Pain management

The Bradford Pain Management Team, based at Bradford Teaching Hospitals NHS Foundation Trust, provide an experienced and specialised approach to the treatment of chronic pain.

Chronic pain is a pain that persists for more than three months after an injury or illness. It is very common and affects a large proportion of the population.

Sadly, due to its severity it can have an impact on patients’ employment, daily activities, relationships, mood, sleep and general health.

Our aim is to work with the patient to reduce pain and its impact on their life. We achieve this by utilising a combination of the most up-to-date treatment options available with the primary target of improving function.

Back pain usually affects the lower back and generally arises from three places:

• Facet joints – small joints in the back which join the vertebrae together
• Sacroiliac joints – the joints that join the back to the pelvis
• Discs – the ‘shock absorbers’ of the back

Pain most commonly results from wear and tear and occasionally injury. Patients will usually have an ache in the lower back that may spread through the buttocks and into the legs as far as the knee.

Back pain can also be associated with nerve root pain (See below).

Nerve pain results from injury to a nerve. As well as causing pain, injury to the nerve can also affect its function leading to abnormal sensations (numbness, pins and needles and painful sensitivity) and muscle weakness.

Nerve pains are difficult to treat with conventional painkillers and, although the nerve may heal, it can remain sensitive and function abnormally for a long time.

Nerve roots can be irritated or compressed by disc bulges (disc prolapse) or by deformity of the bones of the back due to wear and tear or injury. This produces nerve root pain.

Nerve root pain occurs in the part of the body supplied by the effected nerves. For example, injured nerves arising from the lower back will cause pain in the legs and feet.

As well as being injured at the root, nerves can be injured as they travel through the body. Numerous things can cause this injury, including:

• Accidents
• Surgery (e.g. amputation, mastectomy, chest surgery, hernia repair)
• Cancer and its treatment
• Shingles
• Medical conditions that gradually damage the nerves, such as diabetes
• Complex Regional Pain Syndrome (See below)

From person to person the location, timing and type of pain described as a headache can vary. There can also in some cases be a variety of other symptoms including bloodshot eyes, eye watering, visual and hearing disturbance, vomiting, slurring of speech and muscle weakness.

This variety occurs because there are a large number of different causes of headache. We cannot help with all headaches and you will need your GP and in some cases a neurologist to decide which type of headache you have. They may then start treatment that reduces the number and the severity of your headaches.

Generally speaking we are most effective at relieving headaches derived from the neck. The same nerves that supply the scalp over the back of the head also supply the bones of the neck. Thus wear and tear or injury of the neck can produce pain over the back of the head in a condition called Cervicogenic Headache.

We can also help with a headache caused by irritation of a specific nerve supplying the scalp over the back of the head. This occurs in a condition called Occipital Neuralgia.

CRPS is diagnosed by identifying a characteristic group of symptoms affecting a particular part of the body, usually a limb. It often follows injury although this can be minor, and in some individuals no trigger can be identified.

The symptoms occur in two stages. At first there may be sustained pain, swelling, redness and increased temperature, as an exaggerated and prolonged response to injury. Then there is progression to decreased temperature, painful sensitivity, hair loss and increased nail growth followed by muscle wasting and thinning of bone.

Scientists are only beginning to understand the mechanisms that produce these symptoms and are yet to discover why they only develop in a small group of people. We follow the current guidelines on how to manage this pain in the first and second stage.

Our talented and compassionate staff help care for a diverse population, which is what makes Bradford such a special place to work. Choosing the right people is key to our success. If you think you’ve got what it takes, please contact us by email at careers@bthft.nhs.uk to discover more about our latest opportunities.

To contact us for appointment queries please call 01274 274274.

Please see the AccessAble pages on the Pain Management department at St Luke’s Hospital.

Chronic pain effecting the abdomen or pelvis can arise from a great number of sources. These include any one of the organs of the digestive system, urinary system or reproductive system, as well as the muscles of the abdomen and pelvic floor and the bones and nerves of the back.

Diagnosing a potential cause for the pain is complex and will require input from a patient’s GP and quite often other specialists (gastroenterologists, general surgeons, gynaecologists, urologists).

It is important that prior to seeking our help, all possible causes have been fully investigated and any potential treatment started.

In some cases a cause may be found where medicines or surgery do not greatly improve the pain or where such treatment is not possible. Also, on occasion, no clear cause may be found. It is in these situations that our assistance will be most helpful. Painful conditions we most commonly see include:

• Chronic dyspepsia
• Irritable bowel syndrome
• Chronic pancreatitis
• Endometriosis
• Interstitial cystitis
• Chronic kidney pain
• Chronic pain following infection or surgery

Facial and mouth pains often arise from irritation or compression of nerves, which arise from the brain and supply and travel through a number of structures in the head before they finally supply the skin of the face or the lining of the mouth and tongue.

As a result to discover the source of pain will require input from a patient’s GP and quite often other specialists in this area including neurologists, ear, nose and throat surgeons, maxillofacial surgeons and neurosurgeons.

It is important that prior to seeking our help, all possible causes have been fully investigated and any potential treatment started. Painful conditions we most commonly see include:

• Trigeminal neuralgia
• Post shingles pain
• Burning mouth syndrome
• Chronic dental pain

Joint pains may affect one joint or a number of joints. They are most commonly caused by injury or wear and tear (osteoarthritis) but can also be associated with more complex medical conditions (e.g. rheumatoid arthritis).

Joint pains should be assessed and investigated by the patient’s GP. Patients may then require further assessment and treatment by specialist GPs from their local musculoskeletal service.

We cannot treat the cause of the pain. We will only offer physiotherapy and medication to reduce the pain where this has not been tried already and, in appropriate people, perform procedures that temporarily numb the nerves supplying the joint.

Fibromyalgia is a condition with widespread pain which affecting joints and muscles and is associated with fatigue. It can be diagnosed when other causes for these symptoms have been investigated. This in-depth investigation can be carried out by the patient’s GP or a rheumatologist.

The most effective treatment for this condition is a pain management programme along with medication that improves sleep pattern and mood. Both of these treatments can be offered by a GP.

People suffering from cancer may have numerous sources of pain. Pain may arise from the cancer itself or from the effect of the cancer on nerves and bones. It may also occur as a side effect of cancer treatment with surgery, radiotherapy or chemotherapy.

We work closely with specialists in cancer treatment (oncologists) as well as palliative care to relieve cancer-related pain.

• The Living with Pain team provides an experienced and specialised approach to the treatment of chronic pain
• Chronic or persistent pain persists for more than three months after an injury or illness. It is very common and affects a large proportion of the population
• Sadly, due to its severity it can have an impact on patients’ employment, daily activities, relationships, mood, sleep and general health
• Persistent pain occurs when the nervous system is sending more messages than it needs to. This means pain can happen without new damage or injury in the body. Unfortunately, there is no medical treatment at present that can correct this over-activity in the nervous system
• The Living with Pain Team’s aim is to work with patients to cope better with their pain and its impact on their life. The team aim to achieve this by utilising a combination of the most up-to-date treatment options with the primary target of improving function and quality of life, despite pain
• The team includes pain specialist physiotherapists, clinical psychologists, occupational therapists, a doctor with a special interest in pain and an administrator

NHS help on offer for people with pain
British Pain Society
Fibromyalgia