Centres of Excellence -> Anestesiology & Pain Management -> When to contact a Pain Management Clinic

When to contact a Pain Management Clinic

1. Who works in the Pain Treatment Clinic?

A specialist anesthesiologist usually works. Namely, in the Republic of Croatia there is currently no subspecialization in the treatment of pain, although in the world (especially in the USA) there is. In the Republic of Croatia, anesthesiologists are most often used to treat pain.

2. Who can be treated in the Pain Treatment Clinic?

Anyone who has painful sensations in one or more areas of the body can be treated. We must distinguish between acute (within a month) and chronic (longer than 3 months, usually more than 6 months) pain. Why? Because most often insufficient and / or inadequately treated acute pain can turn into chronic pain, which then represents a significant problem for the patient in normal functioning in daily life, and often disturbs his night's rest.

3. Do I have to have a diagnostic method done before the examination?

Most patients who appear at the first examination have some type of diagnostic examination (X-ray, MSCT, MR) or have already performed an examination by another specialist (orthopedist, neurosurgeon, physiatrist, etc.). What is important to emphasize here is that it is possible to come with problems to our Clinicr, where a specialist doctor will make a clinical examination and decide whether it is necessary to make a first diagnostic test or further expand the current diagnostic processing.

4. Do I have to be referred by a doctor specialist or family medicine specialist?

Sometimes we get a recommendation from other specialists for a consultation on changing the analgesic therapy, although it is possible that if people have already prescribed analgesic therapy and are not satisfied with it, they can contact our Clinic for a second opinion.

5. What does a typical examination in the Pain Treatment Clinic look like?

The specialist doctor usually starts a conversation with the patient and takes medical data called anamnesis (previous diseases, clinical picture, previous treatment, nature of pain, current analgesic therapy, possible side effects and allergies to some drugs, etc.). After the conversation, a clinical examination and various tests are usually performed, which confirm the possible working diagnosis to the clinician. After that, the patient is explained the cause and consequences of his problems and a possible treatment plan is made, whether it involves minimally invasive treatment and/or taking medication by mouth.

6. What are the most common pain conditions that can be treated in our Clinic?

The most common conditions that are treated, and which are also prevalent in the general population are acute and chronic pain syndromes caused by degenerative changes in the spine (lumbago, chronic lumbosacral syndromes, lumbosciatica, chronic neck pain, acute and chronic cervicobrachial conditions), myofascial problems (tension headaches, pain in one or more muscle groups, etc.), which can be clinically manifested by reffered pain - this means in the case of tension headache that a person has a squeezing pain in the head that disturbs him during the day , and that the cause of this headache is not in the area of the head but in the area of the muscles of the neck and upper shoulder girdle, so the pain is distant. In addition to the above, the most common are patients who have already undergone an examination at another institution and ask for a second opinion.

7. What methods of treatment exist?

We most often use minimally invasive methods of treatment that can be performed in an outpatient setting and after which the patient can go home. These methods involve blocks of either the joint, tendon, nerve or nerve plexus under ultrasound control (no harmful radiation). Depending on the severity of the problem and the clinical symptoms, the specialist determines what is best for each patient at that time. In addition to these problems, it is possible to use methods of treatment with acupuncture needles, which predominantly solve the problems caused by myofascial syndrome - this method of treatment is called dry needling.

8. What is a blockade or block?

It is the most commonly used term in the treatment of pain. Also the most misused term.

The term block or blockade refers to the placement of a combination of a local anesthetic and corticosteroid (using ultrasound or X-ray) in a particular joint, surrounding connective tissue with or without tendon involvement, a single nerve or nerve plexus, and muscle. By block blockade we do not mean giving intramuscular injections of a combination of a non-steroidal anti-inflammatory drug and corticosteroids as is usually colloquially thought.

9. How long can a block last?

In most cases when the block is successfully performed and an appropriate combination of drugs is given, long-term improvement and reduction of symptoms is expected. It is important to emphasize here that in most cases block or blockade does not lead to a significant cure of the underlying disease and is not a substitute for the implementation of other methods of treatment. The most common example is frozen shoulder syndrome where successful blockade immediately mobilizes the painful shoulder, but then the patient is instructed to target physical rehabilitation for an additional effect in treatment that was not possible until then due to a very pronounced painful component. The same is true for acute pain syndromes in the lumbar spine.

The goal of the block is primarily analgesic so as to reduce inflammation and consequent pain in one or more parts of the body.

10. How long can treatment take?

Unfortunately, the answer is not easy. It depends on the severity of clinical symptoms and the duration of the pain syndrome. Acute cases when presented very early sometimes have a better chance of treatment compared to longer-term, chronic ailments. Ideally, one block can reduce the patient's pain by more than 50%, but sometimes it is necessary to repeat the block once or twice at intervals of a week to a month. Acupuncture needle treatment usually requires more frequent visits and longer-term treatment, and is an ideal choice for patients who are not allowed to take certain medications for personal reasons or for medical reasons.

11. What are the most common blocks that can be made?

Most often, blocks are made on the lumbar spine for certain painful syndromes, then blocks are made on the shoulder joint (either on the joint itself, bursae or surrounding muscles and tendons) or to block the nerve innervating the shoulder joint. Also blocks of the elbow region (medial and lateral epicondylitis or called golf and tennis elbow) and block of the medial nerve with pronounced symptoms of the carpal tunnel. Then hip joint blocks in advanced diseases of the hip joint with a pronounced painful component and pain in the knee joint (it is possible to apply the drug to the knee joint itself, but also to 3 surrounding nerves that significantly reduce the painful component). Also for tension headache, when indicated, the predominantly sensory nerve occipital nerve can be blocked which transmits painful stimuli forward and thus can significantly reduce the headache.

12. Can I go home after treatment?

Yes. Most of the blocks are made in an ambulance, which means that after a period of 30 minutes to 1 hour, the conditions for going home are met.

13. Do I have to get corticosteroids?

Corticosteroids are drugs with a very pronounced anti-inflammatory effect and consequently analgesic and are therefore an integral part of treatment. The given corticosteroids are mostly topical formulations and very little of the drug enters the systemic circulation, although it is always possible for people to be more prone to side effects and develop short-term (1-2 days) side effects after drug administration.

14. What if I don't want corticosteroids?

Then there is the method of treatment with platelet-enriched plasma (Platlet Rich Plasma or PRP). At the same time, blood is taken from the patient and centrifuged with a special device until a plasma part with platelets is obtained, which is then injected into the damaged parts of the body. This treatment is most often used for tendinitis, torn tendons and muscles, pain caused by arthritis or joint injuries. It has also shown exceptional potential in treating carpal tunnel syndrome in a minimally invasive way.

15. Is it possible to get a second opinion about analgesic therapy?

Of course. There is a very inter-individual response to drug treatment. 21st century medicine knows the so-called pharmacogenetic testing where by excluding and analyzing genetic material (saliva sample from the cheek) one can accurately assess the action of the vast majority of drugs in the body and choose the best one for each of the patients. Namely, there are people who react very poorly to certain drugs with many side effects unlike others, and this is precisely because of the existence of "different" genetic material involved in biotransformation and metabolism of drugs in the liver.

Pharmacogenomic testing is intended for people taking multiple drugs at the same time, especially those acting on the central nervous system (all semi-opioid and opioid drugs, adjuvants such as antiepileptics and antidepressants). This type of testing is done only once and is valid for life.

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