Some of the most difficult pain to live with comes not from a single injury but from an underlying medical condition — a neurological disease, an injury to the brain or spinal cord, or an inherited disorder that changes how the body moves and signals pain. Pain in these conditions is often complex: it can be neuropathic (nerve-related), musculoskeletal, or driven by muscle overactivity and spasticity, and frequently it is a combination of all three. At Persistent Pain Solutions, we assess that full picture and manage it from both a pain medicine and a rehabilitation perspective, coordinating with your GP, your neurologist, and the rest of your care team.

Parkinson’s Disease

The pain. Pain is one of the most common and least recognised symptoms of Parkinson’s disease. It can take several forms: musculoskeletal pain from rigidity and altered posture; dystonic pain from sustained muscle cramping, often early in the morning or when medication is wearing off; and central or nerve-related pain arising from the way the condition changes pain processing itself.

How we help. We work to identify which type of pain is driving your symptoms, because each responds to a different approach. Management may include reviewing how your pain fluctuates with your Parkinson’s medication timing (in coordination with your neurologist), botulinum toxin therapy for focal dystonia, targeted pain medications, and a physical therapy and rehabilitation program.

Spinal Cord Injury

The pain. Pain after spinal cord injury is common and frequently has more than one source: musculoskeletal pain from the increased load placed on the arms, shoulders, and back; neuropathic pain at or below the level of the injury, which can be burning, electric, or shooting; and pain related to spasticity and muscle spasm.

How we help. Treatment is matched to the type of pain, and may combine medications for nerve-related pain, interventional pain procedures where appropriate, spasticity management (including botulinum toxin therapy), and a rehabilitation program aimed at protecting function and preventing secondary problems such as overuse injury. For selected types of refractory neuropathic pain, neuromodulation may be considered.

Post-Stroke Pain

The pain. Pain is a frequent but under-treated consequence of stroke. It includes central post-stroke pain — a neuropathic pain often felt as burning, aching, or heightened sensitivity on the affected side; shoulder pain on the weaker side, which is common and often musculoskeletal; and pain related to spasticity as muscle tone increases after a stroke.

How we help. Management is tailored to the type of pain present, and may include medications for neuropathic pain, careful assessment and treatment of the painful shoulder, botulinum toxin therapy and medication for spasticity, and a rehabilitation program to support recovery — in coordination with your stroke and rehabilitation team.

Central Pain Syndrome

The pain. Central pain syndrome is a neuropathic pain that arises from damage to the central nervous system — the brain or spinal cord — from causes such as stroke, multiple sclerosis, spinal cord injury, or other neurological conditions. It is often constant, may be felt as burning, aching, or pins-and-needles, and can be accompanied by heightened sensitivity in which even light touch or a change in temperature is painful.

How we help. Central pain can be one of the more challenging pain conditions to treat, and honesty about that is part of good care. Our aim is meaningful improvement in comfort and function. Management may include medications used specifically for nerve-related pain, neuromodulation techniques in selected cases, and a multidisciplinary plan that addresses the physical and psychological impact of living with persistent pain.

Cerebral Palsy

The pain. Pain is common in adults and children with cerebral palsy and is often under-recognised. It can arise from spasticity and sustained muscle contraction; from musculoskeletal problems such as joint, hip, and back pain related to posture and movement over time; and from nerve-related pain. Pain after orthopaedic surgery is also common in this group.

How we help. We assess the sources of pain and how they affect daily life, then build a plan that may include spasticity management with botulinum toxin therapy and medication, treatment of musculoskeletal pain, and a rehabilitation approach focused on comfort, posture, and function — coordinated with the wider care team.

Multiple Sclerosis

The pain. Pain affects a large proportion of people living with multiple sclerosis and comes in several forms: nerve-related pain such as trigeminal neuralgia or the burning and pins-and-needles of dysaesthetic pain; pain related to spasticity and muscle spasm; and musculoskeletal pain that develops secondary to changes in gait and posture.

How we help. Because MS pain is so varied, treatment is individualised. It may include medications for nerve-related pain, spasticity management with botulinum toxin therapy and oral medication, interventional procedures for specific neuralgias, and a rehabilitation program — all coordinated with your neurologist and treating team.

Post-Herpetic Neuralgia

Persistent Pain Solutions has a dedicated page on post-herpetic neuralgia — the nerve pain that can persist for months or years after an episode of shingles. Rather than repeat that content here, please see our post-herpetic neuralgia page.

Peripheral Nerve Entrapment Syndromes

The pain. Peripheral nerve entrapment occurs when a nerve is compressed as it passes through a narrow space — the wrist in carpal tunnel syndrome, the elbow in cubital tunnel syndrome, and other sites elsewhere in the body. The result is often pain, numbness, tingling, and weakness in the area the nerve supplies, with symptoms that are worse at night or with particular activities.

How we help. Diagnosis matters, and a nerve conduction study and EMG can confirm which nerve is involved and how significantly. Management may include activity modification and splinting, targeted injections where appropriate, and treatment of any residual nerve-related pain with anti-neuropathic medications or pain interventions. Where a nerve is significantly compressed, we coordinate referral for surgical assessment.

Hereditary Muscular Conditions

The pain. Inherited conditions that affect the muscles — including the muscular dystrophies and related disorders — can cause pain in several ways: aching and cramping in the muscles themselves, pain from contractures and altered posture, joint and back pain from changes in movement over time, and fatigue-related pain.

How we help. Our role is supportive and tailored to the individual: managing musculoskeletal and nerve-related pain, supporting posture and movement through a rehabilitation program, and coordinating with your neurologist and the broader care team, with the aim of keeping you as comfortable and functional as possible at each stage.

Other Neurological Conditions (Hereditary and Degenerative)

The pain. Many other neurological conditions — both inherited and degenerative — can produce persistent pain, whether nerve-related, musculoskeletal, or related to changes in muscle tone and movement. Because these conditions are so varied, the pain they cause is equally varied, and it is often overlooked while attention is focused on the underlying diagnosis.

How we help. We assess pain in the context of your specific condition and your goals and manage it with the full range of pain medicine and rehabilitation options — medications, interventional procedures where appropriate, spasticity management, and a rehabilitation program — always in coordination with your treating neurologist and care team.