Pain Overview: What is Neuropathic Pain?

Pain Overview: What is Neuropathic Pain?

Neuropathic pain can be defined as pain caused by a lesion or dysfunction, often due to disease, of the somatosensory system. The somatosensory system is responsible for the perception of pain, pressure, touch, temperature etc. When damaged, it may lead to altered transmissions of sensory signals to the spinal cord and brain which results in neuropathic pain. Neuropathic pain has multiple causes including injury, diabetes, shingles, HIV, amputation, peripheral nerve injury, radiculopathy and as a result from surgical procedures. While it can be acute, neuropathic pain is most often chronic.

Chronic neuropathic pain is experienced by 7-10% of the general population and is more common in older patients and women. It is usually felt in the lower back, lower and upper limbs or neck. Symptoms can be quite distinct; Patients may describe their pain as burning, pins & needles, numbness, electrical shocks or itching. They may also experience pain from non-painful stimuli, such as light touching.

Neuropathic pain can be a challenge to both manage and recognise. It’s important to take a holistic approach in managing neuropathic pain, as it heavily impacts multiple facets of patient’s lives, even more severely than patients suffering from non-neuropathic chronic pain. Difficulties with sleeping, anxiety and depression are common amongst these patients.

Neuropathic pain is usually managed with conservative therapies before resulting to interventional techniques, however there has been an increasing use of interventional therapies due to aging population, side effects of opioids and polypharmacy in older patients.

At Metro Pain Group, we have an experienced multidisciplinary team of doctors, nurses, physiotherapists, a psychologist and a rehabilitation coordinator to deal with the multifaceted aspects of neuropathic pain. As specialists, we regularly treat patients with neuropathic pain and offer advanced and evidence-based treatments, both conservative and interventional.

To refer your patients please download our referral form and forward to us by one of the following options:

Postal: Metro Pain Group, Monash House, Ground Floor, 271 Clayton Road, Clayton, VIC 3168
Email: referrals@metropain.com.au
Fax: 03 9595 6110

For more information on our referral process click here.

 

References:
Colloca, L., Ludman, T., Bouhassira, D., Baron, R., Dickenson, A. H., Yarnitsky, D., Freeman, R., Truini, A., Attal, N., Finnerup, N. B., Eccleston, C., Kalso, E., Bennett, D. L., Dworkin, R. H., & Raja, S. N. (2017). Neuropathic pain. Nature reviews. Disease primers, 3, 17002. https://doi.org/10.1038/nrdp.2017.2




Growing pains: chronic pain in children and youth

Growing pains: chronic pain in children and youth

Much of the pain experienced by children and teenagers are chalked up to growing pains. While this may be part of the picture, the label ‘growing pains’ can mask underlying conditions and issues that may require medical intervention. For example, sports injuries are the most common cause of muscle, bone and joint pain in childhood. Minor injuries are generally identifiable and resolved within minutes, hours or days, however severe or persistent pain requires medical attention. While acute sports injuries are common, what about the child who is repeatedly injured or in pain each time they participate? While growing pains and the nature of acute injury could be to blame, there is also a possibility that the child is suffering from overuse syndromes, childhood arthritis, or a variety of other medical conditions’ 1

Another common cause of pain in children, especially in young females is pelvic instability. This can be caused due to asymmetrical growth of the hips during puberty, leading to an excessive range of motion, without the necessary muscular control. This is most common in young females involved in sports requiring a high degree of mobility such as dance or gymnastics and can be a source of ongoing pubic pain.

As a parent it can be hard to determine what ‘growing pains’ are normal and what pain requires medical attentions. These symptoms may indicate that it’s something more serious:

  • Your child’s pain persists throughout the day.
  • The pain is there in the morning.
  • They still hurt long after getting an injury.
  • They have joint aches.
  • They have a fever.
  • They have an uneven gait or favour one leg.
  • They are tired or weak.
  • They less active than usual.

At Metro Pain Group, we offer an integrated approach to treating paediatric pain and understand the difficulties and challenges of looking after a child with chronic pain and how this can impact on the child and the family. Dr Simon Cohen is our Paediatric Pain Specialist and has worked for over 14 years treating newborns and young adults.

Dr Bruce Mitchell is an Interventional Pain Physician with a special interest in Pelvic Pain.

To find out more please fill out the form below:

Paediatric or Pelvic Pain Inquiry

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References:
[1] Lehman, T. (2004). It’s Not Just Growing Pains. New York: Oxford University Press.




Make a New Year’s Resolution to Manage Pain Effectively this Year!

Make a New Year’s Resolution to Manage Pain Effectively this Year!

As we bring in the new calendar year, it is a time to reflect and check in with ourselves. To ask if we are moving in the direction we desire or being hindered by old habits. It is a time where we are encouraged to dream big and imagine our best lives and determine the resolutions we will make to get there.

For many people living with chronic pain, the ultimate dream is to be pain-free. While this is not always possible, good pain management is a practical and achievable goal, which can give you the space to focus on other things that are important to you. That is why our new year’s resolution is to provide every patient we see with the best possible pain management plan that suits their individual needs and to empower them to take back their life from pain. Ultimately, we want what you want. To reduce the suffering associated with pain.

Looking back on 2019, we helped over 5000 patients on their pain journey. In bringing in the new year, we remember that what we do is not just a job. We work with patients experiencing some of the hardest times in their lives and have the power to help make significant positive changes. In bringing in 2020, we recommit to providing patient-centred care, to furthering research in pain medicine and striving for excellence in every step of our patient’s journey.

In actualising our goal to reduce the widespread suffering of chronic pain, we will be expanding the practice by taking on more practitioners. This will help reduce waiting times between appointments and allow us to respond proactively to patient demand, as pain becomes more widely recognised as a disease in its own right.

To join us in reducing your pain, fill out the form below to learn more about our tailored pain management option.

Pain Management Inquiry

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What are the next steps in chronic pain relief?

What are the next steps in chronic pain relief?

It is estimated that 1.2 billion adults globally suffer from chronic pain, impacting on their quality of life and capacity to go about their day to day activities. While some patients find relief from conservative treatments, what happens when these treatments aren’t enough or prove ineffective for the patient?

Neuromodulation can be the life-changing step in providing relief for these patients. Neuromodulation is the ‘modulation’, or the process of altering ‘neural’ (or nerve) activity by delivering electrical currents to interrupt pain signals on their pathway to the brain. This is achieved by a neuromodulation device which consists of precisely placed leads connected to a power source.

Here are 8 things to know about neuromodulation:

1. Neuromodulation aims to alleviate or lessen pain without the ‘brain fog’ that sometimes result from opioids.
Neuromodulation is a therapy aiming to relieve pain with neuro-stimulation, enabling patients to avoid brain fog side effects associated with opioids or excessive sedation. These side effects include clouding of thoughts, fatigue, forgetfulness, lack of concentration or inability to focus.

2. Potential neuromodulation patients can test the treatment to see if its right for them.
Neuromodulation is administered in two stages: a trial stage and an implant stage. The temporary trial stage consists of a needle-based approach through which the leads of the device are inserted. This allows the patient to test the therapy before final consideration of the device’s implantation.

3. Neuromodulation is an evidence-based therapy that has shown to decrease chronic pain and improve quality of life for some patients.
Approximately 1.2 billion adults are affected by chronic pain globally—more than the total affected by heart disease, cancer, and diabetes combined. Pain can affect an individual’s ability to function and even perform the simplest of activities of normal living.
Many studies and clinical trials have documented neuromodulations ability to decrease chronic pain in patients, thus improving their quality of life. Studies show that neuromodulation can halve your pain [1,2], with those experiencing foot pain achieving average pain reductions of 80% [1,2]. Additionally, measures of quality of life (such as the ability to sit, walk and stand) were improved and patients reported high levels of satisfaction after implantation.

4. It is a low risk procedure and has been used in practice for over half a century.
Extensive research and clinical trials have shown neuromodulation to be a low risk treatment. With the modern era of neuromodulation beginning in the 1960’s, neuromodulation has been highly practiced, improved and researched, resulting in the highly modernized and low risk procedure provided today. A study assessing the safety of devices over the course of a year found no serious adverse events related to devices [3] with minor complications reversible and usually resolved [2]. Neuromodulation devices are also approved by the Australian Government Department of Health’s Therapeutic Goods Administration (TGA) regulatory body.

5. Neuromodulation devices can be programmed to optimise pain relief
Neuromodulation devices can be programmed by manipulating amplitude, pulse width and frequency of electrical stimuli in order to optimise pain relief in patients. Modern devices allow patients to program their own devices and gives the ability for them to be switched on or off. It is highly recommended for the patient to check with their pain practitioner before making any changes to their programming to optimise pain relief.

6. Neuromodulation can be applied through different techniques.
Neuromodulation comprises of multiple treatment modalities including spinal cord stimulation (SCS), dorsal root ganglion (DRG) stimulation, sacral stimulation, peripheral nerve stimulation (PNS) and peripheral nerve field stimulation.

7. Neuromodulation implants can be removed.
Even if a patient chooses to proceed with the second stage of neuromodulation after a successful trial, the device can still be removed if the patient chooses to stop treatment.

8. In Australia, neuromodulation procedures are covered by most gold cover private health insurance.
As with all medical procedures, the patient must check with their insurance plan to receive proper approvals.

 


References:
[1] Liem, L., Russo, M., Huygen, F.J., Van Buyten, J.P., Smet, I., Verrills, P., Cousins, M., Brooker, C., Levy, R., Deer, T. and Kramer, J., 2015. One‐year outcomes of spinal cord stimulation of the dorsal root ganglion in the treatment of chronic neuropathic pain. Neuromodulation: Technology at the Neural Interface, 18(1), pp.41-49.

[2] Verrills, P., Sinclair, C. and Barnard, A., 2016. A review of spinal cord stimulation systems for chronic pain. Journal of pain research, 9, p.481.

[3] Deer, T., Pope, J., Benyamin, R., Vallejo, R., Friedman, A., Caraway, D., Staats, P., Grigsby, E., Porter McRoberts, W., McJunkin, T. and Shubin, R., 2016. Prospective, multicenter, randomized, double‐blinded, partial crossover study to assess the safety and efficacy of the novel neuromodulation system in the treatment of patients with chronic pain of peripheral nerve origin. Neuromodulation: Technology at the Neural Interface, 19(1), pp.91-100.




Dorsal Root Ganglion Stimulation Is Paresthesia‐Independent: A Retrospective Study

Overview

Neuromodulation is an important treatment for pain relief in neuropathic pain conditions. Dorsal root ganglion (DRG) stimulation is a type of neuromodulation that allows for more precise treatment for some pain regions.

Although DRG stimulation can produce paresthesias (often described as a tingling feeling), many patients operate their devices at a subthreshold level that does not elicit this sensation. This study investigated pain relief both with and without paresthesia of permanent DRG stimulation treatments over a three-year period.

Pain (0-10 rating scale) was assessed at baseline, at the end of the trial period and after three, six and twelve months of treatment. Of the 39 patients, 87% reported no paresthesias during the 12 month period and reported an average pain relief of 73.9% after the trial period and 63.1% after 12 months. More than 80% of these patients had pain relief of over 50% after three months of treatment. Results were similar for the paresthesia group of (5) patients.
As sustained pain relief over a 12 month period was achieved without perceived paresthesia through DRG stimulation, the positive outcomes observed with this treatment was found to be paresthesia-independent.

The full details of the study can be found here.

Neuromodulation




Why the Holiday Period Can be Challenging for Some Chronic Pain Patients

Why the Holiday Period Can be Challenging for Some Chronic Pain Patients

“The holidays can be exhausting. Chronic pain doesn’t care that it’s the holidays. It’s supposed to be busy and you’re supposed to have a good time. The pain will still be there and the increase in activities can make it so much worse.” [1]

As the holiday season rapidly approaches us, we begin to find ourselves winding down and catching up with family or friends. While it can be a wonderful time of festivities for many, this season can be challenging for some patients with chronic pain. Often patients feel pressured to push themselves to the point of exhaustion from the expectations of family or friends or feel overly stressed with holiday preparations. This can result in pain flares and increased fatigue, worsening their suffering.

If you have patients with chronic pain, it is important to be especially considerate during this period and to employ an empathetic approach. You may find the following tips helpful in dealing with patients:

  • Encourage them to manage their stress by spacing out activities and setting boundaries for what they are unable to do.
  • Remind them the importance of listening to their bodies. Ensure that they are getting adequate rest and not pushing themselves too hard.
  • Tell them to be realistic about what they can do and to prioritise the most important tasks to not cause further unnecessary pain. By pacing their activities, they are conserving energy for the things that are important.

If your patients are struggling with feelings of heightened isolation or loneliness, there are online support groups that may help. Being in connection with others who are dealing with the same pain and feelings can help patients feel a sense of community and connection without the physical stress on their bodies.

On the other hand, as practitioners, we must also practice self-care and utilise the upcoming holiday break for some well-deserved rest and to recharge our batteries. Nurture the positive relationships you have with family or friends and schedule some downtime between the busy festivities.

We hope you enjoy this time of the year and wish you happy holidays from the Metro Pain Group.

References:
[1] https://themighty.com/2016/12/what-to-know-about-chronic-pain-during-the-holidays/




Wishing you a happy holiday season and a healthy dose of self-care

Wishing you a happy holiday season and a healthy dose of self-care

“The holidays can be exhausting. Chronic pain doesn’t care that it’s the holidays. It’s supposed to be busy and you’re supposed to have a good time. The pain will still be there and the increase in activities can make it so much worse.” [1]

From Yule and Hanukkah to Christmas, Kwanzaa, Hogmanay and New Year’s Eve – this time of the year is filled with celebrations from all different cultures and backgrounds.

Unfortunately, chronic pain isn’t magically cured just because it’s December. No surprises there! While the holiday season can be a wonderful time of festivities, it can also be overwhelming, stressful and challenging for those living with persistent pain. With high expectations for this time of the year, we are tempted to push ourselves beyond the point of exhaustion. For chronic pain patients, this can lead to pain flares and increased fatigue. That is why managing stress, pacing activities and setting boundaries with family and friends is key to enjoying the holiday season.

At this time of the year, being able to say no is more important than ever. Take the time to determine your priorities and be realistic about how much you can do and what it is you want to be doing. It is easy to get carried away in holiday excitement, but be careful not to overuse your “spoons“. Listen to your body and take time to rest when you need it. Pushing yourself beyond your limitations to please others will generally backfire. Let go of any guilt around resting and remember that by pacing your activities you are conserving your energy for the things that are most important.

For those who aren’t able to be with family and friends during this season or who may be struggling with feelings of isolation and loneliness, remember you are not alone. Reaching out to online support groups and talking with others living with pain can be a great way to feel connected during the holiday season.

Whatever your situation, we hope you enjoy this time of the year and practice self-compassion. It is not easy being in pain. Be kind to yourself and remember that you are doing your best.

To book an appointment with Metro Pain Group.

References:
[1] https://themighty.com/2016/12/what-to-know-about-chronic-pain-during-the-holidays/




Support groups can foster resilience for chronic pain patients

Unity And Diversity

Few conditions can be as isolating as chronic pain. Nobody else can see it or feel it – not your friends or family, not even your doctors. Nobody knows what it is like for you living with chronic pain, except, of course, other people who have chronic pain. This is why support groups can be so worthwhile. They can bridge the gap between medical care and your need for emotional support and understanding.

Chronic pain support groups provide a space that brings together people with chronic pain to provide each other mutual support. They are a place for sharing experiences, stories, coping strategies, information about conditions and, at times, advocacy. While family and friends may not understand the full impact of living with a chronic condition, meeting other people living with similar conditions can reduce feelings of isolation and offer hope.

There are many different types of support such as online groups, telephone helplines and face-to-face groups.

These resources may be a good place to start in finding the right support groups for your needs:

Facebook Groups
A quick Facebook search for chronic pain support will bring up hundreds of hits. Within these groups, you will likely find a good source of support. These groups can be narrowed down by specific pain conditions such as pelvic pain or fibromyalgia.

Things to be aware of before joining a support group:
Support groups are often run by volunteers or people who have had experience with chronic pain. They may not be healthcare professionals or trained counsellors. If you receive advice about treatments or healthcare professionals, check with a healthcare professional you trust, such as your treating physician at Metro Pain Group, before starting on a new treatment regimen.




Altering Pain Signals with the Latest Technology

How pain signals are changed with latest technologies

Neuromodulation can be a life-changing treatment for the carefully selected patient. In recent years, we have seen neuromodulation therapy advance in a way that has dramatically reduced pain and improved functioning for many of our patients.

Neuromodulation aims to reduce pain by interrupting ‘pain signals’ in the body. Neuromodulation devices do this by sending electrical currents along the spinal cord, which can disturb ‘pain signals’ on their pathway to the brain. These devices consist of a battery and leads that are surgically placed in two stages. The first stage is a two-week trial which allows the patient to test out the possible pain relief they may experience, and then a permanent implant if the trial is successful.

As global leaders in pain intervention, Metro Pain Group has been able to work closely in developing ground-breaking technology for neuromodulation. One of the advancements includes the development of a recharge-free spinal cord stimulation (SCS) device.

The recharge-free spinal cord stimulator (SCS) has a battery life of up to 10 years and uses low-dose electrical pulses, that mimic natural brain patterns, to preserve battery. This SCS device has the functionality to be used alongside some mobile digital devices and wireless technology for seamless integration with a modern lifestyle. The SCS device also features upgradeable technology, ready for the next advancements in chronic pain therapy via software updates. [i]

A recent innovation in the treatment of chronic back and leg pain is the introduction of 10-kHz high-frequency therapy. This device works by delivering high frequency (10kHz) pulses to the spinal epidural space, which interrupts the transmission of pain signals. This treatment is free from the common side effects of traditional SCS, being a tingling or buzzing feeling known as paraesthesia. This device can be used while driving and can stay on while you sleep. [ii]

For patients with peripheral chronic pain (e.g. feet, legs and knees), a type of neuromodulation where leads are placed around the dorsal root ganglion (DRG) may be able to provide the desired pain relief. Traditional spinal cord stimulators modulate the transmission of pain signals along the spinal cord, whereas DRG therapy works on a bundle of nerves located marginally outside of the spinal cord. By placing leads along the DRG, pain relief can be achieved within a focal area on the feet, legs, hands and knees. [iii]

As different devices on the market perform varied functions, your doctor can help match the device that is right for your needs and specific pain condition. For more information or if you would like to find out if neuromodulation is right for you, please fill out the form below.

Neuromodulation inquiry

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References:
[i] Deer, T., Slavin, K. V., Amirdelfan, K., North, R. B., Burton, A. W., Yearwood, T. L., … & Justiz, R. (2018). Success using neuromodulation with BURST (SUNBURST) study: results from a prospective, randomized controlled trial using a novel burst waveform. Neuromodulation: Technology at the Neural Interface, 21(1), 56-66.

[ii] Kapural, Leonardo, et al. “Novel 10-kHz high-frequency therapy (hf10 therapy) is superior to traditional low-frequency spinal cord stimulation for the treatment of chronic back and leg pain. The SENZA-RCT randomized controlled trial.” Anesthesiology: The Journal of the American Society of Anesthesiologists 123.4 (2015): 851-860.

[iii] Krames, Elliot S. “The dorsal root ganglion in chronic pain and as a target for neuromodulation: a review.” Neuromodulation: Technology at the Neural Interface 18.1 (2015): 24-32.