Pain Medicine

Pain Medicine

Pain Medicine is responsible for understanding and studying the mechanism underlying patient pain. Pain is defined by the ISAP (International Association for the Study of Pain) as: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.” So, pain is an experience, not just a simple symptom, and can be multifactorial – nociceptive, neurogenic, and psychogenic. For that reason, the holistic assessment of the patient is crucial to understand the mechanism of pain and treating it properly. The non-surgical treatments could include pharmacological medication, minimally invasive procedures, and physiotherapy. To make a correct plan adjusted to you, we have with us an experienced team that is always available for you.

Treatments

Radiofrequency

Radiofrequency ablation is a minimally invasive procedure guided by ultrasound or fluoroscopy. After identifying the nerve, radiofrequency ablation uses an electric current to heat up a small area of nerve tissue to stop it from sending pain signals.

Cryoablation

Cryoablation uses cold temperatures and is a minimally invasive procedure guided by ultrasound or fluoroscopy. The indications are many and include treatment of chronic low back pain, others spine pain, and osteoarthritic joints with severe pain and non-controlled by medication.

Nucleoplasty

Nucleoplasty is an advanced injection procedure guided by fluoroscopy for treating disc herniation for patients who suffer prolonged and severe back pain that did not respond to conventional treatment. The aim of this procedure is to relieve the pressure inside the disc and on the nerves responsible for causing pain. The procedure should take less than one hour. This procedure is an ambulatory treatment.

Intra-articular Corticosteroids Injection

Corticosteroid medications are used to reduce pain and inflammation and can be taken orally or through an injection. The rationale for injecting steroids is to target more precisely the area of pain and avoid systemic oral medication. This procedure is minimally invasive and is guided generally for an ultrasound. Indications include inflammatory arthritis and other musculoskeletal diseases.

Platelets Rich Plasma Injection

After some blood is taken from a patient, it is spun very quickly using a centrifuge. This very fast spinning causes the blood to separate into a range of parts depending upon weight. PRP (platelet-rich plasma) is a specific part of the separated blood that will contain 2-5 times the usual number of platelets and have a regenerative effect on the tissues of the body by triggering natural healing processes. Through a minimally invasive procedure guided by ultrasound, the PRP is delivered in the joint, muscle, or tendon of pain and degeneration. Most research shows that a series of 3 PRP injections each 1-2 weeks apart gives the best outcome. PRP injections can be used in a lot of diseases, including osteoarthritis knee, epicondylitis of the elbow, and muscle tears.

Peripheric Nerve Block

This minimally invasive procedure, such as radiofrequency ablation and cryoablation, should be guided for ultrasound or fluoroscopy. Through the injection of local anesthetic, the signal transduction pathway of the selected nerve will be blocked. Corticoids can be added to prolong the duration of the pharmacological effect. The indications are still many but include especially acute or subacute musculoskeletal diseases.

Hydrodistension

The frozen shoulder, or adhesive capsulitis, typically will start with severe pain and marked loss of range of motion around the shoulder. This condition is more common in females, in patients with pathologies, like diabetes, and following a traumatic injury. The treatment of this condition includes oral anti-inflammatory medication and physiotherapy. Despite that, the last one is painful and hydrodistension could be performed to reduce the pain and allow stretching and exercises of the shoulder. Hydrodistension is a minimally invasive procedure guided by ultrasound that aims to stretch the tight joint capsule. To do so, local anesthetic and steroids as well as saline are injected into the shoulder under pressure in an attempt to stretch the capsule, allow movement and reduce the pain in the shoulder. Another indication of this procedure is Achilles tendinopathy, but in this case, corticosteroids should be avoided.

Calcification Barbotage

Calcific tendinitis is a disorder characterized by deposits of hydroxyapatite in any tendon of the body, frequently on tendons of the rotator cuff. Calcification barbotage is a minimally invasive procedure guided by ultrasound used to treat this condition. The aims of this procedure are to dissolve and remove calcium that can build up on tendons. To do so, our specialist doctors will use ultrasound to find the area to be treated and pass a small needle through this area attempting to break up the calcium. After that, they aspirate the contents of the calcific lesion. This also allows the body to reabsorb the remaining calcium easier over time. Lastly, the doctor injects corticosteroid into the bursal lining around the tendon to alleviate any existing inflammation.

Botulin Toxin Injection

Botulinum toxin is a potent neurotoxin that inhibits the release of acetylcholine at the neuromuscular junction. Injection of botulinum toxin into specific overactive muscles causes localized muscle relaxation. This injection preferably is made by ultrasound control. For that reason, the indications of this minimally invasive procedure are spastic muscles secondary to a primary motor neuron lesion, contractures, some overuse tendinosis, and aesthetic reasons. The botulinum toxin injection also shows evidence of treatment of other conditions, like knee osteoarthritis and migraine.

Pharmacological Pain Management

Pain is a common symptom and is often associated with significant physical disability and psychosocial problems. This symptom may be present in several conditions and the proper anamnesis and physical examination is crucial to make the right diagnosis and the respective treatment. Pharmacological management of pain is commonly part of the treatment and a wide range of drugs can be used to manage pain resulting from tissue damage, inflammation, or disorders of the peripheral nervous system or the central nervous system. Due to its complexity, our clinic selected an experienced team of professionals in pain management.

Common Pain areas treated

Head Pain

Head pain is a common health problem with a global prevalence of 47% (symptoms occurring at least once in the past year) and women are disproportionately affected (3:1). Many factors, like stress, anxiety, injury, and migraine can lead to headaches.

Cervical Pain

Cervical facet joints (FJs) constitute a common source of pain and remain a misunderstood, misdiagnosed, and improperly treated pathology. Facet osteoarthritis is the most frequent form of facet pathology.

Lumbar Spine Pain

Chronic low back pain (LBP) is one of the most common pain syndromes and represents an enormous burden and cost generator for society.

Shoulder Pain

Shoulder Pain is the third most common cause of musculoskeletal consultation in primary care.

Hand and Elbow Pain

Their complexity requires the skills of an expert for diagnosis and recovery from injury.

Hip and Groin Pain

Percutaneous interventional pain management (Steroid, Platelet Rich Plasma, or Hyaluronic Acid Injection) is a good alternative treatment for some patients who are not eligible for an operation or experience persistent or intense pain after surgery or while waiting for surgery.

Knee Pain

Among adults over 50 years old, osteoarthritis is the main cause of knee pain and the ultimate treatment is prosthetic surgery. Nevertheless, some patients are not eligible for an operation or experience persistent or intense pain after surgery or while waiting for surgery, and for those percutaneous interventional pain management is a good alternative treatment.

Thoracic Wall Pain

After a surgical procedure involving the thoracic wall, it is frequent to experience chronic pain.

Abdominal Wall Pain

There are several reasons that can result in severe pain in the chronic abdominal wall: post-surgical pain, peripheral nerve entrapment, muscle problems… Other than oral medication, there are other weapons to control this pain

Pelvic & Gynaecological

There are different causes for pelvic and gynecological pain, resulting from injury or pathologic states.

Facial Pain

Facial or orofacial pain refers to any type of pain in the area bounded by the eyes and the lower mandibles, including the oral cavity. Facial pain with or without accompanying symptoms appears to be a very frequent complaint.

Foot and Ankle Pain

Foot and/or ankle pain is known to be common and associated with several conditions.