This article was brought to you by:
Back pain affects approximately 17.1% of the total Singaporean population, with knee pain affecting an estimated 8.5% according to recent data.
These conditions can be attributed to a range of factors, including an ageing population, sedentary lifestyles and the impact of chronic medical conditions.
Chronic medical conditions can significantly impact an individual’s quality of life, limiting their mobility and daily activities.
While traditional treatments, such as surgery and Traditional Chinese Medicine (TCM), have their place, there is a growing need for alternative, minimally invasive pain relief solutions that offer long-term benefits.
CHRONIC PAIN SYNDROMES VS QUALITY OF LIFE
Chronic musculoskeletal pains emanating from such pathologies as osteoarthritis, herniated discs, tendinitis, bursitis and degenerative joint disease (among many others), may be crippling. They can significantly affect an individual’s capacity to do even the most ordinary activities, lowering the quality of their lives.
While these symptoms can be managed temporarily with the aid of medications like NSAIDs or opioids, these medicines are palliatives, not treatments. They may result in adverse effects or dependence.
On the other hand, surgical treatments, though effective for certain situations, are encumbered with increased risks, prolonged convalescence and potential complications.
Minimally invasive interventions offer a realistic alternative to pain relief medications and surgery. Such therapies are directed at the cause of pain by employing smaller incisions or even non-surgical methods (i.e. by way of injections using needles).
Thus, there is much less trauma to the musculoskeletal system, less post-operative recovery time, and faster resumption to normal activities.
MINIMALLY INVASIVE SOLUTIONS FOR PAIN RELIEF IN THE BACK, SHOULDER AND KNEE
While different areas of the human body have varying mechanisms for managing pain, numerous minimally invasive treatments have proven to be effective across various regions, particularly the back, shoulders and knees.
We will be discussing a few common options and how each one works.
Radiofrequency Ablation/Pulsed Radiofrequency (RFA/pRF)
Radiofrequency Ablation (RFA) is a minimally invasive procedure that uses heat produced by radiofrequency waves to selectively target nerves that provide painful stimuli to various tissues.
This modality is mostly utilised by clinicians for chronic pain states affecting the spine, shoulder and knee, in cases where conservative management, in the form of physical therapy or injection, has failed and pain is no longer adequately relieved.
RFA is usually indicated for back pain caused by facet joint and degenerative disc disease. A needle is advanced through the skin to approach the painful nerve. Radiofrequency energy creates a lesion that stops or impairs the ability of the nerve to carry the pain signal to the brain.
It is the same treatment given in the knee for conditions like osteoarthritis of the knee and bursitis, while Pulsed Radiofrequency (PRF) is applied to the shoulder for conditions like rotator cuff and impingement syndrome.
Generally, RFA is quite effective and relieves pain for several months or even over a year.
If the pain comes back, it can be repeated. Over time, this may lead to lasting non-surgical pain relief.
Annuloplasty and Nucleoplasty for Discogenic Pain
Annuloplasty and Nucleoplasty are the least invasive procedures directed at the disc for the treatment of back pain, including those caused by an injured or degenerated disc.
Application of these treatments can be considered in patients with disc-related pain who do not want to proceed with conventional spine surgery.
Annuloplasty involves the application of radiofrequency energy to the outer layer of the intervertebral disc, aimed at shrinking and tightening the tissue.
This is particularly useful in treating discogenic pain caused by annular tears. Nucleoplasty uses plasma ablation to shrink the disc bulge.
This alleviates the pressure on the surrounding nerves and diminishes the pressure on the nerve roots. It is performed via a small needle inserted into the disc and is less invasive compared to traditional spinal surgery. Both procedures focus on the cause of the pain, not just alleviating it.
Hence, they are viable solutions for persons affected by chronic back pain originating predominantly from disc pathology.
Spinal Cord Stimulation (SCS)
Spinal Cord Stimulation (SCS) is another minimally invasive technique developed to treat chronic pain in the back and neck.
In this procedure, a small device is placed that generates electrical impulses to the spinal cord, disrupting the pain signals before they reach the brain.
This procedure typically involves implanting a small pulse generator under the skin, often at the abdomen or lower back, and placing electrodes near the spinal cord. With the use of a handheld remote to control the level of stimulation, this treatment is indeed very adaptable for various pain levels.
SCS is considered an optimal way to manage chronic pain in patients for whom all other treatments have failed and for those suffering from conditions like failed back surgery syndrome, sciatica and degenerative disc disease.
It is especially effective in neuropathic pain or pains that result from damage to the nerves because the pain signals are masked. As SCS is modifiable and reversible, it can be turned off or removed if the desired results are not achieved.
Platelet-Rich Plasma Therapy (PRP)
Platelet-Rich Plasma Therapy (PRP) is a regenerative therapy based on natural processes in the body for the management of musculoskeletal pain.
It can be used to treat the knees and shoulders. The plasma is prepared from the blood of the patient, and once withdrawn, it is processed to concentrate the platelets responsible for the healing and regeneration of tissues.
PRP injections stimulate the healing of injured tissues related to the source of pain i.e. ligaments, tendons and muscles.
The ability of these injected platelets to release growth factors stimulating the repair of injured cartilage, ligaments and muscles should relieve the pain and improve functionality.
PRP is considered to be a non-surgical alternative or an adjuvant therapy for patients who fear entering the operation theatre. It is highly indicated in conditions where the healing of tissues is a major concern, like tendinopathy, sprains of the ligaments and muscle strain, to ensure that there is reduction of pain in the long term.

Dr Nivan Loganathan providing top-notch healthcare at the Total Pain Specialist Clinic @ Farrer Park Medical Centre
Injectables and Biologic Therapies
Some minimally invasive injections in knee, shoulder or back pain management include Corticosteroid Injections, Hyaluronic Acid Injections, and Stem Cell Injections.
Most of these injections usually use local anaesthesia, and are associated with quick relief and minimal downtime.
Corticosteroid injections are usually associated with arthritis or bursitis. They reduce inflammation and offer quick relief, but must be used judiciously to minimise possible long-term side effects.
On the other hand, hyaluronic acid injections are especially helpful in cases of knee osteoarthritis where the fluid that keeps the joints lubricated is depleted. Hyaluronic acid supplements the natural fluid, and therefore reduces friction between articulating bones and increases joint mobility.
Stem cell injections make use of the regenerative properties of stem cells, often harvested from the body of the patient. These cells act in the repair of tissues and reduction of inflammation, thus proving very effective for joint pains and tendinous injuries.
These injections have proven to be quite efficient for long-term pains, when combined with physical therapies or other non-surgical modes of treatment.
FINDING THE RIGHT TREATMENT FOR YOU
Fortunately, many of the common areas where we suffer chronic pain do have non-invasive treatments available that might provide long-term solutions without the risks and downtime associated with surgery.
These treatments address the cause of pain and can allow patients to get back to their normal activities sooner, with much less discomfort.
These chronic pains differ in their management from one individual to another. Alternatives to avoid surgical treatment and prolonged medicinal ingestion include minimally invasive treatments like radiofrequency ablation, spinal cord stimulation, PRP therapy, nucleoplasty, and injections.
Each treatment has different indications, risks and possible outcomes. The choice of treatment always needs to be done in close consultation with your pain physician so that they can work out the best modality for your problems.
Many a time, a combination of treatments might be the best solution to bring comprehensive long-standing relief, including physical therapy, regenerative medicine and minimally invasive interventions.
With the guidance of a pain physician, you can find the correct pain management treatment that best suits you and improves the quality of your life.