Pain Management Clinic London

Find Our London Consulting Room

9 Harley Street
London, W1G 9AL

Call 020 7060 5109 today for an appointment.

Dr Mark Miller MB ChB, FRCA, FFPMRCA

Photo of Dr Miller

Consultant Anaesthetics and Pain Management

Dr Miller is a highly experienced pain management specialist and has been practising as a consultant in pain management since 1999. Dr Miller was awarded with his MBChB from Manchester University in 1990. Fellow of the Royal College of Anaesthetists in 1997 and Fellow of the Faculty of Pain Medicine of the Royal College of Anaesthetists in 2007.

9 Harley street is one of the world's leading private health clinics, Harley Street itself is famous for its large number of private specialists in medicine and surgery. It is one of the most prestigious and respected areas in London for private health and because of this, it attracts some of the finest consultants in the UK.

 

What is Pain Management?

This branch of medicine is dedicated to helping improve the quality of life, and ease the suffering for those living with chronic pain. Pain management is an extremely broad subject branching out into many areas. At Pain Management, treatments are individualised to suits the different needs of each patient. Dr Miller is an integral member of a multidisciplinary team, working with surgeons, physiotherapists and psychologists and uses the biopsychosocial model, this assumes that in order to determine the state of an individual's health, biological, psychological (emotions, thoughts and behaviour) and social (socio economic, socio-environmental) must be taken into consideration.

 

Pain Dr Miller can help with

  • Back Pain
    • Cervical Spine Pain
    • Thoracic Back Pain
    • Low Back Pain
    • Coccydinia (Painful Coccyx)
  • Nerve Pain
    • Shingles and Post-herpetic Neuralgia
    • Scar Pain
    • Headaches
    • Trigeminal Neuralgia
    • Phantom Sensations and Pains
  • Myofascial Pain Syndrome
  • Complex Regional Pain Syndrome (CRPS)

 

Help with Back Pain

The most frequently occurring complaint here at Pain Management, often causing chronic pain which can be felt anywhere along the spine from the cervical spine (neck) to the thoracic spine (felt behind the chest wall or thorax) to the lumbar and sacral area (the lower back) to the coccyx (the lowest tip of the spine)

Spinal pain can be divided into two categories; mechanical or referred symptoms. Mechanical pain is felt only in the spinal area whereas referred pain radiates to other parts of the body. Sciatica is a good example of this, as the pain is usually felt in the legs.

Treatments and Diagnosis:

  • MRI
  • SPECT CT Scan
  • CT scan
  • X Ray
  • Physiotherapy
  • Transforaminal root blocks
  • Radiofrequency denervation

 

Help with Neuralgia (Nerve Pain)

Pain occurring along a damaged nerve, often described as severe pain. It differs from tissue pain (nociceptive pain: implicating the pain receptors in the skin, bones or surrounding tissues); common symptoms of nerve pain include: stabbing or shooting pain, skin sensitivity and colour changes and swelling of the skin. Different medications are used in the treatment of nerve pain, to those used in the treatment of tissue pain, such as anitepileptic drugs and antidepressant drugs.

Common forms of Neuralgia:

Trigeminal Neuralgia

A severe intermittent shooting facial pain that usually affects one side, or part of one side of the face. In the majority of cases, it stems from compression of the trigeminal nerve (the nerve that transmits sensations from the face to the brain).

Possible treatments and further diagnosis include:

  • MRI or CT scan of the brain
  • Pharmaceutical medication for nerve pain
  • Surgery

 

Headaches – The Trigeminal Cephalagias

These are primary headaches involving Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT), Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache.

All of these pain states are caused by the distribution of the trigeminal nerve.

Possible Treatments

  • Occipital nerve blocks with steroids and botox
  • Occipital nerve stimulation
  • Drugs for nerve pain

 

Shingles and Post-herpetic neuralgia

Shingles is an infection of a nerve area caused by the reactivation of the Varicella-Zoster virus (the Chicken Pox virus). It causes a painful rash on the skin of the area of affected nerves. Post-herpetic neuralgia is a persistent pain that occurring in the area previously affected by an attack of Shingles.

Possible Treatments

  • Topical and Oral pain relief drugs
  • Pulsed radiofrequency treatment
  • Botox injections to the affected areas

 

Scar Pain

One of the most common nerve pains, damage to nerves in the skin usually stems from an operative or traumatic cause. Symptoms can include: itching, swelling, pain during deeper palpation, skin colour changes, hyperalgesia, allodyma or hypersensitivity to touch.

Possible Treatments:

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

 

Phantom Sensations and Pains

Phantom pain is a sensation that occurs when a patient has lost a body part, usually a limb, the patient feels as though the missing body part is still there, and in some cases, can feel pain in the missing limb.

More commonly reported than phantom pain, is pain felt in the stump of a missing limb. The cut nerves in the stump often grow swellings at the end, these are known as neuromas.

Possible Treatments

  • Medication
  • TENS machines or mirror box therapy
  • Spinal cord stimulator

 

Myofacial Pain Syndrome

This is a muscular pain in distinct isolated areas of the body. It can be an indication of deeper skeletal and joint problems. In a classical diagnosis, palpation of the muscle over the affected area is associated with finding Trigger points (small knots in the muscle).

Possible Treatments:

  • Acupuncture
  • Physiotherapy
  • If the above do not help and the diagnosis is of deeper skeletal problems, then treatment should be concentrated here.

 

Complex Regional Pain Syndrome (CRPS)

A chronic pain condition in which the patient may experience severe and debilitating pain. This often occurs after muscoskeletal trauma.

CRPS can be divided into types 1 and 2:

  • Type 1: Can be triggered by an apparently trivial injury
  • Type 2: Can be triggered by a more serious type of injury or infection

Possible Treatments:

  • Physiotherapy
  • Psychotherapy
  • Medication such as Gabapentin or Pregabalin

 

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 from any of the above or indeed any other type of chronic or acute pain, then please do not hesitate to book a consultation with Dr Miller here in Harley Street.

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