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Low Back Pain
Low back pain refers to pain most commonly in the lumbar spine. The lumbar spine provides a stable column connecting the upper body to the pelvis. One of its important functions is to provide structural support though interconnected vertebral bodies, intervertebral discs, ligaments and muscles.
Low back pain can originate from a number of structures or joints in the lower spine. It can also be a product of nerve injury or compression resulting in typically nerve related (neuropathic) pain, weakness or other changes in sensation. Clinicians utilize clinical skills, Xrays, CTs and MRIs together with diagnostic procedures to accurately determine the cause of pain, in order to provide the best treatment plan moving forward.
Neck pain occurs in the upper part of the spine, clinically known as the cervical spine. The cervical spine provides structural support to the head, allows complex movements and protects the spinal cord as it travels from the brain to the rest of the body.
Neck pain can originate from irritated and inflamed structures causing pain with a sharp or aching nature. Quite often patients present with a combination of symptoms. Diagnosis relies on clinical assessment, interpretation of imaging and response to procedures, to determine the best strategy in pain management.
Spine pain despite surgery (failed back surgery syndrome)
In some instances, back pain persists despite one or more surgeries on the spine. The reasons for this can be complex and often poorly understood. It may occur even if surgery has been otherwise completely successful.
In these circumstances, comprehensive review by the experienced team of clinicians at Axxon Pain Medicine aims to optimise management including medications, exercise and psychological coping strategies and evaluate the potential role of further treatments such as spinal cord stimulation (neuromodulation) or intrathecal drug therapy (targeted drug delivery).
Complex Regional Pain Syndrome (CRPS)
Complex regional pain syndrome is a condition where there is a mismatch between what is happening in an area of the body and what the body feels in that area. It most commonly affects limbs, and can be triggered by trauma to the area including nerve injury and fractures. It is diagnosed by a set of clinical criteria called the Budapest Criteria (LINK), and there is no specific cure.
Early and aggressive diagnosis and treatment gives the best chance of outcome. Treatments include medications, surgery, physiotherapy, occupational therapy and psychology. Severe CRPS may warrant treatments such as ketamine infusions or spinal cord stimulation.
Nerve pain can be severe, and often feels like an electrical or burning sensation. It can be caused by a specific nerve injury, or multiple nerves such as happens with diabetes or some diseases of the immune system.
It can occur by itself, or along with other symptoms such as weakness or numbness. Treatments can involve medications, or interventions such as nerve blocks or pulsed radiofrequency neurotomy. Severe cases may warrant use of an intrathecal drug delivery system or a spinal cord stimulator.
Chronic Hip or knee pain
Hip and knee pain is often degenerative, and due to arthritis. The chance and severity of this is a combination of genetic vulnerability, anatomy, patient age and use. The process, once started, is often usually age related and progressive. Hip and knee pain alter the body’s biomechanics, and often trigger pain in other areas such as the feet or the lower back. Joint replacement surgery is required if degenerative changes become severe.
There are many options for effective management and treatment to delay or avoid the need for surgery. Interventions such as radiofrequency neurotomy (LINK) can assist by decreasing the pain in the joint. Structured rehabilitation, helps to normalise the biomechanical changes, and extends the function and durability of the joint. These measures are also employed to reduce persistent pain following joint replacement surgery.
Shoulder pain is often difficult to treat. The shoulder joint is similar to a golf ball sitting on a golf tee, and is held in place by ligaments which tend to fray and weaken with age. Steroid injections can be helpful to relieve pain and improve movement in and around the joint.
More persistent pain can be treated by interventions to decrease the sensitivity of the nerve which carries pain from the shoulder. These interventions can be with either pulsed radiofrequency neurotomy or in severe cases use of a peripheral nerve stimulator.
This can be the result of a number of causes, including complications of hernia repair and entrapment of nerves. Treatment involves isolating the nerve causing the pain then targeting it.
Steroid injections and local anaesthetic help by both confirming which nerve is responsible, and giving some relief from the pain. In some cases, further treatments such as pulsed radiofrequency neurotomy, surgery or a peripheral nerve stimulator are required to get good long term control of the pain.
This disease remains poorly understood, but probably reflects a neurological change and an oversensitisation of the body’s pain sensing system. As we learn more about the changing nature of pain, and the way the body adapts and evolves to manage pain, we are learning how to manage and improve symptoms of oversensitisation.
Treatment is focussed on decreasing symptoms with medications, interventions and other therapies. Once the symptoms are decreased, we can help retrain the pain sensing system to be less reactive. This leads to improved physical and mental symptoms, and improved function.
Headache is a complex symptom, with a variety of causes from mild to catastrophic. Diagnosis can be difficult, and is focussed on excluding progressive or severe causes. Once this has been done, symptom treatment is often the priority. Treatment is usually in conjunction with a neurologist or a general practitioner.
Neck pain can commonly cause head pain, known as cervicogenic headaches. Often treating the upper neck, including the nerves which run to the temples, can dramatically improve headache symptoms. Other treatments include botulinum toxin, medications, and in some cases use of a spinal cord or peripheral nerve stimulator.
Cancer pain is the result of a number of processes. It causes suffering and limits the ability to engage in activities. The treatments of cancer including chemotherapy, radiotherapy and surgery can also create pain, which can be persistent.
Other treatment options include treatment to stop single or groups of nerves from sending pain signals. Intrathecal pumps can reduce the amount of medication required for pain relief by delivering the drug directly to the nervous system. The involvement of a team specialised in pain management can dramatically improve quality of life in cancer sufferers and cancer survivors.