Chronic Pain Treatment & Diagnosis | Pain Spa, Bristol, UK

Migraine: New Treatments CGRP antagonists and Gepants

Calcitonin gene-related peptide (CGRP) monoclonal antibodies, or CGRP antagonists, are one of the newer treatment options for the prevention of migraine.In recent years, pharmaceutical companies have tested drugs in this class to dramatically reduce the frequency of migraine episodes for people with chronic migraine. Calcitonin gene-related peptide (CGRP) monoclonal antibodies work by bringing down levels of CGRP, which transmits pain. Monoclonal antibodies are a part of a drug class called biologics. These medications are taken by injection. The dosage and frequency of injection may vary depending on symptoms. Gepants block the CGRP receptor, and by doing this blocks the migraine mechanisms. So can gepants can be called “CGRP antagonists” or “blockers”. The most unique thing about gepants is that they can be used for the treatment of the attacks (Ubrogepant, Rimegepant), AND/OR for prevention (Atogepant, Rimegepant). That’s a new reality for migraine therapy. Up until now, acute treatments were taken as needed for the attack, and preventives were taken every day (for pills) to decrease the frequency of attacks. As a rule, acute medications were limited to 10-15 days per month due to the risk of medication overuse headache. With gepants, these concepts do not apply.

Costochondritis

Costochondritis is a type of musculoskeletal anterior chest wall syndrome. It is described as atypical, noncardiac chest pain of the costosternal joints or the costochondral junctions. It is also known as costosternal syndrome or parasternal chondrodynia, but distinct from Tietze syndrome.

Carpal Tunnel Syndrome

Carpal Tunnel Syndrome (CTS) is a prevalent condition characterized by the compression of the median nerve as it passes through the carpal tunnel in the wrist. It often causes pain, numbness, and weakness in the hand and wrist. This article explores the causes, pathophysiology, and various treatment options available for managing carpal tunnel syndrome, including medications, injections, and surgery.

Complex Post Traumatic Stress Disorder (cPTSD)

PTSD is a psychiatric disorder that can develop after a person experiences a traumatic event. Complex PTSD, also known as CPTSD, can result if a person experiences prolonged or repeated trauma over months or years. A person with the condition may experience additional symptoms to those that define PTSD.

Pelvic fooor hypertonicity (tight pelvic floor muscles)

A hypertonic pelvic floor occurs when the muscles in the pelvic floor become too tense and are unable to relax. Many people with a tense and non-relaxing pelvic floor experience pelvic health concerns such as constipation, painful sex, urgency and pelvic pain. A hypertonic pelvic floor may also be accompanied by tension in surrounding hip and pelvic muscles such as the piriformis, obturator internus, coccygeus and hamstrings.

Vulval Pain (Vulvodynia)

Vulval pain is a common gynecologic complaint. Studies of the general population have estimated that chronic vulvar pain is present in 8% to 15%1–3 of reproductive-aged women. It is neuropathic pain of at least 3 months duration that has recognised associated factors but the underlying cause of the condition is unclear.

Thoracic Back Pain

Spinal pain is a well recognised condition associated with significant personal and community burdens. The most common spinal regions studied are the lumbar and cervical spine, probably because of their strong and well-established associations with pain conditions, work-related injuries, intervertebral disc degenerative conditions, headaches and psychosocial disturbances. Compared to the lumbar and cervical spine, the thoracic spine has received less attention in terms of clinical, genetic and epidemiologic research, yet pain experienced in the thoracic spine can be equally disabling, imposing similar burdens on the individual, community and workforce.

Post Mastectomy Pain Syndrome

Several studies have shown that persistent pain after treatment for breast cancer is a common problem, ranging between 25% and 60% depending on definition, measurement, and methods of treatment. The term refers to pain in and around the area of surgery lasting beyond three months after surgery when all other causes of pain such as recurrence have been ruled out. Persistent pain after treatment has a considerable negative influence on the quality of life in breast cancer survivors.

Temporomandibular Disorders (TMDs) or TMJ Dysfunction

Temporomandibular disorders (TMDs) are a group of related musculoskeletal conditions affecting the masticatory muscles, the temporomandibular joint (TMJ), and associated structures. They are one of the most common causes of chronic orofacial pain. TMDs share clinical features, such as pain in the TMJ and surrounding structures, limitation of jaw movements, and/or sounds (such as clicking, popping, grating, or crepitus) from the TMJ.

Post Traumatic Stress Disorder (PTSD)

Post-traumatic stress disorder (PTSD) is a chronic anxiety disorder caused by seeing or experiencing traumatic events. The symptoms of PTSD include re-experiencing the event through flashbacks or nightmares, avoidance of stimuli which remind the victim of the traumatic event, and increased arousal, such as anxiety, anger or hypervigilance. A formal diagnosis of PTSD requires these symptoms to persist for at least a month and to cause significant disruption in one’s personal and/or professional life. The person with PTSD has clinically significant distress and/or functional impairment.

Genitofemoral Neuralgia

Genitofemoral neuralgia is a cause of neuropathic pain that is often debilitating in nature. It is characterized by chronic neuropathic groin pain that is localized along the distribution of the genitofemoral nerve. Genitofemoral neuropathy has been attributed to iatrogenic nerve injury occurring during inguinal and femoral herniorrhaphy, with cases developing after both open and laparoscopic techniques. Diagnosis of genitofemoral neuralgia can be challenging, due to the overlap in sensory distribution the nerve shares with the ilioinguinal and iliohypogastric nerve.

Migraine Headaches

Migraine is a common, multifactorial, disabling, recurrent, hereditary neurovascular headache disorder affecting 15% of the population during the formative and most productive periods of their lives, between the ages of 22 and 55 years. It usually strikes sufferers a few times per year in childhood and then progresses to a few times per week in adulthood, particularly in females. Attacks often begin with warning signs (prodromes) and aura (transient focal neurological symptoms) whose origin is thought to involve the hypothalamus, brainstem, and cortex.

Complex Regional Pain Syndrome (CRPS)

Complex regional pain syndrome (CRPS) is a debilitating condition, characterised by pain in a limb, in association with sensory, vasomotor, sudomotor, motor and dystrophic changes. It commonly arises after an injury to that limb. Pain is typically the leading symptom of CRPS but is often associated with limb dysfunction and psychological distress. Patients frequently report neglect-like symptoms or a feeling that the limb is ‘alien’.

Chronic Fatigue Syndrome (CFS)/ ME

Chronic fatigue syndrome (CFS) is a serious disorder characterised by persistent post-exertional fatigue and substantial symptoms related to cognitive, immune and autonomous dysfunction. Disease mechanisms are complex with no single causal factor identified. Yet there are indications that infections and immunological dysfunction contribute to development and maintenance of symptoms, probably interacting with genetic and psychosocial factors.

Intractable Hiccups

‘Intractable hiccups’ are present if the attack lasts more than 1 month. The incidence and prevalence of persistent and intractable hiccups in the community have not been studied. Hiccups are more common in diseases affecting the gastrointestinal or central nervous systems. Up to 20% of patients with Parkinson's disease and 10% of patients with reflux symptoms complain of recurrent hiccups compared to approximately 3% of controls.

Dorsal Scapular Nerve Entrapment Syndrome

Dorsal scapular nerve (DSN) entrapment syndrome is an under-recognized cause of neck and shoulder pain. DSN injuries can be the origin of a well-defined chronic pain syndrome, often referred to as DSN syndrome. DSN syndrome is often characterized by a dull ache along the medial border of the scapula. The dorsal scapular nerve may be injured in the neck (at the scalenes) or in the thoracic back at the level of the rhomboids.

Supraorbital Neuralgia

Supraorbital neuralgia is characterized by persistent pain in the supraorbital region and forehead with occasional sudden, shocklike paresthesias in the distribution of the supraorbital nerve. Supraorbital neuralgia is the result of compression or trauma of the supraorbital nerves as the nerves exit the supraorbital foramen.

Ilioinguinal Neuralgia

Ilioinguinal neuralgia is one of the most common causes of lower abdominal and pelvic pain encountered in clinical practice. Ilioinguinal neuralgia is caused by compression of the ilioinguinal nerve as it passes through the transverse abdominis muscle at the level of the anterior superior iliac spine. The most common causes of compression of the ilioinguinal nerve at this anatomic location involve injury to the nerve induced by trauma, including direct blunt trauma to the nerve, as well as damage during inguinal herniorrhaphy and pelvic surgery. Rarely, ilioinguinal neuralgia can occur spontaneously.

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