Services
Treatments that I offer reflect up to date evidence based practice in pain medicine and generally follow national recommendations (NICE guidelines) or relevant local clinical experience.
Chronic lumbar spinal pain
This is the commonest condition that patients present with in pain clinics. Conservative measures such as physiotherapy and simple painkillers are the mainstay of treatment. However, when the pain becomes severe and starts to have an impact on mobility, I will consider X-ray guided pain interventions that include:
Diagnostic / therapeutic facet medial branch blocks
Diagnostic / therapeutic epidural steroid injections
Facet joint radiofrequency denervation
Chronic spinal pain is quite often due to underlying age related degenerative changes (spondylosis, spondylolisthesis, facet joint hypertrophy). I sometimes request an MRI scan to determine the location of these changes and guide future treatments which could include referral to a surgeon if there is evidence of significant spinal instability or nerve compression.
Degenerative disc disease
Disc herniation can lead to severe pain and disability in the leg (also known as sciatica) or arm. If physiotherapy and manual therapies do not achieve the desired relief, I can offer X-ray guided epidural steroid injections which are proven to give sustained effective relief in the majority of patients.
I would usually request MRI imaging in this situation if the pain is associated with weakness (e.g. foot drop) or if the response to the first injection is not satisfactory.
Neuropathic pain
This is pain due to an injury or disturbance of the nervous system. It is characterised by stabbing burning tingling sensations, numbness, and hypersensitivity (even light touch or blowing of air can cause severe pain). It is difficult to diagnose and treat, but I have excellent expertise in managing neuropathic pain and can offer treatments that include:
Diagnostic nerve blocks: local anaesthetic is injected under ultrasound guidance around certain nerves to determine whether they are responsible for pain
Anti-neuropathic medication trials: I will carefully try one or more medication trials that can help diagnosis and treatment.
Qutenza (Capsaicin 8%) and Lidocaine patches: used for management of post herpetic neuralgia and other forms of focal neuropathic pain
Spinal cord stimulation (see under separate heading)
Complex regional pain syndrome (CRPS)
If you have been given this diagnosis or you think you might have it, I will do my best to see you urgently because it is an extremely painful condition and early treatment has certain benefits. I can offer the following interventions:
Nerve block series: local experience has shown that a series of peripheral upper or lower limb nerve blocks followed by intensive physiotherapy could reduce disability and improve function.
Spinal cord stimulation (see under separate heading)
Abdominal and pelvic pain
I would only assess patients for these conditions once they have been seen by all relevant specialists (e.g. gastroenterology, surgery, gynaecology, urology) and sinister pathology of abdomino-pelvic organs has been excluded. Pain interventions for these conditions have mixed results, are not always straightforward and have slightly higher complication rates. Depending on your condition I can offer the following:
Splanchnic / coeliac plexus blocks (Diagnostic and therapeutic)
Hypogastric plexus blocks
Ganglion Impar block
Pudendal nerve blocks
If nerve blocks give a good result, pulsed radiofrequency treatment can give longer term benefits.
Spinal cord stimulation (SCS)
This is one of the most promising recent technological advances in the management of chronic pain, the main indications that I will implant this device are:
Failed back or failed neck surgery syndrome
CRPS (Complex regional pain syndrome)
Chronic neuropathic pain (e.g. post herniorrhaphy pain, post mastectomy pain, post thoracotomy pain, caesarean section pain)
Lower limb pain secondary to intractable peripheral vascular disease
Please visit the following websites for more information:
Joint pain (shoulder, knee and hip)
Pain from these sites can be managed by various interventions including:
Suprascapular nerve blockade and radiofrequency denervation (for shoulder pain)
Genicular nerve blockade and radiofrequency denervation (for knee pain)
Intra-articular hip injection and radiofrequency denervation of hip joint articular branches (for hip pain)
Facial and head pain
The two conditions I treat in this area are the following:
Trigeminal neuralgia: I can offer balloon compression of the trigeminal ganglion if medical and surgical treatments have failed or if you do not wish to undergo surgery.
Occipital neuralgia: This can be successfully treated with occipital nerve blockade and radiofrequency denervation.
Myofascial pain
if you have specific points in your neck, shoulders, trunk or chest wall that are particularly tender I can offer trigger point injections which can be very useful.
Coccyx pain (Coccydynia)
This condition can be managed by coccyx injections or ganglion impar blockade for longer term relief.
Sacroiliac joint dysfunction
The SIJ is a large important joint that supports the spine. SIJ dysfunction is often overlooked as a cause of low back pain and hip / buttock pain. Clinical examination and imaging alone are not reliable enough to pick up SIJ pain. An X ray guided local anaesthetic and steroid injection is the most reliable method to diagnose this condition. If this leads to significant pain relief, radiofrequency denervation can be an option to prolong such relief.
Cancer pain
I can offer the following interventions:
Intrathecal phenol injection: This is a very effective procedure for patients suffering from severe resistant pain in the rectal / perianal area secondary to invasive pelvic cancers.
Coeliac plexus neurolysis: This is a very effective intervention for patients suffering from severe resistant abdominal pain secondary to pancreatic cancer.
Intrathecal drug delivery: Cancer patients who are on very high doses of morphine and not getting much relief or suffering from side effects can benefit from an implant that can deliver morphine and local anaesthetic directly into the spinal fluid. This means a very small dose of morphine is required and such patients will achieve a significant improvement in their quality of life.