Treatment of Chronic Pain with Greater Precision and Efficacy
During ultrasound scanning (or sonography), a transducer is used to send high-frequency sound waves, which are inaudible to the human ear, into the body. These waves bounce off organs, muscles and tissues, creating echoes that are collected by the transducer and converted into images on an ultrasound machine. Other than being a common device used by OB/GYN (Obstetrics and Gynaecology) doctors to monitor the growth and take pictures of unborn babies, ultrasound also serves other medical purposes.
Traditionally, ultrasound is used mainly used for diagnostic purposes and to guide needle biopsy. The use of ultrasound allows its operator to capture real-time images of the structure and movement of the body’s internal organs, ligaments, joints as well as blood flowing through blood vessels. This versatility allows the use of ultrasound to guide therapeutic procedures such as joint or ligament injections, biopsy of nodules and insertion of intravascular monitoring lines.
Ultrasound’s role and effectiveness in managing pain
Pain is the common denominator of many medical conditions, and it can adversely affect a person’s quality of life. Apart from physical discomfort and disruption of daily activities such as sleeping and eating, pain often leads to emotional distress. Above all, pain that is not well controlled can develop into chronic pain.
Compared to conventional landmark or palpation techniques to injection medications, ultrasound greatly improves the accuracy of these injections to target areas such as nerve, muscle, tendon and ligament. As these structures are radiolucent and not seen under fluoroscopy (X-rays), the use of traditional fluoroscopic guided techniques to guide these injections has its limitations. Besides the precision, ultrasound-guided injections are also safer as important structures such as blood vessels can be identified and avoided to prevent intravascular puncture and other complications.
In recent years, there has been increased use of ultrasound-guided injection techniques – such as stellate ganglion block, piriformis muscle injection, pudendal nerve block, intercostal nerve block, facet joint injections and deep trigger point injections – to relieve chronic pain. The portability of the ultrasound machine also means that some of these procedures can be done in an outpatient clinic instead of hospital facilities such as operating theatre, which brings cost savings without compromising the quality of treatment.
A patient of mine, who suffered from sciatica-like pain (pain radiating from the back, down the hip and leg), showed no signs of lumbar nerve root impingement following a lumbar spine MRI (Magnetic Resonance Imaging) test. He was subsequently diagnosed with piriformis syndrome during a clinical assessment – his tight piriformis muscle was irritating the sciatic nerve below it, causing the symptoms to mimic nerve root compression. After receiving an ultrasound-guided injection into his piriformis muscle trigger points and a few sessions of physiotherapy to stretch and condition his muscles, the patient’s symptoms resolved completely.
As ultrasound scanning does not use ionising radiation (as used in X-rays), it is a modality that prevents both the patient and the one carrying out the procedure from radiation exposure. However, ultrasound is not suitable for certain chronic pain interventions such as intra-discal procedures. With the numerous research journals that acknowledge the efficacy of ultrasound-guided procedures, as well as strong recommendations from both doctors and treated patients, the use of ultrasound to guide chronic pain injections could become a common practice in the near future.
A Specialist’s Point of View – Written by Dr Wilson Tay
Dr Wilson Tay
Consultant Pain Medicine & Anaesthesiologist
Master of Medicine (Anaes) (Singapore)
Fellow of Interventional Pain Practice (World Institute of Pain, USA)
Certified Interventional Pain Sonologist (World Institute of Pain, USA)
Fellow of Academy of Medicine Singapore (Anaes)
Graduate Diploma in Acupuncture (Singapore)
APICARE PAIN CLINIC
Farrer Park Medical Centre
1 Farrer Park Station Road #14-09/10
Connexion Singapore 217562
Gleneagles Hospital Annexe Block
6A Napier Road #03-37C
Tel: +65 6513 3383 I Fax: +65 6443 9798
Dr. Tay is a Consultant Pain Specialist, Anaesthesiologist and the Medical Director of Apicare Pain Clinic in Farrer Park Medical Centre.
He graduated from the Faculty of Medicine, with a Masters of Medicine (Anesthesiology) from National University of Singapore. Upon completion of his specialist training, he undertook a multi-disciplinary Chronic Pain Clinical Fellowship at St Joseph Hospital in London, Ontario, Canada.
Dr. Tay specializes in performing minimally invasive interventional procedures to manage and treat various chronic pain conditions such as neck/back pain, headache, abdominal pelvic pain and cancer pain. He is highly skilled in using ultrasound to guide various chronic pain interventions, thereby improving efficiency, achieving better treatment outcome with greater precision and avoid exposure to radiation.
He consulted at the Pain Management Centre of Singapore General Hospital and is a Senior Clinical Lecturer with Yong Loo Lin School of Medicine, National University of Singapore as well as a Clinical teacher with Duke-NUS Graduate Medical School.
He is awarded Fellow of Interventional Pain Practice (FIPP) and a certified Interventional Pain Sonologist from the World Institute of Pain (WIP) in the United State of America and is a registered acupuncturist with Singapore Traditional Chinese Medicine Practitioners Board certified with the Singapore College of Traditional Chinese Medicine.
Dr. Tay is the Medical Director at Apicare Pain Clinic and a Visiting Consultant at Singapore General Hospital, Pain Management Centre. He is accredited with Farrer Park Hospital, all Parkway Hospitals (Mount Elizabeth Hospital, Gleneagles Hospital, Mount Elizabeth Novena Hospital, Parkway East Hospital), Mount Alvernia Hospital and Thomson Medical Centre.
He is a member of the Singapore Society of Anaesthesiologists and serving as Honorary Treasurer of the Pain Association of Singapore currently. He has published articles in numerous peer-reviewed medical journals and is frequently invited to speak at local and overseas conferences on pain related topics. He is also actively involved in teaching and conducting hands-on chronic pain intervention workshops.
Multi-Dimensional Pain Treatment Include
At Apicare Pain Clinic, we provide a comprehensive assessment, diagnosis and management of various painful conditions such as headache, neck/shoulder/back pain, abdominal pelvic, facial, nerve and cancer pain. We specialise in minimally invasive interventional pain procedures with special emphasis on using ultrasound to guide bedside injection therapy, improving efficacy and treatment outcome.
Our Clinic focuses on the diagnosis and comprehensive treatment of wide spectrum of pain conditions rising from acute, chronic to cancer pain. Using state of the art techniques, we are able to effectively treat complex painful conditions using ultrasound guided and minimally invasive pain procedures.