Pain Solutions and Pain Management in Melbourne

What is a Pain Specialist?

A pain specialist or pain management doctor is a physician who specialises in diagnosing and treating chronic or persistent pain.

Dr Meena Mittal is a medical doctor with advanced training and expertise in the evaluation, diagnosis, and treatment of various types of pain, including musculoskeletal pain, neuropathic pain, complex pain, and other chronic pain conditions.

As a pain specialist, she works closely with patients to develop personalised treatment plans that may include a combination of medications, physical therapy, interventional procedures (such as nerve blocks or injections), behavioural therapy, and other modalities to help manage and alleviate pain. 

If necessary, she will collaborate with other healthcare professionals, such as physical therapists, psychologists, and surgeons, to provide comprehensive care to her patients with chronic pain.

Overall, Dr Mittal’s goal is to improve the quality of life for individuals suffering from chronic pain and empower them to more effectively manage their pain and related symptoms and live their lives to the fullest.

What is Pain Management?

Pain management is a medical specialty that’s focused on reducing, controlling, and relieving pain, chronic pain in particular. It’s a multidisciplinary approach that may include various medical, rehabilitative, and psychological techniques plus interventional procedures to address pain effectively. 

The process and discipline of pain management includes multiple components, starting with the initial assessments and diagnosis of a patient’s pain.

This stage includes its location, intensity, duration, and any underlying causes; it involves a medical history review, physical examination, imaging studies like X-rays or MRI scans, and other diagnostic tests.

Pain medications are often part of the pain management process.

The choice of medication depends on the type and severity of the pain, as well as individual factors and potential risks. 

Over-the-counter medications (like acetaminophen or nonsteroidal anti-inflammatory drugs) or prescription medications (such as muscle relaxants, antidepressants, or anticonvulsants) are often prescribed by pain specialists to alleviate pain and day-to-day symptoms.

Interventional procedures are another key component of the pain management process.

These are invasive techniques designed to target and relieve pain at its origin, and they include nerve blocks, epidural injections, joint injections, radiofrequency ablation, spinal cord stimulator or peripheral nerve field stimulation, and other techniques meant to target the source of a patient’s pain.

These types of procedures can provide targeted pain relief and may be particularly beneficial for certain types of pain, such as nerve-related pain or pain due to arthritis or injury.  

Physical therapy and rehabilitation play a crucial role in pain management by improving strength, flexibility, and function, as well as promoting overall physical health and well-being.

Often, physiotherapists and exercise physiologists work in tandem with pain specialists, such as exercise, manual therapy, traction, heat/cold therapy, and electrical stimulation to help patients manage pain and regain mobility.

Pain management doctors also work with psychological and behavioural therapists.

Chronic pain can have a significant impact on mental health and emotional well-being, so accordingly, psychological and behavioural therapies like cognitive-behavioural therapy (CBT), mindfulness-based stress reduction (MBSR), relaxation techniques, and biofeedback can be beneficial.

These types of therapies can help patients develop coping strategies, manage stress, and improve their emotional resilience while coping with the stress and challenges of chronic pain.

Lifestyle modifications may also be a key part of pain management. Some kinds of lifestyle changes can play a crucial role in management, such as maintaining a healthy diet, regular exercise, adequate sleep, stress management, weight management and avoiding activities that exacerbate pain. 

Making positive lifestyle modifications can help reduce inflammation, improve overall health, and enhance the body’s innate pain-relieving capabilities. 

The overarching goal of pain management is to improve the quality of life for patients suffering from chronic pain by reducing the intensity of the pain, improving physical function and mobility, enhancing emotional well-being, and promoting overall health and wellness. 

Your pain management doctor will create a treatment plan based on your unique needs, preferences, and treatment goals. 

As Dr Mittal’s patient, your customised plan may involve some combination of pharmacological, interventional, rehabilitative, and psychological methods that involve close collaboration between you and a multidisciplinary team of healthcare professionals, including general practitioners, physicians, physical therapists, psychologists, dieticians, and surgeons. 

What Does a Pain Clinic Do?

A pain clinic or pain management clinic is a medical facility or practice that specialises in the evaluation, diagnosis, and treatment of chronic pain. 

Staffed by multidisciplinary teams of pain management physicians, nurses, physical therapists, psychologists, and other specialists, pain clinics are where healthcare professionals collaborate to provide comprehensive care for individuals suffering from chronic pain.

Some of the key functions and services provided by a pain clinic include evaluation and diagnosis of chronic pain, treatment planning, medication management, interventional procedures, physical therapy and rehabilitation, psychological and behavioural therapy, 

Designed to assess the nature, severity, and underlying causes of a patient’s chronic pain, evaluations involve reviewing a patient’s medical history, performing physical examinations, and conducting diagnostic tests like imaging studies (MRIs and X-rays) and nerve conduction studies to identify the source of the pain.

Based on the results of the evaluation, the multidisciplinary team at a pain clinic develops individualised treatment plans tailored to each patient’s specific needs, preferences, and treatment goals.

Treatment plans may include a combination of pharmacological, interventional, rehabilitative, and psychological interventions aimed at managing pain and improving overall quality of life.

Managing pain medications can be a complex process in and of itself. Pain clinics provide medication management services to help patients effectively manage their pain while minimising the risk of medication-related complications, such as addiction, tolerance, or side effects.

Pain management physicians may prescribe a variety of medications, including analgesics (such as nonsteroidal anti-inflammatory drugs, or muscle relaxants), antidepressants, anticonvulsants, and topical medications, as part of the treatment plan.

Interventional procedures and techniques are also performed at pain clinics, These are aimed at providing targeted pain relief by addressing the underlying mechanisms of pain and may include nerve blocks, epidural injections, radiofrequency ablation, spinal cord stimulation, joint injections, and other minimally invasive procedures performed via fluoroscopy or ultrasound guidance.

Generally, pain clinics have physical therapists on staff or who work on a referral basis that specialise in the management of chronic pain.

Their physical therapy and rehabilitation programs will be customised to improve strength, flexibility, and function, reduce disability, and enhance the overall physical health and well-being of patients with chronic pain.

The impact of chronic pain on a patient’s mental health and emotional well-being cannot be denied.

Pain clinics often offer or collaborate with mental health professionals to provide psychological and behavioural therapy services, such as cognitive-behavioural therapy (CBT), mindfulness-based stress reduction (MBSR), relaxation techniques, biofeedback, and coping skills training, to help patients develop effective coping strategies, manage stress, and improve their emotional resilience in dealing with chronic pain.

Perhaps most importantly, pain clinics provide education and support to patients and their families to help them better understand chronic pain, its causes, and treatment options.

This may include information about pain management techniques, lifestyle modifications, self-care strategies, and community resources for ongoing support and assistance.

The social and mental aspects of chronic pain can be as challenging as the pain itself, and pain clinics can help mitigate those issues. 

Through a complete range of services and expertise, pain clinics strive to help patients effectively manage their pain, regain function and mobility, and achieve optimal health and well-being.

What is Chronic Pain?

Chronic pain is persistent pain that lasts for weeks, months, or even years, and it can significantly affect a person’s quality of life. This type of pain persists despite treatment or healing of the initial injury or condition that caused it.

Unlike acute pain, which is a normal and short-term sensation that alerts us to possible injury, chronic pain remains over time and can significantly interfere with daily life, leading to physical limitations, emotional distress, and decreased quality of life.

Chronic pain can result from various causes, including injuries, medical conditions such as arthritis or fibromyalgia, nerve damage, or it can develop as a symptom of an underlying disease. It can affect any part of the body and may manifest as dull, aching, burning, or shooting pain. 

Managing chronic pain often requires a multidisciplinary approach involving medication, physical therapy, lifestyle changes, and psychological interventions to improve functioning and alleviate suffering.

Types of Chronic Pain

The term “chronic pain: covers a variety of conditions that persist over an extended period, significantly impacting individuals’ daily lives. 

Understanding the various types of chronic pain is essential for effective management and treatment. 

From neuropathic pain stemming from nerve damage to musculoskeletal pain affecting muscles and bones, and from persistent headaches to central pain syndrome and visceral pain originating from internal organs, each type presents unique challenges requiring personalised approaches for relief. 

Each type of chronic pain may require different treatment approaches tailored to the underlying cause and individual needs.

Musculoskeletal Pain

Chronic pain that affects muscles, bones, ligaments, and tendons, often resulting from conditions like arthritis or tendonitis.

Neuropathic Pain

This is a type of chronic pain caused by damage or dysfunction of the nervous system, leading to shooting, burning, or tingling sensations.

Sciatica Pain

Sciatica pain is caused by irritation or compression of the sciatic nerve or lumbar nerve roots, resulting in sharp, shooting pain that radiates along the path of the nerve, typically from the lower back through the buttocks and down one leg.

Facet Joint Pain

Facet joint pain refers to discomfort or inflammation occurring in the facet joints of the spine, which are small joints located between adjacent vertebrae that provide stability and facilitate movement.

Back Pain

Chronic back pain refers to pain or discomfort in the upper, lower, or all of the back, which may result from various causes such as muscle strain, injury, poor posture, or underlying medical conditions.

Neck Pain

Chronic neck pain refers to discomfort localised in the area of the neck, typically ranging from the base of the skull to the top of the shoulders. It may stem from various factors such as muscle tension, poor posture, injury, or underlying medical conditions affecting the cervical spine.

Arthritis Pain

Arthritis pain refers to discomfort or pain in the joints caused by inflammation, stiffness, and damage to the cartilage within the joints.

Headache Pain

Chronic headache pain or persistent headaches such as migraines or tension headaches that occur frequently over an extended period are common in the community and can lead to significant debility. 

Occipital Neuralgia 

Occipital neuralgia is a form of headache characterised by shooting or stabbing pain in the upper neck, back of the head, and behind the eyes, caused by irritation or injury to the occipital nerves.

Post-Herpetic Neuralgia 

Post-herpetic neuralgia is a type of chronic pain that occurs after a bout of shingles (herpes zoster).

It manifests as persistent burning, stabbing, or shooting pain in the area where the shingles rash was present, even after the rash has healed.

Complex Regional Pain Syndrome 

Complex regional pain syndrome (CRPS) is a chronic pain condition that occurs after an injury or trauma to the affected limb and may involve abnormal responses from the nervous system.

It is characterised by severe and persistent pain, typically in one limb, along with changes in skin colour, temperature, and swelling. 

Chronic Pelvic Pain and Endometriosis Pain

Chronic pelvic pain refers to persistent discomfort or pain in the pelvic area, which may be caused by medical conditions such as endometriosis, pelvic inflammatory disease, or other pelvic disorders.

Chronic Abdominal Pain

Chronic abdominal pain refers to persistent discomfort or pain in the abdominal region that lasts for an extended period, typically beyond what is considered normal for digestive issues or temporary discomfort.

Treatment for chronic abdominal pain may include medication, dietary changes, stress management techniques, and lifestyle modifications.

In some cases, doctors may recommend therapies such as cognitive-behavioural therapy (CBT). It is essential to identify and address the underlying cause of the pain to develop an effective treatment plan.

Visceral Pain

This is a type of chronic pain that arises from internal organs and may be experienced as a dull, deep ache or cramping sensation.

Causes of Chronic Pain

Chronic pain may result from severe acute injury or chronic medical conditions like arthritis, cancer or endometriosis. 

In general, some of the causes include (but are not limited to):

1. Idiopathic where the cause is not known
2. Infections like as Epstein Barr Virus (EBV), HIV etc
3. Auto-immune conditions such as rheumatoid arthritis, systemic lupus erythematosus (SLE)
4. Inflammatory conditions such as Inflammatory Bowel disease, Ankylosing spondylitis, tendonitis
5. Degenerative conditions such as osteoarthritis
6. Tumours – benign or cancerous
7. Injury or trauma to the nerves, muscles, tendons or joints
8. Neurological conditions such as multiple sclerosis, peripheral neuropathy
9. Neurological dysfunction such as in fibromyalgia and complex regional pain syndrome
10. Muscular disorders such as muscular dystrophy, dystonia
11. Toxins such as alcohol, Vitamin B6
12. Medications such as chemotherapy medications
13. Radiation therapy causing damage to the nerves, skin and muscles
14. Deficiencies such as Vitamin B12 deficiency, iron deficiency
15. Endocrine conditions such as diabetes and thyroid disorders
16. Hormonal fluctuations such as perimenopause or menopause
17. Vascular disorders such as migraines, peripheral vascular disease
18. Psychiatric conditions such as Chronic Pain disorder

Understanding the diverse range of potential causes is crucial for effective management and treatment. Each type of pain presents unique challenges that require tailored approaches for relief. 

Chronic Pain Symptoms

Some symptoms associated with chronic pain, or persistent discomfort or pain extending beyond the expected healing period, include (but are not limited to) the following:

1. Sensitivity or tenderness in specific areas of the body.
2. Reduced mobility or flexibility in affected joints or muscles.
3. Fatigue and sleep disturbances due to ongoing pain.
4. Emotional effects such as irritability, anxiety, or depression.
5. Difficulty concentrating or completing tasks due to pain distraction.
6. Changes in appetite or weight due to pain-related discomfort.
7. Avoidance of certain activities or movements that worsen the pain.
8. Muscle stiffness or weakness in the affected areas.
9. Tingling or numbness sensations.
10. Alterations in posture or gait to alleviate discomfort.

Working with a pain specialist and a multidisciplinary team of professionals can help alleviate or mitigate the above symptoms and improve your day to day life.

Pain Medications for Chronic Pain

There are several types of pain medications commonly used to manage chronic pain. Some of the medication options for persistent pain include the following over-the-counter and prescription medications:

1. Nonsteroidal anti-inflammatory drugs (NSAIDs): These medications, such as ibuprofen, naproxen, celecoxib or meloxicam to help reduce inflammation and relieve pain.
2. Acetaminophen/ paracetamol: This medication can help alleviate mild to moderate pain, although it doesn’t reduce inflammation.
3. Opioids: Strong pain relievers like oxycodone, morphine, tramadol and tapentadol are sometimes prescribed for severe chronic pain. However, their use comes with the risk of tolerance, dependence, and addiction and is typically reserved for short term use only.
4. Antidepressants: Certain antidepressants, such as tricyclic antidepressants (such as amitriptyline) or serotonin and norepinephrine reuptake inhibitors (SNRIs) like duloxetine, may be prescribed to manage chronic pain, especially neuropathic pain.
5. Anticonvulsants: Medications typically used to treat seizures, such as gabapentin or pregabalin, may also help relieve neuropathic pain.
6. Muscle relaxants: These medications, like orphenadrine and baclofen, can help reduce muscle spasms and associated pain.
7. Low-Dose Naltrexone. This medication has limited evidence but may be used in patients with widespread pain, neuropathic pain and chronic fatigue. 
8. Botox therapy. Its main use is in conditions such as migraines, cervical dystonia, pelvic floor muscle spasm, temporomandibular joint dysfunction. 
9. Lignocaine infusions. These are used for refractory migraines and require an inpatient stay in hospital for 5-7 days. 

Note that the choice of medication depends on the type and severity of pain, as well as individual factors such as medical history, other medications being taken, and potential side effects.

What is the Best Pain Medication for Chronic Pain?

There isn’t a single “best medication for chronic pain”, as the choice depends on various factors including the type and severity of the pain, individual response to medications, and any underlying health conditions. 

Treatment for chronic pain and its underlying conditions often involves a combination of medications tailored to the specific needs of the patient.

It’s important for individuals with chronic pain to work closely with their healthcare provider to find the most effective and safest medication regimen for their condition, and always consult with a physician before starting or changing a medication regimen. 

Why is My Doctor Sending Me to Pain Management?

Your doctor may refer you to a pain management specialist for many reasons, the primary reason being that pain management specialists and their associated teams have expertise in treating chronic pain conditions. 

If your pain condition is complex or difficult to manage, a pain management specialist can provide a more focused and comprehensive evaluation to develop an effective treatment plan.

Pain specialists provide a comprehensive, customised, and multidisciplinary approach to pain management, incorporating various therapies including medication management, physical therapies, interventional procedures, and psychological support.

They may also offer more advanced treatment options that general practitioners do not typically provide, like nerve blocks, spinal cord stimulation, and intrathecal drug delivery. 

The goal of pain management is not only to alleviate pain but also to improve your overall quality of life by minimising the impact of chronic pain on your daily functioning and emotional well-being.

By referring you to a pain management specialist, your doctor is ensuring that you receive the most comprehensive and effective care for your chronic pain condition, optimising your overall quality of life.

The Importance of Pain Management

Pain management plays a crucial role in improving the quality of life for individuals experiencing chronic pain.

By effectively managing pain, patients experience increased functionality, enhanced well-being, and better sleep.

These improvements help to prevent long-term disability and even help patients to preserve relationships. 

Pain management techniques can help individuals regain and maintain functionality in their daily lives, enabling them to perform essential tasks, engage in activities they enjoy, and maintain independence.

Because chronic pain often disrupts sleep patterns, leading to insomnia and daytime fatigue, treating chronic pain helps enhance sleep quality.

What’s more, chronic pain can have a significant impact on emotional and psychological well-being, leading to depression, anxiety, and stress.

Proper pain management can alleviate these negative effects, promoting a greater sense of overall well-being and mental health.

Untreated or poorly managed chronic pain can lead to physical deconditioning, reduced mobility, and even disability.

Pain management interventions aim to prevent or minimise these consequences, allowing individuals to maintain optimal physical functioning.

Chronic pain can strain relationships with family, friends, and caregivers due to the limitations it imposes on daily activities and social interactions.

By managing pain effectively, individuals can maintain and strengthen these relationships, reducing the impact of pain on their social support networks.

Overall, pain management is essential for addressing the physical, emotional, and social aspects of chronic pain, ultimately helping individuals lead fulfilling and meaningful lives despite their pain.

Chronic Pain Management Plan

A chronic pain management plan begins with a thorough assessment to understand the pain’s nature. 

Both over-the-counter and prescription medications may be prescribed, alongside physical therapy to improve mobility. Interventional procedures like nerve blocks provide targeted relief. 

Psychological support and stress management techniques address the emotional impact. Lifestyle modifications, including a healthy diet, are emphasised. 

Regular follow-up appointments ensure ongoing assessment and adjustments. This comprehensive approach aims to minimise pain, improve functionality, and enhance overall well-being for individuals living with chronic pain.

Goals of Pain Management

Goals of pain management include reducing pain intensity, improving functionality and mobility, minimising reliance on medications, addressing emotional distress, improving sleep quality, enhancing quality of life, and promoting self-management skills. 

Additionally, pain management aims to identify and treat underlying causes of pain, prevent or minimise disability, and foster patient empowerment and autonomy in managing their pain. 

By implementing an interdisciplinary approach tailored to individual needs, the overarching goal is to optimise physical, emotional, and social well-being, allowing individuals to live fulfilling and meaningful lives despite chronic pain.

Regular assessment and adjustments ensure ongoing progress towards these goals.

Advanced Treatments for Chronic Pain Relief

Some cutting edge treatments for chronic pain relief include rapidly developing technologies such as neuromodulation, which involves implanting devices (like pacemakers) to deliver electrical stimulation to targeted nerves or areas of the spinal cord to disrupt pain signals.

These have proven to be very effective in managing specific types of pain such as neuropathic pain, complex regional pain syndrome, refractory migraines and even cardiac conditions such as angina.

Alternative Treatments for Pain Management

Complementary and alternative therapies, such as mindfulness-based stress reduction, and virtual reality therapy, also show promise in providing non-pharmacological pain relief.

These and other alternative pain relief treatments should be accompanied by a program and plan designed by a pain management specialist and their team of healthcare professionals. 

How to Find a Pain Specialist Near Me

To find a chronic pain specialist near you, you can consult your general practitioner, use online directories or resources to search for pain specialists in your area, ask for referrals at your local medical centre, and seek recommendations from friends, family members, or support groups.

They may provide valuable insights and referrals based on their own experiences.

Once you’ve identified potential specialists, consider factors such as their expertise, local experience, and patient reviews to make an informed decision.

Additionally, verify their credentials and ensure they are board-certified in pain management or related specialties.

If you are in the Victoria, Australia area, Dr Meena Mittal is an experienced Melbourne pain specialist.