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.
Spinal pain (back and neck pain)
So, how do we diagnose back and/or neck pain? It is important to understand that to pinpoint the exact structure causing neck or back pain can be complex especially from a MRI scan or clinical examination alone. It is important therefore to be able to combine all the assessment and investigations and history in an integrated manner to arrive at the diagnosis.
There are multiple factors that can cause back or neck pain. It can come on because of muscular problems, joint problems, or discs/nerve related problems. It often requires a specialist and a consultant to actually investigate, diagnose and establish a treatment strategy.
You could ask: “What is the role of a pain consultant in this?”
Often most back/neck pains can be managed very well by the GP and by some good physiotherapy, which is what is available initially. However, once you have chronic back pain, you could benefit from seeing a pain consultant.
What are the various options that pain consultants have?
This will vary. We have access to our specialist physiotherapists. We can offer interventions where appropriate, which may include injections into muscles, around the joints, or perhaps nerve blocks or epidurals. We can also signpost our patients to various complementary therapists who can offer them other options such as acupuncture/yoga/osteopathic therapy or massage.
What you need will be a personalized and individualized strategy for your condition, based on other medical conditions you have, and that kind of approach is best done by a pain consultant.
Shoulder, hip and knee pain
Joint pains especially shoulder, elbow, hip and knee pains are often quite complex and there are often multiple structures that can cause pain. The reality is that the joint arthritis is often not the only source of pain yet that is the only thing that is thought about commonly when one gets pain in their shoulder, elbow, hip or knee. Often, the first port of call is your GP and physiotherapist, who may suggest onward referral to a surgeon.
However, we have realised now that in the last 10 years there are so many other strategies and newer techniques that have come that can help you with your shoulder, elbow/hip or knee pain. These can help you get your quality of life back, and these may involve less invasive treatment options that can make a big difference and reduce your pain.
What is it that a pain consultant can do for hip/knee or shoulder/elbow pain that may not be coming from the joint?
Structures such as ligaments, tendons and the joint capsule (covering) can all be potential pain generators and sometimes the nerves can be sensitised as is often seen in repetitive strain injury or what is often called work related upper limb disorder in the case of elbow or shoulder pain. You may have something as simple as an inflammation of a bursa. You may have a frozen shoulder which has tightness of the muscles around there, or it may be a referred pain from your neck that comes into your shoulder. Similarly pain around the lower back or gluteal muscles can radiate to hip or sometimes down to knee.
So, it’s important that you have a comprehensive examination and a thorough investigation so that the treatment strategies can be personalized and individualized for you and that’s where a pain consultant is able to bring all of those treatments under one roof.
What are the treatments that pain consultants can offer for joint pain that has been chronic and persistent and bothersome?
It may be something as simple as looking at your medications and reviewing and optimizing them. It would be looking at other conservative measures such as physiotherapy and other complementary therapies that could be added in. It would be addressing the biopsychosocial aspect. So, looking at how stress and how your workplace or vehicle posture changes can sometimes make a difference to your joint pain and where needed you would have interventions such as muscle trigger point injections or joint injections.
We also offer regenerative medicine techniques like platelet-rich plasma and other drugs like Botox as well as prolotherapy in selected patients.
Headache including chronic migraine
If you been diagnosed with chronic migraine by your GP or neurologist and not having much benefit from the traditional medication therapies, then it might be time to consider other treatments options like interventions and nutrition options.
If you have had migraine attacks for more than 15 days a month, which have been so debilitating that they have affected your quality of life, and reduced your ability to be productive and work, then it is likely that you have a variant of migraine called chronic migraine.
There are many other treatment options that can be done for you other than just medication. Medications can have side-effects, or they may stop working and you may be wondering what your next treatment options are.
Pain consultants have been able to make a difference in the management of chronic migraine. We realized that migraine is a condition and it can have many overlapping features. It does not mean that it is only due to the nerves in and around your brain and around your neck.
We realized that sometimes tightness in the muscles or joints in the neck or even a nerve trapped in the back of the head (called a greater occipital nerve) can all contribute to it. These are conditions that pain consultants have been trained to manage and provide a variety of strategies.
What are the treatment options?
If symptoms are coming from the muscles, then trigger point injections could help. If the pain generator could be in the joint, then facet joint injections could benefit. One of the more recent interventions for chronic migraine is Botox.
There are newer electrical therapies such as Vagal nerve stimulation. We could discuss with you and decide with you because at the end of the day managing chronic migraine and headache especially in your case has to be individualized to your condition and has to be personalized to you so that we get the right strategy.
Fibromyalgia is a chronic widespread pain condition where pain has been present in multiple areas of your body along with fatigue and tiredness, concentration problems and memory issues. Did you know that up to 2 to 5 percent of the UK population now are being diagnosed with fibromyalgia?
We have been seeing a large number of fibromyalgia patients. We have over time developed experience in looking after patients with fibromyalgia and more importantly an understanding what it is that can be done for this very difficult condition.
What is fibromyalgia and when can a pain consultant help?
Sometimes local GPs or healthcare professionals and even family members may not even be aware of or may not even want to acknowledge the existence of this condition.
Fibromyalgia, indeed is a very complex condition in which the nervous system behaves in a very erratic manner and it is associated with a huge number of other medical conditions that can make management of this difficult.
This is where a pain consultant with their expertise can make a big difference in the management of your fibromyalgia.
What treatment options are available?
We have access to a wide variety of other healthcare professionals such as physiotherapists and psychologists who we work closely with. By understanding our fibromyalgia patients, we can understand the causes that may trigger this condition.
If we know the particular trigger that has happened in your case, we can develop a personalized and bespoke treatment strategy that could involve medications, simple interventions like lidocaine infusions and trigger point injections, nutrition, sleep strategies and mind body therapies.
Have you been struggling with very severe intense pain in your arm or your leg after recent injury and has this been accompanied by colour change or swelling or pins and needles?
If you have been diagnosed with CRPS, or chronic regional pain syndrome, then you would benefit from the expertise of seeing a pain consultant.
What does a pain consultant actually bring to the management of CRPS?
It is important for you to understand what the treatment options are for CRPS. In CRPS the nervous system of that area gets sensitized and may even be damaged because of the injury and therefore it’s important to recognize that you have to manage the nervous system most importantly.
At the same time, we need to prevent the loss of function so the strategies that you need to put in with the help of the pain consultant need to be targeted at both these options not just the medications but also the various interventions that can be done.
It is the pain consultant and their team that can put together a treatment plan that is quick, intensive and that is tailored and individualized for your particular condition so that we can get the best outcome.
What are the treatments that can be done?
Restoration of the movement in that affected part is the most important thing so your pain consultant will be working with a specialist physiotherapist and maybe an occupational therapist and possibly even your GP to come up with a plan that’s appropriate for you. Injection based interventions could include nerve blocks or sympathetic blocks and the use of radiofrequency techniques are all possible to aid physiotherapy. Spinal cord stimulation is an accepted technique as well and if that is needed, we can discuss about that as well.
We have access to our specialist psychologist who can help create a programme that will help manage the stress and the psychological changes that can amplify the pain so getting a pain consultant’s opinion and a referral is going to be the first step.
It does not matter when you’ve had the injury. Getting the treatment and understanding your options is vital and important in getting the function and quality of life back.
The earlier you get treatment, the earlier you can get better pain relief and rehabilitation and hence better recovery and quality of life.
Whiplash injury refers to any kind of neck or upper back or lower back pain that is present after you’ve been involved in a road traffic accident. It can also occur when you have been exposed to any kind of injury which causes a sudden unexpected extreme bending or looking up of your neck or twisting movement of your back. These unexpected movements can cause sudden pain often in the neck or the lower back and this can be accompanied by a variety of other symptoms such as pins and needles or tingling or numbness that starts from the neck and goes down into the arms or it may start from the upper or lower back and go down your legs. With neck pain we can also get headaches and blurring of vision and other symptoms that can be seen with a concussion such as drowsiness, tiredness, fatigue, concentration problems, and other muscle aches.
Whiplash related pain can often be very disabling and there can be many factors that are responsible for the maintenance of the pain. Pain could be coming from tight muscles or joints or sometimes trapped nerves that may be causing the pins and needles, tingling and headaches.
What can a pain consultant do in this situation?
Pain consultants often work as part of multidisciplinary teams and we have access to a good network of physiotherapists and psychologists who are able to work with us and our patients and create a personalized bespoke strategy that is very specific for the patient’s neck or back pain. Our main aim will be to restore function and a good range of movement, and this can be done with a combination of strategies that may include medication, minimally invasive injections, treatments like acupuncture, physiotherapy, and possibly other complementary therapies such as mindfulness or meditation that could be added to all the other treatments to improve the chance of success and long term pain relief
Cancer pain is quite complicated. The cancer itself can often cause a combination of acute or chronic pain and most often in cancer pain the pain is caused by the tumour pressing on adjacent bones, nerves or other organs in the body. Often the chemotherapy and radiotherapy treatments can cause nerve damage, and this can cause a different form of a very severe nerve pain that can affect the feet and the hands called cancer chemotherapy related peripheral neuropathy. This can be quite a difficult condition to solve and if original cancer treatment is still ongoing, then success rates can be very varied.
Nevertheless, there are different strategies that can be used depending on whether we think the cancer pain is due to a nerve pain or a bone pain or it’s coming from the soft tissues surrounding the tumour or whether this is a referred pain.
How can a pain consultant help?
The pain consultant often has access to a multidisciplinary team of physiotherapists, psychologists, occupational therapists and nutritionists, and with the help of this team, we can often come up with a more personalized individual strategy that is tailor made for each patient.
Cancer pain treatments could involve optimizing the nerve pain tablets. It could also involve exploring any nutritional aspects as we now understand that the change in the immune system because of chemotherapy or the cancer itself can lead to pain as well. Other treatments that could be pursued would include nerve blocks, use of TENS machines, high dose chilli (capsaicin) plasters for localized pain, and the use of injection-based interventions including intrathecal pumps and morphine implants. With one of these or a combination of such treatments, patients can often get a much better quality of relief.
Regenerative medicine / platelet rich plasma (PRP) / prolotherapy
In recent years, we have understood that the body has inherent capacity to heal itself. This has led to the rise of a new field called regenerative medicine, which was initially more actively used in sports field but now more studies have been done on other groups of patients with promising results and outcomes when combined with good physiotherapy and rehabilitation.
Our blood contains three main components (red cells, white cells, and platelets) suspended in a liquid called plasma. The platelets are most important in clotting blood and also have hundreds of proteins called growth factors which are very important in the healing of injuries. If this blood sample is then centrifuged, then we can concentrate the platelets alone in a mixture called PRP. The concentration of platelets and growth factors can be 10 times greater than usual.
It is an important branch of medicine where the ability of the body to self-heal can be harnessed and it can be used to amplify any natural growth factors that are already present in our blood. An older treatment called prolotherapy stands for proliferative therapy, which effectively involves the injection of substances such as hypertonic dextrose and phenol that can be used to provoke a small amount of inflammation. The body’s inflammatory system then kicks into action and brings about further healing causing new fibres to be laid down, thus improving strength. We had autologous blood injections where the patient’s own blood could be taken from a vein and then injected into the site of a soft tissue injury such as tendinopathies or ligaments or even into the joints, and this can bring about healing.
What conditions can PRP be useful for?
There are studies showing benefits in patients with Achilles tendinitis, golfer’s elbow and tennis elbow, acute ligament injuries and sometimes patients with early mild to moderate arthritis in knees/hips/elbows and shoulder.
How can a pain consultant help?
Pain consultants often work as part of multidisciplinary teams and we have access to a good network of physiotherapists and rehab therapists who are able to work with us and our patients and create a personalized strategy that is very specific for the patient’s pain. Our main aim will be to restore function and range of movement, and combining PRP injections with other holistic treatment strategies that include medication, acupuncture, massage and physio can significantly improve the chance of success and long-term pain relief
Have you been suffering with chronic low back pain and leg pain along with numbness and pins and needles or tingling in one or both of your feet? If so, it is possible that spinal stenosis is a condition that you might be having.
By the time patients with spinal stenosis are referred to the pain service, it has been at least 5 to 6 years and often we do wish that they had come earlier so we would have been able to give those patients a better set of strategies to help manage the pain.
Surgery is very rarely needed for this condition but there are a lot of other things that can be done with the help of a pain consultant. The pain consultant and the multidisciplinary team that they work with becomes important in understanding what your treatment options are.
In these times you have a number of other treatment strategies that can be put forward in a holistic manner and that can be personalized to your care in order to get the outcome that you want.
What are the treatment options then for spinal stenosis?
It’s important for us to understand what the causes are because spinal stenosis refers to a narrowing of the area for your nerves in the middle of your back or in your spine. This narrowing can happen in the neck so you may have symptoms going into your arms or this narrowing can happen in your lower back then you would have symptoms going in your legs.
The narrowing can be because of disc related problems or joint arthritis related problems and each of them presents with corresponding muscle spasm and therefore treatments can be injection based or slightly stronger nerve pain tablets.
Strategies can be personalized to you.
Post surgical pain
Post surgical pain refers to a pain that started at least 3 months after your surgery, once surgical causes have been excluded. It can be the new pain that came on after a routine operation such as a hernia or a knee replacement.
You’re not alone because post-operative pain and what we call post surgical neuropathic pain happens in one out of five patients who undergo any form of surgery. Post-operative neuropathic pain can often be a challenge to diagnose and treat and then a challenge to manage.
It’s important that a pain consultant is often involved early on in the care of this condition to get the best outcomes for you.
What is the pain consultant going to do?
You will usually have been referred back to your surgeon to exclude any ongoing surgical causes of the pain. Once this has been done, and if the pain is still bothersome, then a pain consultant can help.
If it is a post-operative nerve pain it is quite complex as there are many factors that can lead to this. Sometimes it’s possible to predict who can be having this pain so it is important to have a thorough evaluation and a proper treatment strategy that involves the whole person approach.
We are able to bring mechanism-based strategies and we can think of nerve blocks or electrical interference with the nerves that are sensitized so we can think of spinal cord stimulation, pulse radio frequency. These are options that could be considered and often it’s understood that psychological mechanisms or even stress can make such symptoms a lot worse and therefore we have access to physiotherapists and psychologists who can help us in managing and getting a better outcome.
Slipped disc/disc prolapse
If you have recently suffered a severe pain in your arms or your legs accompanied by an acute episode of back pain, then often this is due to a suspected slipped disc or prolapse. If you have had ongoing symptoms of pins and needles going down your arms or your legs and disturbing a sleep and your quality of life, then this another feature of disc prolapse.
We often see a number of patients who have started to have symptoms due to a slipped disc and by the time they come to us, it has been years down the line. If they had come earlier, we might have been able to come up with a set of strategies that would have given them a good quality of pain relief and recovery and restoring the quality of life.
What is a pain consultant going to do different?
Pain due to slipped disc in most cases does not need surgery. It can be managed well with the care of your GP and quality physiotherapy. Occasionally if the symptoms are more severe than it is important in some cases of a slipped disc or a prolapsed disc to get an intervention such as a nerve block quicker and earlier so that you can prevent muscle spasm from persisting.
The pain consultant makes a difference because they have the ability and the skills to recognize when a injection based treatment needs to be introduced and stronger painkillers may need to be added at the right time to get a successful outcome.
What are the treatment options then that are existing for slipped discs?
Surgery is very rarely required. Emergency or urgent MRI scans can be done and based on that you may be suitable for a nerve block combined with a very aggressive physiotherapy can result in excellent outcomes and good functional recovery.
These can be put in place by the pain consultant because all of us work with a good team consisting of physiotherapists and other complementary therapists to create a more bespoke approach and use a multidisciplinary strategy to improve outcomes and faster recovery and quality of life.
Chronic abdominal and pelvic pain
Chronic abdominal pain is pain that is present for more than 3 months either continuously or it may come and go. By the time patients are referred to a pain clinic it has been present for 3 months or more and they would have been investigated by their GP/Specialist. Typical disorders that cause abdominal pain have already been ruled out. It does mean that only about 10% of them have a specific physical disorder. The remaining 90% have what is called functional abdominal pain.
Functional pain is real pain that exists for more than 6 months and occurs with no evidence of a specific physical disorder or flare up of that disorder. For example, you might have had a bad stomach infection or surgery but repeated flare ups with no evidence of recent infection or scarring etc would be classified as functional. Even most forms of IBS do have a functional element. Functional pain can be severe and typically interferes with the person’s life. What we mean by functional is that the nerves of the digestive tract may become oversensitive to sensations (such as normal movements of the digestive tract). Genetic factors, life stresses, personality, and underlying mental disorders (such as depression or anxiety) may all contribute to worsening of this functional pain.
Pelvic pain is more common in women than men. While common causes of acute pelvic pain include pelvic inflammatory disease (PID), urinary tract infection (UTI), ectopic pregnancy, and rupture of ovarian cysts, chronic pelvic pain can be due to various other problems like endometriosis, PID and dense adhesions. It can again be classed as acute or chronic. It would significantly impact on a woman’s quality of life as well as carrying a heavy economic and social burden.
In addition, past pelvic or abdominal surgery, or trauma during childbirth may contribute to the start of chronic pelvic pain. Social and psychological factors are strongly associated with chronic pelvic pain. Often the same principle of oversensitive nervous system from the pelvis can contribute to the worsening of the pain and tightening of the pelvic muscle floor and these can respond to some medications or interventions and specialised physiotherapy.
How can the pain consultant help?
Pain consultants often work as part of multidisciplinary teams and we have access to a good network of physiotherapists/psychologists and specialised pelvic rehab therapists who are able to work with us and our patients and create a personalized strategy that is very specific for the patient’s pain. Our main aim will be to restore function and range of movement and combining invasive injections with other holistic treatment strategies that include nutrition advice, medication, acupuncture, massage and physio can significantly improve the chance of success and long-term pain relief.
Our first aim is to undertake an accurate diagnosis and provide holistic management from the first presentation. This will help to reduce the disruption caused by multiple referrals, investigations and operations.
Injection treatments include piriformis muscle injections, trigger point injections into the pelvic floor, Botox injections into the tight muscle floor, organising for biofeedback therapy, pudendal nerve block, impar ganglion block and superior hypogastric plexus block.