Pain & Palliative Care

Our department provides a wide variety of services:

• Diagnostic tests and procedures
  • C-arm guided diagnostic nerve blocks for chronic pain: Minimally invasive procedure performed using X-ray imaging; signals from specific nerves are temporarily blocked to identify the source of chronic pain.
  • Point-of-care ultrasound-guided diagnostic nerve blocks for chronic pain: The use of ultrasound to perform nerve blocks, i.e., temporarily blocking signals from specific nerves; the ultrasound helps doctors visualise the needle and the structures surrounding the target nerves.

• Treatments for pain
  • Pain nerve-blocking injections or nerve blocks
  • Pain nerve ablation (or radiofrequency ablation):The use of heat energy generated by radio waves to eliminate or inactivate pain-causing nerves in various regions, such as the face and spine.
  • Pain interventions (including minimally invasive pain interventions):
    • Abdominal wall blocks: Regional anaesthesia/pain relief techniques involving injection of a local anaesthetic around the nerves in the abdominal wall.b. Brachial plexus and lumbar plexus block: Regional anaesthesia/pain relief techniques involving injection of a local anaesthetic around the network of nerves that transmit signals from the spinal cord to the shoulder and upper limbs (brachial plexus) and those that transmit signals from the spinal cord to the lower limbs (lumbar plexus).

    • Chest wall blocks: Regional anaesthesia/pain relief techniques involving injection of a local anaesthetic around specific nerves in the chest wall; these include the following: 

      a. Intercostal nerve blocks: Injection of a local anaesthetic in and around the intercostal nerves, which run under each rib.

      b. Pectoral nerve blocks: Injection of a local anaesthetic in and around the pectoral nerves, which are located on the pectoral muscles, i.e., the muscles that connect the chest to the bones of the upper arms and shoulders.

      c. Serratus anterior plane block: Injection of a local anaesthetic between the serratus anterior muscle, a fan-shaped muscle extending from the upper ribs and along the inner border of the scapula (shoulder blade), and the latissimus dorsi, which is a large flat muscle extending from the back to the back of the humerus (the upper arm bone).

  • Facet joint injections: Minimally invasive pain relief procedures involving injection of a local anaesthetic in and around the facet joints, the paired joints present at the end of each vertebra in the spine.
  • Ganglion impar injections: Minimally invasive pain relief procedures involving injection of a local anaesthetic or anti-inflammatory medications, such as corticosteroids, around the ganglion impar, a network of nerves in front of the coccyx (tailbone).
  • Glossopharyngeal nerve block: The injection of a local anaesthetic near the glossopharyngeal nerve, which controls the functions of organs and processes around the mouth and throat, such as taste, saliva production, and swallowing.
  • Sphenopalatine block: Injection of a local anaesthetic in and around the sphenopalatine ganglion, a nerve cluster located behind the nose that is involved in tear production, nasal congestion, headaches, and saliva secretion.
  • Splanchnic nerve block: Injection of a local anaesthetic in and around the splanchnic nerves, which carry pain signals from the spinal cord to the abdominal and pelvic organs.
  • Stellate ganglion block: Injection of a local anaesthetic in and around the stellate ganglion, a nerve cluster located at the bottom of the front side of the neck that is involved in controlling blood pressure, sweating, and heart rate.
  • Superior hypogastric plexus block: Injection of a local anaesthetic in and around the superior hypogastric plexus, a nerve network in the pelvic region; blocking reduces pelvic pain.
  • Transforaminal epidural steroid injections: Injection of steroid medications into the epidural space, which is the region between the membrane surrounding the spinal cord and the vertebrae.
  • Ultrasound-guided musculoskeletal injections: The use of ultrasound to visualise the needle and surrounding regions to inject specific medications, including anaesthetics, into regions in the musculoskeletal system to block pain signals originating from specific nerves.
  • Platelet rich plasma therapy (PRP Therapy): The injection of a concentrated platelet sample derived from the patients themselves into an injured area to enhance regeneration and healing.

• Caregiver support in families whose relatives are affected by disease: We adopt several treatment strategies in palliative care. These strategies are highly personalised and involve multi-disciplinary meetings, analysing case histories in detail, and tailoring plans to include the following:
  • Medical management using the best possible treatment guidelines.
  • Minimally invasive surgical procedures and pain management interventions.
  • Supportive management including psychosocial support and rehabilitation services.