Spinal Pain

CONDITIONS


  • Neck Pain

  • Low Back Pain

  • Sciatica Pain

  • Headaches

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Neck Pain


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Neck Pain


What causes neck pain?

Neck pain can result from muscle sprain, ligament strain, facet joint pain or slipped discs (discogenic pain). Facet joints are the small joints between the bones in the spine. Besides causing neck pain and headaches, slipped discs can also press onto nerves and lead to pain and numbness that radiate into the arms.

Whiplash injury and age-related degeneration are the common causes for neck pain. Poor workplace ergonomics and bad sleeping posture perpetuate the condition.

What is the treatment for neck pain?

In general, painkillers, exercises, physiotherapy and correction of poor posture are all that is necessary. Patients who do not recover despite conservative management may require interventional pain therapy.

What are the common types of interventional pain therapy?

These include muscle trigger point injections, epidural steroid injections, nerve root blocks, facet joint injections, disc decompression (nucleoplasty) as well as radiofrequency ablation.

Depending on the source of your pain, your doctor will advise you on the appropriate therapy.

Whiplash Injury


What is whiplash injury?

It is an injury to the neck which results from sudden forceful movement of the head forward and then backwards. This commonly occurs from a rear-end vehicle collision, but may also happen after physical trauma, sports injuries and even roller-coaster rides.

What are the symptoms of whiplash injury?

Symptoms may develop immediately or a few days after the incident. They include neck pain and stiffness, headache, dizziness or unsteady gait.

However, if you experience numbness and weakness of the arms or legs, and loss of bladder or bowel control, please seek immediate medical attention.

How is whiplash injury treated?

Most people will recover with rest, gentle stretching exercises, physiotherapy and painkillers. If you have severe pain or worrisome symptoms, you may need X-rays, CT or MRI scan of the cervical spine.

In some cases, cervical facet joint injections, epidural steroid injections or disc annuloplasty may be needed.

Low Back Pain


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Low Back Pain


What causes low back pain?

Low back pain can result from muscle sprain, ligament strain, facet joint pain or damaged intervertebral discs (discogenic pain). Besides trauma or injury, the commonest cause for low back pain is age-related degeneration.

Facet joints are the small joints between the bones in the spine. Besides causing low back pain, damaged discs can also press onto nerves and lead to sciatica – shooting pain that radiates into the legs.

What is the treatment for low back pain?

In general, painkillers, physiotherapy and early mobilisation will help about 80% of all cases of low back pain. Patients who do not recover despite conservative management may require interventional pain therapy.

What are the common types of interventional pain therapy?

These include muscle trigger point injections, epidural steroid injections, nerve root blocks, facet joint injections, disc decompression (nucleoplasty), annuloplasty, transdiscal biacuplasty as well as radiofrequency ablation.

Depending on the source of your pain, your doctor will advise you on the appropriate therapy.

Spinal Stenosis


What is spinal stenosis?

Spinal stenosis is a condition where there is narrowing within the spine, causing compression of the spinal cord and the nerve roots exiting from the spine.

It can affect the neck (cervical spinal stenosis) or low back (lumbar spinal stenosis).

What are the symptoms of spinal stenosis?

Symptoms include neck or back pain, numbness, tingling or weakness in the arms and legs. In lumbar spinal stenosis, you may feel pain after walking a short distance and pain is relieved upon sitting down to rest.

Progressive weakness in the legs, loss of bladder or bowel control can also occur in severe spinal stenosis.

How is spinal stenosis treated?

Pain medication, physiotherapy and exercises can help alleviate symptoms temporarily.

Depending on the severity of the spinal stenosis, some patients may benefit from epidural steroid injections, and/or percutaneous disc decompression before definitive surgery.

Herniated Disc or Radiculopathy


What is radiculopathy?

Radiculopathy occurs when the nerve is pinched when exiting from the spine. It is most commonly due to a herniated disc (or slipped disc) in the neck or back that is compressing the nerve.

Bone spurs, thickened ligaments, cysts or tumours can also cause radiculopathy.

What are the symptoms of radiculopathy?

Sharp, lancinating pain radiating into the arm or leg, associated with tingling sensation, numbness or weakness. There may also be loss of sensation in the arm or leg.

How is spinal stenosis treated?

Non-surgical treatment include pain medication, physiotherapy and rest.

Epidural steroid injections, nerve root blocks, pulsed radiofrequency and percutaneous disc decompression are some minimally-invasive procedures that can be effective.

Severe cases of radiculopathy will require surgical decompression.

Tailbone Pain (Coccydynia)


What is coccydynia?

Coccydynia is the medical term to describe pain in the tailbone, which lies at the end of the spinal column. It can result from trauma after a fall, repetitive injury from sports such as rowing or cycling, and from childbirth.

Being overweight or underweight may also lead to coccydynia.

What are the symptoms of coccydynia?

Pain localised to the tailbone, which is worse with sitting. Sitting on hard surfaces or leaning backwards when sitting almost always aggravates symptoms.

How is coccydynia treated?

Avoid prolonged sitting, using a wedge- or donut-shaped cushion when sitting, strengthening pelvic muscles and taking pain medication when necessary.

Severe cases may benefit from steroid injection, nerve blocks, or radiofrequency ablation of the ganglion impar. Surgical resection (coccygectomy) is rarely performed and may not guarantee that the pain will resolve.

Piriformis Syndrome


What is piriformis syndrome?

The piriformis is a small, deep muscle in the buttock. Piriformis syndrome occurs when the piriformis compresses the sciatic nerve causing pain and inflammation.

Prolonged sitting, long-distance running, climbing stairs, tight muscle from lack of exercises are common causes of piriformis syndrome.

What are the symptoms of piriformis syndrome?

Aching or sharp pain in the buttock with pain radiating into the leg. There may be associated tingling sensation, numbness or weakness in the affected leg.

Symptoms are aggravated by sitting, walking or running.

How is piriformis syndrome treated?

Non-surgical treatment include rest, stretching and strengthening exercises, taking pain medication and muscle relaxants.

Persistent pain may need piriformis muscle injection with either local anaesthetics or Botulinum toxin. Injections are performed under ultrasound guidance.

Sciatica Pain


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Sciatica Pain


What is Sciatica?

Sciatica is a condition characterised by pain along the sciatic nerve path, from the lower back through the hips and buttocks, down to the legs. It’s typically caused by a “pinched nerve” in the spine due to a herniated disc, bone spur, or narrowing of the spine, known as spinal stenosis. This compression results in pain, inflammation, and sometimes numbness in the affected leg.

Symptoms, Impact, and Treatment Options

The symptoms of sciatica can vary, ranging from a mild ache to severe discomfort that intensifies with activities like sitting or standing for long periods. It can significantly impact daily life, affecting mobility and comfort.

While the pain can be intense, most cases of sciatica may improve with time and non-surgical treatments. However, severe sciatica, causing significant weakness or changes in bowel or bladder function, may require surgical intervention.

Symptoms of Sciatica Pain

Understanding the symptoms of sciatica is crucial for recognising the condition and seeking timely medical assistance. Sciatica pain can manifest in various forms, from a mild tingling or dull ache to an intense burning sensation. In some cases, the pain can be so severe that it limits mobility.

Typically, sciatica affects only one side of the body, however the pain pattern varies among individuals. Some may experience sharp pain in a specific part of the leg or hip, coupled with numbness in other areas. This pain or numbness often extends to the back of the calf or the sole of the foot. One of the notable symptoms is the weakness of the affected leg, which can affect walking stability and cause the foot to drag. The onset of sciatica pain can be gradual, but certain actions or times of the day can exacerbate it.

Prolonged sitting or standing often worsens the pain. It may also become more intense at night or during activities that trigger pressure on the lower back, such as sneezing, coughing, or laughing – especially if caused by a herniated disc. Additionally, actions like bending backward or walking more than a short distance can aggravate the pain, particularly if the cause is spinal stenosis. People with sciatica may also experience discomfort when engaging in activities that increase spinal canal pressure, such as straining or holding the breath, like during a bowel movement. For an in-depth understanding of sciatica, it’s advisable to consult healthcare professionals who can provide personalised guidance and treatment options based on individual cases.

Causes of Sciatica

Sciatica’s origin lies in issues affecting the sciatic nerve, leading to varying levels of pain and discomfort. This nerve stretches from the lower back, through the hips, and into each leg, and its irritation or compression can result from several conditions:

  • Slipped or Herniated Disc
  • In a slipped or herniated disc, the disc in the spine protrudes and compresses the sciatic nerve. This may result in pain in the lower back and legs, which can range from mild to severe. Additionally, it may cause inflammation and sometimes numbness, due to the nerve’s impact on both sensory and motor functions.
  • Spinal Stenosis
  • This condition involves the narrowing of the spinal canal, leading to compression of the sciatic nerve. Symptoms include leg pain and discomfort, with severity ranging from mild to severe, much like a herniated disc. Numbness and inflammation can also occur.
  • Piriformis Syndrome
  • The piriformis muscle in the buttocks spasms, irritating the sciatic nerve. This results in pain predominantly in the back of the legs, similar in intensity to that caused by a herniated disc, along with possible numbness.
  • Pelvic Injury or Fracture
  • Any trauma to the pelvic region may affect the sciatic nerve, leading to symptoms akin to those from a herniated disc, including pain and potential numbness.
  • Tumours
  • When tumours develop in the spine or near the sciatic nerve, they may lead to sciatica-like symptoms, including pain and discomfort. Additionally, if the tumour is malignant, it can also contribute to cancer pain in the affected area, necessitating a careful and thorough medical evaluation to address the cancer and resulting nerve pain effectively.
  • Spondylolisthesis
  • In this condition, a spinal bone slips out of place, compressing the nerve roots that form the sciatic nerve. The resulting pain and discomfort can be similar to that experienced with spinal stenosis or a herniated disc.
  • Age and Gender Factors
  • Men in the 30 to 50 age range are more likely to experience sciatica. The reasons for this age and gender-specific prevalence are not entirely clear but may relate to physical activities and lifestyle factors common in this demographic.

In some cases, despite thorough investigation, the exact cause of sciatica may remain elusive. This highlights the importance of comprehensive evaluation by healthcare professionals to determine the most effective treatment strategy.

Understanding the underlying cause is key to the provision of pain relief and improving the patient’s quality of life. In situations where the cause is not immediately clear, or if symptoms persist and significantly impact daily life, it’s essential to seek medical advice for proper diagnosis and treatment planning.

Sciatica Treatment Options

Sciatica treatment in Singapore encompasses a range of approaches, tailored to the specific cause and severity of the condition.

  • Conservative Sciatica Pain Treatment
  • The initial strategy often involves conservative treatment, focusing on managing pain and reducing inflammation. This includes the use of over-the-counter pain relievers such as ibuprofen or paracetamol. Applying heat or ice to the affected area is also recommended, typically starting with ice for the first 48 to 72 hours, then switching to heat.

    Rest is not generally advised; rather, maintaining moderate activity levels is beneficial. Early on, specific back exercises are recommended to strengthen the back and improve flexibility. After a couple of weeks, patients are encouraged to gradually resume their usual activities, while avoiding heavy lifting or twisting movements for the first six weeks.

    In Singapore, where access to varied healthcare options is available, physical therapy is a commonly suggested part of the treatment plan for sciatica. This may include exercises to strengthen core muscles and increase spine flexibility, further aiding in pain management and recovery.
  • Minimally Invasive Sciatica Treatment
  • When conservative treatment is not effective, minimally invasive options are explored. Epidural steroid injections, for instance, are used to reduce swelling and relieve pain around the sciatic nerve. Another option is disc decompression, aimed at alleviating pressure on the nerve. These methods can provide significant relief, especially when standard medications fall short.
  • Sciatica Surgery
  • Surgery for sciatica pain is generally considered a last resort, primarily used when other treatments have not provided sufficient relief and is typically performed to relieve the compression of spinal nerves. Surgical interventions are undertaken with careful consideration, usually after exploring all other less invasive treatment options. Each of these treatment approaches is decided upon after thorough consultation with your pain management specialist, ensuring that the chosen method aligns with your overall health status and treatment goals.

Strategies to Help Prevent Sciatica

Adopting certain lifestyle changes and habits can significantly reduce the risk of developing sciatica, although prevention is not always possible:

  • Regular Exercise
  • Incorporating exercises that strengthen the back and core muscles is crucial. These exercises support the spine, reducing the likelihood of nerve compression.
  • Good Posture and Stretching
  • Maintaining proper posture, particularly during prolonged sitting, and regular stretching can help alleviate and distribute the pressure on the spine evenly.
  • Maintaining a Healthy Weight
  • Excess weight can increase stress on the spine. Keeping a healthy weight helps in reducing this stress, potentially lowering the risk of sciatica.
  • Healthy Lifestyle Choices
  • Ensuring sufficient sleep, staying hydrated, and avoiding harmful habits like smoking are essential for spine health. These factors collectively contribute to overall well-being and reduce the risk of spinal issues.
  • Low-Impact Activities
  • Engaging in low-impact exercises such as swimming, walking, yoga, or tai chi can keep the spine flexible and strong without exerting excessive pressure.

These preventive measures are not a guarantee but can play a significant role in maintaining spinal health and potentially reducing the risk of developing sciatica.

Seek Help to Relieve Sciatica Pain

When it comes to the management of sciatica pain, there is a need for a comprehensive and patient-centric approach. As such, pain management specialists such as those from The Pain Clinic will begin with in-depth assessment to understand an individual’s pain pattern and health to form the basis of a personalised treatment plan.

This plan includes various treatment methods in line with Singapore’s medical standards, with an emphasis on enhancing one’s quality of life. These treatments are selected to match each patient’s unique needs, ensuring targeted pain relief. However, it should be noted that such treatments are never a one-size-fits-all solution.

The response and tolerance to pain treatments vary from person to person, therefore periodic reviews and modifications of the treatment plan and care for the patient are necessary for better results.

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Headaches


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Headaches


What causes headaches?

There are many causes of headaches. When headaches persist, it is important to exclude sinister causes including encephalitis, meningitis, tumours and stroke. Other causes may include tension headache, migraine, cluster headache and cervicogenic headache.

Can headaches be treated without medications?

Migraine that is not responding to oral medication may respond to Botulinum toxin injections of the muscles of the face, head and neck.

Cervicogenic headaches arise because of abnormalities in the neck or cervical spine. Steroid injections or nerve blocks of the cervical facet joints or radiofrequency ablation of the nerve supply to the facet joints may help relieve cervicogenic headaches.

What is radiofrequency (RF) ablation?

RF ablation utilises RF energy that is generated through a machine to create heat. This heat is transmitted through a special RF needle to destroy the painful nerve branches of the cervical facet joints. This is a day surgery procedure that is performed under X-ray guidance with mild sedation.

Frequently Asked Questions (FAQs)

About Sciatica Pain

What is the best position to sleep if I suffer from sciatica pain?

For sciatica pain relief during sleep, adopting a foetal position with a pillow between your knees is recommended. This position will help “open up” the spinal canal. Alternatively, lying on your back with a pillow under your knees may also potentially reduce pressure on the sciatic nerve, offering much needed relief.

What triggers a sciatica flare-up?

Common triggers of painful sciatica flare-ups include prolonged sitting, poor sitting or standing posture, heavy lifting, and sudden movements. Stress may also be a contributing factor, as are lifestyle aspects such as being overweight or frequently wearing high heels. Therefore, it is crucial to make relevant lifestyle and posture adjustments that can help prevent future flare-ups.

What is the best form of pain relief for sciatica?

Relief from sciatica pain often combines physical therapy, over-the-counter pain relievers, and the application of hot or cold compresses. Regular physical activity and targeted exercises to strengthen the back and core muscles are crucial for ongoing pain management and prevention. Always consult a qualified medical professional for personalised treatment options.

How can I alleviate my sciatic nerve pain without going through surgery?

To manage sciatic nerve pain non-surgically, a combination of regular exercise, physical therapy, heat or cold therapy, and over-the-counter pain medication may be helpful. It’s also important to avoid activities that worsen the pain and to maintain good posture. Consult a pain management specialist for personalised recommendations of non-surgical treatment options. It is also important to note that in some cases, surgery may be necessary for long-term relief from sciatica pain.

Insurance and Health
Network Coverage

We work with various insurance partners to assist with your hospitalisation and surgery claims. In some instances, pre-approval from your insurer allows direct billing between the hospital and insurer so that you will have peace of mind during your treatment. We are MOH-accredited so you may also utilise Medisave for your hospitalisation expenses.

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