Management of pain problems may require manual therapies, pharmacotherapy, referral to allied health professionals including physiotherapists, osteopaths, chiropractors, psychologists, psychiatrists, occupational therapists and physicians, ACC programmes etc. Acute pain problems should be aggressively treated so as to prevent chronicity which may have profound effects on the patient and family.

Patients with sciatic pain (leg pain) after a prolapsed disc with abutment or compression of a nerve root may get significant relief from injections into the site of bupivacaine and a steroid. These injections are only given under x-ray guidance for safety reasons and usually after the patient has had an MRI.

Any joint in the upper or lower limbs may be a source of pain, and intra-articular injection may be the best treatment option. Often these can be done as an office procedure but the more complex ones may require x-ray guidance such as the hip joint, sacrococcygeal joint etc. The advantage is that joint entry can be confirmed with contrast, thus maximising the treatment effect.

Peripheral nerve blocks are interventions which involve injections of local anaesthetic and/or steroids around peripheral nerves in order to influence pain phenomena. These can include injections under the flexor retinaculum at the wrist for carpal tunnel syndrome, injections around the suprascapular nerve for varieties of shoulder and periscapular pain, occipital nerve blocks for occipitalgia and headaches, ilio-inguinal nerve blocks, intercostal nerve blocks, lateral femoral cutaneous nerve blocks, genitofemoral nerve blocks, and diagnostic cervical and lumbar medial branch blocks for the diagnosis of chronic pain in those regions.

Spinal facet joint injections can be done for non-radicular back pain, and can be done precisely under x-ray guidance. In the office a peri-facet injection can be performed without x-ray and may be the first approach used.

Sacroiliac joint pain can be disabling and often occurs after a direct blow to the sacral region, such as slipping and falling onto one's bottom. Typically pain is felt over the lower sacral area and may extend in a somatic fashion down the back of the thigh. Often pain is felt in the lateral hip region and a small percentage of patients experience ipsilateral groin pain. The injection is performed with x-ray guidance, and intra-articular positioning is validated by an arthrogram with contrast medium. The effectiveness rate is 40-70%.

Occipital nerve blocks can be performed as an office procedure without imaging guidance. They are done for occipital pain and headaches of various types.

Most muscles in the body can produce ongoing pain and disability. Sometimes this is associated with the presence of trigger points which sometimes resolve with injections of local anaesthetic and/or steroid injection.

Ongoing pain can be a very difficult problem to manage and may require advanced techniques or medication to control the pain.

Chronic pain syndromes are those situations where pain has continued long after any damage or precipitating cause would have reasonably been expected to have settled. In these situations, the pain is not a symptom of disease but can be regarded as a disease in its own right. Accordingly it needs special management which may involve a variety of medical professionals and specialists e.g. interventional pain specialists, physiotherapists, assessors of disability or work capacity, cognitive behavioural specialists, psychiatrists, surgeons etc.

Most headaches are not due to significant underlying problems, but you may be referred if your GP is worried about the nature of your headaches or you are having difficulty controlling them with standard treatment. Migraine headaches are common in the community, and are repeated or recurrent headaches, often accompanied by other symptoms, and triggered by certain factors/events/foods. In some people, a visual disturbance called an aura happens before the headache starts. Nausea, vomiting, intolerance of light are frequent features. Other headaches, especially those which start in the back of the head, can be initiated from neck problems and have a variety of different causes and patterns. The treatments offered will depend on the cause. More rarely, especially after an accident, headaches may indicate concussion or intracranial bleeding, and will need special management.

Carpal Tunnel Syndrome is caused by a pinched nerve in the wrist that causes tingling, numbness and pain in your hand, and especially night pain. Some patients may respond to an injection of steroid at the wrist.

Rarely, post-surgical scars may be associated with a special burning pain and some of these may respond to steroid injection therapy.

Otherwise known as degenerative arthritis, OA occurs when there is a breakdown of the cartilage surrounding the joint. It is very common and usually affects people as they get older. The symptoms can be very mild with just occasional pain with activity. Worsening symptoms include pain with activity and stiffness with rest. Joints can become swollen and restricted in movement. Joints can change shape as the bone changes in response to loss of protection. You otherwise feel well. The diagnosis is made on the basis of the history, examination findings and sometimes x-rays. The severity of joint damage seen on x-ray does not always correlate with the degree of pain you experience. Treatment includes guided exercises, weight reduction if needed, pain relief and sometimes joint injections or surgery. For more information see www.arthritis.org.nz