Don't put up with chronic pain! Find out how you can manage it better.

Pain is a common symptom experienced by people of all ages. You may experience different levels of pain when you have a painful condition or recovering from surgery.

Good pain relief not only reduces suffering but can also help with faster healing. With adequate pain relief, it

  • Minimises interferences with activities e.g. rest and sleep, and

  • Enables you to do your physiotherapy exercises leading to speedy recovery

In this "Ask the Specialist" forum, Clinical Assistant Professor Diana Chan, Head & Senior Consultant from the Department of Pain Management at Singapore General Hospital (SGH), answers your questions about pain conditions, how to manage pain better, support available for pain management and more.

SGH is a member of the SingHealth group.

This 'Ask the Specialist' forum has closed. Thank you for your interest and participation.

1. Question by pathfinder4
Hi Prof, I'm 60 yrs old and last Dec diagnosed with Lumbar Spondylosis. On a good day, it's only aching. Some  day, it can be excruciating pain just getting up. Apart from pain killers and exercise, anything can help to alleviate this pain? Tks.

Answered by Clin Asst Prof Chan:
I would suggest managing the pain through a combination of modalities. Pain killers, muscle relaxants, exercises are mainstays of therapy. Other complementary therapy may include acupuncture, massage, warm/cold pads/TENS machine, lifestyle modifications such as watching our posture. 

It is important to strengthen the core muscles through appropriate exercises as the muscles would help the spine to support the body weight. If weight is a problem, losing weight may help to alleviate the pain as well. 

Sometimes, there may be a pinched nerve which we can help to reduce the pain through epidural steroid injections. Doing something that you enjoy also helps to distract one from the pain.

2. Question by Cypress
What could have caused knee pain and how to deal with it?

Answered by Clin Asst Prof Chan:
There are a lot of causes of knee pain. The most common one would be osteoarthritis as a result of aging/ high impact exercises. Other rarer causes include inflammatory processes such as rheumatoid arthritis/ gout/ ligament tears.

Management would be appropriate pain killers, physiotherapy, use of a knee brace, injections when appropriate. Complementary therapy includes acupuncture/ heat/cold pads.

3. Question by Anonymous
I've the usual lower back pain but what concerns me more is it has a consistent bone grinding sound when I stretch my lower back diagonally. I am worried if the grinding means my spinal bones are rubbing against each other which would means wear and tear?

Answered by Clin Asst Prof Chan:
The grinding sound may be due to either 
1.Bone spurs 
2.Ligaments stretching
I would not be overly worried about the grinding sound if it doesn’t cause pain. Continue to exercise and stretch! Keeping active is the key to slowing the effects of ageing.

4. Question by Kunnath
I was diagnosed with L4/L5 and L5/S1 facet arthropathy and Right lower limb radiculopathy. After treatment, I am at present undergoing physiotherapy. However, pain persists. Please advise me how to manage the pain arising from this condition. Thanks.

Answered by Clin Asst Prof Chan:
May I know what treatments did you have? Sometimes treatments may involve 
1.Pain medications 
3.Complementary therapy like acupuncture 
4.Steroid injections 
Pain may still come on/off due to ongoing stresses and ageing process, and may occur most commonly in certain awkward postures, after sitting/walking/standing for too long/ or early in the morning after a night’s sleep. 

Self management of the pain other than the treatments above include stretching/ exercises and maintaining a positive mindset, doing something that you enjoy will help you be distracted from the pain.

5. Question by LJMIN
Hi Prof Chan, my father has been experiencing pain and aches at his lower back near his hips. If he sits in a position for too long, the ache will also extend to his left leg. He is currently in his mid-50s and has also injured his back when he was younger. Would like to check if he should be seeking professional help for the condition and how could we help him to better manage it? Thank you.

Answered by Clin Asst Prof Chan:
When the pain extends to his left leg, it might imply a pinched/compressed nerve. It is more common if he has injured his back before. I would advise to seek professional help e.g. seeing an orthopaedic surgeon/getting some imaging done to rule out sciatica/nerve compression.

6. Question by PTB
Dear Dr Chan,
My wife had been suffering from shoulder and chest pain since February this year.
She was treated by a pain specialist. The pain specialist informed my wife that her pain system is down and may take about six to twelve months to recover.
She took the medicine but the medicine does not reduce the pain and there are many side effects like constipation, drowsiness, depression and sleeplessness.
Finally, she was referred to see a psychiatrist but the medicine made her sleep almost 24 hours and increase in drowsiness. I told her not to take the medicine anymore because she cannot continue sleeping for 24 hours. 

I really pity her. She was in pain since February but the pain still there. My family is greatly affected by her illness.
Please advise how to help her.

Answered by Clin Asst Prof Chan:
The cause of the pain needs to be determined and then we can treat the root cause. Besides taking medications, I would advise also maintaining a positive mindset and being optimistic, as the emotion centre of the brain controls pain as well. Doing something that she enjoys will help to distract her from her pain. If the current medications are not helping her it’s always good to seek a second opinion.

7. Question by Millie
Hi Dr,
I am having a nasty shoulder blade aching pain for a few months already. I have attempted to many types of massages, which still did not resolve my issue. Basically, I have aching from my shoulder to the whole of my left hand, and there is always one spot at the shoulder blade area that is always very discomfort (like some kind of frozen pain). When I tried exercising by rotating my left shoulder, there is a cracking sound. I have also tried stretching to relieve the pain, it just doesn't go away and I can't sleep well with the pain bugging me.

Can advise what could be done about this? Appreciate your help, please.

Answered by Clin Asst Prof Chan:
Would advise seeking professional help on this either by getting a referral to an orthopaedic surgeon and doing some scans to determine the cause of the pain.

8. Question by Margaret C
Dear Prof Chan,
I am 72 years old and have had bad back pains, always at the lower left of my back for more than 5 years.
Ortho docs had diagnosed it as curvature of my backbone and have been given stretching exercises to ease the pain. But sometimes I end up straining myself.
But these do not help and at times it can be so bad that I need to lie down and stretch. 
It has affected my daily lifestyle and especially since I have always loved to walk.
Now I cannot walk far, not more than 2 km, before my back aches. Please help.

Answered by Clin Asst Prof Chan:
If the pain has been affecting you greatly and affecting your activities of daily living and enjoyment in life, please seek help. Ortho doctors can advise whether surgery is needed, or if not, most will refer to a pain specialist for further management. Continue to remain active. Acupuncture may help also.

9. Question by Tan S H
Good day Dr Chan,
If you had knee/shoulder/joint pain, does using it more often make it go away? even though using it will cause pain.
Does exercising more now cause less joint pain later as we age? Won't the cartilage wear off when we exercise? If yes, are we to do less exercise?
When do we persevere, and when not to?

Answered by Clin Asst Prof Chan:
I would advise low impact and moderate exercise, not push harder than our limits. Low impact exercises like stationary bike and swimming, yoga/ pilates are good exercises to do. Or seeing a physiotherapist on guided exercises would help also. 
I would advise AGAINST running/jumping/high-impact exercises. Also, just do moderate duration: 20-30 minutes per day is enough.

10. Question by Adeline
Dear Dr,
1.Almost every day early in morning about 3-5 am my legs always feel tingling. May I know what is the causes?
2.How to get rid of Tinatus. I had this for 12 years. But recently in day time I hardly hear but sometimes it's come back. Also night time it can be loud at time. Please advise how I should go about.

Thank you and hope to hear good news.

Answered by Clin Asst Prof Chan:
Lots of causes can cause tingling in the legs. I would advise seeing a GP/ family doctor to get a referral to the appropriate specialist. 
I am not specialised in treating tinnitus. I would advise also getting a referral to an Ear, Nose and Throat (ENT) specialist.

Follow-up question posted by Adeline
Dear Dr,
I have seen the ENT Specialist for the past 4 years but there is nothing been done. The doctor only cleaned up my ears. I even went for hearing test. I have the strong feeling it has to be do with the nerves. Am I correct with this assumption?

Answered by Clin Asst Prof Chan:
Sorry I do not have enough information to diagnose whether it’s a nerve problem. In Pain Management, we usually manage pain that has already a definite diagnosis from other primary specialties. Suggest seeing a neurologist if you suspect it’s a nerve issue.

11. Question by g********
I am in my mid 50s
Notice when I do brisk walking, my left shin will feel pain after a while. My right leg no problem. I can easily cover 10km with no pain on both legs though on normal speed. 
What can I do to mitigate this pain & what could be the cause. Thanks.

Answered by Clin Asst Prof Chan:
Certain causes can be: 
1.Weight placed more on the left shin 
2.Previous injury 
3.Wear and tear e.g. Osteoarthritis of the knee 
4.Back issues 

Mitigation of pain 
1.Treating the root cause: can visit a primary doctor and upon examination/ history he/she can refer you to the right specialist/for the right scans 
2.Pain killers include paracetamol, NSAIDs, topical gels
3.Lifestyle modifications: knee guards/appropriate shoes

12. Question by ireneneo
Good day Dr Chan,
Other than plantar fasciitis , is there any other issues with heel pain especially during the morning after waking up? If its plantar fasciitis, is there any home remedies / treatment for it without consulting the doctors?
Best regards,

Answered by Clin Asst Prof Chan:
Causes can include Achilles tendonitis/inflammation/rheumatoid arthritis.
I would advise consulting the doctors to find out the root cause for appropriate management. 
Heat/cold pads may help.

About Clin Asst Prof Diana Chan

Clinical Assistant Professor Diana Chan is presently the Head and Senior Consultant of Department of Pain Management, SGH.

She did her pain fellowship in Sir Charles Gairdner Hospital in 2016, and also has a keen interest for pain-related research.

She is also a member and ex treasurer of the Pain Association of Singapore, and a member of the Pain Chapter, Academy of Medicine. Besides her qualifications in anaesthesiology and pain, she also has a Graduate Diploma of Acupuncture (GDA) and Masters of Clinical Investigation.

Ref: J22