Pharmacological: Medication can play an important role in the management of chronic pain. If you are currently taking opioid containing medications, do not feel guilty. At some point in the past a medical professional thought that this type of medication might be the best way to manage your pain. Long-term opioid use however has significant negative effects on your overall health and function, and in some instances can cause or make pain worse – we call this opioid induced hypersensitivity. We would support you weaning off opioid medication or reducing the dose. Some medications acting as a neuromodulator can be helpful to manage certain types of chronic neuropathic pain. For example, Amitriptyline taken at a low dose at night time can reduce nerve sensitivity type pain and improve sleep.

Physical therapies like physiotherapy or osteopathy: We will empower your current physiotherapist or osteopath to help you move better and more, and to fear less. We will use treatments that reduce your pain, thus making physical therapies more effective.

Minimally invasive interventions: If we have identified a specific pain generating structure, we use long-term nerve blocks to reduce pain from that structure e.g. radiofrequency neurotomy. If you have nerve pain causing referred pain we use injections that can reduce inflammation at the site of compression e.g. epidural injections, or if your pain is due to long-term nerve compression we can use injections that aim to break down scarring between the nerve and surrounding structures, or use techniques that reduce nerve hypersensitivity. For central or peripheral nerve sensitivity type pain we use modalities that desensitize nerve endings at the level of the spinal cord e.g. spinal cord stimulation, or at a peripheral level e.g. nerve field neuromodulation.

Surgical: Surgical interventions can be successful for some pain presentations e.g. acute nerve pain, spinal stenosis and spinal instability.