What does a Neurosurgeon/Pain Management Specialist do?
I trained as a Neurosurgeon and still consult in that capacity but my main role these days is managing chronic pain. I try to improve the lives of people with chronic pain. it is not always possible to completely relieve pain that has been present for a long time, but it is possible to ease the pain and also to help people with chronic pain to become more active and improve their quality of life.
Why did you decide to look after people with chronic pain?
As a Neurosurgeon, I am interested in the way the nervous system works and in helping people with problems affecting the nervous system. Pain is transmitted by nerves to the spinal cord and brain and has a major effect on our ability to function and our overall quality of life. For many years, chronic pain was poorly understood. acute pain was easy to understand and relatively easy to treat with the pain medicines we have available. Chronic pain often doesn't respond very well to these medications and the medications can create their own problems. Research has shown that changes occur in the nervous system in chronic pain and the nervous system no longer responds the way it does in acute pain. Even though the original injury to the tissues that caused the pain has healed, the pain continues. If we are able to prevent these changes occurring or are able to reverse them, we should be able to relieve chronic pain.
Do you think medications work for chronic pain?
Some medications can help reduce chronic pain. Traditional pain medicines are often not as helpful for treating chronic pain as they are for treating acute pain. They only help approximately one third of patients with chronic pain and they often only reduce the pain by less than 50 percent.
There are a number of other drugs that are helpful in treating chronic pain, although they were not originally developed to treat pain. Some anti-convulsant medications (developed to treat epilepsy) and some anti-depressant medications (developed to treat depression/anxiety) can be helpful in treating chronic pain. They do this be reducing nerve irritability, making nerves less likely to fire off and send pain messages to the spinal cord and brain.
What kind of procedures do you perform?
There are a number of procedures that can help chronic pain. Radiofrequency ablation of the small nerves carrying pain sensation from facet joints can relieve neck and back pain. Radiofrequency ablation can also be used to treat knee pain. Pulsed radiofrequency treatment can reduce pain being transmitted along major peripheral nerves or spinal nerves. Pulsed radiofrequency treatment can also be used to reduce disc pain, often in combination with platelet-rich plasma injection.
Cortisone injections around nerves can reduce pain by reducing inflammation in the nerves.
Neurostimulation can block pain transmission along peripheral nerves or in the spinal cord, without otherwise affecting the way the nerves function. It can be used to reduce pain in a variety of conditions, including back and leg pain and neck and arm pain following disc surgery or fusion, pain from complex regional pain syndrome, groin pain following hernia surgery, knee or foot pain following injury or surgery and some headache and facial pain.
Are there new technologies now that have become available recently to help with chronic pain?
Platelet-rich plasma injections have recently been used to treat a number of painful conditions, but there is no long-term information about their success rate at present. Conditions that may benefit from platelet-rich plasma injections include sacroiliac joint pain, lateral epicondylitis (tennis elbow), shoulder pain from rotator cuff tendon injuries, disc injuries.
Peripheral electrical nerve stimulation (PENS) therapy can be helpful in treating localised peripheral pains, including some headache pain.
For more information see our Dr Michael Davies information page.