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.

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.

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.

Otherwise known as degenerative arthritis. OA occurs when there is a breakdown of the cartilage, leaving the bones unprotected. It is very common and usually affects people as they get older. You can get it at any age and are more likely to if you have previously injured a joint, or are overweight. 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 surgery. For more information see www.arthritis.org.nz

This is a syndrome of widespread aches, pains and fatigue. There may be morning stiffness and sleep problems. The diagnosis is made on the history of the pain and accompanying symptoms as well as the presence of tender points at specific sites on the body. There are a number of different theories and reasons for this condition. There will often be blood tests and maybe x-rays to exclude other diagnoses. Treatment involves pain killers, exercises, rest and sometimes antidepressant medication. For more information see www.arthritis.org.nz

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 repeated or recurrent headaches, often accompanied by other symptoms. They can be triggered by certain factors/events/foods. In some people, a visual disturbance called an aura happens before the headache starts. Other symptoms that may precede or accompany the headache include loss of appetite, nausea, vomiting, increased sweating, irritability, fatigue and intolerance of light or noise. The headache may last several hours to days. There is no cure for migraine headaches but treatment is aimed at: preventing migraines from occurring, stopping the migraine once early symptoms develop, and treating the symptoms of migraine (e.g. pain, nausea).