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HPC | Hertfordshire Pain Consultants

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Chronic headache

Mrs K.R presented to my clinic with a 15 year history of headache on the suggestion of her neurologists. She had seen a number of specialists in the past and received a number of investigations including MRI brain scan that revealed no abnormalities. I felt that her pain had a large nerve related component, and would respond well to nerve related medications. After trying a number of different combinations we achieved success with a combination of Pregablin and duloxetine. She is now headache free.

Chronic testicular pain

Mr D.M presented to my clinic with a long history of testicular pain in the absence of any trauma or surgery.  He was under the care of a urology specialist who could not identify a cause for the pain.  Being a very active/sporty person he found that the pain was having a massive impact on his recreational activities.

I scheduled him for a spermatic cord injection which gave him excellent benefit for a week.  Based upon this positive response he was scheduled for a pulsed denervation procedure..

Three months after the procedure he was reviewed in clinic and was pain free and able to participate to sports once again.

Failed Back surgery Syndrome

Miss L.A  is a who young lady in her 20’s presented to my clinic with persistent low back and leg pain on the background of multiple spinal surgeries for disc pain.  An MRI of her lumbar spine could not identify any further disc problems, and she was not considered a candidate for further surgery. She had tried a range of physical treatments including physiotherapy and standard over the counter medications and was now using strong morphine based medications with no benefit. She was unable to stand/sit/ walk for long distance and was not able to work..  Understandibly the pain and her poor quality of life had left her feeling depressed.

She was scheduled for an epidural combined with a nerve block to assess whether there was a focal nerve irritation, and she had a positive response.  Given the chronic nature of her pain she was referred to have a spinal cord stimulator implanted. 

She had an excellent response with excellent pain relief, and was able to come off some of her pain medications completely.  Her activity levels increased considerably and she was able to find work.

Back pain secondary to facet joint arthritis

Mr W.C presented to my clinic with a long history of progressively worsening right-sided low back pain.  The pain was triggered by prolonged standing, sitting with difficulties rising form a seated position.  An MRI of his lumbar spine identified degenerative changes in his lumbar spine but no disc prolapse.

He was an active man who enjoyed golf and gardening and had to stop these activities due to the pain.  On examining him, he was tender not in the middle of the back, but just to the side.  He also had pain on extension of his back.

I felt that his pain was likely to be facet joint arthritis and schedule him for diagnostic medial branch blocks which gave him excellent benefit.  He went on to have radiofrequency denervation that provided him with a years pain relief.  He returned for a repeat procedure the following year with the same success.


Miss B.P presented to my clinic with a chronic history of widespread body pain.  She had been seen on several occasions by the Rheumatology specialist who could not find an inflammatory cause for her pain.

Based on her symptoms and examination finding I diagnosed fibromyalgia.

She was started on pregablin and duloxetine and is now pain free.

Coccyx pain

Mrs N.B is a 30 year old who presented to my clinic with a history of low back pain worsened after pregnancy. She was told that her symptoms were disc related and received caudal epidural injections that relieved her symptoms temporarily. She was on a vast cocktail of anti-nerve medications and strong morphine related medications and used a crutch to walk, but still there were times when the pain was so bad that she required admission into A&E. I felt that her symptoms were more likely to originate from her coccyx and I scheduled her for a coccyx injection. She reported immediate relief. She was then prescribed a versatis (lidocaine) plaster that she uses every day. She no longer needs strong morphine medications and had no further admissions into hospital.

Neck and arm Pain

Mr T.D presented to my clinic with a one year history of neck and right sided arm pain with no history of trauma. He had tried an extended period of physiotherapy with no benefit and the pain was stopping him sleeping and causing a great deal of difficulties at work. An MRI of his neck revealed an osteodiscal bar pinching on of his nerves. He was tried on a range on anti-nerve pain medications but reported no benefit.

He was scheduled for a cervical epidural injection. At follow-up 6 weeks after the procedure he reported no pain and was off all medications.

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