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Pain management

Investigation, diagnosis and treatment or management of chronic (long-term) pain

Pain Management is a specialist area of medicine involved with the appropriate investigation, diagnosis and providing appropriate patient centred treatment or management of chronic (long-term) pain.

Many of us only experience pain that is relatively mild or short-lived. For example, we may knock into a piece of furniture or get a sore back after an afternoon of gardening.

This type of pain tends to go away over time, and at worst may require some type of painkiller for a day or two to ease symptoms. In more serious cases of acute trauma, such as a broken leg or dislocated shoulder, the initial pain may be incredibly severe, but it with appropriate treatment, it will improve and go away over time.

Chronic pain can have a much more significant, and potentially life-altering, effect on people. When you experience pain every waking moment, and are possibly even woken up by pain, it can affect every aspect of your life - work, relationships, physical, mental and emotional health.

If you have pain that is not being managed or controlled properly, it can be a huge relief to get expert help and support from a specialist in pain management. A doctor who specialises in this field is known as a Consultant in Pain Medicine and Anaesthesia.

At BMI The Blackheath Hospital, experienced Pain Management Consultants help manage a wide variety of chronic pain conditions and symptoms for people aged 18+. They would be delighted to help you too.

Chronic pain can take many different forms. People who visit The Blackheath for help with pain management may be struggling with:

  • Neck (cervical) pain
  • Back (lumbar or thoracic) pain
  • Sciatica – in the arm or leg
  • Pelvic and/or abdominal pain
  • Headaches
  • Facial pain
  • Nerve pain - this can include persistent post-operative pain, phantom pain and pain after shingles
  • Fibromyalgia – a long-term condition that can cause pain all over the body
  • Complex Regional Pain Syndrome (CRPS) – often results from an injury (“trivial” trauma). Even though the injury heals, swelling and hypersensitivity cause severe and long-lasting pain
  • Ischaemic leg pain – a vascular problem such as a blocked or narrowed artery reduces the amount of blood able to reach the leg
  • Pins and needles in the arm, fingers, back or leg

There are many different types of pain. For example, it can be

  • sharp or dull
  • localised (in one specific place) with or without radiation to the leg /arm or widespread pain
  • constant or intermittent

Long-term pain can be exhausting to live with. Interrupted sleep, inability to exercise (or even be reasonably active) and the effects of trying to cope with pain over an extended period of time takes a toll physically, emotionally and mentally. It can easily lead to depression, frustration and anger and close relationships can be significantly affected.

While loved ones often try to support you, it can be very hard for them to truly understand and appreciate the reality of what you are going through and the effect it has on you.

A Consultant in Pain Medicine has a number of treatment options available that may help to relieve or manage your pain symptoms. These can be split into two categories – medication and interventional procedures.

There are a number of pain-relieving medications available in the UK. It is important to choose the appropriate medication or combination of medications to target your specific pain, and the optimal dose to use.

This is where the value of an expert in pain management is most often felt, as they have an extremely good insight into the different combinations and dosages available for a variety of conditions and types of pain.

Different pain medicines help with different types and causes of pain. For example, pain from inflammation may be best treated with an anti-inflammatory drug or a combination of paracetamol and an opioid (a strong painkiller – Morphine group of medications), whereas pain caused by a nerve issue will most likely need a different type of medication to reduce the hypersensitivity of the affected nerve.

An epidural involves injecting an anaesthetic into your back (specifically, into the epidural space around the spinal cord) under X-ray guidance to confirm the targeted location. It is also often used for pain relief during labour and childbirth, and during and/or after some operations in the acute pain situations without the X-ray guidance.

Interventional procedures available at The Blackheath include:

  • Nerve blocks
  • Nerve root blocks / Pulsed radiofrequency neuro modulation
  • Facet joint injections
  • Medial branch blocks / Radiofrequency denervation
  • Dorsal root ganglion (DRG) block
  • Peripheral nerve blocks
  • Sympathectomies

Nerves act as the body’s messenger system, transmitting signals (electrical impulses) around it, from one part to another. A nerve block deliberately interrupts a signal in specific nerves to try to help relieve pain.

A nerve root block involves injecting an anaesthetic (and usually steroid as well) directly into the place the nerve leaves the spinal cord (known as the nerve root). The anaesthetic numbs the pain while the steroid acts to reduce any inflammation and swelling. This type of injection is usually targeted at one particular nerve and X-ray guidance is used to ensure precision.

Facet joints are small joints in the spine that join the vertebrae (bones of the back) together. A facet joint injection involves injecting an anaesthetic (and again, usually a steroid as well) into a facet joint.

A medial branch block involves an injection of an anaesthetic and steroid near the nerves connected to a specific facet joint (see above). This stops pain signals being transmitted along the nerve to the brain.

A Dorsal root ganglion block is carried under fluoroscopic (X-ray) guidance. An anaesthetic and steroid injection is targeted to the dorsal root ganglion, the part of a spinal nerve that connects the nerve to the spine. This is often used to treat sciatic pain in the leg or arm.

Peripheral nerve blocks are best thought of as being an area-specific (regional) anaesthesia, used to block pain from being felt in certain areas. Often used in the legs, arms, hand and face.

Radiofrequency denervation of facet joints uses radio waves to destroy specific nerve fibres that supply a painful facet joint in the neck or back.

Pain management is an incredibly specialised and complex area of medicine. Not all types and causes of pain can always be fully treated, but your Consultant will ensure you receive the best possible pain relief for your specific condition.

Because of the complexity of this area and its overlap with so many other areas of medicine, your Pain Management Consultant works closely with other experts like spinal and orthopaedic surgeons to ensure you receive the best possible treatment and support you need at all times, from the most relevant expert.

When you first meet with your Pain Management Consultant at The Blackheath, they will take a medical history and talk in detail about your pain and any other symptoms you have. They may ask you questions like:

  • What symptoms do you have?
  • How long have you had these symptoms?
  • Where exactly is your pain, and how would you describe it?
  • How is your pain affecting or limiting you?
  • Have you had any treatments for your pain previously? (For example, have you already been prescribed any pain relief medication?)

It can be incredibly difficult to talk about chronic pain, and the effect it is having on you, openly and honestly with somebody else. Your consultation is the ideal opportunity to talk about these things in a safe, relaxed environment, with the knowledge that your Consultant has extensive experience of the effects of long-term pain in people of all ages and from all walks of life.

Your Consultant will review your current medication and/or treatment plan and discuss potential alternatives or changes with you.

Depending on your symptoms and the type of pain you’re experiencing, you may be referred for additional investigations. This may be X-ray, CT, MRI or Ultrasound. With all of these readily available on-site at The Blackheath, they are easily and quickly arranged when needed. Radiologists provide a prompt reporting of any tests so that your Consultant can start planning your treatment pathway sooner.

In some cases, your consultant may discuss the best treatment options within a multidisciplinary team, with specialists like spinal surgeons, neurologists, rheumatologists, physiotherapists and psychologists. 

Pain management is very much a collaboration between you and your Consultant. They will explain possible treatment options to you and will always be very happy to talk through any questions or concerns you may have.

It’s important to know that pain management is not usually a one-time treatment. Chronic pain can often flare up at random intervals, and a treatment that has been working well for some time may suddenly stop being as effective. 

Regular review when required means that your treatment can be adjusted as needed to help continue managing your pain as well as possible.

People visit the experienced Pain Management Consultants at BMI The Blackheath Hospital for a variety of reasons.

Many have been referred by their GP, physiotherapist or another specialist such as a spinal or orthopaedic surgeon.

 Others are directed our way by their private medical insurance provider or a friend or family member who has been helped by us previously, while others self-refer in order to get expert help sooner.

We treat patients with private medical insurance and those using one of our self-pay options.

Many of our patients live in London itself, while others travel from further afield to benefit from the expertise and experience of our Pain Management Consultants. 

When you choose to visit The Blackheath for help with your pain, you will benefit from:

  • Rapid access to an expert in pain management – When you’re struggling with pain, the last thing you’ll want is to have to wait weeks (or even months) to be seen for an initial consultation, followed by more time waiting for tests and investigations. At The Blackheath, we can easily schedule a consultation for you with an experienced Pain Management Consultant, at a time that is convenient for you.
  • Remote consultations available – Pain management consultations are usually carried out in person at The Blackheath, but we can also provide remote consultations by telephone or video call when required (and where clinically appropriate).
  • Tailored treatment – Pain management requires a tailored approach, with regular review and adjustment as necessary to ensure you receive the pain relief you need.
  • Multidisciplinary team – Your Pain Management consultant has easy access to experts in other fields, including neurologists, spinal surgeons, orthopaedic surgeons, radiologists and physiotherapists. Where additional input or support is needed, it is easily (and quickly) arranged at The Blackheath.
  • Recommended by patients - In an independent survey, 97.9% of the people we treated at BMI The Blackheath Hospital said they were likely or extremely likely to recommend us to their friends and family.

Help is available for your pain, sooner than you may think. We look forward to welcoming you to BMI The Blackheath Hospital soon and helping with your pain management.

Specialists offering Pain management

Dr Gerald Coakley

Consultant Rheumatologist

MB BS, FRCP, PhD

BMI The Blackheath Hospital

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Dr Viji Vijay

Consultant in Anaesthesia and Pain Management

MBBS, Bsc, FRCA FFPMRCA

BMI The Blackheath Hospital 2 more BMI Chelsfield Park Hospital BMI The Sloane Hospital

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Dr Sanjay Kuravinakop

Consultant in Pain Medicine and Anaesthetics

MBBS, DA, FRCA, FFPMRCA

BMI The Blackheath Hospital

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Dr Mukul Agarwal

Musculoskeletal & Sports Physician

FFSEM, MRCP, JCPTGP, MA(Cantab), Dip Sport & Exer Med, DTM&H

BMI The Blackheath Hospital

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Mr Gordan Grahovac

Consultant Neurosurgeon

MD, PhD, FRCS

BMI The Blackheath Hospital 2 more BMI The Sloane Hospital BMI Chelsfield Park Hospital

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