Pain Management


Introduction

Pain is a system of natural defence of the organism in order to maintain its integrity. This initial alarm signal indicates that something is not working well, that the organism has had an injury that may become a major disorder, and limits the quality of life of the person who suffers it, by conditioning his/her personal, social and professional life.

Pain is controlled by the nervous system and sometimes is a complex process. The intensity of the pain varies: it may be mild, a localized discomfort, or a severe pain. It can be acute and brief or appear as a long-term chronic disorder. Acute pain acts as a protection factor in humans, as it helps to avoid body injuries or situations of potential risk; and protects the affected area while it recovers.

Most of the problems of localized chronic pain are caused by overload, physical inactivity, or degenerative lesions.
Pain treatment is intended to palliate muscle and muscle fascia pain, tendinitis, ligaments and joints (knees, shoulder, ankles, finger); and also the bascule-nervous entrapment pains (carpal tunnel syndrome, or cubital tunnel, neck pains, low back pain), fingers and ankles.

To deal with chronic musculoskeletal pain, Clínica Planas has launched an innovative program to treat these ailments. The key to this treatment is based on the exact location of pain, that is, the "pain trigger" areas, which are usually areas of contracture or inflammation, resistant to the usual treatments.


Indications

The most common pains that can be treated are:


Head and neck
Headaches and many dizziness or vertigo can be caused by tensions and/or muscle contractions that can press vascular-nervous packets. They are usually found in muscle insertions in the occipital area (Arnold neuralgia) and in the muscle of the neck (sternocleidomastoid).

Cervical pain
Keeping the head fixed for long periods of time (watching TV, working with the computer for a long time, reading or ironing, among others) can overload muscles near the neck and shoulders, and discomfort can even appear in arms and hands; and in many cases, with loss of strength and tingling.

Shoulder pain
It can be caused by the muscles, tendons, and ligaments of the joint that limit the movement and in some cases, may affect the forearm and hand. The most common is the rotator cuff tendinitis due to the bone entrapment of tendons. This type of pain limits the common movement of arms and gestures such as combing your hair or raising your arms to put on a garment.

Pain in the elbow, wrist and hands
The most common elbow pain is the known as epicondylitis or tennis elbow. It involves the muscles and tendons of the forearm. It can be suffered by anyone who performs a repeated movement or position of the arm.
Daily activities, such as working with a computer, sewing or racket sports can cause swelling and pain in the hand, which is known as carpal tunnel syndrome. Hand pains can be caused by multiple causes, but the most frequent is tendonitis (especially of the thumb: De Quervain’s disease) of the joints of fingers due to arthritis, and contractures such as those of Dupuytren’s.

Lumbar pain, low back ache or lumbago
It is so common that it is estimated that 80% of the general population will suffer from lumbar pain, at least one episode in their lives. Only in 20% of the cases the cause of pain can be found, and in most of these cases the quadratus lumborum muscle is the responsible for it. It has the insertions in the iliac crests and vertebral spinous process.
The origin comes from sitting for a long time, wrong postures, or muscle weakness. When the pain radiates through the leg to the heel is called sciatica and may be due to an entrapment of the nerve roots that come off of the lumbar spine, but also to a pressure on the sciatic nerve due to an inflammation of the pyramidal muscle.

Trochanteritis or trochanteric bursitis
It is a common pain among people aged 40 to 60 that mainly affects the hip, with a higher incidence in women. Bursa is a tissue that acts as a pad between bones, muscles, and tendons of the hip, and can cause swelling by overloading.

Knee pain not caused by injury
If an injury has occurred, ligament or meniscal tear should be ruled out. The most frequent diseases are due to bursitis, meniscal tears, patellar tendinitis, osteoarthritis, division of iliotibial band syndrome, pes anserine inflammation, and patellar disorders such as chondropathy or chondromalacia patellae.

Leg, ankle and foot
Chronic pains caused by badly healed lesions of the ankle joint or astragalus, or the deviation of the normal axes of the joints are frequent. A common problem is plantar fasciitis (pain in the foot sole) and calcaneus spurs (heel pain). Pains of the big toe (bunions) are also common and can be treated.


What the treatment consists of

After a detailed examination of the affected area to identify the inflammation points, the areas with different intensity of pain are marked, and a map of the pain is drawn up.

The technique is carried out in a personalized way and consists of local treatment with infiltrations, using the finest needles of the market, which allows carrying out a treatment with very little pain.

The treatment with Plasma Rich in Growth Factors (PRGF) allows isolating and using the growth factors (bio-stimulating substances) present in the patient’s own plasma, in order to stimulate, enhance and accelerate tissue regeneration.

This technique allows taking advantage of the regenerative and anti-inflammatory factors that exist in the blood to correct the alterations of the affected tissues.

Obtaining plasma rich in growth factors is simple: it is just to extract a small volume of blood from the patient, put it into tubes with an anticoagulant, and separate the plasma fractions through a controlled centrifugation process for later use of this plasma rich in growth factors, platelets and regenerative elements.

To this plasma rich in growth factors, a local anaesthetic and an inflammatory treatment will be added, in case of inflammation. The patient should notice a significant pain relief soon after the treatment. It is important to note that the treatment is personalized and in each case it will be necessary to adapt the local treatments to be used.


Postoperative

The patient can go back to normal activity after the treatment, although there may be some slight discomfort the first 24-48 hours.
The treatment should be carried out once a month, and the usual is 3 sessions in 3 months.

The importance of a correct diagnosis

Pain is mostly treated with oral anti-inflammatory or analgesic drugs and in fewer cases with injectables. When pain has a general origin or is in well irrigated tissues, this type of therapy is usually effective; since the given drugs circulate mainly through blood. The problem occurs when pain is located in a poor vascularised area with low blood flow; products administered by other non local routes become ineffective, as they do not reach the trigger area of pain and/or inflammation.

If the areas of inflammation, pain and nervous entrapment are detected, this very limiting pathology can be stopped with a local treatment.


Benefits

With the first session, pain disappears and the patient’s quality of life improves.


Expert opinion

Dr. Jordi Ibáñez
Dr. Jordi Ibáñez

The treatment has a success close to 100%. In a first session, pain relief is immediate and only three months are necessary to say goodbye to localized chronic pain thanks to this new anti-inflammatory and regenerative treatment.

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