At Pain Management Sydney, our five-step processis a multi-disciplinary approach to pain management combining medical and holistic techniques.

These five steps are based on our belief that pain is a whole person issue and requires a variety of treatment options in order to formulate an effective, long-term pain management plan.

Pain diagnosis and chronic pain management planning

Establishing a diagnosis and excluding surgical pathology is a crucial first step in our pain management planning.

We perform a thorough examination of the patient’s affected areas. We also obtain appropriate investigations such as MRI scans, CT scans, bone scans (checking for arthritis) and blood tests (including electrolytes, renal function, full blood count, glucose profile, liver function tests, thyroid function tests and serology for HBV and CMV).

During this stage, we may find that we need to refer a patient to a specialist such as a neurosurgeon, neurologist or endocrinologist. In worker’s compensation cases, an occupational physician referral is also helpful.

Ongoing support for medication rationalisation

It’s vital for us to gain an accurate picture of the patient’s full medication history in order to develop an effective pain management plan for the future.

Patients who come to our clinics have often experimented with many pain-relieving medications and therapies already.

We review the efficacy of all previous medications and treatments the patient has attempted, whether helpful or not. Some of the treatments patients have experimented with include surgery, physiotherapy, acupuncture, massage and chiropractic treatments.

Cognitive behaviour therapy

We take an active interventional psychological approach so that your patient can negotiate the psychological hurdles in chronic pain.

Some of these hurdles can include:

• Sleep – in patients with chronic pain, sleep is often affected. Patients may wake regularly and experience anxiety associated with their ability to fall asleep and stay asleep. Sleep/wake cycles can be disturbed, as can the time of day a patient sleeps (they may be sleeping during the day and awake at night, for example).
• Low mood – when sleep is disturbed, mood is often affected. Pain pathways run through the mood centres in the brain, and when pain is severe, mood can become low. Depression can intensify pain, and anxiety can often accelerate it. Finding strategies to address low mood can enhance sleep quality and make it easier for patients to manage their pain better.
• Self talk – such as “I am angry”, I am never going to get better” and “I am scared” is addressed with techniques such Acceptance and Commitment Therapy. This technique allows the patient to distance those thoughts.

 Lifestyle planning

We examine any external lifestyle factors that may influence your patient’s pain as part of our whole person approach to pain management.

For patients who have chronic pain, the idea of becoming healthy and well again can seem like turning the Titanic around. Heading in the direction of wellness is dependent upon what the patient’s goals are. We work on realistic, measurable goals together and help patients to achieve their goals in small steps.

Lifestyle goals may be as simple as walking for 5 minutes daily at the same time. Goals can also focus on:

• Sleep – sleep hygiene is an integral part of managing pain and a simple goal to improve sleep levels is to stop daytime sleeping.
• Limited muscle activity – pain limits muscle activity and tends to reduce local and whole body activity. Patients with a sore back who are accustomed to walking daily may be not only resting more, they may also be walking shorter distances, less often.
• Career adjustment – sometimes, advice and hope from an occupational physician about a suitable career adjustment may be part of the patient’s lifestyle plan.
• Appetite and weight – it’s also common for appetite and weight to be affected by pain. Reduced exercise will shrink muscle mass so that basal metabolic rate decreases and less calories are required. Patients can gain weight and may find it difficult to achieve physical and mental goals that would normally constrain unhealthy eating. We assess the patient’s diet and look at healthy eating options with our nutritionist. Regular visits with a menu coach can help patients to achieve their weight loss or healthy eating goals.

Procedures

We offer interventional pain procedures that give your patient the opportunity to re-establish a healthy lifestyle. To read more about the procedures we perform, go here.