OUR TREATMENTS
Other Procedures
TENS - Transcutaneous Electrical Nerve Stimulation
Transcutaneous means 'through the skin'. TENS machines deliver small electrical pulses to the body via electrodes placed on the skin. TENS machines are thought to affect the way pain signals are sent to the brain. Pain signals reach the brain via nerves and the spinal cord. If pain signals can be blocked then the brain will receive fewer signals from the source of the pain.
TENS machines are thought to work in two ways.
When the machine is set on a high pulse rate (90-130 Hz) it triggers the 'pain gate' to close. This is thought to block a pain nerve pathway to the brain. This is the normal method of use.
When the machine is set on a low pulse rate (2-5 Hz) it stimulates the body to make its own pain easing chemicals called endorphins. These act a bit like morphine to block pain signals.
Your Pain Medicine Consultant will show you how to use the machine, and it will come with a little book that will explain the features of your particular machine.
If you have a pace maker you should not use a TENS machine.
Here are some points that you may find helpful using your machine.
The sensation that you are experience should feel pleasant, if it is unpleasant turn the machine down.
You will get a nicer feeling if you place the sticky pads on muscle, not bone.
If you want to move the pads, make sure the machine is turned off, if may feel very unpleasant on your fingers.
If you turn the machine up accidentally, you will have a very unpleasant sensation – it is important that you know that this will not do you any harm, turn it down quickly, and try not to do it again!
Because the sensation of accidentally turning the machine too high may make you jump, it is very important that you do not use the TENS machine when you are driving.
You may wear the TENS machine when you are at work (providing you are not driving or operating machinery).
If the sensation goes away, turn the machine up until it is at a pleasant feeling again. If you are at the highest setting, and the sensation is faint try a new battery and check the connections.
If the TENS machine is not working it is most likely that the battery is flat, or that the cables connecting the machine to the pads have become broken.
Acupuncture
Acupuncture has been used for more than 2,000 years in China. In the past 30 years it has become more popular in the UK, and your Pain Medicine Consultant may feel that it is an appropriate treatment for your pain.
If acupuncture is felt to be appropriate then your Pain Medicine Consultant will do it in the outpatient room.
Acupuncture has been used to treat many medical problems, but is particularly useful for pain. It can help with joint pains, muscular pains, migraine, and even period pains. It has also been used to treat problems such as sinusitis, hay fever, irritable bowel, and nausea.
We know that acupuncture stimulates the release of natural pain killing chemicals within your body. These are released in several areas of your body - around the needles, in your spinal cord where the nerves run, and in your brain. Acupuncture also causes the release of other natural substances in your body which promote healing and aid recovery.
Most people will get some benefit from acupuncture treatment. You may lose your pain completely, or may find it is much improved. However, about a quarter of patients do not respond to acupuncture, and we can never guarantee results.
Acupuncture is a very safe treatment. Acupuncture has fewer side effects than many drug treatments and most people experience no problems at all. You may have some bruising where the needles were. Acupuncture can make you feel faint, so the doctor will have you lying down or sitting comfortably for the treatment. Some people feel very tired after the treatment, this is normal, simply rest when you need to and be careful.
Acupuncture involves the placing of a number of very fine needles into various points in your body for a short time, 15 – 30 minutes. The needles may either be simply left in, they may be manipulated (twiddled), or they may have a small painless electrical simulation applied to them. They are single use only, so are discarded when taken out.
Some of these points will be in the area of your pain, but some may also be away from your painful area, for example your ears, knees, hands or feet.
Acupuncture is mostly completely painless. The needles are very thin, and most patients are surprised at how little they can feel them. You may feel a slight prick as the needle is inserted. After that you may feel a warm, heavy sensation around the needle - this is normal and usually quite pleasant. If you feel pain when a needle is inserted, simply tell the doctor and it will be taken out.
You may find you feel very relaxed and sleep better following your first treatment. However, it may take several treatments before you notice much real improvement. Treatments are normally given at weekly intervals, although your doctor may advise more or less time between treatments. If you have not noticed any improvement after 3 treatments your doctor may feel that you are unlikely to respond and may advise you to stop the acupuncture treatment.
Most people need between 3 to 8 treatments, and some people need to return for regular "top up" treatments every few months.
Functional Restoration Programme
Although it may not be possible to cure your pain, in most instances a considerable improvement in physical ability and general well being can be achieved with a functional restorative programme.
Each programme is individually tailored to your special circumstances with a combination of Physiotherapy, to improve your muscles, Occupational Therapy, to teach you the best way of doing all your household activities, without hurting yourself, and psychological support to teach you relaxation techniques, pacing and other methods of manipulating your own pain.
The exact mix of these disciplines will depend on your circumstances. This will be decided by you and your specialist together. Medical supervision will be available during your stay.
The programmes usually run as an inpatient setting from Monday to Friday with approximately three hours of activity and therapy a day. Although the exercise sessions are one to one, and specifically measured to your ability, you will need to rest, in order to help your physical recovery.
When you have completed your programme you will be provided with a comprehensive exercise programme and full advice as to how to manage flare ups of pain and your medication.
Follow up with an approved physiotherapist, to progress your exercise programme, will be arranged as near your home or work as possible. A follow up appointment with your pain specialist, to supervise reduction of medication, will also occur.
Painkillers - Analgesics
Your Pain Medicine Consultant may prescribe for you a variety of pain medications. This is part of an individual treatment plan that your doctor has designed for you.
The different medications that they may prescribe are described briefly below, along with some basic principles of taking painkillers. If you wish more information about the tablets, it is important that you ask your doctor, as there will a reason that they will have prescribed as they have.
Paracetamol
This is a very safe and effective painkiller. Many people do not take it regularly and so do not get the full benefit of the painkilling action. We suggest taking 2 tablets 4 times a day.
It is important to know that you must not take more than 4g (8 tablets) in a single 24 hours.
Combinations
Sometimes drugs like co-codamol, co-dydramol or Transtec© will be prescribed by your pain consultant. These drugs combine a weak opioid like codeine, dihydrocodeine or tramadol with paracetamol. They come with various strengths of the weak opioid.
It is important that you do not take these as well as paracetamol as they contain paracetamol in them.
NSAIDs
Non steroidal anti inflammatory drugs (NSAIDs) are common drugs that may be prescribed for pain. These include medications like Nurofen (ibuprofen) or Voltarol© (dicofenac). These are effective pain killers, and can and should be taken with paracetamol as they work very well together.
These medications can cause stomach ulcers, please discuss with your pain consultant if they think you will need protection from this side effect.
COX-2 Inhibitors
Cox-2 drugs are similar to NSAIDs, but have much less gastro intestinal or bleeding problems. Common ones you may be prescribed are Celebrex© (celecoxib) or Prexige© (lumericoxib).
Again these are effective pain killers, and can and should be taken with paracetamol as they work very well together. They should not be taken with any other NSAID or Cox-2, as this will increase the likelihood of getting side effects without really giving you more pain relief.
Contra-indications to these drugs might be myocardial infarction and hypertension
Weak Opioids
These drugs are codeine, dihydrocodeine, tramadol and buprenorphine. They are very effective pain killers, for mild to severe pain, especially if taken in combination with paracetamol and NSAIDs.
If you take more than the recommended dose, it is unlikely that you will get more pain relief, simply more side effects.
Strong Opioids
These drugs include morphine, oxycodone, hydromorphine, fentanyl and diamorphine. These are very strong painkillers that your consultant may discuss with you. They can be taken in a variety of way including, tablets, both long and short acting, elixir, lozenges, and patches.
Neuropathic pain
If you have neuropathic pain, some of the above medications will not be the most effective solution for your pain. You may be prescribed some other sorts of tablets.
Tricyclic antideptressants – eg. amitriptyline
While these drugs are antidepressants, they are not used at the strength that would provide any antidepressant effect. At the low doses used for pain (10 – 75mg), these drugs work especially for nerve pain, but do not have an antidepressant effect. The pain doctor does not think that you are depressed and are making up your pain. These drugs may make you sleepy so it is always better to take them at night. If you are very tired in the morning, take them earlier in the evening.
Anticonvulsants – eg gabapentin, pregaballin, carbamazipine
These drugs have always been used for nerve pain. They calm down nerves that are sending wrong signals of pain to your brain. These drugs can also make you sleepy, though we know that in most cases this effect will wear off in a week or two.
Capsacin
This is a cream made from a substance founding chilli peppers. While it does not work for everyone, it is worth trying as it may help your nerve pain.
Lidocaine Plaster
This is a plaster that has local anaesthetic impregnated into it. It feels cool on the skin and has shown to be helpful for nerve pain.
Summary
It is important to try to take all the pain medications that the Pain Medicine Consultant has prescribed for you, as we know that they work in very different ways and a combination of medications will help your pain. If you feel that one does not agree with you, stop taking it, but remember to discuss this with you Pain Medicine Consultant.
If you have any questions about any of these medications, please ask your Pain Medicine Consultant.
Exercise
Many people wish to keep the painful area still, as they are afraid of doing more harm, so will stop doing any exercise. This is the wrong thing to do as we know exercise is effective in the treatment of pain.
It is very important that you continue to do some exercise. Much of the pain treatment that you will have at The Wellington Hospital is too enable you to regain some function so that you are able to return to exercise.
It is very important that you do appropriate exercise. If you have been not been very active, it is not a good idea to go and play 18 holes of golf, or go for a 5k run, just because you feel good today. People with pain often find themselves in what we call an overactivity/underactivity cycle. You do more activity on your ‘good days’ when your pain is less, but find your pain is worse the next day because you have overdone it. You may need more rest and or medications to recover from this burst of activity.
Pacing is a technique that you can use to plan and spread exercise evenly over the day and week, so that these pain flare-ups are minimised.
You need to have a goal in mind, but make it a realistic one. If you are unable to walk more than a few paces at present, your first goal should be to maybe get up the stairs, rather than walk the two miles into the shops, or to get the garden cleared up for the winter. If however you are more mobile, these may be appropriate goals. Discuss your goal setting with your Pain Medicine Consultant. Write down your goal and devise a series of little steps that slowly build up to it. You should gradually increase the amount of activity you take, as per your schedule, in these planned little steps. When you reach that goal, congratulate yourself and devise the next one, again with planned little steps.
If you have a pain flare-up during this pacing, they are likely to less severe, but even if they are, you will only have to step down a few steps, rather than go back to the beginning.
The pacing technique, can be used for all the activities that you do, not just your exercise programme but also your normal work activities, or as part of a return to work programme.
Life coaching
Life coaching can be a useful pain medicine tool, aimed as it is at allowing people to reach their potential. You may be prevented at the moment from reaching your potential because of your pain and a series of sessions with a life coach may give you the necessary confidence to make positive changes to your life style to enable you to live more comfortably with your pain.
Pilates
Pilates is an exercise program that focuses on the core muscles that help keep the body upright and balanced. These muscles are essential to providing support for the spine. Pilates exercises will teach you to be aware of the neutral position of the spine and will help strengthen these deep postural muscles that support this posture. It is the strengthening of these muscles and your more neutral position which will help your back and neck pain.
The Pilates exercise program
Pilates is an exercise system named after its originator, Joseph Pilates. Mr. Pilates developed this system in the early 1900’s to improve his health and to support the health of fellow World War I internees.
Initially the Pilates exercise program was primarily used by professional dancers, who appreciated improved strength, balance and flexibility. In the 1980’s Pilates was re-discovered and has now become a popular form of exercise for anyone interested in its health benefits.
Important principles of the Pilates exercise program include:
- Use of mental focus to improve movement efficiency and muscle control
- Awareness of neutral spine alignment, or proper posture, throughout the exercises
- Development of the deep muscles of the back and abdomen to support this posture
- Use of breath to promote mental focusing and centering
- Creating length, strength, and flexibility in muscles
The exercise system is usually taught in one of two formats:
- Using the unique Pilates equipment in private, or semi-private, sessions
- Group mat classes not using equipment