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Pain treatments

Pain treatments

There are many causes for pain, many of which we do not fully understand. So whilst two people may describe similar pains, the cause of it, and its treatment may be very different. It is also for this reason, not all pains with a seemingly similar cause will respond the same with the same treatments.

In addition, the way that pain affects a person, how they feel, their relationships, work, social life and more will also be different for everyone.

This is where the skill and experience of Dr Keogh's individualised treatment plans pay off. His expansive knowledge and repertoire of treatment strategies gives his patients the best possible chance of finding the treatment, or treatments, that work for them.

Please use the gallery below to explore common treatments Dr Keogh is skilled in using.

 

The lists do not include all of the available treatments used so do not be concerned if you are interested in a particular treatment that is not mentioned.

If you have any general questions about treatments Dr Keogh offers, please contact us.

Assessment, diagnosis & treatment plan

  • Assessment includes:

    • Review of your comprehensive pain questionnaire.

    • Review of your pain history.

    • Review of your past medical history.

    • A complete pain medications review.

    • Review of your diagnostic tests.

    • A diagnosis.

    • A tailored treatment plan.

Diagnostic tests or blocks

  • May include additional specialised scans such as ultrasound, CT, SPECT or MRI scans.

  • May include additional specialised tests such as nerve conduction studies, EMG or QST studies.

  • May include diagnostic injections to further pin-down the source of your pain.

  • You may benefit from an opinion from another specialist such as a surgeon, neurologist or, psychiatrist - if a referral is needed, Dr Keogh will facilitate this.

Advanced medications management

  • Comprehensive review of your past & current pain medications.

  • An emphasis on reducing your reliance upon your pain medication, or stopping it altogether, where possible.

  • The use of non-opioid (non-morphine) based medications.

  • Access to sub-specialised pain medications.

  • Significant expertise in the use of novel and emerging medications for the treatment of pain.

  • Liaison with your community prescriber.

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Topical therapies

  • Topical therapies are creams, gels & medicated plasters applied to the skin.

  • They can be very useful for superficial sensitivity-type pain and often avoid a lot of the side-effects you may get with oral medications.

  • They may include:

    • Capsaicin (chilli pepper) derivatives.

    • Local anaesthetics such as lidocaine.

    • Expertly compounded anti-neuropathic and anti-inflammatory compounds.

    • Ketamine creams, often mixed with other compounds.

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Medication infusions

  • Medication infusions can be very useful for some patients.

  • Medication infusions usually require a patient to be admitted to hospital for between 5 & 7 days.

  • Sometimes ultrashort infusions over a few hours may be appropriate.

  • Typical medications used in infusions include:

    • Ketamine;

    • Lidocaine;

    • Calcitonin;

    • and others.

  • Infusions can sometimes be repeated more than once.

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Joint injections

  • Simple joint injections can be a very effective treatment for degenerative (wear-and-tear) joint pain or inflammatory joint pain due to conditions such as rheumatoid arthritis or ankylosing spondylitis.

  • A mixture of local anaesthetic and steroids or local anaesthetic and Platelet Rich Plasma (PRP) can be injected.

  • Joints which are commonly injected include:

    • The small joints of the wrists and hands.

    • The small joints of the spine (facet joints).​

    • The shoulder.

    • The sacroiliac (pelvic) joints.

    • Hip and knee joints.

    • Ankle joints.

  • But most joints can be injected.

Soft tissue & trigger point injections

  • Muscle and soft tissue (tendon, ligament and bursae) pain is often overlooked as a condition that causes too much of an issue or that can be treated by anything other than physiotherapy - this is not true.

  • In addition, very specific sensitive areas of muscle called trigger points or trigger zones, can be particularly painful.

  • These points can often be pin-pointed by patients with high levels of accuracy.

  • Dr Keogh is highly experienced at targeting muscle and soft tissue pains.

  • Injections of local anaesthetic and steroids, local anaesthetic and Platelet Rich Plasma (PRP) and Botox can be used.

  • Occasionally, the nerve supply to the muscle or soft tissue can be effectively targeted.

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Platelet Rich Plasma (PRP) injections & prolotherapy

  • Dr Keogh is an expert in the preparation and injection of Platelet Rich Plasma (PRP).

  • PRP is where a sample of your own blood is taken and then processed to remove the red-blood cells, leaving the plasma and platelet cells behind.

  • This process is carried out in the clinic and takes around 10 minutes.

  • This mixture is then injected, usually together with local anaesthetic, into the painful area.

  • Chemicals within the platelets called growth factors aid healing of injured and worn tissues.

  • PRP can be particularly useful in:

    • Osteoarthritis (wear-and-tear) of joints.​

    • Injured tendons and ligaments.

    • Muscle and soft tissue pain.

    • Bursitis.

    • Discogenic low back pain.

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Botox® therapy for pain

  • Botox is an injected drug which blocks the connection between nerve endings and muscle.

  • It may also help to decrease nerve sensitivity.

  • It has many uses including in the treatment of:

    • Migraine headache.

    • Myofascial (muscle) pain.

    • Cervical dystonia syndrome.

    • Temporomandibular joint pain.

    • Pelvic floor muscle dysfunction.

    • Pain related to spasticity (tightness) of muscles in certain neurological conditions.

  • Dr Keogh is experienced in the use of Botox for pain.

Nerve blocks, epidurals & nerve root (spinal) injections

  • Almost any nerve can be injected.

  • This can help to pin-point the source of pain (diagnostic injection) or help to treat inflamed and sensitive nerves (therapeutic injection).

  • Local anaesthetics with or without steroids are commonly used.

  • 'Epidurals' are injections, usually of local anaesthetics and steroids, given into the epidural space of the spine of the neck or low back.

  • They can be useful to treat pain coming form the discs of the spine when they are degenerate (worn).

  • They can also be very useful to teat nerve pain coming from the spine which may be felt as pain in the arms (brachalgia) or in the legs (sciatica). 

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Epidural hydrodilatation, epidurolysis / neuroplasty

  • Epidural hydrodilatation, epidurolysis / neuroplasty is a highly specialised technique performed as a day-case procedure under sedation.

  • Patients who have this procedure performed will typically have low back and leg pain that has persisted after a spinal operation, such as a spinal fusion, laminectomy or nerve root decompression.

  • It involves placing a catheter (thin plastic tube) into the epidural space to physically breakup adhesions (scar tissue) around the epidural nerves and inject medications to soften scar tissue as a result of surgery, or occasionally, infection.

Sympathetic nerve blocks

  • Certain types of pain can be caused through an issue in the sympathetic nervous system.

  • Common types of pain that may be caused in this way includes:

    • Certain types of headache and facial pain.

    • Some types of arm and leg pain such as in Complex Regional Pain Syndrome (CRPS).

    • Certain types of abdominal and pelvic pain.

  • Injections to the sympathetic nerves can help with this pain and includes:

    • Sphenopalentine ganglion blocks.​

    • Stellate ganglion blocks.

    • Thoracic chain sympathetic blocks.

    • Splanchnic and hypogastric blocks.

    • Ganglion of Impar blocks.

  • Stellate ganglion blocks may also be useful for non-pain conditions such as in the treatment of symptoms associated with:​

    • Post-traumatic Stress Disorder (PTSD).​

    • Dizzyness (vertigo).

    • Ringing / noises in the ears (tinnitus).

    • Loss of smell (anosmia).

    • Symptoms of long-COVID.

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Nerve Pulsed Radio-Frequency (PRF) treatment

  • Almost any peripheral nerve(s) can be targeted with a Pulsed Radio-Frequency (PRF) treatment.

  • This treatment does not destroy nerves but has the effect of resetting the nerve or decreasing its sensitivity to reduce pain.

  • In a PRF treatment, a fine needle is placed next to the sensitive nerve through which a mild electrical impulse is passed.

  • The discs of the spine and some joints can also be targeted with this treatment.

  • Common nerves targeted include:

    • The occipital nerves in patients with migraine and other headaches.​

    • The nerves of the face or mouth in people with trigeminal neuralgia.

    • The nerves supplying the shoulder, hip or knee.

    • The cervical and lumbar spinal nerves (dorsal root ganglia) in people with arm and leg pain.​

    • The cluneal nerves in people with low back pain.

  • It is common practice to have a diagnostic nerve block before being offered a PRF treatment.

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Nerve Radio-Frequency (RF) ablation / neurotomy

  • Nerve Radio-Frequency Ablation (RFA) is a treatment where nerves, usually to a painful joint, are cauterised to stop the pain signals.

  • Some people refer to this treatment as a neurotomy or rhizolysis.

  • This is achieved through specialised needles placed next to the nerve(s) which are heated up.

  • For some patients with joint pains, this can be a particularly successful treatment.

  • Common joints targeted in this way include:

    • ​The facet joints of the neck and low back.

    • The sacroiliac joints (SIJs) of the pelvis.

    • The shoulder joint.

    • The hip and knee joints.

    • The coccyx.

  • It is common practice to have a diagnostic nerve block prior to being offered an RFA treatment.

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Percutaneous Electrical Nerve Stimulation (PENS) therapy

  • Percutaneous Electrical Nerve Stimulation (PENS) therapy is a needle treatment designed to reduce sensitivity of nerves in patients with nerve pain.

  • It can be very effective where the area of pain and sensitivity is quite large and may be supplied by many small nerve fibres.

  • A little like a Pulsed Radio-Frequency (PRF) treatment, a mild electrical impulse is passed to the nerve(s) via a needle.

  • Painful scars following trauma or surgery can also be successfully treated with PENS therapy.

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Advanced spinal cord & peripheral nerve stimulator implantation.

  • Spinal Cord Stimulation (SCS) is a highly specialised technique where fine wires are implanted in the epidural space of the spine and electrical impulses passed directly to the spinal cord to reduce pain signal transmission.

  • The electrical impulses are powered by a small battery (like a cardiac pacemaker) implanted under the skin.

  • Peripheral Nerve Stimulation (PNS) is the same as Spinal Cord Stimulation except the fine wires are implanted next to nerves outside of the spinal column.

  • Not all types of pain can be treated by these therapies.

  • Dr Keogh will discuss with you if this is a treatment option for you.

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Education & self-management

  • Regardless of the type of pain you suffer, education and self-management strategies will often lie at the heart of Dr Keogh's comprehensive treatment plan.

  • Numerous studies have demonstrated that patients who are well informed about their pain and are motivated to work with their health professionals to help manage it, have significantly better outcomes.

  • Often, when pain is severe or has been present for along time, people become tired and develop negative behaviours which overall can be unhelpful, such as:

    • Over or under-doing things.​

    • Becoming fearful of movement, exercise or socialising.

    • Having low mood.

    • Having feelings of hopelessness and that nothing can be done to help.

    • Loosing sight of how to help yourself

  • Input form a pain psychologist, pain physiotherapist and / or a pain occupational therapist can help to address and undo these unhelpful behaviours.

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Pain psychology

  • Pain psychology is unlike the traditional-type therapy you may have been used to. It aims to:

    • R​educe mental stress.

    • Reduce physical stress and inflammation.

    • Help you better understand pain neuroscience (how the brain is involved in your pain) and how to re-wire it.

    • Help you think about and frame your pain in new ways.

    • Help you manage other conditions that have arisen due to your pain such as anxiety, depression and poor sleep.

    • Regain control if the pain has begun to control you.

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Pain physiotherapy

  • Pain physiotherapy is unlike the traditional-type therapy you may have been used to. It aims to:

    • Improve your understanding of your pain condition & to combat the fear of movement.

    • Use reconditioning exercises to reverse the effects of weakness, stiffness, poor balance and fatigue.  

    • Get you back to the physical activities you used to do using a graduated and structured program.

    • Give you strategies to prevent and manage pain flare ups.

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Pain occupational therapy

  • Pain occupational therapy is unlike the traditional-type therapy you may have been used to. It aims to:

    • Get you back to the activities that you need to do to live life.

    • Help you to better care for yourself.

    • Get you back to work or study.

    • Improve your ability to socialise and form relationships again.

    • Improve sleep and fatigue.

    • Decrease the bodies sensitivity to pain.

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