Back pain

Pain in the lower back is a pathology caused by various factors, such as excessive stress or poor posture. Less common is the lower back pain caused by more serious problems like herniated discs. The most common cause of lower back pain is because the lumbar spine, the final segment of the spine, has endured excessive weight. The main symptom of this injury is pain that is usually located in the lower back, sometimes reaching the legs. This pathology may cause alterations in the different structures that form the backbone such as ligaments, muscles, spinal discs and vertebrae. In addition, lower back pain can be accompanied by a muscular contraction in the area, limiting mobility in this section of the body.

Neck pain

Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive deterioration, bad posture or emotional tension. Specifically, this cervical pain can be caused by any anomaly or tension in this area of the spine, both in the muscles, ligaments, discs or nerves, as well as in the vertebrae and in their joints. The symptoms of cervical pain may be of varying degrees, from mild discomfort to acute, sudden and intense pain. It can also become chronic neck pain when it lasts for more than three months, and it is more common in women than in men. In addition, in patients suffering from persistent cervical pain and headaches, consultation with a physician and physiotherapeutic treatment is recommended.

Neuropathic pain

What is neuropathic pain?

Neuropathic pain is a neurological disorder in which people experience intense chronic pain due to nerve damage. It often results from an injury or disease of the peripheral or central nervous system. Neuropathy can exist without pain, in the same way that pain can exist without evidence of nerve injury. Neuropathic pain, therefore, can be defined as a sensation or unpleasant emotional experience associated with dysfunction or injury of the nervous system.

What are the symptoms of neuropathic pain?

This pain usually causes numbness and pain in the hands and feet, as well as tingling or burning.

Along with pain, other symptoms may appear, such as:

Insomnia

Constipation

Lack of appetite

Anxiety

Vomiting

Weakness

Discomfort in the mouth

Acute pain or a stinging sensation

What causes neuropathic pain?

Peripheral neuropathic pain, or chronic neuropathic pain, is a result of damage to the peripheral nerves. This damage can be caused by:

Nutritional imbalances

Alcoholism

Toxins

Infections

Autoimmunity

Amputation

Diabetes

Diseases, such as kidney failure or cancer

Trauma to the nerves

Shingles

Thyroid problems

How is neuropathic pain treated?

The treatment for neuropathic pain can vary according to each case. These are the treatments available:

Medication: The first thing that specialists recommend are certain medications (e.g. antidepressants, NSAIDs, painkillers).

Physiotherapy: To reconstitute the muscles so they can move normally and with less pain.

Psychological therapy: pain can cause stress in the patient. This therapy helps the patient to manage the pain and resulting stress.

Nerve blocks: local anaesthesia or steroid injections are administered at the origin of the pain, providing temporary relief.

Medical devices: implantable devices can modulate pain signals before reaching the brain.

Sciatica

What is sciatica?

Sciatica is a very painful condition that can last for several days. It occurs due to the irritation of the sciatic nerve, which can happen through inflammation or injury. Sciatica is not a disease itself, but is a symptom of another health problem.

It usually causes a radiating pain that extends from the back to the leg, even reaching the feet. The muscles around the area tend to contract before the pain, worsening the situation. On other occasions, one of the spinal discs moves backwards, putting pressure on the nerve.

What are the symptoms?

The symptoms that sciatica produces can hinder quality of life. Some of the most common indicators include:

Pain: the degree of pain can vary from a mild pain that hardly causes discomfort to a dull or very intense pain that hinders the ability to move.

Tingling: occuring in the legs, calves and feet.

Numbness: areas where pain and tingling occur may be numb.

Weakness: it is very common to feel weakness in some parts of the body.

Causes of sciatica why it occurs

Sciatica pain is caused by inflammation or injury of the sciatic nerve, sometimes caused by compression in muscle contractures, a disc displacement in the spine, or a narrowing of the nerve channel.

The most common causes of sciatica are:

Herniated disc

Spinal stenosis

Piriformis syndrome

Lesion or fracture of the pelvis

Tumours

Can it be prevented?

Sciatica cannot be prevented since it is not a disease, but a symptom. However, experts recommend regular exercise and practising good posture.

What is the treatment?

Because sciatica is a symptom of another condition, the cause must be identified and treated.

In some cases, no treatment is necessary and the sciatica gets better on its own. In other cases, medication, surgery, or physiotherapy may be indicated in order to alleviate the pain or to correct the problem.

Trigeminal neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a nervous system disorder that causes a stabbing or electric shock type pain in parts of the face. The pain stems from the trigeminal nerve, which is responsible for sending sensation and pain from the face, eyes, paranasal sinuses, and mouth, to the brain. This condition tends to affect adults, although it can affect anyone regardless of age.

Prognosis

Diagnosis and progression of trigeminal neuralgia varies depending on the person and situation. Pain attacks can appear multiple times a day for weeks or months. They come on without prior warning and may stop just as suddenly. These attacks may get longer over time. It is thought that 29% of patients only have one attack. It is thought that 21% of trigeminal neuralgia episodes cause the same kind of pain in the first five years. In most cases tha pain can be avoided by carrying out treatment, although this may only be effective short term. None of the existing treatments is able to cure it.

What are the symptoms?

Trigeminal neuralgia symptoms tend to be very intense facial pain, it is normally unilateral, and lasts between one second to two minutes on average. It is said to be one of the most painful things that a person can experience. Many patients have described the pain as an electric shock type pain. The episodes of pain can be recurrent and repetitive. They appear spontraneously without an identifiable trigger. Everyday actions that don’t normally trigger pain can do so in patients with trigeminal nerualgia, they include; touching the cheeks or forehead, talking, laughing, brushing teeth, chewing, and swallowing, among others.

Medical tests

There are many tests that can be done to correctly diagnose trigeminal neuralgia. One of the first tests that the specialist may do is a cranial magnetic resonance tomography (MRT). This test is done because the trigeminal nerve starts at the base of the brain and passes through the base of the skull. The cause can be due to an irritation on any part of the nerve. An MRT scan can rule out certain kinds of tumours. It can also show any nerve damage by a blood vessel or the first symptoms of a demyelating disease. If it is thought that the patient may have multiple sclerosis, a lumbar pucture may be done. If the specialist thinks that the patient has symptomatic trigeminal neuralgia, a CT scan may be carried out.

What causes it?

The most common cause for trigeminal neuralgia is the pathological contact between the nerve and a blood vessel. In most cases there is numbness and the arteries swell up due to arteriosclerosis. This increase in size can affect the nerve and even damage it. Symptomatic trigeminal neuralgia is usually caused by other diseases, such as multiple sclerosis, which is a demyelinating disease. What typically causes trigeminal neuralgia pain is damage to the myeling sheath. The pain may be bilateral (both sides of the face).

How can it be prevented?

There isn’t a known way of preventing trigeminal neuralgia from developing. If nerve pain lasts a long time, the intensity of the attacks can be alleviated with appropriate treatment, in some cases flare ups can be completely avoided. Risk factors should be prevented. An exapmple of this is to prevent arteriosclerosis which can often lead trigeminal neuralgia. This is done by following a healthy lifestyle, eating a balanced diet, and regularly exercising.

What is the treatment?

Treatment tends to be pharmaceutical. There are many medications that can be used. Surgery is only resorted to in cases that do not respond to pharmacological treatment or if the side effects put the patient at risk. The medications for trigeminal neuralgia serve to prevent a flare up, they do not make the pain stop. Painkillers are inneffective as they ususally take half an hour to start working, by which point the worst part of the flare up will have lessened.

What specialist should I see?

Neurologists can diagnose and consult for trigeminal neuralgia, and if surgery is a possibility, you will be referred to a neurosurgeon.

Dr James Blackburn

GMC: 4219831

Dr James Blackburn is one of London's leading consultants in pain management. He practises at a number of prominent hospitals in the capital including St George's University Hospital and Parkside Hospital and has a special interest in trigeminal neuralgia, neck and back pain, sciatica, neuropathic pain, cancer pain and facial and head pain syndromes.

Outside of his clinic, he serves as a primary educator at St George's, is a board member for the London Pain Training Advisory Group and a member of numerous other organisations such as the British Pain Society.

Professional experience
- Consultant in anaesthesia and pain medicine, St George's University Hospitals NHS Foundation Trust (present)
- Consultant in anaesthesia and pain medicine, Parkside Hospital (present)
- Consultant in anaesthesia and pain medicine, the New Victoria Hospital (present)
- Consultant in anaesthesia and pain medicine Spire St Anthonys Hospital (present)
Professional membership
- Member British Pain Society
- Member of London Pain forum
- Member of Royal College of Anaesthetists
- Member of the faculty of Pain Medicine at the Royal College of Anaesthetists
Teaching posts
- Primary Educator, St George’s Hospital

Back pain

Pain in the lower back is a pathology caused by various factors, such as excessive stress or poor posture. Less common is the lower back pain caused by more serious problems like herniated discs. The most common cause of lower back pain is because the lumbar spine, the final segment of the spine, has endured excessive weight. The main symptom of this injury is pain that is usually located in the lower back, sometimes reaching the legs. This pathology may cause alterations in the different structures that form the backbone such as ligaments, muscles, spinal discs and vertebrae. In addition, lower back pain can be accompanied by a muscular contraction in the area, limiting mobility in this section of the body.
Chronic pain
What is chronic pain?

Chronic pain, sometimes described as persistent pain, refers to pain which lasts for longer than 12 weeks, despite medication or treatment being prescribed. Usually, over time, pain settles, but in some cases it can go on for a long time, affecting mental well-being, and causing discomfort and distress to those experiencing it.

Chronic pain is relatively common, with estimates from a 2018 BMJ study putting prevalence in the UK at 43%.

What causes chronic pain?

Chronic pain can happen as a result of an injury, or after an operation. Normally the pain we feel after trauma goes away after a while, but in some cases the pain can be chronic. Nerves can be damaged after trauma, which results in pain being more intense, and lasting longer.

Those with certain conditions can also experience chronic pain, such as those with diabetes, fibromyalgia, irritable bowel conditions, endometriosis, chronic fatigue syndrome, arthritis, and back pain.

Chronic pain can also occur without any obvious cause or trigger. This can be frustrating as medical tests do not always show the reason behind why you are experiencing the pain, or offer a clear source.

What are the symptoms of chronic pain?

Chronic pain refers to symptoms of pain lasting over 12 weeks, but you may also experience some of the following symptoms as a result of pain affecting your physical and emotional health:
- Anxiety
- Depression
- Lack of sleep
- Loss of libido
- Fatigue
- Irritability
How is chronic pain treated?

While it was once treated by bed rest, it is now known that the key to recovering from chronic pain is through exercise, and resuming normal activities. This is because resting for long periods causes your body to stiffen through inactivity. It is also not good for your mental health, as you can begin to feel lonely, and feelings of depression. Chronic pain is now typically managed through a combination of resuming regular activity, exercise, physical therapy, and pain medication.

Some may also choose to visit or be referred to a psychologist to help them cope with feelings of anxiety or depression.

Speak to your GP to come up with a treatment plan and for specialist referral if necessary. Many doctors can help with chronic pain, including pain management specialists, sports medicine doctors, rheumatologists, and neurologists.
Epidural infiltration

What is an epidural?

An epidural is a strong anti-inflammatory medication that is administered in the space surrounding the spinal cord. This is called the epidural space. This injection temporarily relieves inflammation or pain in the spine or limbs. The injection can help confirm the exact site of the pain generator.

Why would you do it?

This type of treatment is often used to treat short-term sciatica, however it doesn’t help non-sciatic back pain. Patients who have sciatica due to a slipped lumbar disc may feel a temporary improvement thanks to these injections but it won’t treat the cause.

What does it involve?

The doctor must first establish the location that the injection should be administered, then disinfect and sterilise the skin with an antiseptic. An anaesthetic will then be injected which will relax the area before the epidural injection. Once the area is completely relaxed, the specialist will use a visual aid to identify the epidural space correctly, then they will administer the epidural, which is made up of cortisone or steroids.

How to prepare for it

In a lot of cases an epidural is performed without the need for medical admission. However, in some cases it may be necessary, the specialist carrying out the treatment will decide. They will also suggest some post-treatment care such as not to eat or drink anything in the hours following the injection, to wear a loose gown, and to go the toilet before the procedure. It is advisable to be accompanied by a family member or friend in order to ensure getting home safely.

Post-treatment care

Some people may experience tingling in the arms and legs, depending on the injection site, after the procedure. If you have a sharp pain you should see a medical specialist. Some people have some difficulty walking unaided or getting in and out of the car, this normally subsides over time. The effects of the epidural can last months, weeks, and sometimes days.
Frozen shoulder
What is a frozen shoulder?

A frozen shoulder is a condition that causes pain and stiffness in the shoulder and hence a loss of mobility.

The shoulder joint capsule has ligaments that hold the shoulder bones together; when this capsule becomes inflamed, the bones are not able to move freely in the joint, causing a stiffened, frozen shoulder.

Prognosis:

Typically, frozen shoulder treatments help to restore mobility and the functioning of the shoulder after one year; even without treatment, it may improve after two years.

In cases that are treated by surgery, this should be followed with physical therapy for a few weeks or months to prevent the frozen shoulder from returning.

Frozen shoulder symptoms:

The main symptoms of frozen shoulder are pain, stiffness, and decreased joint mobility.

Medical tests for frozen shoulders:

To make a diagnosis of frozen shoulder, the specialist will ask the patient about their symptoms, examine the shoulder, and they may also require x-rays or, less often, an MRI scan.

What causes a frozen shoulder?

There are no specific causes of a frozen shoulder, although there are some risk factors:
- Shoulder injury and/or surgery
- Diabetes
- Thyroid problems
- Parkinson’s disease
- Hormone changes
Can a frozen shoulder be prevented?

Generally, a frozen shoulder cannot be prevented, however, if you have suffered a shoulder injury or have recently had shoulder surgery, you should practise certain exercises to keep the joint mobile and avoid stiffening. If your shoulder does become stiff, you should see a specialist as soon as possible.

Frozen shoulder treatments:

Frozen shoulders can be treated with NSAIDs and steroid injections, in addition to physical therapy. It may take a few weeks to see progress, and a few months to achieve a full recovery.

Frozen shoulder surgery is recommended when non-surgical treatment is not effective. In these cases, it is performed by a shoulder arthroscopy, which is done under anaesthesia.

Which specialist treats frozen shoulder?

Orthopaedic surgeons treat cases of frozen shoulder.
Joint injections
What are joint injections?

Joint injections are administered in a joint or periarticular soft tissue that is affected by inflammation.

Injections – when prescribed correctly – can be an excellent solution for problems such as bursitis or tendonitis, or for physical discomforts that prevent daily activities from being carried out. Therefore, joint injections can provide relief, as well as reduce pain.

Different liquid substances can be injected, including joint components such as collagen or hyaluronic acid, anti-inflammatory or growth factors and platelet rich plasma (PRP).

With injections, rheumatic conditions can be treated - arthritis, bursitis, tendonitis, epicondylitis or nerve entrapments. Other conditions such as trigger finger, carpal tunnel syndrome or frozen shoulder can be treated with injections too.

What are joint injections used for?

These injections can be applied to both larger joints, such as the knee, wrist or shoulder and in the surrounding tissues, such as ligaments or tendons.

Joint injections can be used to treat two different types of joint disease:
- Degenerative joint disease: those caused by wear and tear (e.g. arthritis).
- Inflammatory joint disease: those in which the synovial membrane is affected, such as rheumatoid arthritis.
How are joint injections given?

A joint injection is injected into the area being targeted. It is a simple technique and can be carried out on an outpatient basis.

Joint injection preparation

An injection does not require extensive preparation. The specialist should know the patient's medical history, as well as medications to which the patient may be allergic.

Aftercare

Once the injection is given, the patient should keep the injected limb at rest during the first 24 hours, as well as take any painkillers indicated by the specialist. Ice may also need to be applied to the area too in the first few hours.

If any intense pain, colour changes in the injected area, or fever after the intervention are experienced, the patient should immediately return to see their specialist.

Alternatives to joint injections

If joint injections are not suitable for the patient, the specialist may also recommend physiotherapy, anti-inflammatory medications, and in more severe cases surgery.
Joint pain

Joint pain is usually caused by diseases such as arthritis, osteoarthritis and rheumatism. This type of joint pain is that of the musculoskeletal system and is often caused by inflammation due to internal bleeding in the joints, wearing of the joints, or a combination of both. The pain can affect the structures surrounding the joint, such as ligaments, bones, tendons, muscles, etc.

Other symptoms of this type of pain are discomfort and fatigue in a particular area of the body, punctures and a heavy sensation. Depending on the location of the joint, pain may cause limitation of motion, and depending on the severity of the injury joint swelling or warmth and redness in the area can occur.
Low back pain

Low back pain or lumbago is pain in the bottom of the spinal column. Low back pain is not a disease itself, but a problem or a symptom which can have multiple causes. It may manifest due to bad posture, psychological factors, or degenerative diseases (such as osteoarthritis and osteoporosis). Lumbago treatment involves the administration of analgesics, muscle relaxants, and applying heat to the painful area. Rest is also recommended.

Low back pain is a muscle strain that generate bottom of the column.
Lumbar herniated disc

What is lumbar spine disc herniation?

A spinal disc herniation, herniated disc or a slipped disc, refers to a condition affecting one of the discs in the spine. Between each vertebrae in the spine, there is a cushion, known as an intervertebral disc.

A tear in the out, fibrous ring of one these discs can allow the central, jelly-like section of the disc to budge out. This is called a spinal disc herniation, more commonly referred to as a slipped disc. Although it can happen anywhere along the spine, it most commonly occurs in the lower back (lumbar).

What are the symptoms?

The most common symptom of a lumbar spine herniated disc is back pain. If the disc presses on surrounding nerves, individuals may experience arm or leg pain, numbness or tingling, and weakness. Intense pain in the buttocks, thighs and even feet is also common.

In some case, people experience no symptoms at all.

What causes it?

The most common cause is gradual wear and tear through ageing. As a person ages, the water content of the intervertebral discs reduces, making them less flexible and more likely to rupture. Additionally, bending, twisting, lifting heavy objects awkwardly, obesity or an injury or trauma can all put increased strain on the back.

How can it be prevented?

The risk of a slipped disc can be reduced by maintaining a healthy lifestyle and a healthy weight, and regular exercise is important. When lifting heavy objects it is also helpful to observe a safe technique to avoid unnecessary strain. Smoking also causes discs to lose flexibility and giving up may help to reduce the chances of suffering a herniated disc.

What is the treatment?

Most herniated discs will gradually improve and treatment may just consist of avoiding painful positions, taking gentle exercise and medication for the pain. Physiotherapy is also commonly used to treat a slipped disc, using exercise plans, positions and massages to treat the injury.

Medications are used to ease the pain and the type used will depend on its severity. Over the counter pain killers are used for mild cases whilst stronger painkillers are prescribed for worse cases. Additionally, anti-inflammatory injections directly into the spine are used to relieve severe pain in the short term in some cases and muscle relaxants are also deployed in some cases.

If the symptoms do not improve or are very severe, surgery might be an option. An operation known as a discectomy can be used to cut away part of the disc to release the pressure on the surrounding nerves.
Neck pain

Cervical pain (neck pain) occurs in the upper part of the spine, in the cervical area. It is a pain usually caused by trauma, illness, progressive deterioration, bad posture or emotional tension. Specifically, this cervical pain can be caused by any anomaly or tension in this area of the spine, both in the muscles, ligaments, discs or nerves, as well as in the vertebrae and in their joints. The symptoms of cervical pain may be of varying degrees, from mild discomfort to acute, sudden and intense pain. It can also become chronic neck pain when it lasts for more than three months, and it is more common in women than in men. In addition, in patients suffering from persistent cervical pain and headaches, consultation with a physician and physiotherapeutic treatment is recommended.
Neuralgia
What is neuralgia?

Neuralgia refers to a severe pain which occurs due to an irritated or damaged nerve. This condition is more common in the elderly but it can affect anyone at any age. Types of neuralgia include:
- Post-herpetic neuralgia: occurs as a complication of shingles, resulting in ongoing pain after a herpes zoster outbreak.
- Trigeminal neuralgia: affects the trigeminal nerve, causing severe, re-occurring pain in part of the face.
- Glossopharyngeal neuralgia: affects the glossopharyngeal nerve, but is less common than other types, producing pain in the neck and in the throat.
What are the symptoms of neuralgia?

The symptoms of neuralgia usually include:
- Acute pain: this is the main symptom of neuralgia and presents as a very intense pain felt throughout the area of the affected nerve.
- More sensitive skin in the region of the nerve that leads to intense pain with contact.
- Muscle weakness where the nerve is located. Sometimes the muscles also become temporarily paralysed.
What are the causes of neuralgia?

In many cases the causes of neuralgia is unknown, but it can be due to some of the following factors:
- Chronic kidney disease.
- Consumption of certain medications.
- Infectious diseases such as herpes zoster virus, HIV or syphilis.
- Pressure in the nerve by some bone, blood vessel or tumour.
- Trauma
- Diabetes
- Porphyria
Neuralgia can also be caused by an infection affecting the nerves, or result through nerve damage/injury to a nerve. However, the cause of particular types of nerve pain is not completely understood.

Can neuralgia be prevented?

One way to prevent neuralgia is to control blood glucose in patients with diabetes. Vaccines and antiviral drugs against the herpes zoster virus can also prevent neuralgia.

Treatment of neuralgia

The treatment for neuralgia will depend on the causes, the location of the nerve and the degree of pain. Pharmacological treatment for pain includes antidepressants, anticonvulsants, analgesics and patches or relaxing creams.

Other treatments that can be carried out are:
- Physiotherapy, especially in postherpetic neuralgia.
- Injections of medication to relieve pain.
- Treatments to relieve pain such as radiofrequency, heat application, chemical injection or balloon compression.
- Blockage of the nerves.
- Surgical intervention to relieve pain.
- Stimulation of the nerves or the spinal cord, especially when other treatments fail to relieve the symptoms of neuralgia. In some cases stimulation of the motor cortex is performed which involves placing an electrode in the nerve, brain or spinal cord to connect it to a pulse generator.
- Some may find therapeutic treatments such as acupuncture help, but it is important to consult your doctor about any complementary therapies you are considering
Neuropathic pain
What is neuropathic pain?

Neuropathic pain is a neurological disorder in which people experience intense chronic pain due to nerve damage. It often results from an injury or disease of the peripheral or central nervous system. Neuropathy can exist without pain, in the same way that pain can exist without evidence of nerve injury. Neuropathic pain, therefore, can be defined as a sensation or unpleasant emotional experience associated with dysfunction or injury of the nervous system.

What are the symptoms of neuropathic pain?

This pain usually causes numbness and pain in the hands and feet, as well as tingling or burning.

Along with pain, other symptoms may appear, such as:
- Insomnia
- Constipation
- Lack of appetite
- Anxiety
- Vomiting
- Weakness
- Discomfort in the mouth
- Acute pain or a stinging sensation
What causes neuropathic pain?

Peripheral neuropathic pain, or chronic neuropathic pain, is a result of damage to the peripheral nerves. This damage can be caused by:
- Nutritional imbalances
- Alcoholism
- Toxins
- Infections
- Autoimmunity
- Amputation
- Diabetes
- Diseases, such as kidney failure or cancer
- Trauma to the nerves
- Shingles
- Thyroid problems
How is neuropathic pain treated?

The treatment for neuropathic pain can vary according to each case. These are the treatments available:
- Medication: The first thing that specialists recommend are certain medications (e.g. antidepressants, NSAIDs, painkillers).
- Physiotherapy: To reconstitute the muscles so they can move normally and with less pain.
- Psychological therapy: pain can cause stress in the patient. This therapy helps the patient to manage the pain and resulting stress.
- Nerve blocks: local anaesthesia or steroid injections are administered at the origin of the pain, providing temporary relief.
- Medical devices: implantable devices can modulate pain signals before reaching the brain.
Orofacial Pain

Orofacial pain refers to any kind of pain or discomfort in the area of the mouth and face. The pain may be mucosal, dental, or masticatory. Mucous orofacial pain is usually caused by tabacco, alcohol, or dentures, dental pain usually originates from decay, and masticatory pain is related to bruxism, joint injuries, and loss of teeth.

Orofacial Pain

Orofacial Pain
Osteoarthritis
What is osteoarthritis?

Osteoarthritis is a degenerative conditions that affects the joints, causing them to become stiff and causing pain. Any of the joints in the body can be affected, but it more commonly affects the hips, knees, and small joints in the hands.

It affects women more commonly than it does men, and is the commonest form of arthritis in the UK.

What are the symptoms of osteoarthritis?

The most common symptoms of osteoarthritis are joint pain, difficulty in mobility, and stiffness or deformity in the joints.

These symptoms vary depending on the patient and intensify in a progressive manner. Joint pain, the most common symptom, appears first with movement and ceases with rest, but as osteoarthritis progresses, the pain may also be present while resting.

What are the causes of osteoarthritis?

The causes of the onset of osteoarthritis are not currently known but there are a number of risk factors associated with it:
- Genetics: In more than 60% of cases, genetic inheritance influences the appearance of osteoarthritis.
- Physical activity: athletes and people who maintain high physical activity have a higher risk of suffering from osteoarthritis.
- Working day: those who perform repetitive joint movements in their working day can wear down the joints and overload them, which can trigger osteoarthritis.
- Menopause: osteoarthritis more commonly affects women who have reached menopause due to the decrease in oestrogen that occurs during this stage of life.
- Injuries: fractures and traumas in the joints can influence osteoarthritis.
- Obesity: although it does not directly cause the onset of osteoarthritis, obesity influences wear and tear of the joints and therefore the progression of the condition.
Prevention of osteoarthritis

To avoid risk factors and therefore prevent osteoarthritis, it is very important to eat a balanced diet, such as the Mediterranean diet, and perform regular moderate exercise, thus avoiding wear and tear of the joints. Avoiding obesity is important as carrying too much weight can be detrimental.

Treatment of osteoarthritis

The objective of the treatment is to avoid or reduce pain and improve mobility. To treat osteoarthritis, the medical specialist will recommend the patient a series of exercises to be performed which are adapted to their situation and abilities, often with the help of a physiotherapist.

Pharmacological treatment: In most cases anti-inflammatories or analgesics are prescribed to reduce swelling and therefore pain. Chondroprotective medications may also be prescribed which may slow the progression of the disease.

Surgical treatment: osteoarthritis in very advanced stages may require prosthetic surgery.
Pain treatment

What is pain management?

Pain management is an interdisciplinary branch of medicine, which aims to improve quality of life for patients with chronic pain by reducing their suffering. It aims to relieve long-term pain, and may be administered by a single doctor, or a pain management team, consisting of different specialists. It can involve pharmacological or psychological treatments, or a combination of both.

Why would you need pain management?

While many branches of medicine focus on diagnosing and treating injuries and pathologies and treating the symptoms and pain during the healing process, pain management is needed when the pain persists after the injury or disease has healed. If the cause of the pain is not clear, relieving it becomes the objective. Patients with chronic (long-term) pain are the usual recipients. Types of pain that often require management include chronic back pain and headaches.

What does it involve?

There are many types of treatments to manage pain, which can be roughly divided into three categories: physical, psychological, and medicinal.

Physical treatments include physiotherapy, therapeutic physical exercise, the application of heat and/or ice, acupuncture, electrotherapy, and various interventional procedures, such as facet joint injections and spinal cord stimulation. Different sufferers may find different things help relieve their pain, such as massage therapy. Some treatments may have a psychological element, including the placebo effect.

Psychological treatments, such as cognitive behavioural therapy (CBT) and hypnosis have been used to treat pain, with varying reports on the efficacy. Studies have shown a small improvement in mood after CBT, but there is insufficient evidence to definitively say that it relieves pain. Similarly, studies on the effects of hypnosis have been limited, but shows signs of improvement. Some believe it the effectiveness of psychological treatments may be based on the placebo effect.

Medicinal treatments involves different kinds of drugs – mainly painkillers and anti-inflammatories. The type of drug depends on the location, severity, and probable cause of the pain. For example, mild pain can be managed with over-the-counter painkillers, while severe pain (after injury or surgery, for example) may be treated with opioids. Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used, and for conditions like fibromyalgia, antidepressants may be prescribed.

Due to the multi-disciplinary nature of the specialty, a pain management team can consist of medical practitioners, nurse practitioners, physiotherapists, psychologists, and other mental health therapists.
Peripheral nerve block
What is it?

Peripheral nerve block is a treatment used to block pain transmission through the nervous system. It involves intravenous painkillers to supress pain impulses. This treatment is mainly used for treating specific peripheral nerves.

The procedure is normally done under fluoroscopy (real time X-ray images) or a CT scan (computerised tomography) which enables the doctor to place the injection in the right place. The results from this procedure tend to be immediate, but they are not long lasting. Some patients may need several sessions before noticing an improvement, depending on the severity of each case.

Why would you do it?

A peripheral nerve block is used to treat pain during surgery and while the wounds from it improve.

Patients who have this kind of pain, whether chronic or not, can be given a nerve block injection to get pain relief, even if it is temporary.

The pain quite often is located in or radiates from the spine, although there are other areas that are quite frequently affected too, such as the upper and lower limbs, the neck, or the upper part of the buttocks.

What does it involve?

Using a peripheral nerve block gives the affected nerve the needed time to recover from the irritant. It can also give the specialist diagnostic information.

The procedure is normally done on an outpatient basis with no need for hospitalisation. It normally takes between 15 minutes to half an hour to perform.

The patient will wait on a stretcher so that the doctor has access to the area to be treated. The doctor will use image guidance to locate the exact area. The needle is placed at a specified depth that is closest to the nerve.

If the injection is to be placed close to a major nerve or set of nerves, such as the sciatic nerve, then the specialist will tell the patient to inform the team if they feel a sudden pain. This indicates that the needle is too close to the nerve and should be relocated.

In some cases, more than one injection is needed, this depends on the number of areas of pain or the size of the area to be treated.

After the injection, the patient will feel immediate pain relief in the area treated.

How to prepare for it

No special preparation is generally needed before a peripheral nerve block. A physical examination, previous anaesthetic information, and the patients clinical history is normally enough.

After the procedure the patient may need someone to escort them home. Doctors may request the patient not to eat or drink for at least twelve hours.

Post-operative care

The patient may notice numbness in their limb, or a tingling feeling or heaviness.

The specialist can prescribe additional medications to help alleviate pain in other parts of the body.

Alternative treatments

There are many alternatives for pain relief:
- Pain physiotherapy
- Narcotic (opioid) and non-narcotic painkillers
- Nerve stimulation
- Surgery to relieve pain
Radiofrequency denervation

Radiofrequency denervation is a procedure to modify and decrease the perception of pain by applying voltage changes to the nervous tissue that produces it. This technique involves the use of electrodes connected to a broadcast system that manages radio waves to eradicate the nerve responsible for the pain, through the heat emitted. It is a treatment that works well for pain in the joints of the neck, and is also used in the treatment of neck pain or to treat lower back pain. To first determine if the nerves of the joints are causing pain, a block can be applied to these nerves and pain relief is monitored.
Radiofrequency treatment

What is radiofrequency treatment?

Radiofrequency is a minimally invasive procedure which can be used to treat varicose veins. It is performed under local anaesthetic, and uses the application of heat to damage tissue, meaning scar tissue forms. This closes the varicose vein and cuts it off, meaning it is destroyed. This type of treatment can be used on large varicose veins.ç

Why undergo radiofrequency treatment?

Varicose veins can be considered unsightly by some, and many wish to have them removed. Varicose veins can also be painful and cause discomfort. Several types of procedure are available for the treatment of varicose veins, and different ones will be indicated depending on the patient and the size of the vein. As radiofrequency is able to destroy larger veins, it may be indicated in patients who have veins of significant size.

What does it involve?

The procedure is performed while the patient is awake, as a local anaesthetic is given to numb the particular area where treatment will be applied. Radiofrequency (an electrical current) is passed through a catheter injected into the vein, which heats up the vein wall and damages it. This causes the vein to close off.

Radiofrequency is generally a successful procedure, and the vein closes off in most patients. One advantage of radiofrequency is that it is less painful than traditional varicose vein surgery, which removes the vein itself.

Some side effects may include burns on the skin, pain after recovery, or clotting in the vein. However, these risks are minimal and usually get better over time.

How to prepare for radiofrequency treatment

Before the treatment, a medical history will be taken to see if the patient is suitable, and where the procedure should be performed. Medication will also be discussed, and those who take aspirin or blood-thinners (such as ibuprofen) as long-term medication will be told to stop several days before the procedure.

Post-operative care

After the procedure, the surgeon places a dressing on the area which has been treated. This dressing must be worn for at least 24 hours. After these 24 hours are up, the patient then should wear compression stockings for at least two weeks. Some mild pain may be experienced, which can be relieved using over-the-counter painkillers.

A follow-up ultrasound will be taken around a week after the procedure, to check the vein is closed and to see if a deep vein thrombosis has developed. This occurs rarely but it is a possibility and it is important for the surgeon to check.

Patients are advised not to partake in strenuous activity for a few weeks afterwards, but light activity is encouraged and the patient will be able to return to work soon after the procedure.
Reflex sympathetic dystrophy syndrome (RSD)
What is it?

Reflex sympathetic syndrome is a condition that affects the sympathetic nervous system. It is a painful chronic condition that tends to last more than six months, it causes stiffness and discolouration in the affected area.

The nerves affected by reflex sympathetic syndrome are located either side of the spinal cord and are responsible for certain bodily functions, such as opening and closing blood vessels.

This condition tends to affect hands and feet, although it can also affect arms and legs.

Reflex sympathetic syndrome is also known as complex regional pain syndrome, Sudeck’s atrophy, reflex neurovascular dystrophy, causalgia, or shoulder girdle syndrome.

Condition prognosis

This can greatly vary, it is thought that in young people disease prognosis is better. In some cases, despite treatment, the person affected will still have pain and disability.

If treatment is started early, it is believed that the condition can be halted, although not enough information is known about the disease progress.

What are the symptoms?

The most defining symptom of reflex sympathetic dystrophy is severe and long lasting pain, it can sometimes be chronic, which affects the sufferers’ life and ability to rest. Sometimes the pain is described as a feeling of pressure, tingling, or even burning on the affected area.

Even though this condition normally only affects one limb, the pain can extend along the limb or to the opposite limb.

The affected area tends to be particularly sensitive to pain, with skin contact being extremely painful. This is known as allodynia.

People affected by this condition may experience body temperature changes as well as changes in skin tone.

The main symptoms are:
- Prolonged pain
- Skin texture changes in the affected area
- Excessive sweating in the area
- Stiffness and difficulty moving the affected joints
- Muscle coordination issues
- Muscle pain
- Skin colour changes, these could be red or blue patches.
Medical tests

There isn’t a specific medical test that diagnoses this condition. Diagnosis is based on medical history, as well as signs of the condition.

The main sign is an issue with an injury in the affected area. An MRI may be requested to confirm the diagnosis.

Causes of reflex sympathetic dystrophy

The specific cause of the condition is still unknown, but it is known that in a lot of cases the condition appears due to an injury, the most common ones are:
- Fractures
- Soft tissues injuries, such as burns or blows
- Sprains and/or strains
- Immobilization of the limb
In these cases, it can be said that the condition is an abnormal bodily reaction that amplifies the effects of the injury or trauma. It can be compared to an allergic reaction in that some people will have an adverse reaction while others won’t be affected.

Blood vessels may leak fluid into the surrounding area, making the skin redden and swell. The muscles in the surrounding area may be starved of oxygen and could tighten or stretch.

How can it be prevented?

This condition is still under investigation, the only way that is known so far to prevent it is to avoid or prevent the injury that causes it.

What is the treatment?

The most common treatments for this condition are:
- Rehabilitation and physical therapy: series of exercises to keep the affected area mobile. It aims to improve blood flow and decrease symptoms related to poor circulation.
- Psychotherapy: this condition quite often causes psychological issues such as; anxiety, depression, or post-traumatic stress disorder.
- Medication: some anti-inflammatory medications for pain can help.
- Blocking sympathetic nerves: many patients have claimed that this has given them some pain relief.
- Surgical sympathectomy: this is a controversial treatment that destroys nerves.
- Spinal cord stimulation: electrodes are placed on the spine, minor surgery is needed for this procedure.
- Neurostimulation: is used in the area of pain or discomfort.
- Intrathecal drug infusion pump: is used to relieve pain by administering pain relief medication, there is no evidence that it improves RSD.
What specialist should I see?

Reflex sympathetic dystrophy is treated by specialists in pain management.
Rheumatism

What is rheumatism?

Rheumatism was the common name given to musculoskeletal disorders that affect one or more structures such as ligaments, tendons, muscles and bones. The term is no longer used by medical professionals, yet words similar to rheumatism such as rheumatoid and rheumatology are still in use. Today, doctors are much more specific in their diagnoses regarding rheumatic diseases and do not use the term rheumatism as a diagnosis but as a category of conditions, such as rheumatoid arthritis.

Rheumatism is a general term, which describes a number of different conditions that produce similar symptoms. Overall, rheumatic conditions are caused by the wear of articular cartilage, inflammation of a joint or bone decalcification. Rheumatic pain may occur from the same joint or from structures around it, such as muscles, tendons, etc. It can also appear solely in the joints or produce pain so persistent that it can affect the quality of sleep.

What are the rheumatic symptoms?

Rheumatism is a broad category but there are several fundamental symptoms among all conditions, which include:

• Pain in hands, fingers, shoulders or knees
• Stiffness, swelling and tenderness in joints and muscles
• Redness and warmth in muscles
• Lack of mobility in specific joints and muscles

What are the different types of rheumatic diseases?

There are over 100 types of rheumatism and each has varying symptoms and treatment options. Overall, rheumatic conditions affect the musculoskeletal system. Some of the most common conditions are:

• Rheumatoid arthritis
• Osteoarthritis
• Rheumatic fever
• Juvenile Rheumatoid Arthritis
• Rheumatic heart disease
• Gout • Fibromyalgia
• Lupus

How is rheumatism diagnosed?

It is difficult to diagnose rheumatic conditions because the symptoms tend to crossover between the different types. The patient will have a physical examination and be asked specific questions about their symptoms. There may also be blood tests and imaging scans too.

How is rheumatism treated?

Treatment is much more effective of the condition if it is diagnosed as early as possible. A specialist doctor called a rheumatologist, will advise of the best treatment option. Treatment options may include non-steroidal anti-inflammatories to reduce inflammation and pain. Patients should continue with exercise to maintain mobility and a healthy diet is recommended.
Rhizotomy

Rhizotomy is a non-invasive surgical technique to address back pain through several punctures in the area of the spine to be treated without hospitalisation. Rhizotomy involves destruction of nerve endings that transmit pain originating in the joints that connect two vertebrae by radiofrequency pulses. Rhizotomy is performed in the operating room with the patient lying face down (in the case of rhizolysis lumbar and dorsal rhizotomy) or lying face up (in case of neck pain). This treatment is indicated in cases of pain caused by movement in which the nerves exiting the spine to the limbs are not affected.
Sciatica
What is sciatica?

Sciatica is a very painful condition that can last for several days. It occurs due to the irritation of the sciatic nerve, which can happen through inflammation or injury. Sciatica is not a disease itself, but is a symptom of another health problem.

It usually causes a radiating pain that extends from the back to the leg, even reaching the feet. The muscles around the area tend to contract before the pain, worsening the situation. On other occasions, one of the spinal discs moves backwards, putting pressure on the nerve.

What are the symptoms?

The symptoms that sciatica produces can hinder quality of life. Some of the most common indicators include:
- Pain: the degree of pain can vary from a mild pain that hardly causes discomfort to a dull or very intense pain that hinders the ability to move.
- Tingling: occuring in the legs, calves and feet.
- Numbness: areas where pain and tingling occur may be numb.
- Weakness: it is very common to feel weakness in some parts of the body.
Causes of sciatica why it occurs

Sciatica pain is caused by inflammation or injury of the sciatic nerve, sometimes caused by compression in muscle contractures, a disc displacement in the spine, or a narrowing of the nerve channel.

The most common causes of sciatica are:
- Herniated disc
- Spinal stenosis
- Piriformis syndrome
- Lesion or fracture of the pelvis
- Tumours
Can it be prevented?

Sciatica cannot be prevented since it is not a disease, but a symptom. However, experts recommend regular exercise and practising good posture.

What is the treatment?

Because sciatica is a symptom of another condition, the cause must be identified and treated.

In some cases, no treatment is necessary and the sciatica gets better on its own. In other cases, medication, surgery, or physiotherapy may be indicated in order to alleviate the pain or to correct the problem.
Trigeminal neuralgia

What is trigeminal neuralgia?

Trigeminal neuralgia is a nervous system disorder that causes a stabbing or electric shock type pain in parts of the face. The pain stems from the trigeminal nerve, which is responsible for sending sensation and pain from the face, eyes, paranasal sinuses, and mouth, to the brain. This condition tends to affect adults, although it can affect anyone regardless of age.

Prognosis

Diagnosis and progression of trigeminal neuralgia varies depending on the person and situation. Pain attacks can appear multiple times a day for weeks or months. They come on without prior warning and may stop just as suddenly. These attacks may get longer over time. It is thought that 29% of patients only have one attack. It is thought that 21% of trigeminal neuralgia episodes cause the same kind of pain in the first five years. In most cases tha pain can be avoided by carrying out treatment, although this may only be effective short term. None of the existing treatments is able to cure it.

What are the symptoms?

Trigeminal neuralgia symptoms tend to be very intense facial pain, it is normally unilateral, and lasts between one second to two minutes on average. It is said to be one of the most painful things that a person can experience. Many patients have described the pain as an electric shock type pain. The episodes of pain can be recurrent and repetitive. They appear spontraneously without an identifiable trigger. Everyday actions that don’t normally trigger pain can do so in patients with trigeminal nerualgia, they include; touching the cheeks or forehead, talking, laughing, brushing teeth, chewing, and swallowing, among others.

Medical tests

There are many tests that can be done to correctly diagnose trigeminal neuralgia. One of the first tests that the specialist may do is a cranial magnetic resonance tomography (MRT). This test is done because the trigeminal nerve starts at the base of the brain and passes through the base of the skull. The cause can be due to an irritation on any part of the nerve. An MRT scan can rule out certain kinds of tumours. It can also show any nerve damage by a blood vessel or the first symptoms of a demyelating disease. If it is thought that the patient may have multiple sclerosis, a lumbar pucture may be done. If the specialist thinks that the patient has symptomatic trigeminal neuralgia, a CT scan may be carried out.

What causes it?

The most common cause for trigeminal neuralgia is the pathological contact between the nerve and a blood vessel. In most cases there is numbness and the arteries swell up due to arteriosclerosis. This increase in size can affect the nerve and even damage it. Symptomatic trigeminal neuralgia is usually caused by other diseases, such as multiple sclerosis, which is a demyelinating disease. What typically causes trigeminal neuralgia pain is damage to the myeling sheath. The pain may be bilateral (both sides of the face).

How can it be prevented?

There isn’t a known way of preventing trigeminal neuralgia from developing. If nerve pain lasts a long time, the intensity of the attacks can be alleviated with appropriate treatment, in some cases flare ups can be completely avoided. Risk factors should be prevented. An exapmple of this is to prevent arteriosclerosis which can often lead trigeminal neuralgia. This is done by following a healthy lifestyle, eating a balanced diet, and regularly exercising.

What is the treatment?

Treatment tends to be pharmaceutical. There are many medications that can be used. Surgery is only resorted to in cases that do not respond to pharmacological treatment or if the side effects put the patient at risk. The medications for trigeminal neuralgia serve to prevent a flare up, they do not make the pain stop. Painkillers are inneffective as they ususally take half an hour to start working, by which point the worst part of the flare up will have lessened.

What specialist should I see?

Neurologists can diagnose and consult for trigeminal neuralgia, and if surgery is a possibility, you will be referred to a neurosurgeon.

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Trigeminal neuralgia – how ‘the worst pain known to man’ can be managed

Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which is located on the face. It is described as being brief, short-lasting episodes of pain that are electrical or stabbing in nature in one or more divisions of the trigeminal nerve on the face. This is an extremely debilitating condition and it is one that Dr Jim Blackburn, a pain medicine specialist, is an expert in diagnosing and treating.

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Dr Blackburn

What is neuropathic pain?

What are the symptoms of neuropathic pain?

What causes neuropathic pain?

How is neuropathic pain treated?

What is sciatica?

What are the symptoms?

Causes of sciatica why it occurs

Can it be prevented?

What is the treatment?

What is trigeminal neuralgia?

Prognosis

What are the symptoms?

Medical tests

What causes it?

How can it be prevented?

What is the treatment?

What specialist should I see?

Dr James Blackburn

GMC: 4219831

Professional experience

Professional membership

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Diseases, Medical Tests and Treatments

What is chronic pain?

What causes chronic pain?

What are the symptoms of chronic pain?

How is chronic pain treated?

What is an epidural?

Why would you do it?

What does it involve?

How to prepare for it

Post-treatment care

What is a frozen shoulder?

Prognosis:

Frozen shoulder symptoms:

Medical tests for frozen shoulders:

What causes a frozen shoulder?

Can a frozen shoulder be prevented?

Frozen shoulder treatments:

Which specialist treats frozen shoulder?

What are joint injections?

What are joint injections used for?

How are joint injections given?

Joint injection preparation

Aftercare

Alternatives to joint injections

What is lumbar spine disc herniation?

What are the symptoms?

What causes it?

How can it be prevented?

What is the treatment?

What is neuralgia?

What are the symptoms of neuralgia?

What are the causes of neuralgia?

Can neuralgia be prevented?

Treatment of neuralgia

What is neuropathic pain?

What are the symptoms of neuropathic pain?

What causes neuropathic pain?

How is neuropathic pain treated?

What is osteoarthritis?

What are the symptoms of osteoarthritis?

What are the causes of osteoarthritis?

Prevention of osteoarthritis

Treatment of osteoarthritis

What is pain management?

Why would you need pain management?

What does it involve?

What is it?

Why would you do it?

What does it involve?

How to prepare for it

Post-operative care

Alternative treatments

What is radiofrequency treatment?

Why undergo radiofrequency treatment?

What does it involve?

How to prepare for radiofrequency treatment

Post-operative care