Pain Management Clinic Manchester

Consulting at Manchester Pain Clinic

599 Wilmslow Road
Manchester, M20 3QD

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 Mark Miller is a highly experienced pain management specialist and consultant anaesthetist. He holds clinics at various locations all over the UK, including Calderbank Chambers here in Manchester.

Qualifications:

MBChB Manchester University 1990

Fellow of the Royal College of Anaesthetists 1997

Fellow of the Faculty of Pain Management, Royal College of Anaesthetists 2007

What is Pain Management?

Pain management is a vast branch of medicine involving an interdisciplinary approach to ease the suffering and improve the quality of life of individuals living with chronic pain. Dr Miller works closely with his multidisciplinary team of expert surgeons, physiotherapists and psychologists.

It is not uncommon for patients to have more than one type of pain. Pain is also a subjective sensation, so all patient treatment is individualised and although two patients may have the same diagnosis, what works for one may not work for the other.

The treatment of pain can be divided into three broad categories:

  • Physical
  • Psychological
  • Pharmacological

A biopsychosocial model is often used in pain management clinics to determine an individual's health. This model, rather than understanding pain purely in biological terms, considers the biological but also the psychological (emotions, thoughts and behaviour) and social (socio-economic, socio-environmental).

Frequently Occurring Complaints 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

Back Pain

This is the most common complaint in the pain clinic and frequently causes chronic pain, the biopsychosocial is Dr Miller's preferred approach for diagnosis and treatment. Back pain can be felt anywhere all 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 (lower back), all the way to the coccyx (the lowest point of the spine)

Spinal pain can be categorised into either referred or mechanical symptoms. Mechanical symptoms are those only felt within the area of the spine itself, whereas referred symptoms are when pain is felt in other parts of the body at distance from the source of the pain.

When diagnosing, SPECT CT scans are frequently used in suspected cases of inflammatory spinal pain. For structural appearances MRI scans are used. X-rays are only indicated when there are red flag symptoms (symptoms that indicate a more serious underlying condition such as infection or possible cancer).

Possible treatment includes:

  • Physiotherapy
  • Radiofrequency denervation
  • Transforaminal root blocks

Nerve Pain

Nerve pain also known as neuralgia has various causes and is caused by problems with one or more of the nerves. It differs from nociceptive pain, also known as tissue pain, such as a cut or a burn. Nociceptive pain can be eased by the use of painkillers such as paracetamol or aspirin, whereas neuralgia requires different types of medication such as antiepileptic and antidepressant drugs and or opiates.

The following are some of the various conditions that can cause neuropathic pain:

Trigeminal Neuralgia

This condition causes a repeated facial pain in parts of the face, generally on one side. The pain is frequently described as a severe stabbing pain, and in the majority of cases is caused by compression of the trigeminal nerve. If a diagnosis cannot be made on typical symptoms, then an MRI or CT scan may be required.

Possible treatments include:

  • Medication
  • Surgery

Shingles and Post-herpetic neuralgia

The shingles virus is caused by the reactivation of the Varicella-Zoster virus (chicken pox virus) which lies dormant in the body after an initial infection. Shingles is an infection that damages nerves. These damaged nerves cause a painful rash on the skin of the affected area. Post-herpetic neuralgia is when pain is felt on and around the area that was affected by a previous attack of shingles. Pain can be anything from mild, moderate or severe depending on the case.

Possible treatments include:

  • Topical and oral pain relief medication
  • Botox injections to the affected area
  • Pulsed radiofrequency treatment

Headache – The Trigeminal Cephalagias

Short Lasting Unilateral Neuralgia with Conjunctival Tearing, (SUN CT), Chronic Paroxysmal Hemicrania, Hemicrania Continua and Cluster Headache are a group of primary headache disorders. They are characterised by severe pain caused by the distribution of the trigeminal nerve (the nerve responsible for transmitting sensations to the face as well as powering the muscles used for mastication). Pain is typically felt on one side of the head.

Possible treatments include:

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

Scar Pain

Generally stemming from an operative or traumatic cause, scar pain is a common complaint at the pain clinic. Common symptoms include, itching, skin colour changes, swelling, allodynia (when pain is worsened by a touch or stimulus that would not normally cause pain), hypersensitivity to touch, hyperalegesia (severe pain from a touch or stimulus that would usually only cause very slight discomfort, such as a tap on the painful area), or severe pain during deeper palpation. These symptoms are seen frequently in patients with Keloid or Hypertrophic scars.

Possible treatments include:

  • Botox injections
  • Pulsed radiofrequency treatment
  • PENS

Phantom sensations and pains

Many patients who have lost a limb commonly report pain in the stump or pain in the missing limb (the patient feels as thought the missing limb is still there and that area is painful), this is known as phantom pain. Phantom pain is more likely to occur in patients that felt pain in the limb prior to amputation, or in those that lost the limb as a result of a traumatic accident.

Pain in the stump of a missing limb is more common, nerves are cut during the amputation and these nerve endings in the stump often grow swellings called neuromas. This can be very painful. Ulceration of the skin on the stump and scarring can also cause a lot of pain.

One theory as to the cause of phantom pain is that the brain has a memory of the missing limb and the nerve signals associated with it. The possible rewiring of the central nervous system which took place while the now absent limb, was still attached to the body means that the memory of the pain remains in the brain when the part is removed. As the memory is subconscious and cannot be controlled, it makes treatment more challenging. This memory is also believed to be recorded in more than one area of the brain and the spinal cord at the same time.

Possible treatments include:

  • Medication such as Gabapentin and other drugs for neuropathic pain
  • TENS machine or Box Mirror Therapy
  • Telescoping

Complex Regional Pain Syndrome (CRPS)

A patient typically experiences continuous, severe and often debilitating pain caused by a group of symptoms occurring together in a painful part of the body.

CRPS type 1 describes the condition where there is no associated nerve damage

CRPS type 2 describes the condition where there is associated nerve damage

Both types are often triggered by an injury or a trauma, but are usually very long lasting. Skin in the affected area can become extremely sensitive and even the slightest touch or temperature change can cause excruciating pain. Symptoms also include spontaneous, intermittent skin colour change and or swelling. Others include changes in hair and nail growth, and changes to the skin. X rays often reveal bone thinning, osteopenia, this can lead to osteoporosis in severe long term cases.

Possible treatments include:

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

Myofascial Pain

Muscle pain isolated to an area of the body, this may involve either a single muscle or muscle group. Myofascial pain may develop from muscle injury or excessive strain. A diagnosis is usually confirmed when small knots in the muscle, known as trigger points, are found during palpation of the muscle area. Thorough examination is required however, as deeper bone and skeletal abnormalities may be present. If any are found then an MRI and SPECT CT scan may be necessary.

Possible treatments include:

  • Physiotherapy
  • Acupuncture

Diagnosis and treatments

  • SPECT CT Scans
  • CT Scans
  • MRI Scans
  • X­Rays
  • Radio frequency denervation for facet joint and sacro­iliac joint pain
  • Sacro­iliac 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 post­herpetic neuralgia for example
  • Paracetamol, Codeine, Dihydrocodeine, Tramadol can all help in the right patient
  • Strong opiates – oramorph, oxynorm, tapentadol and methadone

If you are suffering from any of the above mentioned, or indeed any other type of debilitating pain then please contact Dr Miller for a consultation.

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