By Dr James Yu, Interventional pain specialist & anaesthetist at Prince of Wales Private Hospital
Chronic or persistent pain is pain that lasts for more than 3 months, or in many cases, beyond normal healing time. The defining characteristic is that chronic pain is ongoing and experienced on most days of the week.
Chronic pain is common. 1 in 5 Australians aged 45 and over are living with chronic pain.
Apart from unpleasant persistent pain, chronic pain can affect a person’s physical function, ability to work, exercise and socialise. People with chronic pain are more likely to experience mental health conditions, including depression, anxiety, sleep disturbance and fatigue.
There are many myths about chronic pain. Although chronic pain can be a symptom of a known illness or injury, it can also exist without a clear reason at all.
It is different from acute pain which pain developed due to injured or damaged tissue. This acute pain usually disappears once the tissue has healed.
Chronic pain is more complex. It may result from damage to body tissue from an acute or chronic condition, or changes in the nerves or nervous system that result in the nerves continuing to signal pain after the original condition has healed.
Chronic pain can result from injury, surgery, musculoskeletal conditions such as arthritis, or other medical conditions such as cancer or migraines. In some cases, there may be no apparent physical cause. In my practice, the 3 most common chronic pain presentations are lower back pain, neuropathic pain and arthritic pain.
Due to the complexity of chronic pain, the recommended treatment options are combination treatments which aims to reduce the pain intensity, increase physical capacity, improving mental health and quality of life.
The management of chronic pain will sometimes require the multi-disciplinary management consist of pain relief medication, physical therapy, psychological treatment and minimally invasive pain relief interventional procedures.
The most common cause of back pain in the over 50 years old is a degenerative lumbar spinal condition, especially facet joint arthritis. If the lower back pain is diagnosed to be due to facet joint arthritis, a very simple and successful treatment option is Radiofrequency Ablation (RFA). This technique utilises needles to generate an electrical current to heat a small area of nerve tissue, shutting down pain signals from that specific area to the central nervous system. RFA, a minimally invasive day procedure, may provide patients suffering from facet joint pain with relief between 9- 18 months.
Neuropathic pain is caused by damage or injury to the nerves that send messages to the brain to signal pain. It can be difficult to treat and it usually requires combination treatments including nerve pain medication, physical and psychological treatment; and nerve block procedures. Sometimes surgery with a neurosurgeon will be required to decompress a specific nerve causing the neuropathic pain.
For patients who have tried everything, including multiple spinal surgeries, yet still struggle daily with neuropathic pain, an advanced therapy called spinal cord stimulation is available. Spinal cord stimulation seeks to block pain signals before they travel to the brain. Small electrodes are inserted in the epidural space near the spinal cord that send electrical impulses to block pain signal transmission to the brain. This procedure requires a trial with temporary electrodes, to test the patient’s response to the stimulation. The treatment has a high success rate, varying from 50% to 80% depending on patients.
Due to the aging population, we are seeing more osteoarthritis of the major joints (knee, hip and shoulder). Sometimes joint replacement surgery might not be an option if the patient is too young or too old and frail for the joint replacement surgery.
Other treatment options for this group of patients include anti-inflammatory medications, pain killers, simple joint injections, radiofrequency ablation procedures and Platelet Rich Plasma (PRP) injections.
PRP therapy is part of regenerative medicine. It is a simple procedure: after drawing a patient’s blood, we spin it in a centrifuge for about 5-10 minutes, which allows us to collect plasma with a high concentration of platelets (five to ten times more than in normal blood). The PRP is then injected into the patient’s injured joint. While it is a bit more experimental, there is increasing evidence showing its efficacy for extended pain control.
Dr James Yu
Interventional Pain Specialist & Consultant Anaesthetist
Dr James Yu is a board-certified Interventional Pain Specialist and Consultant Anaesthetist with Fellowships from the Australian and New Zealand College of Anaesthetists (FANZCA), Faculty of Pain Medicine of the Australian and New Zealand College of Anaesthetists (FFPMANZCA), and Interventional Pain Practice of the World Institute of Pain (FIPP). He has clinical expertise in medical and interventional management of chronic pain, including radiofrequency ablation, platelet rich plasma (PRP) injection, spinal cord stimulation, and intrathecal pump implantation.
Dr Yu is the Medical Director of Sydney Spine and Pain (SSP), a clinic with a number of multi-disciplinary pain centres across Sydney. He also serves as the Medical Director of SSP Rehab and the REGAIN Multidisciplinary Pain Management Program. Dr Yu delivers gold standard interdisciplinary pain management approach to chronic pain patients to facilitate better recovery and self-management of pain through the REGAIN program.