Dr Green will advise on a variety of ways to help patients manage their pain.  The aim to is get patients back to a better quality of life by improving how their pain is tolerated.  Dr Green believes this is easiest for patients if the pain severity can be reduced.  He therefore uses a variety of interventional techniques including injections, radiofrequency treatments (both thermal and pulsed), and spinal cord stimulation to help achieve that.  Most procedures are performed using targeted techniques facilitated by X-ray and/or Ultrasound Scan imaging.  These interventions are initially to allow the accurate diagnosis and localisation of the source of pain, and later to try and affect more long-term relief.  They can be helpful in allowing patients to make better progress with other holistic therapies such as physical therapy and lifestyle changes, to achieve sustained improvement in their ability to manage their pain in the longer term.  Dr Green will, therefore, also provide advice on medications as well as general Pain Management strategies, and refer to Physiotherapy and Psychology as required to improve patients general rehabilitation.   

PAIN INTERVENTIONS

 

Dr Green performs a range of interventions, some of which are list below (please click for more information):

 

Facet Joint Medial Branch injections (neck and back)

Facet Joint Medial Branch Radiofrequency Denervations (neck and back)

Sacroiliac Joint injections

Sacroiliac Radiofrequency Denervation

Epidurals (interlaminar & transforaminal) - Cervical (neck) (interlaminar only), Thoracic, Lumbar (low back), Caudal

 

Nerve Root and Dorsal Root Ganglion blocks - all spinal levels

 

Dorsal Root Ganglion Pulsed Radiofrequency Treatment - all spinal levels

 

Peripheral Nerve blocks - including shoulder Suprascapular block (shoulder) and Ilioinguinal nerve blocks (groin)

Genicular Nerve Blocks (knee)

Genicular Nerve Radiofrequency Denervation (knee)

 

Sympathetic nerve blocks - Stellate Ganglion blocks, lumbar sympathetic blocks, Coeliac Plexus, Ganglion Impar

 

Trigger point injections

The above is not exhaustive.  Please contact Dr Green if you require more information of other procedures

MEDICATIONS

Broadly speaking medications fall in to 2 groups.  The first (Primary Analgesics) are ordinary "pain killers" that are used in short-lived injury-related (Acute) pain, or pain immediately after operations.  These can be weak, moderate or strong and come in different types, eg NSAIDs, paracetamol, weak opiates (codeine) and strong opiates (morphine).  Their role in long-term (Chronic) pain is limited.  Often they have little effect, and can lead to physical & mental health consequences if taken over a long period of time.

 

The other group (Secondary Analgesics) are composed of medications that are typically used in nerve pain (anti-neuropathics).  These are a group of drugs originally licensed for use in other conditions, but because of the way they work in altering receptors and chemicals in the nervous system, have been found to be useful in chronic pain.  They are principally made up of anti-epilepsy drugs and anti-depressant drugs, though patients don't need to have either of these conditions to potentially gain benefit from them with their Chronic Pain.  There are other more specialised medications that fall in to this group and Dr Green will be able to advise you if you are likely to gain benefit from them.

PHYSICAL THERAPY

Most patients coming to see Dr Green will have already tried some form of physical therapy, but may be struggling because of their level of pain.  It is import in most instances to continue with these regimes. Pain interventions may help you be able to perform them more effectively, and together should allow you to make progress with managing your pain and living your life fully.  Occasionally patients work too hard on their physical therapies, in which case Dr Green will advise on alternative strategies.​  

COUNSELLING & SUPPORT

Pain is a distressing symptom for anybody to have.  In short-lived (acute) injury-related pain it serves a valuable function in warning the body of potential harm.  It does this by effecting the emotional centres of the brain, resulting in distress, and causing a protective response.  In the early (acute) phase, this response is reversible as the cause is removed or the tissues heal up.  Chronic pain, however, is very different. It is not simply ordinary pain lasting longer.  There are changes that result in a dysfunction of the pain nervous system, such that it continues to send pain signals to the brain even when there is no longer any threat of harm to the body.  The brain will still be under distress from the continuous barrage of pain signals reaching it and puts out a protective response as usual, but over time this process causes secondary consequences on mood, anxiety, sleep, personality etc. which can ultimately result in worse pain through a process of feed-backs and sensitisation.  In that sense the brain can act as a volume dial, increasing or decreasing the experience of pain.  Its ability to do this is influenced by other previous or current experiences, for example stress or social support.

 

It is those secondary effects, however, that can later become a barrier to the effective rehabilitation of chronic pain.  In this situation psychological therapy can help patients move forward.  Patients only have to look at the use of psychology on the performance of sports men and women to see how effective it can be in allowing them to rehabilitate effectively and overcome injury to see that it is does not imply the pain is imagined or not real as some patients fear.  Other patients simply need support through what is a difficult time, and sometimes to come to terms with a new chronic condition and its affects on their life.

Targeting Pain

Specialist Management of Complex Chronic Pain