OUR PAIN EXPERTISE
Singapore Paincare has been providing Minimally Invasive Pain Treatments as alternatives to open surgery for over a decade. Our multi-disciplinary approach in the assessments of our patients allows us to arrive at a multi- dimensional diagnosis that results in the best possible treatments for each patient.
MINIMALLY INVASIVE PAIN TREATMENTS
Myospan injections and Neurospan procedures destroy the source of pain or desensitise painful nerves so that nerve function can recover and return to normal. Supplemented by exercise, physical therapy and medication, we’re able to help patients find long-term solutions to stay pain-free.
Modern medicine has led to the availability of many interventional options that do not require open surgery. We are able to offer Minimally Invasive Procedures (MIPs) to our patients as an alternative to surgical and conservative therapy because of our specialised knowledge and expertise in this area.
Painostic Methodology
The Painostic Methodology is Singapore Paincare’s unique formulation when performing pain assessments, diagnosing pain conditions, and reaching a pain treatment roadmap. It covers the theoretical and practical aspects of pain assessment and differentiates the mechanical and functional aspects of pain transmission. Site specific pain derives its diagnosis from local pathology as well as referred pain pathways. It gives an alternative consideration of other mechanisms of pain generators.
Myospan
Myospan injections target muscles, ligaments, tendons, joints, and nerves to break the pain cycle, reduce inflammation, and improve healing. Myospan is used to treat a wide variety of common pain conditions like tension headaches , tennis/golfer elbow, plantar fasciitis, and joint pain as well as pain in the shoulder, knee, ankle, neck and back. Specialised needles are used to reach the pain source/generator without the need for open surgery or painkillers. Depending on the painful condition, different injections may be utilised to either remove the pain generator or stop the pain signals.
The injections can be given in a doctor’s clinic and usually only take a few minutes. Usually, a single course of treatment is sufficient for sustained pain relief and may be repeated in six months or a year if necessary. Myospan treatments include Coreflex injections, Platelet-Rich Plasma injections, Intra-Articular Injections, and Botulinum toxin injections.
Neurospan
Neurospan is used to treat pain due to spinal causes. It treats the underlying source of pain such as slipped discs, bone spurs, and nerve compressions. In cases of herniated discs, specialised needles and injections are used to decompress and shrink the discs using a vacuum effect to achieve the required volume reduction. Adhesiolysis is used to “free” impinged nerves, thereby releasing scarred, compressed nerves. This also desensitises the irritated nerve, lowers pain sensitivity, and prevents radiculopathy.
Neurospan treatments include Neuroplasty, Nucleoplasty, Radiofrequency Ablation, Pulsed Radio Frequency, Intrathecal Pump Implants, Endoscopic Laser Decompression, Spinal Cord Stimulator, and Epidural Analgesia.
Minimially Invasive Procedures We Perform
Peripheral Nerve
Block
Intra-articular
Injections
Epidural
Analgesia
Trigeminal Ganglion Radiofrequency Ablation
How do our treatments compare with the use of painkillers and traditional pain treatments?
Our minimally invasive pain management techniques bridge the gap between treating pain with open surgery, which may have higher risks and require longer recovery times, and conservative physical therapy, which may not be as quickly effective. While painkillers are helpful to an extent, they also come with a number of adverse effects, especially if used for an extended period of time. Painkillers also do not address the root cause of pain.
Benefits of Our Treatment Methods
MINIMALLY INVASIVE PAIN SOLUTIONS
No risks, complications or long recovery period associated with surgery. READ MORE
TREATMENTS PERFORMED ON OUTPATIENT OR DAY SURGERY BASIS
Treatment can be performed at the clinic without long wait times or incurring hospital room costs. Some treatments are performed in Day-Surgery suites, allowing patients to go home the same day post procedure.
ACCURATE DIAGNOSIS OF ROOT CAUSE
Multi-dimensional diagnosis to identify and address the pain source directly.
SUSTAINED LONG LASTING PAIN RELIEF
Empowered to live a normal life without relying on painkillers or continuous physical therapy sessions.
Cancer Pain Therapy
Cancer pain therapy includes the use of drugs introduced orally or through intrathecal administration to relieve pain or chemicals introduced into the body through minimally invasive techniques to block the pain and “burn-off” further transmission of painful signals.
Medications: Oral, Patches, Subcutaneous
In most cases, pain specialists follow what is called the “pain ladder” when planning treatments for cancer patients. The first rung on the ladder is analgesic medication and if it does not relieve the pain, still stronger medications containing morphine are given. For patients who do not like oral medication, there are sustained-release morphine-like patches that give good long-lasting relief. If further relief is needed, the doctor goes up another rung on the ladder, which is to give higher doses of the strongest medications. Unfortunately, pain medications can cause some patients to experience unpleasant side effects, like nausea, drowsiness and constipation. Not infrequently, other non-pain killers can be effective in the treatment of cancer pain.
Interventional Pain Procedures: Neurolysis
Non-medicine treatments are sometimes added to the pain-relieving process. In certain types of cancer pain that are localized, chemicals may be introduced to the nervous supply of that area through minimally invasive techniques. These medications block the pain and “burn-off” further transmission of painful signals. The effect can last from 36 months. The neurolysis procedures potentially can treat liver, stomach, pancreatic and colonic cancer pain. Other adjuncts include transcutaneous electrical nerve stimulation (TENS), which sends small, non-painful electrical bursts to areas of the skin.
Advanced Pain Control: Intrathecal Drug Delivery
Some pain conditions can be very painful and refractory, eg, cancer pain with bony metastasis, neuropathic pain secondary to cord myelopathy and many others. Despite optimization with conventional oral strong painkillers (eg, Morphine), the pain relief does not increase accordingly but yet the side effects escalate. Patients develop distress and disappointment, progressing to depression and a lower quality of life.
Most pain medication act on the spinal cord as this is where all the pain receptors are. All oral medications, after oral administration, undergo metabolism and breakdown before they finally reach the pain receptor in the spinal cord.
In intrathecal administration, the drugs are applied directly into the spinal cord. This allows for a reduced amount of medication needed to achieve the desired pain control without the associated side effects.
All of it goes into the pump that delivers a set amount of drug into the spinal cord. This computerized pump delivers a very exact amount of medication, without fear of overdosing or underdosing. The patient will return for a refill of medication in the pump once in a couple of months. This small pump will be implanted into the patient.
There are many advantages of an intrathecal (IT) pump:
- Better pain control with less medication
- Increased survival, compared with poorly-controlled cancer pain
- Less sedation effects with more clear-headedness
- Less side effects of medications (eg, constipation, nausea)
- Increased patient satisfaction
- Less oral medication
- No need for frequent follow-ups.
Pharmacotherapy
Many different drugs, both prescribed and non-prescribed, are used to treat chronic pain. While painkillers are assumed to be the default medication given, we often use non-painkillers such as nerve stabilisers and muscle relaxants to abort the pain.
Common Medications Prescribed For Your Pain
Many different drugs, both prescribed and non-prescribed, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before pain reduction can be felt. It is important to let your health professional know all the medicines you are taking (including herbal and other complementary medicines) to avoid dangerous drug interactions.
Medication: Anti-inflammatory (NSAIDs)
NSAIDs, such as Diclofenac or Naprosyn, relieve swelling, aches and pain. They also relieve pain by effectively stopping tissue inflammation. Celecoxib and Etirocoxib belong to the latest generation of anti-inflammatory drugs with better side effects profile.
What to watch out for:
- The most common side effects of NSAIDs are stomach upset, heartburn, ulcers and skin rashes. Taking NSAIDs with food may help prevent some of these problems. Your chances of having these side effects are greater if you take large doses of NSAIDs or for a prolonged period. Celecoxib and Etirocoxib have marked reduced gastric irritation.
- High blood pressure
- Swelling of legs
Drug interactions:
Before you start on NSAIDs, be sure to let your doctor know if you are taking any of the following classes of drugs:
- Blood thinners, such as warfarin, heparin or aspirin
- Medicine to treat kidney impairment
- Medicine to decrease swelling
- Medicine for arthritis or diabetes
Medication: Antidepressants
Antidepressants, such as Amitriptyline, Lexapro or Trazadone, can be used to treat your pain, relax muscle and improve sleep. They are prescribed because they increase the level of serotonin in the brain and central nervous system. When utilized for such purposes, antidepressants are not used to treat depression. Besides, treatment of depression requires a much higher dosage.
Common side effects include:
- Constipation
- Dry mouth
- Blurred vision
- Drowsiness and/or fatigue
- Palpitation and/or nervousness
Medication: Anticonvulsants
You may have been prescribed Anticonvulsants, such as Carbamazepine, Gabapentin or Pregabalin. Indications for its use in pain include the reduction in pain signals (glutamate) transmission; stabilization of overly excited nerves and, consequently, reducing the amount of pain signals to the brain. The dosage used in treatment of pain is far lower than that required to treat fits or seizures.
What to watch out for:
- Common but temporary side effects may include dizziness, drowsiness, headache, skin rash, fatigue, nausea, vomiting and/or loss of appetite. Inform your doctor if you experience any of them.
- Do not abruptly stop taking an anticonvulsant. Your health professional will slowly reduce the dosage of this medicine so that you won’t develop withdrawal symptoms, such as anxiety, nausea, pain, sweating and insomnia.
Medication: Opioid
Opioids, such as Oxycodone, Morphine or Fentanyl, are used in chronic refractory pain by blocking the pain signals in the central nervous system. It is not reserved only for cancer pain but also for moderate to severe pain as well. The fear of addiction and dependence is unfounded when used under your pain specialist’s supervision; addiction or drug-dependencies are minimal or negligible.
Mode of delivery:
- Oral: The oral route is the most common, least invasive and the easiest. All opioids given orally are absorbed via the stomach and intestines, and then transported to the liver where they undergo “first-pass metabolism” before entering systemic circulation. Oxycontin is a long-acting drug, while Oxycodone is a fast-acting drug used for breakthrough pain.
- Transdermal patch: Provides round-the-clock systemic delivery of Fentanyl analgesic for 72 hours. The patch should be applied on intact skin. Apply patch by pressing it firmly in place and held on for a minimum of 30 seconds to ensure adherence.
- Intrathecal infusion: Provides round-the-clock delivery of analgesic in the spinal cord, thus allowing higher concentrations of medication with minimum systemic side effects and, consequently, decreasing the total opioid daily dose significantly.
What to watch out for:
Opioids may often cause side effects, such as:
- Constipation
- Weakness
- Dry mouth
- Sedation
- Difficulty urinating
You may become physically dependent on opioids if you take them regularly. Physical dependence is not addiction, but, rather, a gradual change in your body in response to the opioids. If you stop taking opioids abruptly, you may develop nausea, sweating, chills, diarrhoea, and tremors. The physical dependence and withdrawal symptoms are non life-threatening. You can avoid withdrawal symptoms if you gradually reduce opioid consumption over a set period of time, as prescribed by your pain specialist.
In the past, opioids were used only for short periods for short-term pain or for cancer pain. Many experts now use opioids for longer periods to treat chronic pain, resulting in increased functional capabilities and a better quality of life. If you are about to begin a long-term course of opioids, increase your dietary fibre and water consumption to prevent constipation. Discuss with your pain specialist, should you require a stool softener or laxative.
In some cases, more than one type of opioid medicine may be prescribed to relieve pain without increasing the individual dosage. Many combinations of opioids with non-opioids have been effective, such as combining opioids with NSAIDs.
Cognitive Behavioural Therapy
Behavioural medicine refers to the way a person responds to an illness or disorder. This cognitive behavioural pain management program is a multi-dimensional rehabilitative program aimed at rehabilitating the patient through changing behaviour and cognition.
Firstly, the multidisciplinary team at Singapore Paincare Center meets with each patient to conduct evaluations and gather information that will help them to correctly diagnose the problem, determine a customized treatment plan and help doctors make referrals to appropriate specialists.
Cognitive Behavioural Therapy
Subsequently, we empower patients who suffer from either short-term or long-term pain by giving them a measure of control over their condition. Patients and their families are offered skills training in effective ways to:
- Understand differences between acute and chronic pain
- Reduce and cope with pain
- Have a pacing strategy
- Manage each pain flare and reduce the number of pain attacks
- Reduce and cease medications, due to side effects and lack of efficacies
- Reduce or eliminate unwanted side effects from invasive procedures and surgery
- The team’s psychologist also does evaluations to help determine pain treatment before and after the program. They work closely with patients
- To ease distress and help them move rapidly towards recovery with this intensive rehabilitative program.
The overall aim is focused on pain reduction. Non-pain-related mental and nervous disorders may not be effectively managed. If patients require psychological or psychiatric consultation and therapy, our psychiatrists and specialists will attend to them, as appropriate.
Overall expectations/outcomes:
- Increased functional status, work tolerance and muscular conditioning
- Reduced reliance on unhelpful medications, aids or wrong beliefs
- Less reliance on healthcare professionals and/or utilization, lower less absenteeism
- Retraining of one’s behaviour and cognition to reduce the pain perception
