Pain and Rehabilitation

Dr. CHOW Chi Ping, Alex

Honorary Consultant in Rehabilitation Medicine

Specialist in Rehabilitation

As a specialist in the field of rehabilitation medicine, I often encounter numerous patients with acute or chronic pain in the clinical setting, stemming from various causes such as trauma, chronic illness, or surgical procedures. During each encounter, I shall conduct a thorough assessment and carefully listen to the patients to discern the origin of their pain, whether it is identifiable or of unknown cause. I also pay close attention to how they characterise their pain, including sensations such as electric shock, burning, stabbing, and cutting, which can be challenging to put into words at times. Additionally, I often encounter patients experiencing numbness and weakness in their upper and lower limb as common symptoms.

Numbness and Fatigue are Common in Patients Suffering Pain

Patients with cervical and lumbar spinal pain, long-term diabetes, and rheumatological diseases often experience numbness and fatigue in their upper and lower limbs. Effective management of pain, numbness, and weakness requires an accurate diagnosis of the cause. Through detailed assessment of the nature, location, relationship to physical activity, potential triggers and activities that may alleviate pain, appropriate investigations can be arranged to confirm the cause of the pain and its severity. This allows for targeted treatment and the development of a rehabilitation plan for the patient. This plan aims to reduce the pain, to help patients adapt to the illness, and regain a reasonable level of activity, even if they cannot fully recover their disease.

In terms of the nature of pain, it can be classified as nociceptive pain caused by damage to pain sensitive body tissues, neuropathic pain caused by damage to the nervous system, or a combination of both. For nociceptive pain, non-steroidal anti-inflammatory drugs or even opioids may be considered, especially for severe pain caused by injuries, falls, or post-surgical trauma. In the case of neuropathic pain, nerve conduction tests and electromyography are often necessary to confirm the diagnosis, and medications such as anticonvulsants and antidepressant drugs are utilised for treatment.

Nerve Conduction Test and Electromyography Help to Pinpoint the Source of Pain

In patients with weakness, numbness and neuropathic pain, it is advisable to arrange nerve conduction test and electromyography following the initial clinical examination, to accurately pinpoint the cause and gather reliable objective data on the severity of the condition. This information is crucial for designing treatment plans and confirming the necessity of surgical intervention. Individuals experiencing spinal pain and neuropathic pain in the limbs will benefit from assessment by rehabilitation physicians. In 2010, the Department of Orthopaedics and Traumatology of the University of Hong Kong welcomed Professor Andrew Haig, a distinguished expert in Physical Medicine and Rehabilitation from the University of Michigan at Ann Arbor, as their visiting professor. Prof. Haig had participated in a clinical study of over 1,500 patients suffering from spinal problems requiring spinal surgery consultations. In this study, providing rehabilitation consultations by specialists in Physical Medicine and Rehabilitation in this patient group resulted in a reduction of about 25 percent of surgical interventions, and the patient satisfaction rate was very good.

Rehabilitation Assessment Helps to Guide Surgical Decisions

I had a patient who had suffered from lumbar spinal stenosis for many years, and he experienced severe back pain intermittently. Each time his pain improved after receiving pain relieving treatments and physical therapy. He was able to maintain a normal body weight with regular exercises. However, as he aged, the frequency and severity of the pain recurrences increased, and this significantly limited his participation in sports and hiking. He was worried about the potential risks of surgery, and his family and friends also advised him to avoid surgery. A few years ago, his back pain flared up again and he sought medical advice from me. In the bedside physical examination, I found slight decrease in the strength of his lower limb muscles. I therefore performed nerve conduction studies and electromyography for him, which confirmed the presence of nerve damage in the lumbar spine level. If untreated, this would gradually lead to severe weakness and dysfunction in both lower limbs. I advised him that lumbar nerves decompression surgery was required to avoid progressive loss of neurological function of his lower limbs. In the end, he received lumbar spine decompression surgery by an experienced orthopaedic surgeon and he achieved full recovery with the help of rehabilitation exercises.

In 2021, I saw a patient who experienced sudden onset of left arm pain and weakness while he was infected by COVID-19. He was referred to my rehabilitation clinic by a family medicine specialist. He was offered nerve conduction studies and needle electromyography. The findings suggested that his left upper limb peripheral nerves were severely damaged, most likely caused by nerve inflammation secondary to the COVID-19 infection. He was given neuropathic pain medications to control the pain. After recovering from COVID-19, he was referred to our physiotherapist for rehabilitation exercises. He left upper limb muscle strength and function had greatly improved after a few months of treatment.

The term "rehabilitation medicine" is often thought to be at the later or final stage of treatment journeys, and best to be provided after receiving surgery. With the goal to reduce the impact of invasive treatments or surgery, and to avoid prolonged illness, rehabilitation intervention will best be initiated at the early stage of treatments and sometimes before surgical interventions. This proactive approach allows a comprehensive assessment of patients prior to any medical and surgical intervention, and helps them to strengthen prior to the interventions. This will make it easier for them to handle the related pain and speed up the recovery process.