Pain therapy services have also been evolving concurrent with advances in medical technology. It is widely acknowledged that pain therapy services are an important and integral part of a comprehensive healthcare system, but poor understanding and misconceptions of these services remain. There is an increasing demand for these services alongside growing awareness and expectations. The importance of understanding the scope and limitations of these services cannot be overstated if more patients are to benefit from them. With increasing workload and more new potential therapies introduced on the market, it is important that primary care physicians and allied health professionals unfamiliar with pain services gain some understanding of existing pain services in Singapore, together with their indications, modes of delivery, and limitations. The introduction to pain services in Singapore in this chapter will provide information on these topics. It is important for healthcare professionals to recognize that the treatment of pain can be complex and multidimensional, as well as incorporate both pharmacological and non-pharmacological approaches in its management. Understanding psychological, social, and spiritual issues will also lend meaning and insight to managing pain.
The demand for orthopaedic services has risen significantly in recent years given the increased affluence and ageing population. Advances in medical technology and healthcare delivery systems allow more patients to seek treatment, leading to a strained public healthcare system. Non-emergency orthopaedic cases are often put off and these patients seek treatment at private healthcare facilities, resulting in significant growth in private sector volume. While surgery is often needed, non-surgical conservative management of a number of common orthopaedic conditions is very effective in pain alleviation and restoration of function. This chapter aims to provide the necessary information for primary care physicians and allied health professionals on these conservative management strategies, including the indications and limitations. Knee replacement surgery is a procedure in which damaged knee joint surfaces are replaced with artificial implants, offering relief from pain and improved mobility for individuals suffering from severe arthritis or knee injuries, with outcomes varying based on factors like patient health and rehabilitation.
Minimally Invasive Treatments
The specifics of a patient’s MRI findings determine the type of treatment offered. In many cases, whether the prolapse is directly compressing the nerve root, the buckling of the disc space during movement, or the compression of nerve roots in the lateral recess, rendering surgical access and decompression paramount is the crucial determining factor moderated by an understanding of the patient’s pain, rehabilitative needs, and expectations. As more nerve roots in the lumbar spine could be involved, it is important to perform a comprehensive spinal evaluation. If the patient chooses surgical intervention as the primary treatment, the surgeon and patient would consider minimally invasive spine surgery. Laser discectomy and microdiscectomy are examples of minimally invasive spine surgery. Simulation using local anesthesia (LA) provides a guide to predict pain relief following laser discectomy. The thickness of the anesthetized painful disc corresponds to an extent of relief. Few patients have resolution of severe lower body pain, which is often caused by compression of the nerve roots in the lateral recess. In such cases, the outcomes are less favorable. In laser discectomy, patients are treated under local anesthesia and conscious sedation. Laser energy is transmitted at oblique and perpendicular angles in thin fibers to decompress the central and foraminal spinal canal. Some cautions are necessary, including avoiding those techniques not recommended by the laser manufacturer, with laser used at low power settings adjusted based on clinical findings and stimulation used only with intent to excite the nerves. The surgeon should avoid using laser energy near the sinu-vertebral nerves and dura. The surgeon should focus primarily on releasing the tension in the sinu-vertebral nerves and the dura. Controlled laser decompression, combined with endoscopic discectomy at the beginning and followed by other steps, is an efficient approach to treating patients with persistent aching pain and those with neurogenic claudication.
Minimally invasive spine surgery is a modern solution to problems such as slipped discs or compressed nerves that lead to back pain. Similar to the concept of keyhole surgery, minimally invasive spine surgery uses an incision of only a few centimeters. Through this small incision, equipment is used to directly reach the spine without the need to move tissues such as muscle or ligaments to the sides. As a result, there is minimal damage to surrounding nerves and tissue and the healing time is also significantly reduced. Laser discectomy is an example of a treatment that is used at the Camden Medical Centre Orthopaedic Specialist Clinic in Singapore to treat bulging discs. Bulging discs are commonly treated without surgery using non-invasive methods such as physiotherapy or a combination of mobilisation, manipulation and rehabilitation. The latter methods are used to reduce the degree of disc prolapse and allow “re-seating” of the disc material. However, relief is not instant and takes time. Some patients may require surgical intervention. The severe pain from disc prolapse is caused by compression of the nerve root against the spinal canal or against the exiting nerve roots. Knee surgery encompasses a wide range of procedures aimed at addressing various knee conditions such as ligament tears, meniscus injuries, or cartilage damage, with treatment plans tailored to the specific diagnosis and individual patient needs, often involving a combination of surgical and non-surgical interventions.
Knee Surgery Cost in Singapore
Knee surgery cost Singapore may vary depending on factors like the type of procedure, hospital or clinic facilities, surgeon expertise, and post-operative care, with patients advised to inquire about comprehensive cost estimates and potential insurance coverage prior to undergoing treatment. It is important that clinicians are aware of the current evidence base available for the most common musculoskeletal disorders and ensure that all medical students are taught about evidence-based practice in musculoskeletal problems. This will empower them to make recommendations and deliver treatments based on current evidence. Similarly, clinicians working in the community setting who deal with musculoskeletal complaints on a regular basis should receive similar training. This is done through encouraging experienced and guideline-oriented clinicians to provide adequate supervision, as well as through exposing trainees to a variety of clinical cases.
In conclusion, there is a significant likelihood that a patient visiting an orthopaedic surgeon or a general practitioner with a complaint related to their musculoskeletal system will receive advice and treatment that is not fully evidence-based. As clinicians, it is easy to succumb to the modern trend of seeking quick fixes, given the constraining alternative pressures to see as many patients as possible, while maintaining an accurate and appropriate standard of care. However, patients should be made aware of the evidence level from which the advice and treatment options are drawn. In considering which treatment to choose, the patient should weigh the risks and benefits while understanding its evidence base.
