NQ Pain

16/03/2024

Role of Nerve Block in Pain
Nerve Block
A nerve block is an injection that may provide temporary pain relief. It can also help diagnose sources of nerve pain. There are several types of nerve blocks based on which nerve it’s targeting, such as a genicular nerve block or an occipital nerve block.

Overview

What is a nerve block?

A nerve block is the injection of local anaesthetic close to a targeted nerve to provide temporary pain relief. An injection of anti-inflammatory medication in addition to local anaesthetic may allow the damaged nerves to heal by relieving the inflammation. The effects of the injection are usually quick, but nerve blocks are often just a temporary fix. Some people may benefit from one injection, while others need multiple. Some people don’t experience any effects from the block and may require different treatment methods to manage their symptoms.

What is the purpose of a nerve block?
Nerve blocks have three general purposes:
Therapeutic - These nerve blocks aim to temporarily relieve acute (sudden and short) or chronic (long-term) pain. The block may reduce inflammation, allow your nerves to heal, and, thus, relieve pain.

Diagnostic - If you’re experiencing pain but your healthcare provider doesn’t know the exact source of it, they may perform a nerve block. If you experience pain relief from the injection, it generally means that the targeted nerves are the source of the pain. Diagnostic nerve blocks can usually be followed by a radiofrequency neurotomy to provide prolonged pain relief.

Anaesthetic - For perioperative pain control.

What are the types of nerve blocks?
Your body has hundreds of major nerves that could be potentially targeted for a nerve block. Because of this, there are several types of nerve blocks. A few examples include:
Coeliac Plexus - This block can help relieve pain due to pancreatic cancer and chronic pancreatitis.
Genicular and Saphenous nerve - This block can help with chronic knee pain.
Intercoastal nerve block - Your intercostal nerves are under each of your ribs. This block can relieve temporary pain from rib fractures and help diagnose and treat neuralgia (nerve pain).
Lumbar sympathetic block - This block can help relieve lower back and leg pain, such as Sciatic and/or CRPS.
Greater occipital nerve block - This block can help diagnose and treat occipital neuralgia and headaches.
Pudendal nerve block – These blocks can provide pain relief around the ge****ls, tailbone (coccyx) and re**al pain.
Stellate ganglion block - This block can help relieve pain in your head, neck, upper arm and upper chest. It also has some evidence in managing PTSD.
Trigeminal nerve block - This block can help treat different causes of pain in your face trigeminal neuralgia.

Similarly, blocks can also be done for hip, ankle, shoulder and arm pain.

How do I prepare for a nerve block?
Fast for 6 hours and you may be asked to stop your blood thinners for a few days.

What happens during a nerve block injection?
The blocks will be performed in the operating theatre with an anaesthesiologist in attendance and under the guidance of an ultrasound or X-ray machine.

What happens after a nerve block injection?
After the injection, you will be moved to the recovery room, and once you meet the criteria, you will be given some snacks and discharged home.

What are the benefits of a nerve block?
Temporary or permanent pain relief may help you function better day to day.
Providing a diagnosis. A nerve block can help your provider identify a more specific cause of pain.
It’s important to note that not everyone experiences pain relief from nerve blocks. If this is the case, you may need to try other treatment options. In addition, some nerve blocks may only be effective if you do a course of physical therapy afterwards.

What are the risks or complications of a nerve block?
Complications of nerve blocks are rare. Each type of nerve block has different risks and side effects. For example, a stellate ganglion block may cause difficulty in swallowing, drooping eyes and hoarseness. A celiac plexus block may lead to delayed emptying of stomach contents But in general, risks and complications of nerve blocks include:
Infection and bleeding at the injection site.
Accidental delivery of the medication into your bloodstream.
Unexpected medication spread to other nerves or your spinal canal
Numbness, weakness and injury to the nerve

How long does a nerve block last?
Pain relief from a nerve block can vary significantly. It may last a few days or several weeks. Each person responds differently. Some people don’t experience any pain relief.

When should I call my healthcare provider?
Contact your healthcare provider immediately if you experience any new symptoms or complications from the nerve block, such as an infection or nerve issues like burning pain, weakness, or tingling.

04/08/2023

When a patient is seen for abdominal pain without other clinically significant symptoms, Abdominal cutaneous nerve entrapment syndrome (ACNES) should be high on the list of likely diagnoses. Its a condition characterized by chronic and severe abdominal pain resulting from entrapment or irritation of the nerves in the abdominal wall. It is also known as "anterior cutaneous nerve entrapment syndrome" or "subcostal nerve entrapment syndrome." Here's an overview of the symptoms and treatment of ACNES:

Symptoms of ACNES:
The main symptom of ACNES is chronic, localized abdominal pain. The pain is often described as a sharp, burning, or stabbing sensation and is typically limited to a specific area on the abdomen. The most common site of pain is along the lower ribcage on either side of the abdomen, known as the "anterior cutaneous branches of the lower six thoracoabdominal nerves" distribution.

The pain may be exacerbated by movements such as bending, stretching, or twisting, and it can be constant or intermittent. ACNES pain is often overlooked or misdiagnosed as other gastrointestinal or musculoskeletal conditions, leading to delayed or incorrect treatment.

Treatment of ACNES:
The treatment of ACNES focuses on relieving nerve entrapment and managing pain. The following approaches are commonly used:

1. Nerve Blocks: Local anesthetic injections around the affected nerve(s) can help confirm the diagnosis and provide temporary pain relief. We are able to offer neurotomy (RFN) for these nerves by using ultrasound.

2. Physical Therapy: Specific exercises and techniques can help stretch and strengthen the abdominal muscles, potentially reducing nerve entrapment and relieving pain.

3. Medications: Over-the-counter pain relievers or prescribed medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help manage pain and inflammation.

4. Neuromodulation: In some cases, procedures like pulsed radiofrequency (PRF) can be considered to modify the nerve's activity and reduce pain.

5. Botulinum Toxin Injections: Injections of botulinum toxin (Botox) around the affected nerves may help relax the muscles and alleviate nerve irritation.

6. Surgical Release: When conservative treatments fail, surgical exploration and release of the entrapped nerve(s) may be considered. However, surgery is typically reserved for cases that do not respond to other therapies.

It's crucial to seek medical attention if you experience persistent or severe abdominal pain. A proper diagnosis by a healthcare professional, usually a gastroenterologist or pain specialist, is essential to differentiate ACNES from other potential causes of abdominal pain and to establish an appropriate treatment plan.

If you think you or someone you know may be suffering from chronic pain, please remember help is around and kindly reach out to us.

29/07/2023

Kindly visit us at NQPain.com.au for more information.

29/07/2023

Alcoholic peripheral neuropathy (APN) is a neurological disorder that can result from excessive alcohol consumption over an extended period. It affects the peripheral nerves, leading to symptoms such as pain, tingling, numbness, and muscle weakness in the extremities. If you suspect you or someone else may have APN, it is essential to seek medical attention for proper diagnosis and management. Here's an overview of the symptoms, diagnosis, and management of alcoholic peripheral neuropathy:

Symptoms of Alcoholic Peripheral Neuropathy:
The symptoms of APN can vary from mild to severe and may include:

Numbness or reduced sensation in the hands and feet.
Tingling or burning sensations in the extremities.
Muscle weakness, especially in the legs.
Muscle cramps or spasms.
Balance problems and difficulty walking.
Changes in foot shape or deformities.
Sensitivity to touch or temperature changes.
Loss of reflexes.
Diagnosis of Alcoholic Peripheral Neuropathy:
To diagnose alcoholic peripheral neuropathy, a healthcare professional will typically perform the following:

Medical History: The doctor will ask about alcohol consumption patterns, duration, and any other relevant medical history.

Physical Examination: A thorough physical examination will be conducted to assess symptoms and signs of peripheral nerve damage.

Neurological Evaluation: The doctor may check for muscle strength, reflexes, and sensory responses in the affected areas.

Nerve Conduction Studies (NCS) and Electromyography (EMG): These tests help evaluate nerve function and identify nerve damage.

Blood Tests: Blood tests may be done to rule out other possible causes of neuropathy and assess nutritional deficiencies that could contribute to nerve damage.

Imaging Tests: In some cases, imaging tests like MRI or CT scans may be ordered to rule out other underlying conditions.

Management of Alcoholic Peripheral Neuropathy:
The primary goal of managing alcoholic peripheral neuropathy is to halt further nerve damage, alleviate symptoms, and improve quality of life. Here are some important aspects of management:

Alcohol Cessation: The most critical step in managing APN is to stop alcohol consumption completely. Nerve damage progression can be halted or slowed down significantly by abstaining from alcohol.

Pain Relief: Over-the-counter pain relievers (such as acetaminophen) or prescription medications (such as gabapentin or pregabalin) may be used to manage pain associated with APN.

Physical Therapy: Physical therapy can be helpful in improving muscle strength, balance, and coordination.

Occupational Therapy: Occupational therapy may aid in managing activities of daily living that are affected by nerve damage.

Nutritional Support: Ensuring a balanced diet with essential vitamins and nutrients can support nerve health.

Medication Management: If APN is associated with underlying conditions like vitamin deficiencies, appropriate supplementation may be prescribed.

Pain Management Techniques: Non-drug approaches such as transcutaneous electrical nerve stimulation (TENS) may be used to help alleviate pain.

Limb Care: Taking good care of feet, including proper footwear, can help prevent foot injuries due to reduced sensation.

Interventions like peripheral nerve pulsed radio frequency neurotomy could be tried if patient has reduced his alcohol intake and is not on high doses of opioids.

It's essential to consult with a healthcare professional for a comprehensive evaluation, accurate diagnosis, and personalized management plan. They can help address individual needs and provide appropriate recommendations to manage alcoholic peripheral neuropathy effectively. Additionally, support groups or counseling may be beneficial for individuals struggling with alcohol cessation.

07/04/2023

Complex regional pain syndrome (CRPS) is a chronic pain condition that usually affects one limb, often after an injury or trauma. It is a rare disorder that affects both men and women, but is more common in women, and typically develops between the ages of 40 and 60.

Causes:
The exact cause of CRPS is not fully understood. It is believed to occur when the nervous system overreacts to an injury, causing excessive and prolonged pain. The injury may be minor, such as a sprain, or more severe, such as a fracture or surgery. However, some cases may occur without any apparent injury.

Symptoms:
Symptoms of CRPS include:

Persistent, severe pain that is disproportionate to the severity of the injury
Swelling, stiffness, and warmth in the affected limb
Changes in skin color and texture, such as redness, shiny or thin skin, and excessive sweating
Changes in nail and hair growth
Muscle weakness and spasms
Difficulty moving the affected limb
Sensitivity to touch or cold temperatures
Emotional disturbances such as depression, anxiety, or mood swings
Diagnosis:
Diagnosing CRPS can be difficult, as there is no specific test for the condition. Diagnosis is typically based on the patient's symptoms, medical history, and physical examination. The Budapest Criteria, which includes clinical signs and symptoms, are commonly used as a diagnostic tool. Imaging tests such as X-rays, bone scans, and MRI may be used to rule out other conditions.

Treatment:
Treatment for CRPS aims to relieve pain, improve mobility, and restore function. This may include a combination of medication, physical therapy, and psychological support. Some common treatment options include:

Pain medication: Over-the-counter pain medication such as acetaminophen and ibuprofen may be used for mild pain. More severe pain may require prescription medication such as opioids, anticonvulsants, or antidepressants.

Physical therapy: Exercises and stretching can help reduce pain, improve mobility, and prevent muscle wasting.

Nerve blocks: Local anesthetics can be injected around the affected nerves to reduce pain and inflammation.

Psychological support: Living with chronic pain can be emotionally challenging. Counseling and support groups can help individuals cope with the emotional stress of the condition.

In selected cases, implanting a spinal cord stimulator is very helpful.

Early treatment is important for the best outcome, and in some cases, the condition may go away on its own.

04/04/2023

Diabetic neuropathic pain is a type of nerve pain that occurs in people with diabetes. It is caused by damage to the nerves that control sensation and is characterized by tingling, numbness, and burning pain in the feet, legs, and hands. This condition can be challenging to diagnose and treat, and it can have a significant impact on a person's quality of life.

Burden:

Diabetic neuropathic pain is a significant burden on individuals and the healthcare system. It affects up to 50% of people with diabetes, and the prevalence increases with age and the duration of diabetes. The pain can be severe and chronic, leading to sleep disturbances, anxiety, depression, and decreased mobility. The condition can also increase the risk of falls, foot ulcers, and amputations, leading to a substantial economic burden.

Diagnosis:

Diagnosing diabetic neuropathic pain involves a comprehensive evaluation of the patient's symptoms, medical history, and physical examination. The doctor may also conduct nerve conduction studies, electromyography, and other tests to assess nerve function and rule out other conditions that may cause similar symptoms.

Treatment:

The treatment of diabetic neuropathic pain is multidisciplinary and involves managing underlying diabetes and treating the pain. Lifestyle modifications such as maintaining a healthy weight, regular exercise, and smoking cessation can help improve blood sugar control and reduce nerve damage.

Medications such as antidepressants, anticonvulsants, and opioids can be used to manage pain. Topical agents, such as capsaicin and lidocaine, can also be effective. In addition, non-pharmacological therapies such as physical therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS) can be useful in managing pain and improving function.

Intervention options include peripheral nerve blocks and pulse radiofrequency neurotomy. There is emerging evidence of spinal cord stimulators in peripheral neuropathic pain.

At NQ Pain we are able to offer all of these options and treatments tailored to individual circumstances. Please reach out, we are here to help.

In conclusion, diabetic neuropathic pain is a challenging condition that can have a significant impact on a person's quality of life. Early diagnosis and multidisciplinary treatment are essential to managing the pain and preventing complications. People with diabetes should work closely with their healthcare team to manage their condition and prevent complications.

26/03/2023

According to the Australian Institute of Health and Welfare, chronic pain is a significant health issue in Australia. Here are some statistics related to chronic pain in Australia:

1. Around 3.4 million Australians (one in every eight people) are affected by chronic pain.
2. Chronic pain is more common in women than in men.
3. Chronic pain is more prevalent in older age groups, with one in three Australians aged over 65 experiencing chronic pain.
4. The most common types of chronic pain reported in Australia include back pain, osteoarthritis, and migraines.
5. Chronic pain is estimated to cost the Australian economy $34 billion per year in lost productivity and healthcare costs.

Chronic pain also takes a toll on the health of those who suffer from it. People with chronic pain are more likely to have mental health issues, such as depression and anxiety, and are also at a higher risk of developing other chronic health conditions.

In addition to its economic and health impacts, chronic pain also affects work days. People with chronic pain are more likely to miss work or have reduced productivity due to their pain. This can result in lost income and reduced career opportunities.

Overall, chronic pain is a significant issue in Australia that needs to be addressed. More investment in research, treatment, and prevention is needed to reduce the burden of chronic pain on the economy, health, and work days.

It's important to note that these statistics are from 2018, and the prevalence and impact of chronic pain may have changed since then.

https://www.9news.com.au/national/new-trial-for-severe-chronic-pain-sufferers-national-health-study/40ada456-90f8-4dee-8199-e8d27d97a06e

25/03/2023

The sacroiliac joint is located in the pelvis and connects the sacrum (the triangular bone at the base of the spine) to the ilium (one of the bones in the pelvis). Sacroiliac joint pain occurs when there is inflammation or damage to this joint, which can cause discomfort and limited mobility in the lower back, hips, and legs.

Causes:

Arthritis: Osteoarthritis and rheumatoid arthritis can both affect the sacroiliac joint.

Trauma: A fall, car accident or other trauma to the pelvis can injure the sacroiliac joint.

Pregnancy: During pregnancy, hormones are released that can loosen ligaments and cause the sacroiliac joint to become unstable and painful.

Infection: In rare cases, an infection in the joint can cause pain and inflammation.

Symptoms:

Pain in the lower back, hips, or buttocks

Pain that worsens when sitting for long periods or standing up from a seated position

Stiffness or limited mobility in the lower back, hips, or legs

Numbness or tingling in the legs or feet

Aching or burning sensation in the lower back or hips

Management:

Medication: Pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, can help relieve pain and inflammation.

Physical therapy: A physical therapist can teach exercises to strengthen the muscles that support the sacroiliac joint and improve mobility.

Injections: Corticosteroid injections can help reduce inflammation and relieve pain.

Radiofrequency ablation: A procedure that uses heat to interrupt pain signals in the nerves around the joint.

Surgery: In rare cases, surgery may be necessary to stabilize or fuse the joint.

It is important to consult with a doctor if you experience persistent pain or discomfort in the lower back, hips, or legs, as sacroiliac joint pain can be easily misdiagnosed as other conditions, such as herniated disc or sciatica.

24/03/2023

24/03/2023

Chronic lower back pain is a significant burden on Australia, affecting around 3.7 million people, or 16% of the population. It is one of the most common reasons for people to visit their healthcare provider and is associated with significant healthcare costs, lost work productivity, and reduced quality of life.

Common causes are as follows -
Mechanical (80-90%)

1. Myofascial Low back pain - usually attributed to muscle strain or ligament injury 65-70%.

2. Facet arthropathy: It is caused by the degeneration or trauma to the synovial joints present in the back. Pain is mostly axial with some radicular components. Pain aggravates on extension and turning twisting movements. Spondylosis term is used is a degenerative condition that may worsen as a person grows older. It can affect any region of the spine. Spondylosis can affect the spine's intervertebral discs (e.g., degenerative disc disease) and facet joints.

3. Sacroiliac joint Dysfunction: Sacroiliac (SI) joint pain is felt in the low back and buttocks. The pain is caused by damage or injury to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem.

4. Vertebral fracture: A compression fracture is typically caused by a loss of bone mass (osteoporosis) that occurs as part of aging.

5. Congenital deformity (such as scoliosis, kyphosis, transitional vertebrae.

B) Neurogenic(5-15%)
1. Herniated disc.

2. Spinal stenosis: Lumbar spinal stenosis is caused by insufficient room in the spinal canal for the neural elements. It is mostly degenerative in origin. Patients with spinal stenosis experience leg pain with prolonged standing or walking (neurogenic claudication).

3. Annular fissure with chemical irritation of nerve root or 4. Discogenic low back pain: It causes radicular LBP (sciatica). It happens when the nucleus inside the disc bulges or leaks through the annular tear causing indentation of the thecal sac or chemical neuritis of the Dorsal Root Ganglia (DRG) or mechanical compression of the nerve roots coming out of the spinal canal.

4. Failed back surgery syndrome (such as arachnoiditis, epidural adhesions, recurrent herniation); may cause mechanical back pain as well.

C) Non-Mechanical spinal conditions (1-2%)

1. Neoplastic (such as primary or metastatic) disease.

2. Infection (such as osteomyelitis, discitis, abscess).
3. Inflammatory arthritis or spondylarthritis: They share certain clinical characteristics (e.g., back pain, uveitis, GI symptoms, rashes). Some are strongly associated with the HLA-B27 allele. Clinical and genetic similarities suggest that they also share similar causes or pathophysiology. Rheumatoid factor (RF) is usually negative in spondyloarthropathies (hence, why they are called seronegative spondyloarthropathies). They include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and other disorders.

D) Others (2-4%)
1. Fibromyalgia.

2. somatoform disorder (such as somatization disorder, or pain disorder).

The symptoms of chronic lower back pain can vary, but common symptoms include:

Pain that is dull, aching, or sharp.
Stiffness in the lower back.
Limited range of motion or flexibility.
Pain that radiates to the buttocks or legs.
Tingling or numbness in the legs.

Management:

The management of chronic lower back pain typically involves a multidisciplinary approach that may include:

1. Physical therapy: This can involve exercises to strengthen the muscles of the lower back, improve flexibility, and correct posture.

2. Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be helpful in managing pain. Prescription medications such as muscle relaxants or opioids may be used for severe pain, but these should be used with caution due to the risk of addiction and other side effects.

3. Injections: Diagnostic injections into the facet joints followed by radiofrequency neurotomy to achieve longer pain relief. Similarly targeted injections towards the specific nerve roots, Sacroiliac joint, and cluneal nerves could be done. Lumbar epidural and caudal epidural are other treatment options for radicular pain.

4. Spinal cord stimulators - Inserted around the spinal cord in the epidural space which keeps giving electrical current into the dorsal column of the spinal cord. Its indicated in conditions like failed back surgery syndrome, resistant radicular low back pain, CRPS, and refractory diabetic neuropathic pain to name a few.

5. Surgery: In some cases, surgery may be necessary to relieve pressure on the nerves and address structural issues in the spine.

6. Complementary therapies: Acupuncture, chiropractic care, massage therapy, and other complementary therapies may provide relief for some people.

Overall, the management of chronic lower back pain can be challenging and requires a tailored approach based on the individual's specific needs and underlying causes.

23/03/2023

Chronic pain is a significant health problem in Australia that affects many individuals' quality of life. Here are some statistics and impacts of chronic pain in Australia:

1. Prevalence: Chronic pain affects approximately one in five Australians, with the prevalence increasing with age.

2. Economic Cost: The economic cost of chronic pain in Australia is estimated to be around $34 billion per year, including direct healthcare costs and lost productivity.

3. Workforce: Chronic pain affects an individual's ability to work, with an estimated 3.2 million working days lost each year due to chronic pain.

4. Mental Health: Chronic pain is also linked to mental health issues, including depression, anxiety, and sleep disturbances.

5. Social Isolation: Chronic pain can lead to social isolation, with sufferers often missing out on social events or activities they enjoy.

6. Family and Relationships: Chronic pain can also impact family and relationships, with sufferers often experiencing strain in their relationships due to their pain and the impact it has on their daily lives.

7. Treatment: There are various treatments available for chronic pain, including medication, physiotherapy, and psychological therapies. However, access to these treatments can be limited, and some individuals may not respond to treatment.

Overall, chronic pain has a significant impact on individuals' lives in Australia, affecting their physical, emotional, and social well-being. It is essential to improve awareness and access to effective treatments for chronic pain sufferers to improve their quality of life.

23/03/2023

Chronic neck pain is a common condition that can affect people of all ages. Here's some information on its causes, symptoms, and treatment:

Causes:

Chronic neck pain can be caused by various factors, including:

Poor posture and ergonomics
Injuries, such as whiplash or sprains
Degenerative conditions, such as osteoarthritis or herniated discs
Pinched nerves (Various causes)
Muscular strains or imbalances
Certain medical conditions, such as fibromyalgia or rheumatoid arthritis

Symptoms:

The symptoms of chronic neck pain can vary from person to person, but they may include:

Persistent pain or stiffness in the neck
Headaches
Shoulder or arm pain
Reduced range of motion
Tenderness or soreness in the neck muscles
Numbness or tingling in the arms or hands
Treatment:

There are various treatment options available for chronic neck pain, including:

Physical therapy - this can involve exercises to strengthen the neck muscles, improve posture, and increase range of motion.

Medications - over-the-counter pain relievers such as acetaminophen or ibuprofen can help relieve pain and inflammation. Prescription medications, such as muscle relaxants, may also be prescribed in some cases.

Injections - corticosteroid and local anesthetic injections and RFNs targeted to a facet joint and nerve could be done if indicated. We also offer spinal cord stimulatorsspinal cord stimulators if indicated.

Surgery - this may be recommended in severe cases when other treatments have failed, such as for herniated discs or spinal stenosis.

Alternative therapies - acupuncture, massage, and chiropractic care are some alternative therapies that may help relieve chronic neck pain.

It's important to talk to a healthcare professional to determine the underlying cause of chronic neck pain and develop an appropriate treatment plan. In some cases, a combination of treatments may be necessary for optimal pain relief and functional improvement.