral medications due to side effects. The device can provide continuous pain relief for months before the medication needs to be refilled.
Lignocaine and Ketamine infusions are two types of intravenous (IV) or Subcutaneous (SC) infusions used to manage chronic pain.
Lignocaine infusion, also known as lidocaine infusion, involves the administration of a local anesthetic medication called lignocaine or lidocaine through an IV or SC injection, It is used in cases of refractory neuropathic pain (nerve pain).
Ketamine infusion involves the administration of a medication called ketamine through an IV or SC injection. It is used for refractory pain and also to facilitate opioid reduction (help cutting down opioid medications smoothly and more comfortably).
Overall, lignocaine and ketamine infusions are often used to manage chronic pain conditions such as refractory neuropathic pain, complex regional pain syndrome (CRPS), and complex pain individuals with high opioid use.
Platelet-rich plasma (PRP) therapy is a non-surgical interventional pain management procedure that uses an individual’s own blood to promote healing and alleviate pain.
The procedure involves drawing a small amount of the patient’s blood and then using a special machine to separate the platelets from the rest of the blood components. The platelet-rich plasma is then injected into the affected area, such as a joint or tendon, to promote healing and reduce pain.
Platelets contain growth factors and other proteins that help stimulate tissue regeneration and repair. By injecting the concentrated platelets directly into the injured area, the healing process can be accelerated and pain reduced.
PRP therapy is often used to treat musculoskeletal injuries such as tendinitis, osteoarthritis, and ligament sprains. It is a safe and minimally invasive procedure with few side effects. Patients may experience some pain and swelling at the injection site.
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