Pain by Area Click on the area of pain you are interested in reading more about.

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Low Back Pain (Lumbar Spinal Pain) Sciatica and Leg Pain Coccydynia Upper Back Pain (Thoracic Spinal Pain) Neck Pain Headache Facial Pain Shoulder and Elbow Pain Arm Pain Wrist and Hand Pain Hip and Knee Pain Ankle and Foot Pain Chest Pain Abdominal Pain Pelvic and Gynaecological Pain Groin, Testicular and Prostatic Pain Renal / Kidney Pain

Low Back Pain (Lumbar Spinal Pain) Lumbar or low back pain is a common symptom of musculoskeletal spinal conditions. Examples include age-related degenerative spondylosis, osteoarthritis, osteoporosis and degenerative disc disease. Trauma from accidents, injury or from abnormal postural positions may result in persistent low back pain, often associated with muscle spasm and myofascial pain. Other causes include spinal stenosis, spondylolithesis, vertebral fractures and failed spinal surgery, occasionally associated with arachnoiditis. Diagnosis requires taking a detailed medical history, examination and possible investigation such as blood tests, X-ray or MRI scan. So called ‘Red Flags’ of serious disease (trauma, unexplained weight loss and a history of cancer), should be excluded. Acute episodes of low back pain are often self-limiting and usually respond to simple measures: painkillers, acupuncture, exercise and lifestyle changes. Chronic back pain, defined as pain persisting beyond 6 months may be helped with specialist medication, acupuncture, physiotherapy and lifestyle changes. When such measures fail to afford benefit, there is evidence to support the use of targeted treatment including facet joint, epidural and nerve root injections. Persistent mechanical spinal pain from established facetal joint disease may require radiofrequency denervation of the facetal nerves.

Sciatica and Leg Pain Sciatica is a set of symptoms including low back, buttock and leg pain, possible numbness, pins and needles and muscle weakness. It is usually the result of irritation of the sciatic nerve roots from a lumbar disc herniation (slipped disc) or pinching caused by arthritis or bony abnormality within the spine. An occasional cause is Pyriformis Syndrome, where the sciatic nerve is trapped in a muscle in the buttock. Cauda Equina Syndrome is a rare neurological condition with loss of bladder and bowel control, and numbness in the perineum (saddle area). This may require prompt decompression surgery. Diagnosis is by medical history, examination and investigation such as blood tests, X-ray or MRI scan. 90% of sciatic cases resolve spontaneously with anti-inflammatory medication and physiotherapy. Persistent or severe symptoms may require specialized nerve-pain medication, epidural or targeted nerve root injection and occasionally spinal surgery. Persistent leg pain may be the result of trauma or disease. Traumatic causes include bony fracture, soft tissue injury or surgery. Diseases include arthritis, ischaemia (impaired blood flow from poor circulation), diabetes, neuropathies and pain referred from the lumbar spine. Treatment of soft tissue and joint pain may include medication, exercise and acupuncture. Persistent pain may require targeted joint, peripheral nerve or myofascial injection therapy. Nerve and ischaemic pain may respond to specialist medication, nerve root or sympathetic nerve injections. Established joint and ischaemic pain may require surgery.

Coccydynia Coccydynia is pain in the coccyx or tailbone, usually exacerbated by sitting on hard seats. Trauma is a common cause following a fall, childbirth or persistent pressure on the lower spine such as with bicycling. Degenerative arthritis may also cause coccydynia. The diagnosis is usually made on medical history, examination and rarely an X-ray. Simple treatments include medication, exercise and adaptive seating. Persistent coccydynia may require a local nerve block (sacro-coccygeal nerve or caudal epidural). This may be combined with a manipulation of the coccyx under general anaesthesia.

Upper Back Pain (Thoracic Spinal Pain) Thoracic spinal pain extends from the bottom of the neck to the lumbar spine. Upper back pain may be the result of muscular sprains and postural problems, degenerative disease of the discs and facet joints and fractures of the vertebral bones from trauma or osteoporosis. Diagnosis is made with history, examination and investigations such as an MRI scan. Muscular and soft tissue thoracic pain is usually treated with analgesia, exercise and acupuncture. Persistent upper back pain due to myofascial muscle spasm may be

treated by targeted paravertebral injection therapy. Persistent upper back pain due to facet joint degeneration or sprain, or dorsal nerve root impingement may require facetal joint or nerve root injection. A painful compression fracture of the vertebra from osteoporosis may be treated with initially with local injections. If this fails to control the pain, vertebroplasty may be considered.

Neck Pain There are several causes of neck pain. Age-related degenerative spondylosis is common. Disc disease may cause neck and nerve root pain with sensory changes and muscle wasting in the arm. Muscle spasm and strain following whiplash injury, sustained abnormal positions or stress can result in chronic neck and myofascial pain. Neck conditions are diagnosed on history, examination and investigation such as X-ray or MRI scan. Simple treatments of muscular neck pain may include medication, acupuncture, exercise and lifestyle changes. Persistent neck pain associated with injury or arthritis that fails to improve with simple measures may require facet joint or paravertebral muscle injection treatment. Nerve root pain may respond to injection therapy (root block or cervical epidural) directed to the affected level.

Headache Headaches can result from a wide range of causes both benign and more serious. Ninety percent of headaches are benign. The most common are migraine and tension-type headaches. Other types include cluster headache, trigeminal neuralgia and hemi-cranial headache. Secondary headache may be caused by problems elsewhere in the head or neck, such as cervicogenic headache (pain arising from the neck muscles), trauma including whiplash type injury and medication overuse. More serious causes of secondary headache include meningitis, temporal arthritis, brain haemorrhage and tumour. The diagnosis is confirmed by careful history, although some conditions may require investigation such as a MRI scan. Treatment is based on the cause of the headache, frequently by selection of appropriate medication. Headaches secondary to neck or muscle problems may require treatment targeting the cause: cervical facet joint, muscle or occipital injections. Acupuncture is often helpful and migrainous headaches may respond to Botulinum Toxin treatment.

Facial Pain There are various causes of facial pain, many neuropathic in nature including trigeminal neuralgia, atypical facial pain and post-herpetic neuralgia. Temporomandibular joint dysfunction and neck disorders may also cause facial pain.

Diagnosis of facial pain can often be difficult, although is usually confirmed by careful history and in some cases, investigation such as X ray or MRI scan. Treatment is tailored to the cause of the pain, usually with specialist pain medication, acupuncture and injection treatments. Microvascular decompression surgery, stereotactic radiation therapy and radiofrequency denervation of the trigeminal nerve may be considered for persistent trigeminal neuralgia.

Shoulder and Elbow Pain The shoulder is a shallow joint and susceptible to injury, over-use and under-use. Causes of persistent pain include frozen shoulder, tendinitis, bursitis and rotator cuff tears. Degenerative joint arthritis and upper arm fractures may also cause chronic shoulder pain. It may also be referred from the neck or associated with muscle spasm. A full history, examination and if required, investigation with Xray, arthrogram or MRI scan allows diagnosis. Conservative treatments include appropriate medication, exercise and steroid injection. Persistent pain from arthritis and rotator cuff disease may respond to suprascapular nerve injection and radiofrequency treatments. Muscle (myofascial) pain may be treated with acupuncture and targeted myofascial trigger point injections. There are various causes of pain around the elbow joint including tenosynovitis, tennis and golfer’s elbow, trauma and arthritis. Diagnosis is made with history, examination and investigations with Xray or MRI scan if required. Treatments include medication, acupuncture and injection therapy.

Arm Pain Arm Pain may be caused by injury and disease within the arm or may be referred from the neck.Fractures and arthritis may result in chronic arm pain; soft tissue injury may result in myofascial pain, and over-use or abnormal use may lead to repetitive strain disorder. Referred pain may be neuropathic arising from disc disease, arthritis in the neck associated with nerve root irritation, or from compression of brachial nerves and vessels in thoracic outlet syndrome. A full history, examination and if required, investigation with Xray, MRI scan and nerve conduction studies allows diagnosis. Treatment of soft tissue and joint pain may include medication, exercise, adaptive technology, acupuncture and steroid injection. Nerve pain may respond to specialist medication, nerve root injections, joint or myofascial trigger injections and occasionally surgery.

Wrist and Hand Pain Wrist and Hand Pain may be caused by injury and disease or be referred from neck problems. Post-traumatic soft tissue injury, fractures and lacerations involving the nerves or fingers may result in persistent neuropathic, scar or phantom pain. Local causes include DeQuervain’s tenosynovitis and Carpal Tunnel Syndrome. The diagnosis is dependent upon on history, examination and, if required, investigation such as Xray, MRI scan and nerve conduction studies. Treatment of pain from soft tissue causes may include medication, exercise, adaptive technology, acupuncture and steroid injection. Nerve pain may respond to specialist medication, topical local anaesthetics and injection therapies including scar infiltration treatment, nerve block injections and stellate ganglion injection. (See also Complex Regional Pain Syndrome and Peripheral Neuropathy.)

Hip and Knee Pain Hip and knee joint pain may be caused by degenerative and rheumatological arthritis, trauma including injury, mechanical effects of sport and surgical interventions or metabolic and developmental disease. Patients report joint tenderness, stiffness with restricted mobility, creaking (crepitus) and occasionally locking. Diagnosis is by history, examination and investigations with X ray or MRI scan if required. Treatment is usually directed at the cause and specific symptoms and includes medication, some topical, exercises and lifestyle changes, acupuncture and targeted injection treatment such as a hip block or genicular nerve (knee) block. Severe joint degeneration may require joint replacement surgery.

Ankle and Foot Pain Ankle and foot pain may be caused by arthritis, injury through sport, accidents or surgery. Foot pain may also be referred from the back or be due to metabolic disease, such as diabetes or circulatory problems. Other causes include joint and soft tissue disease including plantar fasciitis and sprains of the ligaments resulting in local tenderness with restricted mobility. Diagnosis is with history, examination and investigations with X ray or MRI scan if required. Treatment is usually directed at the cause and specific symptoms and includes medication, some topical, exercises and lifestyle changes, acupuncture and targeted injection treatment such as joint injection.

Chest Pain There are several causes of chest pain. Serious underlying heart and respiratory disease should always be excluded. Causes of persistent pain include chest trauma such as rib fractures, soft tissue injury, muscle sprain, and costochondritis (Tietze’s syndrome). Other causes include nerve pain from surgery, post-herpetic neuralgia or referred pain from the thoracic spine. Diagnosis is made with history, examination and investigations with X ray or MRI scan if required. Treatment of heart and respiratory disease requires referral to an appropriate specialist. Treatment of myofascial (muscle) pain and costochondritis may include medication, exercise, acupuncture and selected injections. Nerve pain may respond to specialist medication including topical and intravenous local anaesthetic and specific injection therapies.

Abdominal Pain Abdominal pain is a common problem. Persistent abdominal pain may be due to a variety of conditions and diagnosis may be challenging. Inflammatory conditions include Crohn’s disease, ulcerative colitis and chronic pancreatitis. Post-surgical causes include adhesions, post-surgical hernia and scar pain. Irritable bowel, vascular disease and abdominal wall nerve entrapment also cause chronic abdominal pain. Diagnosis is with history, examination and investigations such as blood tests, endoscopy, ultrasound and MRI scan if indicated. Serious causes of abdominal pain are managed jointly by the gastroenterology team and the pain clinician. Treatment is usually directed at the cause and specific symptoms and includes specialized medication, lifestyle changes, acupuncture and targeted injection treatment such as splanchnic and abdominal wall nerve blocks.

Pelvic and Gynaecological Pain Most women experience pelvic pain at some time. When the condition persists it is known as Chronic Pelvic Pain: a dragging and throbbing, occasionally stabbing pain. Causes include chronic infection, previous gynaecological surgery, endometriosis, pudendal neuralgia, vulvodynia, ovarian and vaginal disease leading to visceral nerve hypersensitivity. Diagnosis is with history, examination and investigations such as laparoscopy, ultrasound and MRI scan if required. Treatment of Chronic Pelvic Pain may include specialized neuropathic pain medication, physical therapies, lifestyle changes and targeted injection treatment including pudendal and hypogastric nerve blocks.

Groin, Testicular and Prostatic Pain Male groin and genital pain may be due to a variety of conditions including infection, trauma, varicocele, hydrocele and chronic non-bacterial prostatitis or pelvic myoneuropathy resulting in chronic testicular or prostatic pain. Pain may be referred from the kidney and in a small proportion of cases, hernia repair surgery may be associated with persistent groin pain. Diagnosis is with history, examination and investigations such as ultrasound and MRI scan if indicated. Treatment of testicular and prostatic pain is with specialized neuropathic pain medication, physical therapies and lifestyle changes. Post-hernia repair groin pain may also respond to targeted injection treatment such as genitofemoral and ilioinguinal nerve blocks.

Renal / Kidney Pain Loin pain may be due to a variety of conditions including recurrent kidney infection, renal stones, loin pain haematuria syndrome and previous surgery including nephrectomy. Pain in the loin may also be referred from the dorsal (thoracic) spine or be due to muscle sprain or spasm. Diagnosis is with history, examination and investigations such as blood tests, endoscopy, ultrasound and MRI scan if required. Treatment is directed at the cause and includes specialized medication and targeted injection treatment such as dorsal paravertebral and splanchnic nerve blocks.