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What to Expect

Initial Consultation

Your doctor will interview and examine you to better understand your pain condition.

Blood Tests and Imaging

If needed, blood tests, X-rays, CT or MRI scans will be arranged to further evaluate and confirm the diagnosis. Please bring along all previous blood test and scan reports that you may have.

Pain Management Plan

Your pain doctor will discuss the various treatment options and design a treatment plan for you. The plan may involve pain medications, physiotherapy and advice on exercises, workplace ergonomics and posture.

Follow up Review

Your doctor will track your progress by monitoring your reduction in pain, improvements in physical function and sleep. He will then determine if further treatment is needed.

Pain Procedure

If your pain control remains suboptimal, your doctor may recommend a minimally invasive procedure to treat your pain. This may include the use of shockwave therapy, nerve block, steroid injection, radiofrequency ablation, drug pumps or neuromodulation.

Chronic Pain Treatment Options

Shockwave Therapy

Shockwave therapy is a non-invasive treatment for painful muscles, ligaments and tendons. Acoustic waves are created which can (1) release trigger points (or muscle knots); (2) break up calcium build-up; (3) accelerate collagen synthesis; and (4) promote new blood vessel formation within the injured structures. All these processes help reduce chronic inflammation.

Suitable for:
  • Painful shoulder
  • Tennis elbow (lateral epicondylitis)
  • Jumper’s knee (patella tendinitis)
  • Heel pain (Achilles tendinitis)
  • Foot pain (Plantar fasciitis)
  • Muscle tendon pain

Trigger point injections

Chronic muscle or myofascial pain due to injury or poor posture can be annoying and lead to persistent pain and stiffness. Trigger point injections with local anaesthetics or Botulinum toxin are effective in breaking the pain cycle and restoring muscle function. Coupled with the right stretching and strengthening exercises, myofascial pain can be treated.

Suitable for muscle pain affecting the neck, shoulders, back and limbs.

Epidural Steroid Injections or Nerve Root Blocks

Epidural steroids help reduce pain and inflammation at the painful disc, or next to the pinched nerve due to disc protrusion.

Suitable for:
  • Herniated discs (slipped discs)
  • Sciatica (shooting pain or numbness in the arms or legs)
  • Discogenic pain (neck or low back pain)

Disc Decompression & Biacuplasty/Annuloplasty

Herniated discs can be treated using minimally invasive needles that only require a small puncture through the skin. Removing disc material with the needle shrinks the disc and reduces the compression on the nerve. When the disc is also causing pain, biacuplasty or annuloplasty can be performed using radiofrequency energy to destroy nerves that carry pain signals through the outer layer of the disc.

Suitable for:
  • Herniated discs (slipped discs)
  • Sciatica (shooting pain or numbness in the legs)
  • Discogenic pain (neck or low back pain)

Facet Joint Injections or Medial Branch Nerve Blocks

Chronic neck or low back pain can result from the tiny joints in the spine called the facet joints. This condition is called facet joint syndrome and is very common in patients with cervical or lumbar spondylosis. Steroids and local anaesthetics can be injected into these joints to reduce pain and inflammation.

Suitable for:
  • Neck pain (cervical facet syndrome)
  • Low back pain (lumbar facet syndrome)

Joint Injections

Injection of local anaesthetics and steroids into joints is a simple yet effective way of treating joint pain. Viscosupplementation with hyaluronic acid can also help lubricate and cushion joints. Advanced arthritis of the knees or hips can also benefit from radiofrequency ablation to remove painful nerves around the joints.

Suitable for:
  • Shoulder pain
  • Hip pain
  • Knee pain

Radiofrequency ablation

Radiofrequency (RF) ablation uses RF energy to generate heat for treating pain. Heat destroys signals within sensory nerves and effectively removes the source of pain coming from discs, joints or nerves.

Suitable for:
  • Neck pain (Cervical facet joints)
  • Low back pain (Lumbar facet joints)
  • Discogenic pain (herniated discs)
  • Sacroiliac joint pain
  • Hip pain (osteoarthritis or fractures)
  • Knee pain (osteoarthritis)
  • Coccydynia (tailbone pain)

Sympathetic Blocks or Neurolysis

The sympathetic nervous system has a role in neuropathic, vascular and visceral pain. Blocking the sympathetic nerves help to block nerves that carry painful signals. For vascular pain resulting from poor blood circulation, sympathetic blocks can improve blood flow and relieve pain. This procedure is also effective for chronic abdominal or pelvic pain conditions as well as cancers.

Suitable for:
  • Peripheral vascular disease
  • Chronic pancreatitis
  • Complex regional pain syndrome (reflex sympathetic dystrophy)
  • Abdominal cancers (liver, pancreas, stomach)
  • Pelvic cancers (uterus, rectum, anus, vagina)

Targeted Drug Delivery (Intrathecal Drug Therapy)

A small motorised pump is implanted under the skin to deliver medications via a small tube (catheter) directly into the spine to treat severe, intractable back pain, pelvic pain as well as cancer pain. Medications used include morphine, fentanyl and local anaesthetic drugs.

Suitable for:
  • Chronic back pain
  • Spinal fractures
  • Advanced cancer pain
  • Persistent pain even after spinal surgery

Neurostimulation

Neurostimulation uses electricity to stimulate nerves or the spinal cord to block pain signals. It includes spinal cord stimulation and peripheral nerve field stimulation. Electric wires (leads) are surgically placed near painful nerves or next to the spinal cord. An implanted battery (pulse generator) is connect to these leads to stimulate the nerve or spinal cord, in turn blocking the transmission of pain signals to the brain.

Suitable for:
  • Intractable neck pain or low back pain
  • Radicular pain (shooting pain in the arms or legs)
  • Occipital neuralgia
  • Complex regional pain syndrome
  • Phantom limb pain
  • Diabetic peripheral neuropathic pain
  • Ischaemic limb pain or peripheral vascular disease
  • Angina
Pain
conditions
Cooled
Radiofrequency (RF)
An innovative RF technique that allows the creation of large-volume, spherical lesions to treat nerves that cause pain.
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