• Spinal cord stimulation has become an increasingly popular treatment option for patients who suffer from chronic neck or back pain.
• This stimulator has similarities to a cardiac pacemaker, leading some to call the device a “pacemaker for pain” that works by blocking pain signals from the spinal cord travelling through to the brain.
• Besides the SCS, the peripheral nerve stimulator is used to target nerves outside the spine, for example, in the shoulder or the knee, in order to help relieve the chronic pain in the limbs.

What is a stimulation trial?

Before being implanted with a SCS, you are advisable to undergo a stimulation trial procedure to see if you will benefit from the procedure. This takes about 45 minutes.

• Surgical insertion of stimulating leads next to the spinal cord or a peripheral nerve 
• A day surgery under ultrasound or fluoroscopic guidance, following which you can be discharged home 
• The evaluating period is for about 7 to 10 days 
• We will arrange another appointment for the permanent implant to be placed should the trial be successful 

During the evaluation period, should you experience a reduction in pain and your reliance on pain medications, it means the trial has shown good results. You should be able to resume normal activities like traveling, sport activities and work. 

How is the permanent spinal cord stimulator implanted?

An implantation of a stimulator: 

• Will take around 2 hours 
• Will be performed under general anaesthesia or deep sedation 
• Involves placement of the leads and cables under the skin, whereas the pulse generator will be implanted in the flank 
• The stimulator will then be able to produce continuous pain relief 
• A remote control will be provided for setting adjustments 
• Close follow-ups are necessary initially to achieve the optimal setting for pain relief 

What are the possible risks?

Generally, SCS or PCS is a safe and effective procedure, which is also completely reversible. The risks are often minor, but may include: 

• Soreness and bruising over the injection point 
• Potential infection 
• Spinal cord nerve damage 
• Allergic reaction
• Device malfunction 
• Weakness, numbness

What should I expect after the procedure?

• An increase in back pain for 48 to 72 hours
• You must not bend, stretch, twist or lift with big movements or more than 45 degrees 
• Check your back for redness, swelling or any discharge regularly 
• Keep the insertion area of stimulator and the dressing dry and clean all the time 
• Wipe yourself with a damp cloth instead of taking a shower 
• The clinic will call and check on you daily 
• A follow-up date in a week

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

The post Spinal Cord Stimulation appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is a stellate ganglion block and how does it help me?

The stellate ganglion is a bundle of nerve fibres which is located in your neck next to your voice box. It makes up the sympathetic chain and delivers pain signals and movement messages to your brain. A stellate ganglion block is a local anaesthetic injection which aims to block the sympathetic nerves, providing pain relief to your face, neck and arm. Sometimes, a block can also improve the blood flow to the arm. 

How is the stellate ganglion block performed?

The procedure: 

• Takes about 30 minutes to complete
• Done under light sedation 
• A local anaesthetic will be given to numb the skin of your voice box
• Medications (local anaesthetic and steroids) will then be injected using ultrasound or X-ray guidance 

You may experience immediate pain relief until the local anaesthetic effect wears off. The pain relief will then improve again in 2-3 days, and it can last for weeks to months, depending on each individual. We usually use the block as a part of multi-modal pain management treatment. Therefore, you might need to continue with medications, physiotherapy or other treatment advised by your doctor. 

Am I a good candidate for a stellate ganglion block?

This treatment may be helpful for you if you are suffering from: 

• Complex regional pain syndrome (CRPS)
• Shoulder/hand syndromes
• Causalgia (nerve injury)
• Phantom limb pain
• Intractable angina
• Shingles (herpetic neuralgia from herpes zoster)
• Poor circulation in the upper extremities
• Raynaud’s phenomenon
• Scleroderma
• Excessive sweating (hyperhidrosis) in the face and upper extremities
• Hot flashes and sleep dysfunction related to hot flashes

What are the possible risks?

Some patients may experience Horner’s syndrome which includes symptoms like drooping of the upper eyelid, pupil constriction and dressed sweating. It is a normal response and symptoms usually subside within several hours after the procedure. 

Other rare side effects and risks include: 

• Difficulty swallowing or speaking 
• Hoarseness 
• Minor bleeding 
• Nerve injury 
• Red, teary eyes 
• Allergic reaction 
• Numbness and/or weakness down the hand and chest
• Temporary bruising
• Increased pain at the injection site 

Many of these side effects are minor and only persist for a few hours.

What should I expect after the procedure?

You will need a family member or a friend to fetch you upon discharge as you are not advisable to drive.

• General guidelines include:
  1. Apply a cold compress over the injection site to reduce any minor swelling or pain
  2. If you experience difficulty swallowing (which is temporary), do not eat, drink or swallow anything for 4 hours after the procedure
  3. You should also avoid any strenuous activities for at least 24 hours, you may return to your normal activities the next day

The post Stellate Ganglion Block appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is an annuloplasty procedure and how does it help with my back pain?

An annuloplasty, also known as an intradiscal electrothermal therapy (IDET), is a minimally invasive and a non-surgical procedure, used to treat back pain originating from your intervertebral discs. These discs are made up of layers of collagen fibres, much like layers of an onion. The layers can tear and disc materials can leak outside the discs causing nerve irritation.  

How is annuloplasty performed?

The annuloplasty procedure: 

• Will take less than an hour to complete
• Involves sedation 
• Followed by the insertion of a needle, with X-ray guidance, into the affected discs and applying heat directly into the discs through a catheter
• The heat cauterizes the collagen fibres, closing disc wall (annulus) tears and reducing the symptoms from the disc injury
• You will go home on the same day.

Am I a good candidate for annuloplasty?

This might be the right treatment for you if you: 

• Have lower back pain because of a torn annulus in your disc
• Have not had success with conservative treatments such as medications, physiotherapy and/or injections 
• Do not wish to undergo major spinal surgeries, which have much higher risks 

What are the risks?

An annuloplasty is considered very safe and severe side effects or complications are pretty rare. Possible risks include, but are not limited to, increased pain, bleeding and infection. 

What should I expect after the procedure?

In carefully selected patients, the success rate of the procedure can be as high as 80-90%. 

You might experience some increased pain during the first couple of days, which can be relieved with medications. 

Your doctor will map out a course of treatments including: 

• Easy stretching exercise
• Physical therapy 
• Avoidance of heavy lifting, bending and prolonged sitting 
• Refrain from any strenuous sports like running, golf, tennis etc.

Your compliance with your doctor’s recommendation for the first few months is necessary for an optimal recovery outcome. 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

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What is a radiofrequency ablation and how does it help with my pain?

Radiofrequency ablation, also known as radiofrequency neurotomy, is performed to treat the chronic pain arising from the neck, back, sacroiliac, hip and knee joints. 

How is radiofrequency ablation procedure performed?

The procedure involves: 

• Giving a mild sedative and a local anaesthetic injection to the site 
• Insertion of a radiofrequency needle with X-ray guidance
• Placement of a probe will be placed through the needle to deliver the electric current 
• Using an electric current to heat up the targeted nerve and stop it from sending pain signals

How long does the effect of radiofrequency ablation last?

• The duration of pain relief differs from person to person and it depends on the condition.
• It usually can last from 6 months to 2 years, depending on how fast the pain fibres grow back. 

In some cases, the effectiveness can last for many years. 

Am I a good candidate for radiofrequency ablation treatment?

This treatment may be helpful for you if you have the following conditions: 

• Knee arthritis
• Hip arthritis
• Lumbar spondylosis, where there is arthritis of the small joints of the back 
• Sacroiliac joint arthritis

What are the possible risks?

Radiofrequency ablation is considered very safe and complications rarely happen. 

Less common risks or side effects include but not limited to: 

• Bleeding 
• Infection 
• Worsening of pain symptoms 
• Discomfort or bruising at the injection site 
• Weakness, numbness 

What should I expect after the procedure?

You are not advisable to drive or engage in strenuous activities for a day. You may resume your normal activities on the next day and slowly increase your activity level from the 3rd day onwards. 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

The post Radiofrequency Ablation appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is a sympathetic nerve block and how does it help me?

• Sympathetic nervous system (SNS) is best known for its role in helping in your “fight-or-flight” response. SNS consists of stellate ganglion, splanchnic nerve, celiac plexus and superior hypogastric nerves. 
• When your sympathetic nerves are irritated or injured, the blood supply to your neck, hands, feet or other areas may be affected and it can produce pain or sensory changes. 
• An abnormal sympathetic nervous system perpetuates some pain conditions.

How is the procedure performed?

The procedure: 

• Will take about 30 minutes to complete
• Will be performed under light sedation 
• A local anaesthetic will be given to numb the skin of the injection site
• Medications (local anaesthetic and steroids) will then be injected into the target site with ultrasound or X-ray guidance You may experience immediate pain relief until the local anaesthetic effect wears off. The pain relief will then improve again in 2-3 days and it can last for weeks to months depending on each individual.

Am I a good candidate for a sympathetic block?

Sympathetic nerve blocks can be an effective treatment option for you if you are suffering from: 

• Chronic abdominal pain
• Complex regional pain syndrome (CRPS) 
• Trigeminal neuralgia (painful sensation on one side of the face)

What are the possible risks?

Sympathetic block is considered very safe and has very few risks: 

• Infection 
• Bleeding 
• Nerve damage
• Allergic reaction 

What should I expect after the procedure?

Sympathetic nerve block recovery is usually fast and easy. You may experience some pain over the injection site which can be relieved with applying some cold compress or taking prescribed medications. 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

The post Sympathetic Nerve Blocks appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is the sacroiliac joint? How can it be responsible for low back pain?

The sacroiliac joint is a major weight-bearing joint which links your lower spine and pelvis with very strong ligaments that are richly innervated by free nerve endings and spinal nerve roots. When there is inflammation of the joint, this abundance of nerves causes intense low back pain. 

How do I get pain in the sacroiliac joint?

You may suffer from this condition, which can occur from: 

• Trauma such as a fall, work injury or car accident 
• Hip or spine surgery 
• Pregnancy and childbirth 

How long does the sacroiliac joint injection take?

The procedure: 

• Takes about 30 minutes to complete
• Takes place under light sedation 
• Delivers medications including local anaesthetics and steroids into the sacroiliac joint with ultrasound or X-ray guidance 
• Decreases the inflammation, allowing you to resume your normal function

How long does the pain relief last?

The pain relief of this injection may be long-lasting or temporary, depending on the severity of the symptoms. It usually lasts for an average of 6 months to a year. We can perform a radiofrequency procedure targeting the nerves of the sacroiliac joint to allow a longer duration of pain relief. 

Am I a good candidate for a sacroiliac joint injection?

This treatment could be helpful for you if you: 

• Have lower back pain for over 3 months and has not improved with the conservative management 
• Wish to identify the source of your back pain (as we can use this method as a diagnostic tool)

What are the risks?

Sacroiliac joint injection is a low-risk, non-surgical tool to combat lower back pain or sacroiliac joint disorders. The potential side effects or risks are minor and occur infrequently:

• Soreness and bruising over the injection site 
• Potential infection
• An allergic reaction to the medication
• Temporary weakness and numbness of the legs 
• Difficulty passing urine which will recover after a few hours 

What should I expect after the procedure?

We advise you to modify your lifestyle for better results: 

• Practice proper lifting techniques 
• Design an ergonomic workstation 
• Healthy diet 
• Increase your daily exercises 
• Stress management 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

The post Sacroiliac Joint Injection appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is an occipital nerve block and how does it help with my headache?

The occipital nerve travels from the spine to the back of the scalp. We commonly perform an occipital nerve block to treat headaches that might arise from the following causes: 

• Occipital neuralgia: a condition in which the occipital nerve is injured or inflamed; there is usually piercing or throbbing pain in the back of the head or behind the ears 
• Tension headaches 
• Whiplash injuries: a neck injury because of forceful, rapid back-and-forth movement of the neck commonly after a vehicle accident

How is the occipital nerve block performed?

• We will perform the procedure under light sedation and ultrasound guidance. We will inject a solution of local anaesthetic and steroid to surround the occipital nerve. The whole procedure should take about 15 minutes.
• Many patients feel pain relief immediately, but it may take a few days to have full effects.

What are the possible risks?

• An occipital nerve block is considered safe, with low risk of side effects/
• The most common side effect is the superficial pain that comes from the injection site. However, it is temporary and mild.
• Our scalp has very thin skin with many tiny blood vessels near the surface. Therefore, any puncture can result in bleeding, but it is common, minimal and easily stopped.
• Other less common risks include, but are not limited to, excessive bleeding, infection and nerve damage.

What should I expect after the procedure?

• Recovery from an occipital nerve block is fast and usually pain-free or with mild pain.
• You should not drive on the day of injection, and should be accompanied home if you had sedatives for the procedure
• You may resume your normal daily activities as your pain level allows.

How long does it last?

• The injection may last for a few weeks to 6 months. If the pain relief is not adequate, the injection can be repeated or a radiofrequency procedure can be performed. 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

The post Occipital Nerve Block & Radiofrequency Treatment appeared first on Pain Treatment Specialist Singapore | Pain Doc.

What is a plasma-rich platelet (PRP) injection? How does it help with my wound healing/joint injury?

Plasma-rich platelet injections comprise 2 elements:

• Plasma, the liquid portion of blood 
• Platelets, a type of blood cell that plays an important role in tissue repair, allowing the body to heal

How is it performed?

• Drawing the blood from a vein
• Putting the blood in a device that separates out the blood components
• Concentrating the amount of platelet in a solution
• Injecting the PRP solution into the target area, such as an injured knee or tendon using ultrasound or  X-ray

How long does PRP take to work?

The PRP aids in healing over the course of weeks and on average, about 3 PRP injections will be required about 3 weeks apart over the course of 6 months in order to ensure the best outcome. 

How long does the injection take?

The procedure is over in about half an hour, depending on the number of injections to be given. You may go home on the same day. 

Am I a good candidate for PRP injections?

You may be suitable for this treatment if you have: 

• Tendon injury 
• Ligament injury 
• Muscle injury 
• Joint injury 
• Plantar fasciitis 
• Post-surgical wounds

The results vary from condition to condition but it is generally more effective for conditions such as tennis and golfer’s elbow. 

What are the possible risks?

PRP injections use components of your own blood, hence the risk of an allergic reaction is much lower. Less common risks of the procedure include: 

• Temporary increase in pain or bruising 
• Bleeding 
• Infection 

The procedure involves a blood draw, so you should ensure that you are hydrated and have eaten beforehand to prevent light-headedness. 

What should I expect after the procedure?

The result of PRP treatment is most noticeable after a few weeks for joint injections; however, you may require additional injections at the direction of your doctor. 

Every condition is different, hence it is best to consult a specialist who is experienced in managing such conditions. Reach out to Dr Timothy Thor today.

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How is a greater trochanteric block performed?

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