NEUROSURGICAL PAIN MANAGEMENT

Pain | Causes | Diagnosis | Range of treatments | Treatment | Consultations

Pain is a complex sensation that everyone experiences at some point in their lives. It can occur in many forms and have various causes.

UNDERSTANDING PAIN 

Pain is our body’s alarm system. It signals that something is wrong.

There are two main types of pain:

Acute pain occurs suddenly and is often a sign of injury or illness. It usually disappears when the underlying cause is treated.

Chronic pain, on the other hand, lasts for a longer period of time, often longer than three months. It may need its own treatment pathway.

COMMON CAUSES OF PAIN 

There are many possible causes of pain. Some examples include injuries, inflammation, infections, diseases and degenerative conditions.

Pain can occur in different parts of the body, such as the back, joints, muscles or nerves.

Sometimes the pain is localised, while in other cases it can radiate to other areas.

HOW IS PAIN DIAGNOSED?

There are various diagnostic techniques to identify the causes of spinal pain and radiculopathy (pinched nerves) in the upper and lower extremities (limbs, hands and feet). Common diagnostic procedures include:

Medical history and physical examination:
The doctor will ask detailed questions to obtain information about the nature and duration of the symptoms. A thorough physical examination may reveal evidence of musculoskeletal problems, neurological deficits or other relevant findings.

Imaging:
This may include X-rays, computer tomography (CT) and magnetic resonance imaging (MRI). These procedures provide detailed imaging of the spine and nerve structures to identify structural abnormalities, slipped (herniated) discs, tumours or injuries.

Electromyography (EMG): This is a neurophysiological examination in which electrodes are used to measure the electrical activity of the muscles. It can help diagnose nerve disorders or damage associated with radiculopathy.

Nerve conduction studies (NCS):
This examination measures the speed and strength of nerve signals and can provide indications of nerve damage or problems.

Laboratory tests:
Blood tests can indicate inflammatory conditions or infections that may be related to the symptoms.

Diagnostic injections:
In certain cases, a diagnostic injection may be administered into the affected area to determine if the pain is caused by a specific structure.

The choice of the appropriate diagnostic procedures depends on the individual’s clinical presentation and what the doctor suspects to be the cause.

In many cases, several of these techniques are combined to make an accurate diagnosis and develop an effective treatment plan.

WHAT KIND OF PAIN AND WHICH PARTS OF THE BODY ARE TREATED AT OUR CENTRE?

Back pain, radiating pain, nerve pain:
These are the types of pain that occur in the spine and are often caused by various conditions such as slipped (herniated) discs, spinal stenosis, spondylolisthesis (vertebral instability), spinal fractures, degenerative disc disease, spinal tumours and spinal infections, all of which can put pressure on the nerves and cause both local pain and pain in the extremities.

Complex regional pain syndrome (CRPS):
CRPS, also known as Sudeck’s atrophy, is a chronic pain condition that often occurs after an injury or surgery and can lead to persistent pain, swelling and changes in skin colour.

Post-surgical pain:
Pain can occur after an operation and is often limited to the operated area. It can be severe and chronic.

Peripheral nerve injury:
Damage to peripheral nerves that supply the extremities can lead to pain, numbness and weakness in the affected areas.

Central nervous system injury:
Damage to the central nervous system, such as a stroke or spinal cord injury, can lead to chronic pain, sensory changes and restriction of movement.

Diabetic peripheral neuropathy:
Diabetic neuropathy is a type of nerve damage caused by diabetes. It can lead to pain, tingling, numbness or weakness in the extremities.

HOW CAN THESE TYPES OF PAIN BE TREATED

Conservative treatment:

• Physiotherapy: Special exercises can help to strengthen the muscles and stabilise the spine.
• Painkillers: Medications such as painkillers and anti-inflammatory medicines can temporarily relieve pain.
• Heat and cold therapy: Applying heat or cold packs can reduce pain and relieve inflammation.
• Weight management: Being overweight puts strain on the spine. Losing weight can reduce the pressure on the spine.
• Ergonomic adaptations: Improvements at work or at home, such as ergonomic chairs or mattresses, can help prevent back pain.

Pain medications:

• Painkillers: Strong painkillers may be prescribed to relieve acute pain.
• Anti-inflammatory medications: These medications can help to reduce swelling and inflammation around the nerves affected.

Invasive pain management procedures:

• Injections: Local injections of anti-inflammatory medication can be administered directly to the painful areas.
• Facet joint infiltration: This involves treating affected joints in the spine with local anaesthetics and anti-inflammatory medication.
• Facet joint denervation: This procedure involves interrupting the nerves that transmit pain signals from the facet joints using heat or chemical agents.
• Denervation of the cluneal nerve: For pain in the sacroiliac joint area (lower back and/or leg) the cluneal nerve, which is responsible for this area, can be blocked using heat to interrupt the pain signals.

Neurostimulation:

• Electrical pulses are used to block pain signals from reaching the central nervous system by placing small electrodes in the area of the spine.

Surgical interventions:

• In severe cases, surgical interventions may be necessary to correct the cause of the pain, such as disc surgery or spinal fusion.

Specific treatments for causes such as instability, infections, tumours or fractures:

• Stabilisation procedures: For unstable vertebrae, surgical interventions such as fusions may be necessary to stabilise the spine.
• Antibiotics: For infections of the spine, antibiotics are prescribed to treat the infection.
• Tumour treatments: Tumours may require surgery, radiotherapy or chemotherapy to remove or shrink the tumour. 

Please note that the choice of treatment depends on the specific diagnosis, the severity of the disease and other individual factors. It is important to talk to a doctor about your symptoms to determine the best course of action for your specific situation.