Areas of Pain Expertise

Dr David Manohar and his team offer a wide range of services that can assist patients with all there pain needs.

There are two well-recognised broad categories of pain

Pain Injury

Pain from damage (trauma)

the common sort of pain

nerve system

Pain from damage to the pain system itself

the nervous system

These two broad categories of pain can be expanded into the following mechanisms of pain

Nociceptive pain: pain is caused by stimulation of sensory nerve fibres that respond to stimuli approaching or exceeding harmful intensity (nociceptors) and may be classified according to the mode of noxious stimulation. The most common categories are “thermal” (eg: heat or cold), “mechanical” (eg: crushing, tearing, shearing, etc) and “chemical” (eg: iodine in a cut or chemicals released during inflammation). Some nociceptors respond to more than one of these modalities and are consequently designated polymodal. Nociceptive pain typically changes with movement, position and load.

Common Examples:

  • Osteoarthritis
  • Ankle sprain
  • Rheumatoid arthritis

Neuropathic pain: pain that arises from damage to the nervous system itself, central or peripheral, either from disease, injury, or physical irritation. The simplest neuropathies are mechanical insults, like hitting your funny bone or sciatica, but this is a big category: anything that damages neurons, from multiple sclerosis to chemotherapy to alcoholism to phantom limb pain. It’s often stabbing, electrical, itching or burning. Unfortunately, it’s also more likely to lead to chronic pain as nerves don’t heal well.

Common Examples:

  • Diabetic neuropathy
  • Carpal tunnel syndrome
  • Complex regional pain syndrome

Nociplastic pain: pain which is mechanically different from the normal nociceptive pain, which caused by inflammation and tissue damage or the neuropathic pain, which results from nerve damage. It may occur in combination with the other types of pain or in isolation. Its location may be generalised or multifocal and it can be more intense than would be expected from any associated physical cause. Its causes are not fully understood but it is thought to be a dysfunction of the central nervous system whose processing of pain signals may have become distorted or sensitised.

Common Examples:

  • Fibromyalgia
  • Temporomandibular disorder
  • Nonspecific low back pain

Psychogentic pain: pain that is caused, increased or prolonged by mental, emotional or behavioural factors. Sufferers are often stigmatised because they struggle to convince their medical practitioner or family member that pain emanating from a psychological can be a “real” source. However, pain specialists consider that it is no less real, or painful, than pain from any other source.

Common Examples:

  • Headache
  • Back pain
  • Muscle pains
  • Stomach pain

Classifying Pain

Timing of Pain

Chronic

Lasting > 3 months

Intermittent

Episodic Pain

Acute

Lasting < 3 months

Breakthrough

Due to waring off of medication

Incident

Caused by activity

Spontaneous

Fleeting neuropathic pain

Location of Pain

Nociceptive (Somatic):

Musculoskeletal

Nociceptive (Visceral):

Internal organs

Nociplastic

Central nervous system

Neuropathic

Functional

Incident

Diabetic neuropathy, fibromyalgia

Functional

No known cause

Psychosomatic

Fibromyalgia

work_related_injury

30+ years of clinical experience

Dr Manohar specialises in diagnosing, treating and managing all mechanisms of pain and has 30+ years of clinical experience.

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My Clinical Areas of Expertise

Reginal Pain

  • Spinal Pain
    • Neck Pain (Cervical Spinal Pain)
    • Upper Back (Thoracic Spinal Pain)
    • Lower Back (Lumbar Spinal Pain)
    • Prolapsed Disc (Sciatica)
    • Spinal Stenosis
    • Sacroiliac Joint Pain & Dysfunction
    • Coccygeal Pain
  • Joint Pain (Osteoarthritis)
    • Shoulder Pain
    • Hip Pain
    • Knee Pain
    • Ankle Pain
  • Nociplastic Pain Syndromes
    • Tissue Damage
    • Inflammation
  • Facial Pain

Reginal Pain

  • Brachial Plexopathy
  • Post Herpetic Neuralgia (Post Shingles)
  • Painful Neuropathies (eg: Diabetic Neuropathies)
  • Occipital Neuralgia
  • Trigeminal Neuralgia
  • Pudendal Neuralgia
  • Meralgia Paresthetica
  • Ilioinguinal, Iliohypogastric and Genitofemoral Neuralgia
  • Post-Surgical pain syndromes
    • Post-Hernia pain
    • Post-Mastectomy pain
    • Post-Thoracotomy pain
    • Post-Amputation Pain
    • Phantom Pains
  • Failed Back Surgery Syndromes or Post Laminectomy Pain Syndromes

Pain Syndromes

    • Complex Regional Pain Syndromes (CRPS)
    • Fibromyalgia
    • Myofascial Pain Syndromes
    • Abdominal Wall Pain Syndromes
    • Functional Abdominal Pain Syndromes
    • Pelvic Pain Syndromes
    • Non-Cardiogenic Angina (Refractory Angina)
    • Piriformis Syndrome
    • Psoas Syndrome

Cancer Pain

All types of cancer pain including background and incidental pain
  • Regional Pain
  • Neuropathic Pain Syndromes
  • Metastatic Bone Pain
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Contact us to make an appointment

Please contact us to make an appointment. A GP referral is needed.