OTHER PAIN – Joint, Muscle and Nerve Pain

Chronic Shoulder Pain and Suprascapular Nerve Block

Chronic Shoulder pain is a frequent patient complaint (overall it occurs in approximately 20% of the general population, especially in the elderly) that leads to significant distress, disability and decrease in quality of life.

Suprascapular Nerve Block (S.N.B) has been shown to be a safe and effective treatment for chronic shoulder pain resulting from conditions such as osteoarthritis and rheumatoid arthritis that have not responded to other conservative treatments (such as simple pain killers, physiotherapy etc.) and surgery is not an option or desirable.

S.N.B is an “injection” that is performed as an outpatient procedure and involves the injection of local anaesthetic and steroid around the suprascapular nerve (using X-rays or Ultrasound scan for guidance) to block the nerve that transmits pain from the shoulder joint. Following the injection your pain may return after the anaesthetic has worn off and there may be some additional soreness as a result of the injection. The steroid can take up to two weeks to work or it may not work at all. If it does work, the effects can last for several weeks or months. Alternatives to steroids include Pulsed Radio-Frequency and Botulinum Toxin.

knee injection

Chronic Knee Pain and Genicular Nerve Block.

Osteoarthritis (OA) of the knee joint can cause persistent pain and reduce mobility. Symptomatic O.A of the knee joint is present in 20-30% of the elderly population aged more than 65 years. In addition to OA of the knee joint there are other causes of persistent chronic knee pain.

Patients with knee pain are normally treated with conservative measures (such as simple pain killers, physiotherapy etc.). In some cases when these treatments are not helpful and surgery is not suitable and/or desirable, diagnostic Genicular Nerve Block (injection of local anaesthetic to block the nerves that transmits pain from the knee), and if positive (good short lasting pain relief), followed by radiofrequency denervation (“cauterizing”) to the nerve supply of the knee joint can be considered.

Coccydynia

Coccydynia refers to pain originating from the coccyx, or tailbone. The pain may also extend down into the buttocks, lower back and the thighs/legs. The pain becomes worse following sitting or with local pressure and is relieved by standing or changing posture. It is five times more common in women than men.

Coccydynia is usually treated with conservative measures such as simple pain killers, manipulation, massage use of T.E.N.s machine etc. However, if despite these measures coccydynia is persistent or severe, additional non-surgical treatment options for coccydynia may include an injection of local anaesthetic and steroid to the nerves supplying the coccyx (caudal epidural, ganglion impar block, coccygeal nerve block)

post herpetic neuralgia

Post-herpetic Neuralgia

Post-herpetic neuralgia (P.H.N) is a complication of shingles. The condition affects pain fibres and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear. In most people, post-herpetic neuralgia improves over time. However, in some people it can persist for a long period of time.

In the first instance, P.H.N is usually treated by your G.P using simple pain killers (for example paracetamol, anti-inflammatories etc.) and pain killers that work on “pain nerve fibres” (for example amitriptyline, nortriptyline, gabapentin). If these simple measures fail then other treatments are available in secondary care such as application of Capsaicin Patches (Qutenza patches, Capsaicin 8%).

Capsaicin is a component of chilli peppers which gives their heat sensation. Capsaicin patch works by blocking receptors on pain- sensing nerves under the skin, which reduces sensitivity to pain. It is applied to the area of skin where you have pain and helps to relieve your symptoms. It is carried out as a day case procedure.

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