Pain Management Clinics Bristol

Consulting at The House Clinics in Bristol

Redland House Clinic

118 Redland Rd
Bristol
BS6 6QT

Bawa House Clinic

(BAWA Leisure Building)
589 Southmead Rd
Filton
Bristol
BS34 7RG

City House Clinic

30 Queen Charlotte St
Bristol
BS1 4HJ

Call 020 7060 5109 today for an appointment.

Dr Mark Miller MB ChB, FRCA, FFPMRCA

Photo of Dr Miller

Consultant Anaesthetics and Pain Management

Qualified in 1990 with an MBChB from Manchester University

A Fellow of the Royal College of Anaesthetists in 1997

A Fellow of the Faculty of Pain Medicine of the Royal College of Anaesthetists in 2007

Dr Miller has been practising as a consultant, diagnosing and treating patients with pain related complaints since 1999

What is pain management?

This extremely broad branch of medicine focuses on the diagnosis and management of chronic pain disorders. Many people in the UK struggle to cope with everyday pain. If pain is severe and affecting the quality of your life then Dr Miller's pain management clinic can help you. Pain management comprises of a multidisciplinary team of expert physiotherapists, surgeons and psychologists. Many patients experience more than one type of pain. It is a subjective sensation differing from patient to patient, because of this, all of Dr Miller's treatments are individualised. Treatments that work for one patient may not necessarily work for another.

Pain management clinics use a biopsychosocial model to determine an individual's state of health, this model understands pain in terms of the psychological (emotions, thoughts and behaviour) and social (socio-economic, socio-environmental), rather than purely in biological terms.

Conditions Dr Miller can help with

Back Pain

  • Cervical Spine
  • Thoracic Back Pain
  • Low Back Pain
  • Coccydinia (Painful Coccyx)

Nerve Pain

  • Trigeminal Neuralgia
  • Shingles and Post-herpetic Neuralgia
  • Headaches
  • Scar Pain
  • Phantom Sensations and Pains

Complex Regional Pain Syndrome (CRPS)

Myofascial Pain Syndrome

Treatment in pain management can be divided into 3 categories:

  • Physical
  • Psychological
  • Pharmacological

Back Pain

Back pain is by far one of the most common complaints here at pain management, often causing chronic pain lowering the patient's quality of life.

Back pain can be felt at any point along the spine, the area of pain will fall into one of the following categories:

  • Cervical pain (pain the neck)
  • Thoracic pain (pain felt behind the chest wall or thorax)
  • Lumbar and Sacral pain (felt in the lower back)
  • Coccyx pain or coccydinia (pain felt at the lowest tip of the spine)

Spinal pain is divided into either mechanical pain or referred pain.

  • Mechanical pain is when the symptoms are only felt in the area that is causing the pain itself, for example if you have a cervical problem the pain will be felt in the area of the neck. The cause of mechanical pain is inflammation in the intervertebral discs and facet joints.
  • Referred pain is when the pain radiates to other parts of the body away from the source of the pain, as seen in sciatica where compressed nerves in the lower back can result in shooting pain felt in the legs. In some cases this can indicate a narrowing of the spine resulting in nerve irritation.

For diagnosis, SPECT CT and MRI scans are the best radiological indicators of inflammatory spinal pain. X rays are generally only indicated if there are red flag symptoms (signs of an underlying condition of a more serious nature such as cancer or infection)

Treatment for back pain is best approached via the biopsychosocial model, some possible treatments include; physiotherapy, radiofrequency denervation and transforaminal root blocks.

Nerve Pain (Neuralgia)

Neuropathic pain is caused by problems with one or more of the nerves themselves. The sensations felt in neuralgia differ from those of nociceptive pain or tissue pain (the pain felt from a burn or a cut for example). Neuropathic pain is often described as variable symptoms of shooting or stabbing pain characterised by skin colour changes, skin sensitivity and swelling amongst other symptoms.

Common neuralgias

Shingles and Postherpetic neuralgia

After recovery from an attack of Chicken Pox (Varicella-Zoster), the Varicella-Zoster virus lies dormant in the nervous system. Reactivation of the virus causes Shingles, which damages the nerves and causes a painful rash on the skin of the affected area. The rash clears leaving a painful area of skin, often characterised by constant extreme sensitivity also known as allodynia and depigmentation. This persistent pain at the site of a previous attack of Shingles is known as Postherpetic neuralgia.

Treatment can include:

  • Topical and oral pain relief
  • Botox
  • Pulsed radiofrequency treatment

Trigeminal Neuralgia

This is a facial pain caused by the trigeminal nerve, often described as a severe repeated stabbing pain, usually on an area of one side of the face. Further investigation with an MRI or CT scan may be required. It can be caused by compression of the trigeminal nerve by a blood vessel. In such cases, surgery can be used to successfully treat the condition.

Treatment can include:

  • Medication
  • Surgery

Headache – The Trigeminal Cephalagias

The following are a group of primary headache disorders: Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT), Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache. They are characterised by often extreme pain states caused by the distribution of the trigeminal nerve, pain is typically only felt on one side of the head and is associated with a headache.

Treatment can include:

  • Medication
  • Occipital nerve blocks with steroids and botox
  • Occipital nerve stimulation

Scar Pain

Scar pain, both operative or traumatic, is a common complaint at the pain clinic. Scars are often hypertrophic or keloid types of scar. Symptoms can include one or more of the following:

  • Swelling
  • Skin colour changes
  • Allodynia (pain is worsened by a touch or stimulus that would not normally cause pain)
  • Hyperalgesia (severe pain from a stimulus that usually would only cause very slight discomfort, such as a light tap on the painful area)
  • Itching
  • Marked pain to deeper palpation

Treatments can include:

  • Topical lignocaine-impregnated patches
  • Botox
  • Pulsed radiofrequency treatment
  • P.E.N.S.

Phantom Sensations and Pains

After amputation of a limb, many patients commonly report pain in the stump of the missing limb or they may even feel as though the missing limb is still attached to their body and in some cases, feel pain in the now amputated limb. This is understood as phantom pain, more commonly reported in cases where the missing body part was painful prior to amputation, also more likely to occur if the missing limb was a result of a traumatic accident.

Pain at the end of a stump of a missing limb is more common than phantom pain, this is thought to be a result of the cut nerves growing swellings, also known as neuromas. Ulceration of the skin and the scar in the stump can also cause pain.

Phantom pains and sensations are thought to be a result of the central nervous system retaining a memory of the missing limb and its associated nerve signals. The memory of the pain of when the part was removed remains in the brain, and as this area is subconscious and can't be controlled, it makes treatment more difficult.

Treatments can include:

  • Medication
  • TENS machines
  • Mirror box therapy

Myofascial Pain

Myofascial pain syndrome describes a muscular pain which is isolated to one area of the body. A typical diagnosis can be made when, during palpation, small knots are found in the muscle. These are known as trigger points. Myofascial pain can also denote deeper skeletal and joint problems, if these are suspected then an MRI or SPECT CT scan may be required for further investigation.

Treatments can include:

  • Physiotherapy
  • Acupuncture

Complex Regional Pain Syndrome (CRPS)

This condition typically appears after musculoskeletal trauma, often surgery. CRPS describes a group of symptoms that occur together in a painful part of the body. If there is no associated nerve damage then it is known as CRPS type 1. When there is associated nerve damage, it is known as CRPS type 2.

Symptoms can include:

  • Extreme skin sensitivity in the affected area
  • Spontaneous intermittent skin colour change and or swelling
  • Changes in hair and nail growth
  • Changes to the skin
  • Bone thinning revealed by X ray, this can lead to osteoporosis in severe long term cases.

Possible treatments include:

  • Psychotherapy
  • Physiotherapy
  • Medication such as Pregabalin and Gabapentin
  • Sympathectomy treatments

How Dr Miller can help with diagnosis and treatments

  • MRI Scans
  • CT Scans
  • SPECT CT Scans
  • X-Rays
  • Radio frequency denervation for facet joint and sacro-iliac joint pain
  • Sacro-iliac joint infections
  • Facet joint injections
  • Epidural and Transforaminal injections for sciatica
  • Dysport/ Botox injections

Pain medication and analgesics

The following medications are used almost exclusively for nerve pain:

  • Tricyclic antidepressants – e.g. Amitryptiline
  • Newer antidepressants – e.g. Duloxetine
  • Pregabalin and Gabapentin – the DoH has recently issued a warning about the potential for recreational abuse of these 2 drugs
  • Lidoderm patches
  • Antiepileptic drugs – Carbamazepine, Oxcarbazepine, Phenytoin – all exclusively for trigeminal neuralgia
  • N.S.A.I.D.s – when nerve pain is secondary to inflammation e.g. sciatica from disc prolapse
  • Capsaicin creams – postherpetic neuralgia
  • Botox injections - Botox can be very useful in painful conditions including neuropathic scars and allodynic skin; in for example postherpetic neuralgia
  • Paracetamol, Codeine, Dihydrocodeine, Tramadol all can help in the right patient
  • Strong opiates – oramorph, oxynorm, tapentadol and methadone are all anecdotally more helpful in nerve pain than the others

If you are suffering from Chronic or Acute Pain, then help is at hand. Dr Miller has clinics at various locations across the country, including Bristol.

BOOK NOW

For the latest availability please call 020 7060 5109 or fill out the form below. Please note that there may be a 1-2 week appointment lead time.

Nerve Pain

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Back Pain

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Treatments

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