Pain Management Shrewsbury, Shropshire

Pain Clinic Consulting Room

Nuffield Health Shrewsbury Hospital
Longden Road
Shrewsbury
Shropshire
SY3 9DP

Call 01743 282505 today for an appointment.

 

What Is Pain?

Chronic Pain management is a vast subject and as pain is a subjective sensation which differs from patient to patient, Dr Miller individualises treatments to suit the needs of each patient.

A recurring theme in the treatment of pain can be divided into the three broad categories:

  • Pharmacological (drugs e.g. paracetamol)
  • Physical (e.g. physiotherapy)
  • Psychological

Rather than understanding pain purely in biological terms, pain clinicians often use the biopsychosocial model which assumes that the best way to determine an individual's health is by considering the biological, psychological (emotions, thoughts and behaviour) and social (socio-economic, socio-environmental).

Dr Miller works closely with surgeons, physiotherapists and psychologists, by collaborating with his multidisciplinary team of experts he is able to offer quality patient care and treatment.

 

Frequently occurring pain problems Dr Miller can help with

Nerve Pain

  • Shingles and Postherpetic Neuralgia
  • Scar Pain
  • Headaches
  • Trigeminal Neuralgia
  • Phantom Sensations and Pains

Back Pain

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

Complex Regional Pain Syndrome (CRPS)

Myofascial Pain Syndrome

 

Help With Nerve Pain

Also known as neuralgia, the sensations differ from tissue pain (nociceptive pain) commonly described symptoms include: shooting pain, skin sensitivity and skin colour changes and swelling. Different medication is needed to treat nerve pain, tissue pain will respond to medication such as aspirin whereas neuralgias won't. Anitepileptic drugs and antidepressant drugs are often used in the treatment of neuralgia.

Common Neuralgias include:

Shingles and Post-herpetic Neuralgia

A result of the reactivation of the Varicella-Zoster virus (The Chickenpox virus) the virus damages the nerves under the skin of the affected area, causing a painful rash. Post-herpetic neuralgia is a persistent pain occurring at the site of a previous attack of shingles.

Shingles and Post-herpetic Neuralgia Treatments:

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

 

Trigeminal Neuralgia

A severe facial pain, in the majority of cases affecting one part or side of the face. It is frequently described as a sharp or shooting pain. In most cases trigeminal neuralgia is caused by compression of the trigeminal nerve.

Trigeminal Neuralgia Treatments:

  • Further investigation with an MRI or CT scan of the brain
  • Pharmaceutical drugs for nerve pain
  • Possible surgery (if the cause of the irritation to the trigeminal nerve is by a blood vessel

 

Scar Pain

Also associated with nerve pain. A common complaint from either a traumatic or an operative cause. Symptoms include: swelling, itching, skin colour changes, marked pain to deeper palpation, hyperalgesia, allodyma or hypersensitivity to touch.

Scar Pain Treatments:

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

 

Headache - The Trigeminal Cephalalgias

Causes pain on one side of the head which is often described as a headache. The pain stems from the distribution of the trigeminal nerve, the nerve that supplies sensation to the face and power to the muscles used for mastication.

Headache Treatments:

  • Specific medication for nerve pain
  • Occipital nerve blocks with steroids and botox
  • Occipital nerve stimulation

 

Phantom Sensations and Pains

This occurs after the loss of a body part, usually a limb. Patients with missing body parts can feel as though the missing body part is still there, and can feel pain in the missing limb. This is known as phantom pain.

Pain at the end of the stump of a lost limb is more common than phantom pain, this is often caused by the cut nerves growing swellings at the ends called neuromas.

Phantom Sensations and Pains Treatments:

  • Specific medication (Gabapentin responds well)
  • TENS machines or mirror box therapy
  • Spinal cord stimulator

 

Help With Back Pain

The most common complaint often causing chronic pain. It can be felt anywhere along your spine, from your neck (cervical spine) to the thoracic spine (this is felt behind the chest wall or thorax), to the lower back (the lumbar and sacral area) to the coccyx (this is at the lowest tip of the spine).

Spinal pain is usually categorised into mechanical or referred symptoms. A mechanical symptom is when the pain is only felt in the spinal area.

Referred spinal pain is pain which radiates elsewhere. Classical Sciatica is a good example as is it often felt in the leg.

Treatments and Diagnosis:

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

 

Help With Complex Regional Pain Syndrome (CRPS)

This is a chronic pain condition commonly associated with injury or surgery. Usually occurring after muscoskeletal trauma. CRPS is divided into two types.

Type 1: Triggered by apparent trivial injury such as a fractured ankle

Type 2: Triggered by a more serious injury, or by serious infection

The condition can occur spontaneously, especially in children.

Treatments:

  • Physiotherapy
  • Psychotherapy
  • The use of drugs such as Pregabalin or Gabapentin

 

Help With Myofascial Pain Syndrome

Muscular pain is isolated to an area of the body. This is usually an indication of deeper skeletal and joint problems. A Classic example is small knots in the muscle, known as trigger points, these are found in palpation of muscle over the affected area.

Treatments:

  • Acupuncture
  • Physiotherapy

If these do not help and deeper skeletal problems are diagnosed, then treatment should be concentrated here.

 

How we can help with diagnosis and treatments

  • MRI Scans
  • CT Scans
  • SPECT CT Scans
  • X-Rays
  • Epidural and Transforaminal injections for sciatica
  • Facet Joint Injections
  • Sacro-iliac joint infections
  • Radio frequency denervation for facet joint and sacro-iliac joint pain
  • 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 the Nuffield Health Hospital in Shrewsbury.

 

Photo of Dr Miller

Who is Dr Miller?

Dr Mark Miller MB ChB, FRCA, FFPMRCA Consultant Anaesthetist and Pain Management

Dr Miller is a highly experienced specialist in the area of pain management. Born in 1965 in Edinburgh. Dr Miller received his MBChB from Manchester University in 1990. A Fellow of the Royal College of Anaesthetists in 1997 and a Fellow of the Faculty of Pain Medicine of the Royal College of Anaesthetists in 2007.

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