Dr Namal Senasinghe, Consultant in Pain describes pain and the various methods of pain treatment.
What is pain - Pain is an uncomfortable and an abnormal sensation which can be difficult to tolerate and can affect physically and mentally. People feel pain when a signal travels through the nerve fibres to the brain for interpretation. People react to this. One example is scratching the site to relieve pain when a mosquito bites. By doing this one would generate repeated sensations in the spinal cord where the whole pain pathway gets distorted. . As a result the mosquito bite sensation finds it difficult to enter the brain and thereby reduces the pain.
In the United Kingdom the NHS hospitals run pain clinics. There are private pain clinics as well. I did run a busy private pain clinic in England. Treating pain costs the U.K. government more than a billion sterling pounds per year. Treating back pain alone cost the U.K. government 800 million sterling pounds a year.
The pain clinic in a hospital is run by 2-5 consultants in pain medicine. I had five pain consultants. The current criteria to appoint a pain consultant in the UK should be double accredited with an additional fellowship in pain medicine. My generation would have two fellowships one in pain medicine. In Sri Lanka they have their own criteria that is, Board certification with the MD (SL) and training in pain medicine locally and abroad.In addition to pain consultants there is also a physiotherapist, psychologist, nurse specialist in pain and clerical staff.
Therefore, running a unit is expensive. It is multi disciplinary, where teamwork is key.
With these resources pain is treated in two ways.
1. Multi-disciplinary approach
2. Interventions carried out by pain consultants.
Multi-disciplinary approach is treating patients with psychotherapy, cognitive behavioural therapy, physiotherapy, hydrotherapy, reflexology, acupuncture and pain management programs. Interventions are carried out by specially trained consultants in pain medicine.
The procedures carried out:
Cervical Epidural
Thoracic Epidural
Lumbar Epidural
Caudal Epidural
Shoulder Injection
Knee Injection
Hip Injection
Cervical facet injection
Thoracic facet Injection
Lumber facet Injection
Cervical radio frequency denervation (RFD)
Thoracic RFD
Lumbar RFD
Dorsal Root ganglion blocks
Dorsal root ganglion Pulse RF
Lumbar Sympathetic block
RFD Sympathetic lumbar
Coeliac plexus block
Ilioinguinal N block
Femoral nerve block
Pulse RF femoral nerve
Genicular nerve block and RFD from for Knee pain
Intercostal nerve block
Paravertebral block
Botox injections for headaches
Trigger Point Injections
Occipital nerve blocks for headaches
Sacro iliac joint inj
Sacroiliac joint (RFD)
Suprascpular N block
Pulse radiofrequency of Suprascapular Nerve block for shoulder pain
Genicular nerve RFD for knee pain
Dr Namal Senasinghe MBBS, FFARCS, Dip in pain med, FFPMCA,CCST (UK) is a Consultant in Pain Medicine at the London Pain Management Centre, Colombo7.
He has an MBBS from the North Colombo Medical College Sri Lanka in 1991. He had his primary and secondary education at Trinity College, Kandy.Dr. Senasinghe immigrated to England in 1995 as a trainee doctor and did his postgraduate training in the United Kingdom. He underwent training in anaesthesia, intensive care and pain medicine for seven years in UK, of which four years were spent in the North Thames School of anaesthesia at St. Bartholomew’s and the Royal London hospital in London.
Towards the end of 2002 he received the certificate for specialist training in the UK (CCST) which allows one to function independently as a medical consultant.
Thus he was eligible to register as a specialist in the general medical council register, and was appointed as a Consultant pain medicine on March 1,2003 to the sixth largest NHS trust in the UK, the East Kent University NHS trust.
He came to Sri Lanka on February 25, 2020 on a break and decided to stay back due to the current situation in the world.
This prompted him to be of service to the Sri Lankans to relieve them of their misery which is pain, for some.