NQ Pain, Ramsay Consulting Suites, Cairns Private Hospital, Level 1, Suite 12, 193-197 Lake Street, Cairns (2026)

04/08/2023

When a patient is seen for abdominal pain without other clinically significant symptoms, Abdominal cutaneous nerve entrapment syndrome (ACNES) should be high on the list of likely diagnoses. Its a condition characterized by chronic and severe abdominal pain resulting from entrapment or irritation of the nerves in the abdominal wall. It is also known as "anterior cutaneous nerve entrapment syndrome" or "subcostal nerve entrapment syndrome." Here's an overview of the symptoms and treatment of ACNES:

Symptoms of ACNES:
The main symptom of ACNES is chronic, localized abdominal pain. The pain is often described as a sharp, burning, or stabbing sensation and is typically limited to a specific area on the abdomen. The most common site of pain is along the lower ribcage on either side of the abdomen, known as the "anterior cutaneous branches of the lower six thoracoabdominal nerves" distribution.

The pain may be exacerbated by movements such as bending, stretching, or twisting, and it can be constant or intermittent. ACNES pain is often overlooked or misdiagnosed as other gastrointestinal or musculoskeletal conditions, leading to delayed or incorrect treatment.

Treatment of ACNES:
The treatment of ACNES focuses on relieving nerve entrapment and managing pain. The following approaches are commonly used:

1. Nerve Blocks: Local anesthetic injections around the affected nerve(s) can help confirm the diagnosis and provide temporary pain relief. We are able to offer neurotomy (RFN) for these nerves by using ultrasound.

2. Physical Therapy: Specific exercises and techniques can help stretch and strengthen the abdominal muscles, potentially reducing nerve entrapment and relieving pain.

3. Medications: Over-the-counter pain relievers or prescribed medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may help manage pain and inflammation.

4. Neuromodulation: In some cases, procedures like pulsed radiofrequency (PRF) can be considered to modify the nerve's activity and reduce pain.

5. Botulinum Toxin Injections: Injections of botulinum toxin (Botox) around the affected nerves may help relax the muscles and alleviate nerve irritation.

6. Surgical Release: When conservative treatments fail, surgical exploration and release of the entrapped nerve(s) may be considered. However, surgery is typically reserved for cases that do not respond to other therapies.

It's crucial to seek medical attention if you experience persistent or severe abdominal pain. A proper diagnosis by a healthcare professional, usually a gastroenterologist or pain specialist, is essential to differentiate ACNES from other potential causes of abdominal pain and to establish an appropriate treatment plan.

If you think you or someone you know may be suffering from chronic pain, please remember help is around and kindly reach out to us.

29/07/2023

Kindly visit us at NQPain.com.au for more information.

04/04/2023

Diabetic neuropathic pain is a type of nerve pain that occurs in people with diabetes. It is caused by damage to the nerves that control sensation and is characterized by tingling, numbness, and burning pain in the feet, legs, and hands. This condition can be challenging to diagnose and treat, and it can have a significant impact on a person's quality of life.

Burden:

Diabetic neuropathic pain is a significant burden on individuals and the healthcare system. It affects up to 50% of people with diabetes, and the prevalence increases with age and the duration of diabetes. The pain can be severe and chronic, leading to sleep disturbances, anxiety, depression, and decreased mobility. The condition can also increase the risk of falls, foot ulcers, and amputations, leading to a substantial economic burden.

Diagnosis:

Diagnosing diabetic neuropathic pain involves a comprehensive evaluation of the patient's symptoms, medical history, and physical examination. The doctor may also conduct nerve conduction studies, electromyography, and other tests to assess nerve function and rule out other conditions that may cause similar symptoms.

Treatment:

The treatment of diabetic neuropathic pain is multidisciplinary and involves managing underlying diabetes and treating the pain. Lifestyle modifications such as maintaining a healthy weight, regular exercise, and smoking cessation can help improve blood sugar control and reduce nerve damage.

Medications such as antidepressants, anticonvulsants, and opioids can be used to manage pain. Topical agents, such as capsaicin and lidocaine, can also be effective. In addition, non-pharmacological therapies such as physical therapy, acupuncture, and transcutaneous electrical nerve stimulation (TENS) can be useful in managing pain and improving function.

Intervention options include peripheral nerve blocks and pulse radiofrequency neurotomy. There is emerging evidence of spinal cord stimulators in peripheral neuropathic pain.

At NQ Pain we are able to offer all of these options and treatments tailored to individual circumstances. Please reach out, we are here to help.

In conclusion, diabetic neuropathic pain is a challenging condition that can have a significant impact on a person's quality of life. Early diagnosis and multidisciplinary treatment are essential to managing the pain and preventing complications. People with diabetes should work closely with their healthcare team to manage their condition and prevent complications.

25/03/2023

The sacroiliac joint is located in the pelvis and connects the sacrum (the triangular bone at the base of the spine) to the ilium (one of the bones in the pelvis). Sacroiliac joint pain occurs when there is inflammation or damage to this joint, which can cause discomfort and limited mobility in the lower back, hips, and legs.

Causes:

Arthritis: Osteoarthritis and rheumatoid arthritis can both affect the sacroiliac joint.

Trauma: A fall, car accident or other trauma to the pelvis can injure the sacroiliac joint.

Pregnancy: During pregnancy, hormones are released that can loosen ligaments and cause the sacroiliac joint to become unstable and painful.

Infection: In rare cases, an infection in the joint can cause pain and inflammation.

Symptoms:

Pain in the lower back, hips, or buttocks

Pain that worsens when sitting for long periods or standing up from a seated position

Stiffness or limited mobility in the lower back, hips, or legs

Numbness or tingling in the legs or feet

Aching or burning sensation in the lower back or hips

Management:

Medication: Pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants, can help relieve pain and inflammation.

Physical therapy: A physical therapist can teach exercises to strengthen the muscles that support the sacroiliac joint and improve mobility.

Injections: Corticosteroid injections can help reduce inflammation and relieve pain.

Radiofrequency ablation: A procedure that uses heat to interrupt pain signals in the nerves around the joint.

Surgery: In rare cases, surgery may be necessary to stabilize or fuse the joint.

It is important to consult with a doctor if you experience persistent pain or discomfort in the lower back, hips, or legs, as sacroiliac joint pain can be easily misdiagnosed as other conditions, such as herniated disc or sciatica.

24/03/2023

Chronic lower back pain is a significant burden on Australia, affecting around 3.7 million people, or 16% of the population. It is one of the most common reasons for people to visit their healthcare provider and is associated with significant healthcare costs, lost work productivity, and reduced quality of life.

Common causes are as follows -
Mechanical (80-90%)

1. Myofascial Low back pain - usually attributed to muscle strain or ligament injury 65-70%.

2. Facet arthropathy: It is caused by the degeneration or trauma to the synovial joints present in the back. Pain is mostly axial with some radicular components. Pain aggravates on extension and turning twisting movements. Spondylosis term is used is a degenerative condition that may worsen as a person grows older. It can affect any region of the spine. Spondylosis can affect the spine's intervertebral discs (e.g., degenerative disc disease) and facet joints.

3. Sacroiliac joint Dysfunction: Sacroiliac (SI) joint pain is felt in the low back and buttocks. The pain is caused by damage or injury to the joint between the spine and hip. Sacroiliac pain can mimic other conditions, such as a herniated disc or hip problem.

4. Vertebral fracture: A compression fracture is typically caused by a loss of bone mass (osteoporosis) that occurs as part of aging.

5. Congenital deformity (such as scoliosis, kyphosis, transitional vertebrae.

B) Neurogenic(5-15%)
1. Herniated disc.

2. Spinal stenosis: Lumbar spinal stenosis is caused by insufficient room in the spinal canal for the neural elements. It is mostly degenerative in origin. Patients with spinal stenosis experience leg pain with prolonged standing or walking (neurogenic claudication).

3. Annular fissure with chemical irritation of nerve root or 4. Discogenic low back pain: It causes radicular LBP (sciatica). It happens when the nucleus inside the disc bulges or leaks through the annular tear causing indentation of the thecal sac or chemical neuritis of the Dorsal Root Ganglia (DRG) or mechanical compression of the nerve roots coming out of the spinal canal.

4. Failed back surgery syndrome (such as arachnoiditis, epidural adhesions, recurrent herniation); may cause mechanical back pain as well.

C) Non-Mechanical spinal conditions (1-2%)

1. Neoplastic (such as primary or metastatic) disease.

2. Infection (such as osteomyelitis, discitis, abscess).
3. Inflammatory arthritis or spondylarthritis: They share certain clinical characteristics (e.g., back pain, uveitis, GI symptoms, rashes). Some are strongly associated with the HLA-B27 allele. Clinical and genetic similarities suggest that they also share similar causes or pathophysiology. Rheumatoid factor (RF) is usually negative in spondyloarthropathies (hence, why they are called seronegative spondyloarthropathies). They include ankylosing spondylitis, reactive arthritis, psoriatic arthritis, and other disorders.

D) Others (2-4%)
1. Fibromyalgia.

2. somatoform disorder (such as somatization disorder, or pain disorder).

The symptoms of chronic lower back pain can vary, but common symptoms include:

Pain that is dull, aching, or sharp.
Stiffness in the lower back.
Limited range of motion or flexibility.
Pain that radiates to the buttocks or legs.
Tingling or numbness in the legs.

Management:

The management of chronic lower back pain typically involves a multidisciplinary approach that may include:

1. Physical therapy: This can involve exercises to strengthen the muscles of the lower back, improve flexibility, and correct posture.

2. Medications: Over-the-counter pain relievers such as ibuprofen or acetaminophen can be helpful in managing pain. Prescription medications such as muscle relaxants or opioids may be used for severe pain, but these should be used with caution due to the risk of addiction and other side effects.

3. Injections: Diagnostic injections into the facet joints followed by radiofrequency neurotomy to achieve longer pain relief. Similarly targeted injections towards the specific nerve roots, Sacroiliac joint, and cluneal nerves could be done. Lumbar epidural and caudal epidural are other treatment options for radicular pain.

4. Spinal cord stimulators - Inserted around the spinal cord in the epidural space which keeps giving electrical current into the dorsal column of the spinal cord. Its indicated in conditions like failed back surgery syndrome, resistant radicular low back pain, CRPS, and refractory diabetic neuropathic pain to name a few.

5. Surgery: In some cases, surgery may be necessary to relieve pressure on the nerves and address structural issues in the spine.

6. Complementary therapies: Acupuncture, chiropractic care, massage therapy, and other complementary therapies may provide relief for some people.

Overall, the management of chronic lower back pain can be challenging and requires a tailored approach based on the individual's specific needs and underlying causes.

NQ Pain

04/08/2023

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