Pain Conditions

Cluster Headache

• Strictly one sided, first attack usually at the age of 20 to 40 years old

• men more common

• trigger by alcohol or certain medicine (hypertension medicine)

• Pain comes in cluster, surrounding eyelid, swelling of face around eye region

• Associate with red eyes, tearing, running nose, blurred vision, flushing face, palpitation and fainting episode.

Migraine

• Aura (visual, sensory and speech disturbances)

• One sided, throbbing, pain lasting for hours

• Associated with photophobia, nausea, vomiting, mood disorders, motion sickness and sensory abnormalities

Single sided headache usually response well to radiofrequency treatment if oral pain relief medication fails to control pain.

Trigeminal Neuralgia

• Consisted either one or two of the three distribution of Trigeminal nerve. Usually one sided. Excruciating, spontaneous, severe in nature. Facial movement such as chewing, laughing, yawning, coughing are severely affected

• Radiofrequency treatment of trigeminal nerve is very effective in controlling trigeminal neuralgia pain.

• Muscle: myofascial pain syndrome of trapezius, scalene, sternocleodomastoid. Muscle tension and pain can be treated with muscle (trigger point) injection and followed by physiotherapy.

• Facet joint pain, one of the most common cause of neck pain. Head and neck movement is limited. The pain usually never extend beyond shoulder. Treatment of choice radiofrequency of facet joint (medial branch).

• Disc prolapse: patient usually presents with radicular pain according to level of involving cervical nerve root. Treatment can be either epidural injection of laser shrinkage of the prolapse disc.

• Piriformis muscle pain mimics disc prolapse causing sciatica. Quadratus lumborum and poses muscle pain causing severe pain that patient could not stand straight. Main treatment for muscle pain is to inject local anesthetic in to trigger point and followed by stretch and strengthening exercise.

• Spine movement especially forward and backward bend will be difficult. Patients invariably will describe ‘low back is jammed’. Gold standard of treatment for this condition is radiofrequency of facet joint (medial branch of dorsal rami nerve) with higher than 90% success rate.

• Radicular pain: Pain is due to compression of nerve root by protruding disc. Patient feels leg pain The pain is felt as travelling down from low back right down to foot and caff. The treatment of choice is laser shrinkage of the protruding disc and nerve root injection.

• Discogenic pain: Pain is felt only around low back area without travelling down to leg. The back pain increases with sitting or standing too long. The pain is due to local chemical inflammation caused by protruding disc. The treatment is radiofrequency small nerve inside the disc (rami communicans) which is responsible for localised back pain.

• Frozen shoulder/ adhesive tendinitis limits shoulder movement among elderly and diabetes mellitus.

• Osteoarthritis, due to long standing micro-trauma or aging process, commonly happens among middle age or older

• Supraspinatus tendinitis, usually due to trauma among younger age group.

• Osteoarthritis is a common cause among elderly.

• Avascular necrosis among younger age group.

• Other causes: rheumatoid arthritis, labrium tear, bursitis

• Osteoarthritis is the most common cause among elderly, overweight people.

• Epigastric pain due to chronic pancreatitis, cancer of pancreas, gastritis
• Lower abdominal pain can be due to bladder causes (cancer, infection, inflammation)
• Pelvic pain most slightly due to repeated urinary tract infection, gynaecology tumour, bladder or prostate tumour

Ischemic means lack of blood flow. It is usually due to diabetes mellitus, arteriosclerosis disease, extreme cold injury (frost bite)