Information contained on this website is general information only and is not intended to replace discussing your symptoms with your doctor. Remember that all treatments and procedures have potential risks as well as the potential benefits. All medications have side effects. Although treatments may have evidence based medicine support they may fail to benefit an individual patient. Please consult your doctor about your pain symptoms and whether a referral to Dr Stephen Gibson may be appropriate.

There are lots of potential reasons. A nerve injury is a common reason; turning off a pain signal requires a normal nervous system. Once part of the system is damaged turning off the pain signal may not happen easily. Another cause is that the nervous system can adapt to the pain whilst it still acute to make the pain signals reach the brain more easily, this is called Neuroplasticity, and can allow pain signals to continue to reach the brain after the injury is healed. The good news is that there are lots of evidence based treatments to reduce nerve injury related chronic pain, and Neuroplasticity can also be reversed.

There are lots of resources available that you can access to help manage your chronic pain. The NSW Govt has provided a great resource here: https://www.aci.health.nsw.gov.au/chronic-pain/chronic-pain This site has some very useful information that will provide you with the general sorts of advice that will help whatever the cause of your Chronic Pain. Start with the "For Everyone": https://www.aci.health.nsw.gov.au/chronic-pain/for-everyone and watch these 7 short videos. The site also has links for: Indigenous Patients: https://www.aci.health.nsw.gov.au/chronic-pain/our-mob Youth: https://www.aci.health.nsw.gov.au/chronic-pain/painbytes Translated Resources (Chinese, Greek, Vietnamese and Arabic): https://www.aci.health.nsw.gov.au/chronic-pain/translated-resources

Pain usually starts in response to an injury, and is called Acute Pain. Sometimes when the injury heals the pain doesn’t stop, and if the pain is still there after 6 months it is called “Chronic Pain”. “Persistent Pain” is just another term for “Chronic Pain”.

Discuss this with your general practitioner. It is important that the disease itself is being well managed separate to the pain, and often managing the disease will control the pain as well. But not always. As a general guide if the pain is still poorly controlled after hormonal treatment and laparoscopic removal of the endometriosis then referral to a Pain Specialist is a good option.

Endometriosis is a disease that affects women of child bearing age. It occurs when the cells that normally line the womb, the endometrium, grow in the pelvis and sometimes in the rest of the abdominal cavity as well. It can cause pelvic pain and infertility. It is very common, but it is not normal. It is not cancer, but does have some invasive qualities that are similar to a cancer. It does not seem to specifically be an auto-immune disease, but the immune system is definitely involved and does not work normally to eradicate these cells. At least 25 % of women with endometriosis have no symptoms at all. Yet mild disease can cause severe pain. The pain is in part due to the immune system trying to eradicate the cells causing an inflammatory response. Additionally, every menstrual cycle some of the cells die, just like what normally happens to the lining of the womb. This gives endometriosis a pattern of monthly worsening in the pain on top of the baseline pain. Where pain from endometriosis is felt depends on where the endometrial deposits are in the pelvis or abdominal cavity. The deposits can be on one side, or the other, or both. Front or back. Deposits around the vagina commonly cause painful sex or dyspareunia. Deposits around the rectum may cause painful bowel motions. Deposits around the bladder can cause pain on passing urine. Every woman with endometriosis experiences symptoms in a unique way.

The following is general advice, and should not replace the disease being managed by a general practitioner and gynecologist. There are 3 levels to treatment. Firstly, for women who have mild symptoms simple analgesics like paracetamol may be adequate to control symptoms. Secondly, for more severe symptoms hormonal therapy can be used to suppress the growth of endometrial tissue. This can include using the oral contraceptive pill, other hormonal treatments, and intrauterine devices (IUDs) that release a hormone. Thirdly keyhole laparoscopic surgery is used to remove endometrial deposits.

Restless legs syndrome (RLS) is a genetic disease characterised by a compulsive need to move your legs, especially when relaxing whilst lying in bed or sitting down. For people affected the disease can cause a severe disruption to sleep, and adversely affect their mood. The disease is at the crossroads of a movement disorder, like Parkinson’s Disease, a sleep disorder like Insomnia, and a chronic pain condition, like Fibromyalgia. Traditional treatment of RLS has been with Anti-Parkinson’s Disease medications, especially pramipexole (Sifrol). This medication typically works well for a time before tolerance develops which requires increasing the dose to maintain the treatment effect. Unfortunately once tolerance has developed the medication commonly goes on to cause a worsening of the disease, referred to as Augmentation. At that point the pramipexole (Sifrol) will need to be weaned off. The modern treatment of RLS is best managed with a multidisciplinary approach including optimising diet, including the use of supplements, clinical psychology to improve sleep hygiene and medications used in the treatment of chronic pain conditions. For patients who are developing tolerance or augmentation to pramipexole (Sifrol) referral to a pain specialist for multidisciplinary care can be very helpful.

An every day experience of nerve pain is hitting the back of your elbow, or "funny bone" causing a burning pain down your arm into the little finger. This is a nerve pain and occurs when you strike the ulnar nerve. Causes of nerve pain include diseases that degrade nerves such as diabetes; damage to a nerve from infections such as shingles; or injury to a nerve such as during surgery. Nerves can also be pinched at several sites around the body causing a nerve pain to develop. Examples of this type of nerve pain include compression of the median nerve as it runs into the hand termed a carpal tunnel syndrome, or compression of a nerve root as it leaves the spinal canal due to a bulging vertebral disc causing sciatica.

The treatment of nerve pain is quite different to tissue injury pain, especially the medications that can be helpful. The useful medications tend to be some of the medications that are used in other patients to treat depression or epilepsy/ seizure conditions. Antidepressant medications used to treat nerve pain include: Duloxetine, amitriptyline, nortriptyline & venlafaxine. Anticonvulsant/ epilepsy medications used to treat nerve pain include: Pregabalin, gabapentin, topiramate and sodium valproate. Opioids such as codeine, morphine or oxycodone should not be used to treat nerve pain as they tend to make nerve pain worse and harder to treat.

Nerve pain tends to become harder to treat the longer it is present. Once nerve pain has been diagnosed treatment should be commenced. If nerve pain is not improving then referral to a Pain Specialist is often helpful.

When the nervous system is working normally pain signals arise when tissue in the body is being threatened. This is called nociceptive pain, also called tissue injury pain or normal pain. The pain signal travels in a nerve to the spinal cord, up the spinal cord to the lower brain centres, and then to the higher brain centres where the signal is interpreted as pain. The brain knows where the nerve signal arises, and so we feel pain in that area of the body. However, if the nerves themselves are damaged then a pain signal can arise in the nerve itself, and the pain signal is transmitted without any tissue damage. This is called neuropathic pain, also called nerve pain.

A nerve block targets a specific nerve that supplies sensation to a specific area of the body and treats that nerve with some agent. Examples of nerve block agents: 1. A reversible short duration local anaesthetic. Local anaesthetic delivered to women in labour via an epidural is a good example of this. The pain relief is excellent but wears off after a few hours. 2. A steroid. This can be very helpful if there is inflammation or compression close to a nerve that is irritating and causing a nerve pain. A steroid injected onto a spinal nerve root that is being irritated by a bulging spinal disc is a good example of this. 3. A long duration local anaesthetic. These agents stop the proteins in the nerve from working and is a controlled way of damaging a nerve. Concentrated alcohol is used for this and the nerve block resulting will last until the nerve regenerates. These nerve blocks are mostly used to help control the pain from some types of cancer, and a coeliac plexus block for pancreatic cancer pain is a good example of this. 4. Radiofrequency neuro-ablation. These nerve blocks use a highly specific type of electrical stimulation to hinder the pain signals transmitted by nerves. The effect of the radiofrequency on the nerve typically lasts 9 to 12 months and if helpful will usually need to be repeated annually. Treating facet joint back pain, occipital neuralgia, pudental neuralgia and some joint arthritic pain (most commonly shoulders and knees) are a good examples of this.

Nerve blocks can have 2 potential roles in pain management; aiding the diagnosis of the pain problem and treating the pain problem. Aiding the Diagnosis of a Chronic Pain Problem A feature of chronic pain is neuroplasticity whereby changes occur in how pain signals are processed in the spine and brain. If present it can sometimes be difficult to determine whether the pain is mostly arising in the periphery of the body (where the pain is felt) or whether the pain is arising from within the spine or brain. The treatment of the pain condition is different depending on where the pain arises so the correct diagnosis here is important. If after a short duration local anaesthetic nerve block the pain largely stops for some hours the pain is likely to be arising in the periphery of the body. However, if after the nerve block the pain is mostly unaffected the pain may be arising centrally in the spine and brain. Treating a Chronic Pain Problem A nerve block with a short duration local anaesthetic won’t provide any long acting pain relief, but can help to determine whether a trial of radiofrequency neuro-ablation is reasonable. As mentioned above, if there is inflammation or compression of a nerve then a nerve block with a steroid can reduce these causes of chronic nerve pain.

Most chronic pain patients are not managed with a nerve block, and even if they are used it is important to remember that they are only part of a patient's treatment plan that will also include medications, mental health and physical therapies. A nerve block can only be considered if a small and specific area of the body is painful, and this area of the body is supplied by a single nerve supply that can be safely targeted. Widespread pain such as seen in fibromyalgia, abdominal pain, all over body pain from arthritis affecting many joints are not typically managed with nerve blocks. Most cancer pain is also not managed with nerve blocks. Nerve blocks can sometimes be reasonable to consider, but may be best deferred whilst less invasive options such as medications are trialed.