New centre at Mediclinic Hermanus offers hope to patients with chronic pain
Posted on 18 December 2017
Chronic pain management requires knowledge about the type of pain and its origin, and how each patient may respond to treatment. Orthopaedic surgeon and pain interventionist Dr Pierre de Villiers talks to us about diagnosing and managing chronic pain.
Orthopedic surgeon Pierre de Villiers recently completed a fellowship in pain management at the World Institute of Pain in Budapest, Hungary. Now back at his practice in Hermanus, he will be operating from the town’s new Pain Centre.
He gives referring doctors more information about the benefits pain specialists can offer their patients.
Pain specialist are trained to identify the source of a patient’s pain, and decide on the best method of management for that patient. Not only do the underlying causes require treatment, but more often than not the condition leads to changes in the peripheral and central nervous system that also require attention.
‘While general practitioners or other medical specialists understand the importance of pain management and usually offer their patients adequate solutions, general medical education in pain management is quite limited,’ he explains.
‘Because pain specialists submit themselves to additional training, and we see more patients with chronic pain, we’re even better equipped to deal with this problem, especially with more difficult cases.’
Chronic pain affects the whole body and can be a ‘disease’ in itself. It’s therefore crucial to not only target the source of the pain but also to manage the patient in his or her totality.
‘We offer the spectrum of pharmacological management of pain, and also referral of patients to other appropriate role-players such as psychologists and physical therapists. We’re also trained to perform targeted delivery of active substances such local anaesthetic or cortisone in close proximity to painful structures, such as spinal nerves in the epidural space, and also in close proximity to specific nerve-tissue bundles (ganglia) that are crucial in relaying pain impulses to the brain. Certain parts of the nervous system are also amenable to temporary inactivation by the application of a radiofrequency energy through the meticulous placement of special needles,’ he says.
‘Cancer patients often have disabling pain that we can manage in various ways. There is no need for a patient with terminal cancer to also suffer from disabling pain. Controlled delivery of an analgesic substance into the spinal canal offers these patients exceptional control of their pain. Pain interventionists are an additional tool in the management of a patient with chronic pain and not an alternative to surgery.’
What type of conditions would be referred to you?
‘Chronic pain is a worldwide epidemic and is too frequently undertreated. Most of our patients have chronic pain, and specifically pain that’s resistant to normal treatment,’ says Dr de Villiers.
‘But we don’t deal only in chronic pain. For example, we offer patients with osteoporotic compression fractures of the vertebra a vertebroplasty and kyphoplasty (procedures in which bone cement is injected through a small hole in the skin into a fractured vertebra), which affords substantial relief of their acute pain and prevents the onset of long-term disability.’
The pain management will depend on the condition that is causing the pain as well as how well the patient responds to certain treatments says Dr de Villiers. For example, the pain caused by fibromyalgia, while incurable, could be managed with a combination of pharmacological and non-pharmacological interventions.