Pain is one of the commonest reasons patients consult their doctors. It is also one of the most difficult symptoms to tolerate over a long period of time. Chronic pain is estimated to affect 40% of the UK population and causes suffering equivalent to cancer, heart disease, or severe depression. In many situations it has not been possible for patients to have treatment for the original cause of pain sufficiently to get rid of their symptoms. In other situations changes in the nervous system means that the pain becomes its own chronic disease and is unchanged by treatment of the initial cause.
Listed below are some common conditions that patients consult Dr Green for, but there are many others, some of them rare. His main interest areas are spinal pain (including sciatica, neck pain, whiplash), pain related to large joints (such as the shoulder and knee), nerve pain (neuropathic pain - including after injury and operations, Complex Regional Pain Syndrome, and Trigeminal Neuralgia), and some forms of difficult to manage headache.
There are many causes of spinal pain. Pain can arise from the muscles and ligaments, arthritis and degeneration of the joints and disc, as well as narrowing (stenosis) of the spine pressing on other structures such as nerves (eg sciatica). In many situations pain can settle with time and physical therapy, but where difficulty arises, spinal interventions can help with rehabilitation.
Facet Joint Arthropathy
Sacroiliac Joint Arthropathy
Discogenic back pain
Spinal central canal narrowing (stenosis)
Injury to nerves can occur after trauma, operations, some medications, as well as other medical conditions. In many situations injury does not result in chronic pain, but where it does it is often more severe and difficult to treat compared with other types of pain. The alteration of the damaged nerves can cause abnormal sprouting of the nerves near the area of injury, or the regenerating nerves can become "trapped" in the scar tissue. This causes the damaged nerve to continually trigger pain signals inappropriately. The continual barrage of pain signals through the nervous system causes secondary changes, for example in the spinal cord and brain, that results in increased sensitivity of the system, further complicating the problem. Dr Green will advise on the appropriate therapy to dampen down the system and improve the pain, but recovery can be protracted in these situations.
Pain after injury
Pain after operations
Complex Regional Pain Syndrome
Pain after chemotherapy
Pain due to other medical conditions, eg Painful Diabetic Neuropathy, pain after stroke (central post-stroke pain)
LARGE JOINT PAIN
HEADACHES & Facial Pain
Headaches related to neck pain (Cervicogenic headache & Occipital Neuralgia)
Central Sensitivity Syndrome (Fibromyalgia)