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Cancer Pain

How does cancer cause pain?
Cancer causes pain when it presses on organs, bones or nerves in the body. Sometimes, cancer treatment itself can also cause pain. For example, radiotherapy can cause skin irritation and chemotherapy can cause numbness or tingling sensation in the hands and feet.
How can cancer pain be treated?
In general, stronger painkillers such as opioids are needed to treat cancer pain. Commonly used opioids include morphine, oxycodone, fentanyl and hydromorphone. Tumour that has invaded or compressed onto nerves will require anti-convulsants or anti-depressants because these drugs are more effective against nerve (neuropathic) pain.
Are there side effects to painkillers?
The common side effects of opioids include drowsiness, dizziness, constipation, nausea and vomiting. If you are experiencing side effects, Your pain specialist can switch your medication to find one that is most suitable for you.
What if I still have pain after taking painkillers?
This may happen in advanced or metastatic cancer as the cancer has spread to many parts of the body. If this happens, delivering painkillers directly into the fluid around the spinal cord can effectively treat pain. This is called intrathecal drug delivery and involves a minor surgery to place a drug reservoir under the skin to pump painkillers through a small tube (or catheter) into the intrathecal space.

Headaches

What causes headaches?
There are many causes of headaches. When headaches persist, it is important to exclude sinister causes including encephalitis, meningitis, tumours and stroke. Other causes may include tension headache, migraine and cervicogenic headache.
Can headaches be treated without medications?
Migraine that is not responding to oral medication may respond to Botulinum toxin injections of the muscles of the face, head and neck.
Cervicogenic headaches arise because of abnormalities in the neck or cervical spine. Steroid injections or nerve blocks of the cervical facet joints or radiofrequency ablation of the nerve supply to the facet joints may help relieve cervicogenic headaches.
What is radiofrequency (RF) ablation?
RF ablation utilises RF energy that is generated through a machine to create heat. This heat is transmitted through a special RF needle to destroy the painful nerve branches of the cervical facet joints. This is a day surgery procedure that is performed under mild sedation.

Joint Pain (Shoulder, Hip, Knee)

What is the treatment for joint pain due to arthritis?
Initial treatment may include physical therapy, exercises, glucosamine supplements and oral painkillers.
What is viscosupplementation?
Viscosupplementation involves injecting a gel-like substance called hyaluronic acid into the joint to lubricate and cushion the joint. Such treatment may help reduce joint pain for about 6 months.
Can radiofrequency ablation help reduce joint pain?
Yes. RF ablation uses RF energy to generate heat. This heat is targeted at nerves that supply the joint. By removing painful signals within the nerves, pain from the joint is reduced.
RF ablation has been shown to be effective in reducing hip and knee pain, improving mobility and range of motion. The effect can last up to 2-3 years. This also avoids the surgical risk of undergoing a joint replacement surgery, especially in elderly patients who may have multiple medical problems.

Low Back Pain

What causes low back pain?
Low back pain can result from muscle sprain, ligamentous strain, facet joint pain or slipped discs (discogenic pain). Besides trauma or injury, the commonest cause for these conditions is age-related degeneration. Facet joints are the small joints between the bones in the spine. Besides causing low back pain, slipped discs can also press onto nerves and lead to sciatica – shooting pain that radiates into the legs.
What is the treatment for low back pain?
In general, painkillers, physiotherapy and early mobilisation will help about 80% of all cases of low back pain. Patients who do not recover despite conservative management may require interventional pain therapy.
What are the common types of interventional pain therapy?
These include muscle trigger point injections, epidural steroid injections, nerve root blocks, facet joint injections, disc decompression (nucleoplasty) or annuloplasty, as well as radiofrequency ablation.
Depending on the source of your pain, your doctor will advise you on the appropriate therapy.

Myofascial Pain

What is myofascial pain?
Myofascial pain is a chronic painful condition that affects muscles and the sheath (called fascia) that surrounds the muscles. It is caused by muscle tension, trauma as well as repetitive motion due to work. Typically, knots or taut bands can be felt within the muscle and there are also sensitive areas called trigger points, which are painful when touched.
What is the treatment for myofascial pain?
Avoiding repetitive strain injury, correcting posture, stretching exercises etc. are important in preventing myofascial pain. Physiotherapy and trigger point injections are useful in breaking the vicious cycle and stop the pain from persisting.
How are trigger point injections done?
Trigger points within the muscle are identified manually and a local anaesthetic is injected into the muscle fibre. Repeated trigger point injections may be needed for chronic myofascial pain. Occasionally, Botulinum toxin injection into the trigger point can help prolong the pain relief to about 3-6 months.

Neck Pain

What causes neck pain?
Neck pain can result from muscle sprain, ligamentous strain, facet joint pain or slipped discs (discogenic pain). Facet joints are the small joints between the bones in the spine. Besides causing neck pain and headaches, slipped discs can also press onto nerves and lead to pain and numbness that radiate into the arms.
Whiplash injuries and age-related degeneration are the common causes for neck pain. Poor workplace ergonomics and poor sleeping posture perpetuate the condition.
What is the treatment for neck pain?
In general, painkillers, physiotherapy and correction of poor posture are all that is necessary. Patients who do not recover despite conservative management may require interventional pain therapy.
What are the common types of interventional pain therapy?
These include muscle trigger point injections, epidural steroid injections, nerve root blocks, facet joint injections, disc decompression (nucleoplasty) as well as radiofrequency ablation.
Depending on the source of your pain, your doctor will advise you on the appropriate therapy.

Neuropathic Pain

What is neuropathic pain?
Neuropathic pain is a term to describe pain that arises from abnormalities of the nerve. Trauma, compression, infections, medical diseases and stroke can damage nerves. Some examples of neuropathic pain include slipped discs with sciatica, shingles, trigeminal neuralgia and diabetes-related peripheral nerve pain.
What is the treatment for neuropathic pain?
Besides treating the underlying problem, neuropathic pain should be managed early and aggressively. Neuropathic pain responds poorly to common painkillers such as paracetamol and anti-inflammatory medications. Anti-depressants, anti-convulsants as well as strong opioids are frequently used.
Severe cases of neuropathic pain will benefit from spinal cord stimulation.
What is spinal cord stimulation?
Spinal cord stimulation uses implanted electric wires (or leads) that are placed onto the spinal cord to block pain signals. A battery – known as an implantable pulse generator – generates the electric current needed to stimulate the spinal cord. When the stimulator is switched on, the painful part of the body is replaced with a comfortable tingling sensation.

Shingles Pain (Herpes Zoster)

What is shingles?
Shingles (also known as herpes zoster) is a painful rash caused by the chickenpox virus (varicella zoster virus). If you have suffered from chickenpox before, the varicella zoster virus remains in your body and resurfaces when your immune system weakens due to aging, stress or disease. It forms a rash that appears as blisters on one side of the body. It can also affect the face.
How is shingles treated?
Antiviral drugs should be started within 48 hours from the onset of the rash. Usually, strong painkillers are needed, as the pain from shingles can be severe.
What is post-herpetic neuralgia?
When the pain from shingles persists for more than 3 months after the onset of the rash, the condition is called post-herpetic neuralgia (PHN). This results from permanent damage to the nerves, leading to continuous pain, numbness or tingling sensation in the area of the body where the rash used to be.
How is post-herpetic neuralgia (PHN) treated?
Strong painkillers, drugs that specifically treat nerve pain and local anaesthetic plasters are used to treat PHN. In selected cases, interventions in the form of nerve blocks or spinal cord stimulation may help alleviate PHN.
In patients older than 50 years old, the risk of developing PHN can be reduced through vaccination.

Trigeminal Neuralgia (Facial Pain)

What causes facial pain?
The most common cause of facial pain is trigeminal neuralgia. Pain arises from the trigeminal nerve (fifth cranial nerve) and manifests as sharp, shooting pain lasting for a few seconds to minutes. Talking, brushing teeth, eating or putting on make-up triggers the pain.
What is the treatment for trigeminal neuralgia?
An MRI scan has to be carried out to exclude compression of the trigeminal nerve in the brain. A blood vessel, or rarely, tumour, can press onto the nerve and cause trigeminal neuralgia. If this happens, referral to a neurosurgeon is needed. In primary trigeminal neuralgia – where there is no cause for the pain – medications such as carbamazepine, gabapentin or pregabalin may help. Severe cases of trigeminal neuralgia not responding to painkillers can also be treated using radiofrequency ablation.
What is radiofrequency (RF) ablation?
A special RF needle is inserted into the trigeminal ganglion. RF energy is then generated through a machine to create heat. This heat is transmitted through the needle tip to destroy the painful division of the trigeminal nerve. This is a day surgery procedure that is performed under mild sedation. RF ablation can effectively reduce facial pain in more than 90% of patients.
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