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Education

Pain treatment choices

When you have been living with chronic pain for a long time, it can feel as if you have tried everything to ease it.  If this sounds like your situation, please contact us for an appointment because it is very likely that we will be able to help.  Equally, if you are just starting to experience a problem with pain, quick action is best so please do not hesitate to get in touch with the clinic.

 

Everyone has their own individual situation and preferences, and most people benefit from a combination of different treatment methods, in an approach known as multi-modal pain management.  For these reasons, at Berkshire Pain Clinic, we offer a full range of treatments for chronic pain, such as exercise and physiotherapy, pain management counselling, pain medication and advanced medical procedures.

 

We also believe that by gaining knowledge about your condition and the various treatment options, you can take control of the pain.  So our website has information about many different pain conditions and treatments, including educational videos. 

 

Please explore the links below, and the rest of our website, to learn more about common pain conditions and ways we can help you feel better.

 

Health professionals treating patients with pain conditions might also find this information of interest.   We accept referrals for pain management from clinicians in Berkshire and beyond, so please don’t hesitate to contact us if you would like to know more about our services and standards.

 

 

Treatment approaches

Pain management and exercise 

 

Pain medications 

 

Epidural injections for lower back pain

Lumbar Transforaminal Epidural Steroid Injection 

 

Nerve blocks for pain relief

 

 

Muscle and ligament injections for pain

 

 

 

Prolotherapy injections for pain

 

Joint injections for pain

 

Nerve destruction to relieve pain

 

Electrical stimulation to relieve pain

  • PENS (peripheral electrical nerve stimulation)
  • Spinal cord stimulation (SCS)

 

Intravenous therapies for difficult to treat nerve pain

  • Intravenous lignocaine infusion
  • Intravenous guanethidine injection

 

Some specialised treatments that we offer are:

1. Stellate ganglion nerve block for pain

A nerve block interrupts the transmission of pain signals to the brain, and that is the basic principle behind this treatment.  The doctor injects a local anesthetic (numbing medication) into the nerve to achieve this effect.  Sometimes, a steroid medication is injected at the same time, to reduce any inflammation of the nerve.  This provides an additional level of soothing treatment for the irritated nerve.

 

As with every nerve block injection, the first step in this procedure is to numb the skin and surface tissues in the area to be treated.  Then the doctor injects the medication into a nerve cluster called the stellate ganglion, which is located in the neck.  Medical imaging technology is used to visualise what is happening inside the body during the injection, so the doctor can guide the needle accurately into place.  Where possible, our first choice for this procedure is ultrasound, which does not involve exposure to ionising radiation.   In some cases, a better choice is fluoroscopy, which uses a type of X-ray machine along with contrast (an iodine based dye) to confirm good needle position.

 

This treatment blocks pain signals from the stellate ganglion to the brain, and is helpful for managing some types of pain in the head, neck and arms, including Complex Regional Pain Syndrome (CRPS).  It can also be an option for refractory angina (difficult to treat heart pain) and shingles pain that does not improve with other treatments.

 

In our experience, a single injection can often give months of pain relief.  If the effect wears off sooner, the treatment may need to be repeated more frequently.

 

2. Ganglion impar nerve block for pain

This treatment works by blocking the transmission of pain signals from certain nerve structures, which are located at the base of the spine, to the brain. 

 

It involves an injection so the first step is to numb the skin and surface tisuses around the treatment area.  Then the doctor injects a local anaesthetic (numbing medication) into the ganglion impar, which is a bundle of nerves at the base of your tailbone (coccyx).  Sometimes a steroid medication is also injected, to soothe nerve tissues that have become irritated and inflamed.

 

X-ray fluoroscopy along with contrast injection (iodine based dye) is used to look inside the body during the procedure, so the doctor can guide the needle accurately into place. 

 

A ganglion impar nerve block is used to treat a condition called coccydynia, or lower back pain around the tailbone.  This pain makes it difficult to sit for any length of time and it can really get in the way of work, driving and other daily activities. This method is also used to treat pain in the perineum, which is the area between the rectum (back passage) and the genitals.  A ganglion impar nerve block can help with cancer pain in this area of the body, as well.

 

The pain relief from one treatment continues for a few weeks or months, and some people can find that a single procedure is enough to give long lasting relief.

 

3. Hypogastric plexus nerve block for pelvic pain

 

A nerve block stops the transmission of pain signals from a specific area of the body, to the brain.  This particular nerve block targets pain signals from the bladder, uterus, vagina, prostate, testicles, and rectum (back passage).  

 

This procedure involves an injection so the doctor will start by numbing the skin and surface tissues of the area to be treated.  Then an injection of local anaesthetic (numbing medication) is targeted at the hypogastric plexus, which is a bundle of nerves located in your lower back, just near the top of the pelvis.  A steroid medication is also injected, to calm inflammation of the irritated nerve tissues.

To guide the needle into its precise position, the doctor uses X-ray fluoroscopy along with contrast (iodine based dye) injection to confirm accurate needle position.

 

This treatment is used for cancer pain in the pelvic area.  It can also help to relieve pelvic pain caused by other conditions, such as endometriosis.

 

The initial injection is a trial of the treatment, to see how well it works for you.  When it is effective, a hypogastric plexus block can provide relief for weeks or even months.  It can be repeated if the pain relief wears off after a time.

 

4. Lumbar sympathetic plexus block for leg pain

This treatment is a nerve block, which interrupts the transmission of pain signals from the legs to the brain.  Nerve blocks focus on pain signals originating from one particular area of the body, in this case the legs.

 

As this technique involves an injection, the first step the doctor takes is to numb the skin and surface tissues in the area that will be treated.  Then a local anaesthetic (numbing medication) is injected into part of the lumbar sympathetic plexus, which is a network of nerves located just in front of the lower spine.  A steroid medication is also injected, to reduce inflammation of the nerve tissue. To guide the needle into the correct position, the doctor uses X-ray fluoroscopy along with contrast (iodine based dye) injection to confirm accurate needle placement.

 

This treatment is helpful for easing persistent nerve pain from the legs, resulting from insufficient blood supply.  It also relieves leg pain after surgery, including complex regional pain syndrome. 

 

 

5. Prolotherapy

Prolotherapy is a treatment that aims to encourage the body’s natural healing processes, allowing the restoration of tissues that have been over-stretched or torn.

It is used to repair damaged ligaments, which are the tough bands of fibrous tissue that normally provide stability to the joints, including those in the spine and pelvis.  When these joints are not properly supported, they experience extra stress and this causes pain.

 

Prolotherapy is a straightforward treatment, which involves having small injections into the affected area.  Before the ligaments are injected, the skin and surrounding tissues are numbed.  The prolotherapy injections typically contain a solution called P2G, which is a mixture of phenol, glycerol and glucose injected with a local anaesthetic to reduce discomfort. Depending on the location of the pain, the procedure is sometimes guided by X-ray imaging.   

 

Prolotherapy owes its name to the theory that it causes the proliferation of healthy new cells.  Even though prolotherapy has been in use for many years, scientists do not know yet exactly how it works.  However, it is believed to stimulate a mild inflammatory response, after the injection creates an area of irritation.  This in turn is thought to initiate a healing process, which includes the production of new fibres to make the ligaments thicker and stronger.

 

Prolotherapy can relieve pain in any of the joints and ligaments, including pain associated with arthritis.  It is commonly used for neck and back pain, and to treat painful sports injuries.  Other conditions that might be suitable for prolotherapy treatment include whiplash pain, tennis elbow, shoulder pain and foot pain.

 

Research to date suggests that prolotherapy works best when used in combination with other treatments such as physiotherapy, mobilization, massage and exercise.  This approach is in perfect accordance with our philosophy at Berkshire Pain and Spine Specialists, where we believe that such a multi-modal programme of pain management is ideal.

 

We typically offer prolotherapy as a course of three or four injections, given four to six weeks apart.  While some people may need an occasional top-up, prolotherapy often provides prolonged pain relief lasting for months.  

 

Pain management and exercise programme

The pain management programme

Many people live with chronic pain for a number of years, having treatment from several different doctors and possibly becoming dependent on medications.  Disabling symptoms of the pain condition erodes their quality of life and there seems to be no solution.

 

Fortunately, our pain management programme can help people who are experiencing ongoing pain that is not fully resolved with other currently available treatments.  It takes a holistic approach to help you cope with the pain and enjoy a lifestyle that is fulfilling and as active as possible.  In addition to relieving the emotional aspects of chronic pain, the programme also includes a review of your medications, and steps to improve your physical abilities to get on with everyday life.

 

When you start a pain management programme, you join a group of people in a similar situation. This can be a great support, as you meet others who really understand your experience.

 

The activities are led by a team comprised of health professionals such as psychologists and physiotherapists. The program here is an outpatient programme where there is a weekly session for six to eight weeks.

 

The first step is to have a consultation with Dr Ravindran so we can discuss whether this is a good option for you.  If it seems like an appropriate choice, he can refer you for a further assessment by the professionals running the pain management programme, which is based at the Royal Berkshire Hospital and in the community.

 

Benefits of physiotherapy and exercise

The right kind of exercise is of benefit to just about everyone with a pain condition.  And for a number of chronic pain conditions, physiotherapy is the main part of treatment.

Back and neck pain

For example, there is increasing research evidence for exercises that stabilise the pelvic, abdominal and lumbar muscles (the so-called core), as a method to restore normal function and reduce back and neck pain.  

 

If you have long-standing back or neck pain, there is a tendency for these core muscles to become inactive. This means all of your other muscles have to work harder, causing even more pain and making you vulnerable to injury, as well.  In such a case, a programme of training to strengthen these core muscles may help to ease the pain over time.

 

Complex regional pain syndrome

Another condition where exercise and physiotherapy are crucial is Complex Regional Pain Syndrome (CRPS). This condition occurs when there has been an injury but the pain is much greater or long lasting than would be expected. Starting treatment early gives the best outcomes.

 

Benefits of aerobic exercise

 Along with specific exercises to help the painful area, aerobic exercise that increases your heart rate for a sustained period is very beneficial for many pain conditions and for your overall health.

 

Aerobic exercise increases the flow of blood and nutrients to your body’s tissues, which supports healing, and can decrease the stiffness that contributes to your pain. Losing weight eases the pressure on the spine and joints. And exercise that makes you huff and puff will cause your body to produce its own painkillers, called endorphins. These natural ‘feel-good’ chemicals made by the body not only lift your mood, but might even reduce the need for pain medication.

 

Our physiotherapists can help you find the kind of aerobic exercise that is safe and effective for your condition. This might mean jogging or cycling, swimming, or taking an exercise class. Whatever method you choose, you will be pleasantly surprised by the difference your new exercise programme can make, as you enjoy higher energy levels and an increased sense of wellbeing.

Complementary therapies 

Most of our physiotherapists also offer other therapies in addition to exercise, such as hydrotherapy, acupuncture, transcutaneous electrical stimulation (TENS) or aromatherapy. They can help you plan an overall programme that suits you best.