Dr Tadhg Lynch
Consultant Pain Specialist
What is a pain specialist?
This is a specialty of medicine which arose out of anaesthesia. So we mainly treat people with minimally invasive procedures. The treatment can be multi-disciplinary so patients may have physiotherapy needs or they may need to see a dietician. I see patients in the clinic, assess them, take their medical history, do a physical examination, establish diagnosis, look at whatever investigations have been done, arrange any further investigations that might be required and then discuss with patients what treatment is indicated.
What is Chronic Pain?
Chronic pain can be very disabling for patients. It can affect their quality of life and it can affect the amount of activities that somebody is able to do. So it is very important for me to be able to provide them with a solution which can reduce their pain, improve their function and improve their quality of life.
A pain specialist treats patients mainly with chronic pain. Chronic pain is any pain lasting more than three months, so most of the time it is spinal pain and back pain. Around 50% of patients over 65 have pain in a major joint, which can be either moderate or very severe. Spine surgeons operate on patients who have spinal problems, for example bones out of place, called spondylolisthesis or nerves being crushed with weakness of a limb. A lot of the time patients have back pain and they do not have any nerve crushing, the bones are in place. They have degenerated discs and surgeons are operating a lot less frequently now than they did in the past. Many patients can get good relief with minimally invasive procedures, for example joint injections in the spine or epidural or nerve root blocks.
How do you diagnose where the pain is coming from?
It is important to find out which structure is causing the pain in the spine. It can be coming from a facet joint, which is one of the small joints in the spine or it can be coming from the sacroiliac joint which is a large joint. It can also be coming from nerve root being irritated by inflammation or it can be coming from the discs which are deeper structures in the spine. So it is possible to inject all these structures and give good relief of back pain.
How do you treat Chronic Pain?
Chronic pain can be treated in a number of ways, sometimes injections give very good relief but sometimes it is important to engage in rehabilitation. Rehabilitation is usually provided by physiotherapists who are the experts in deciding what exercises are going to be of benefit for the patient. It is very important to do those exercises, to get mobility back after having had pain for a period of time.
What treatments are in use today to treat pain?
Probably the most interesting area at present is where platelet rich plasma and regenerative medicine can actually heal injured areas. It will not change your spine from being degenerated back into what it was like twenty years ago but it can give good relief without the side effects of steroid injections particularly.