Back and Leg Pain
Low back pain is a common and disabling problem in the community. It is the second most common reason for a patient to seek medical attention, and has a high rate of recurrence over the life of the individual patient. In some cases it is not possible to identify the exact cause of back pain however, in a significant number of patients there is a specific cause or “pain generator” that is potentially treatable using specialist interventions.
Many patients experience a combination of lower back pain and pain into one or more of the lower limbs. This is perhaps the most common presentation of patients in a Pain Clinic. There are many terms used to diagnose the cause or name of this pain syndrome, such as:
- Lumbar Facet Joint Pain;
- “Sciatica” or Lumbar Radicular Pain;
- Disc Herniation or Disc Bulge in the Lumbar Spine;
- Degenerative Disc Disease or Discogenic Pain;
- Spinal Stenosis;
- Sacroliliac Joint Pain;
- Cluneal Neuropathy.
Neck and Arm Pain
The head is a highly mobile part of the body, and the neck’s role in facilitating this function means that any pain or movement limitation in the neck is severely disabling.
Pain affecting the cervical spine/neck alone, or in combination with pain into the upper limbs is a common pain syndrome. There are a number of potential causes for this, such as:
- Cervical Facet Joint Pain;
- Cervical Radicular Pain or Upper Limb Pain;
- Degenerative Disc Disease or Discogenic Pain;
- Canal Stenosis;
- Whiplash Injury.
Osteoarthritis of the knee, or “wear and tear” deterioration in the knee joint, is a leading cause of knee pain. As a mobile and load-bearing joint, the knee is susceptible to trauma throughout life. Inflammatory diseases and infections can accelerate joint damage, and genetic and lifestyle factors also play a role. The biomechanical changes that occur as a result of cartilage loss add to loss of joint function and increasing pain. These changes may affect one or both knees to varying degrees.
As a highly mobile and functional joint, it is not surprising that shoulder pain increases as we age. The most common causes of shoulder pain include osteoarthritis of the main shoulder joint (glenohumeral joint) and rotator cuff arthropathy (degenerative change). Past trauma to the joint or inflammatory joint disease, such as rheumatoid arthritis, can also be a precursor to the syndrome of shoulder pain.
Patients commonly experience pain in the shoulder region that extends into the upper arm, and is worse both with movement and at night. Often patients find the pain is limiting many tasks, particularly reaching overhead, brushing hair etc, as well as disturbing their sleep. With disuse, supporting shoulder muscles can become weak which makes the pain and disability worse, and can result in a “frozen shoulder”.
Headache is a common and debilitating persistent pain syndrome affecting many members of the community. There are many potential causes, and careful assessment is required to rule out serious and treatable conditions.
Some benign, but disabling headache syndromes that can respond well to pain interventions are:
This syndrome is characterised by pain in the upper neck, base of skull to the back of the scalp, shoulder and upper arm. Patients can experience visual and auditory changes and sensitivity of the skin in extreme cases. Pain is worse with activity and position changes, and can be identified as originating from facet joint arthropathy of the upper cervical spine. Treatment of the cervical spinal facet joints or the C1-2 joint can substantially improve cervicogenic headache.
This is typically episodic severe headache associated with aura, nausea/vomiting and sensitivity to light. Patients often experience episodes form their early teens, but hormonal changes or stressful events can lead to an increase in attack frequency. If attacks are of high frequency, the migraine can become so consistent that it is better defined as Chronic Daily Headache. Neuromodulation or Occipital Nerve Stimulation shows promising results in the treatment of intractable migraine.
Sometimes, more than one problem is contributing to a patient’s experience of headache. Careful assessment and stepwise investigation by your Pain Medicine Specialist is the key to thorough diagnosis and optimal pain management.
Advances in the field of Pain Medicine over the past 20 years have allowed us to recognise a group of painful disorders that originate from disease or dysfunction of the nervous system. Under this very large umbrella are a variety of conditions that effect the brain and spinal cord (central nervous system) or the smaller nerves to the body (peripheral nervous system).
Some conditions have diagnosable tissue damage, such as a stroke or an amputated limb, whereas some have damage of functional changes occurring at a microscopic level, such as diabetic peripheral neuropathy. Treatment options will follow on from accurate diagnosis and selection of the evidence-based best practice, and may include a combination of interventions, medications, physical and psychological therapies.
This is a large category of painful conditions affecting the small nerves, most commonly to the extremities (arms and legs – “glove and stocking” distribution). Patients experience pain and other sensory disturbances, such as numbness, pins and needles (paraesthesiae), and position sense (proprioception). Pain is frequently burning or electric-shock like in nature, and frequently disturbs sleep.
Common causes are:
- Nutritional Deficiency;
- Idiopathic (no external cause identified).