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Types of Pain
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spinal pain

Treatment options

 

Disc prolapse (slipped disc)

If one has a disc prolapse and the surgeon does not want to operate, Dr Munglani will often recommend a nerve root block. This is an injection with steroids that is performed under local anaesthetic with intravenous sedation and using X-ray screening to guide the needle, whilst the patient is lying face down. Some studies suggest that up to two sets of these may well reduce the requirement for a subsequent operation by about 50%.

If the disc continues to bulge and be painful (discogenic pain) and a surgical procedure is still not appropriate then one can consider using nucleoplasty, which is a minimally invasive way
of decompressing the disc by vaporising the jelly-like substance in the middle of the disc.

Soft tissue related pain

In most cases there is no disc prolapse or the degree of bulging is minimal. In this case the pain is much more likely to be related to the soft tissues; muscular or ligament strain or dysfunctioning of the facet joints, the little joints which keep the spine mobile. In about 40-50% of patients who come to the Pain Clinic, these joints seem to be involved in the production of pain. To treat the above, injections with local anaesthetic and steroid can be effective.

If these help Dr Munglani will consider recommending radiofrequency denervation which can give longer term relief in up to 70% of patients. Radiofrequency denervation is a specialised form of injection. Heat damage (referred to as a lesion) is created on the nerves thought to be responsible for the pain, with the aim of cutting pain signals along this nerve. This should relieve pain, at least until the nerve regenerates, in up to 70% of patients for 1-3 years and can be repeated with ease.

In some patients the joint dysfunction is accompanied by ligament dysfunction and one can use prolotherapy (a technique in which to initially inflame and then desensitise the ligaments) to
help treat this type of pain. Prolotherapy is also known as regenerative injection therapy.

The role of injections within a treatment programme

Dr Munglani recommends injections be combined with a number of complementary approaches to managing pain.

Post-injection physical rehabilitation may involve simply increasing the amount of walking one does, exercise such as swimming and attending a physical therapist or enrolling in a Pain Management Programme.

Risks from injections

Overall the risks of injections around the spine are very small indeed. The chances of a minor reaction such as infection are 1 in 5,000 and the chances of a major problem such as paralysis range from 1 in 100,000 to 1 in 300,000 or less.

It is very important to be assessed by a doctor experienced in performing such injections and who uses
x-ray for diagnosis and performs procedures under x-ray control.

The role of psychology in the perception of pain

In certain situations chronic pain is associated with changes in mood. When the mood drops ones pain tolerance drops and this can lead to a vicious cycle of becoming more and more disabled and feeling more and more pain.

In certain situations there is development of what is known as fibromyalgia which is a widespread pain syndrome. The cause of this is not well understood but may involve physical and psychological aspects, and possibly in some situations occur after a trauma and infections. In these cases often a multidisciplinary approach is taken by using initially drugs, the injection therapies and then going on to physical therapies and psychological therapies.

An experienced Pain Clinician can help you decide what is the best approach for your pain.