Pain can be felt in a number of different ways. For example, it may be:
- Sharp or dull
- Localised (in one specific place) or spread more widely
- Intermittent or constant
- Triggered by certain things (bright lights, food, drink, activity etc.)
There are many ways people can experience chronic pain. The people who visit The Alexandra Hospital in Manchester for help are often struggling with one of the following conditions or symptoms:
- Facial pain
- Neck pain
- Back pain
- Abdominal or pelvic pain
- Sciatica - pain in the leg or arm
- Joint pain
- Nerve pain – including post-operative pain, phantom pain and pain after shingles
- Fibromyalgia – a long-term condition that can cause pain all over the body
Any type of pain that is affecting your daily life can be incredibly hard to cope with. Long-term, unmanaged pain can very easily cause depression, frustration and anger, and will often cause relationship difficulties. While loved ones will want to support you, it can be hard for them to truly understand what you are going through.
There are different ways pain may be managed. Depending on your specific condition, your consultant may use medication or interventional procedures (or often a combination of both) to help ease and manage your symptoms.
Managing chronic pain involves comprehensive assessment of the patient, including:
- Physical examination
- Review of investigations
- Ordering of new investigations
- Formulation of a management plan
It deals with:
- Communicating with all relevant healthcare professionals and carers
- Onward referral to other healthcare professionals if appropriate
- Prescription of medication
- Performance of interventional procedures
- Referral for physical or psychological technique
- Appropriate discharge and follow-up plans.
Medicines that relieve pain can work in a number of ways, and this will determine where they are most effective. For example, if your pain is being caused by inflammation, an anti-inflammatory drug or a combination of paracetamol and an opioid (a strong painkiller with a similar effect to morphine) will often be the most effective treatment. Pain caused by a nerve problem will most likely need a different type of medicine that desensitizes the nerves, such as a capsaicin patch.
While there are a great number of medicines available to help relieve pain, the skill of an experienced consultant is in knowing which one(s) will be most suitable for your specific condition, and what dose and frequency will be most effective for you.
An epidural involves an injection of an anaesthetic into the epidural space around the spinal cord. It is commonly associated with pain relief during labour and childbirth but can be helpful for other pain relief, including post-surgery.
Pain management – interventional procedures
Interventional procedures available at The Alexandra Hospital include:
- Nerve blocks
- Nerve root blocks
- Facet joint injections
- Radiofrequency denervation
- Trigger point injections
- Ultrasound guided nerve blocks
Nerves transmit electrical impulses around the body in order to generate a specific response. A nerve block deliberately interrupts the signal in certain nerves in order to help relieve pain. For example, an occipital nerve block is an injection made into the occipital nerves in order to relieve pain from headaches and migraines.
A nerve root block involves injecting an anaesthetic and steroid at the precise point the nerve leaves the spinal cord (this is known as the nerve root). The anaesthetic numbs the pain while the steroid helps to reduce inflammation and swelling. A nerve root block is normally targeted at one particular nerve, with X-ray guidance used to ensure precise positioning of the injection.
Facet joints are small joints in the spine that join the vertebrae (bones of the back) together. A facet joint injection involves injecting an anaesthetic and steroid into a facet joint. As with the nerve root block (described above), the anaesthetic numbs the pain while the steroid helps to reduce swelling and inflammation.
Radiofrequency denervation (also known as rhizotomy or RF ablation) uses radiofrequency waves to interrupt the function of the nerve. It is commonly used to relieve pain in the back or neck.
Because of the complexity of interventional pain management and its overlap with so many other areas of medicine, your consultant works closely with other experts like spinal and orthopaedic surgeons, neurologists and neurosurgeons to ensure you see the most appropriate specialist at all times.