“I had observed that chronic pain is not managed
well in Sri Lanka and it is for this reason that we
thought that we should open a separate pain
management centre,” says Dr Namal Senesinghe, a
consultant in Pain Medicine at Canterbury Hospital
in Kent, UK.
Dr Senesinghe after graduating from North Colombo
Medical College in Sri Lanka, left for the UK about
16 years ago for further studies and specialized in
pain management in the UK.
He is also the director of Kent Pain Services LTD,
“During my trips to Sri Lanka through the years I
met so many friends and family members who were
suffering from chronic pain due to various problems
but there was no proper centre where they could go
for treatment. Even though the need to open a pain
management centre was foremost in my mind for
several year, I did not have the correct partnership
until now,” says Dr Senesinghe.
He says grateful for Professor Arjuna de Silva for
facilitating a dialogue with Nawaloka hospitals.
A state-of-the-art medical centre aimed at pain
management was launched at Nawaloka hospital;
Colombo on December 30, 2010.
This centre will bring together both local and
foreign expertise enabling treatment of various
diseases, which cause pain.
Diseases such as back pain, neck pain, and joint
pains of knees, shoulders, hands and feet will be
treated along with various diseases causing pain in
other areas of the body.
“Generally pain is divided into two groups, acute
and chronic. Acute pain is generally post operative
pain and pain that last for less than three months,
but chronic pain is pain that lasts for more than
three months. Chronic pain can be further divided
into nociceptive pain and neuropathic pain.
Nociceptive pain does not have neurological
involvement and the commonest of this type is back
pain. About 80 – 90% of patients that I see in
England are those with back pain,” explains Dr
“Neuropathic pain occurs due to altered sensations
of the autonomic nervous system and encompasses the
neuralgias such as trigeminal neuralgia, phantom
limb pain that is experienced by people who lose
their limbs, post orbital pain, scar pain etc,” he
Regarding the concept of pain management, Dr
Senesinghe says that currently throughout various
parts of the pain it is considered a sub specialty,
but that due to its importance it might develop into
a specialty in the near future.
“Currently it is well established in the US and
UK, and developing in Australia. In this part of the
world in South East Asia, it has just started to
develop. The importance of this is not merely for
the individual but also causes a huge economic
burden to the countries. Currently it is estimated
that United Kingdom spends 700 million sterling
pounds yearly to treat chronic pain and similarly US
spends four billion dollars a year. Therefore the
target is to identify those patients with chronic
pain as early as possible and then manage the pain
so that they would be able to lead as normal lives
as possible,” he further explains.
The pain management centre opened at Nawaloka
hospital will function almost seven days a week says
Dr Senesinghe. Dr Tharindu Wijesinghe, consultant
rheumatologist who has trained in Australia will be
seeing patients on a day to day basis, while Dr
Senesinghe says that he will be visiting Sri Lanka
about four times an year.
“Dr Wijesinghe will treat all patients who will
come to the clinic and then any other patients who
he would feel should be best seen by me, would be
stacked for my referral,” reiterated Dr Senesinghe.
“This centre will operate on the same principal as
the UK pain management unit. The minimum time taken
to see a patient will be fifteen minutes and we will
do a stepwise management. First we will see if we
can manage them with drugs and if not we will go in
for the procedures. But prior to doing the procedure
we will inform the patient of all the costs involved
in carrying out the procedures,” says Dr Senesinghe.
According to him back pain is the commonest cause of
chronic pain. It could be due to a muscular problem,
ligamental problem, bony issue, end plate problem,
disc prolepses etc. According to the problem, the
management procedures will be done. Treatment will
include interventions ranging from x-ray guided
facet joint injections, nerve root blocks, pulse
radiofrequency of nerves, discography, Intradiscal
electro thermal ablation, radiofrequency ablation of
nerves and state of the art spinal cord stimulators.
“The aim of all these procedures is to give the best
possible treatment for the problem. and to make the
patient pain free even if it is for a while and that
will make them seek pain free physiotherapy which
will further support in breaking a vicious cycle,”
says Dr. Senesinghe.
“We will also refer the patient for other
treatments such as, aromotherapy, water therapy,
reflexology etc. We will develop collaborations with
other such treatment methods so that we could offer
a comprehensive and holistic treatment schedule to
our patients,” says Dr Senesinghe.
As a pain management consultant, Dr Senesinghe
carries out such procedures in his clinic.
He says that last year alone – in 2010 he carried
out 3,200 procedures in pain management.
He says that anything that is available in America
and England regarding pain management will be made
Also procedures will be done only if there is
“For an example it will not be the case of an
epidural injection just for the case of a backache.
If we do such procedures we will make sure that it
is backed by evidence such as an MRI scan and when
we do it we will it will be done under x ray
guidance and an image intensifier. We will give a
copy of the images of the procedures being done to
the patient as well. “Without proper evidence doing
such procedures will be considered as being
On a personal note Dr Senesinghe says that he and
his wife Ruvini – a consultant psychiatrist in the
UK have not shed the emotional bonds with his
homeland Sri Lanka even though they currently live
“Our parents live here and we have such wonderful
and good friends here and I am so very happy that I
was able to do something like this in my own
country,” he says.
you have lower back pain, you are not alone.
Nearly everyone at some point has back pain that
interferes with work, routine daily activities, or
Back pain is the second most common neurological
ailment in neurological clinic, only headache is
Fortunately, most occurrences of low back pain go
away within a few days.
Others take much longer to resolve or lead to more
Acute or short-term low back pain generally lasts
from a few days to a few weeks.
Most acute back pain is mechanical in nature, the
result of trauma to the lower back or a disorder
such as arthritis.
Pain from trauma may be caused by a sports
injury, work around the house or in the garden, or a
sudden jolt such as a car accident or other stress
on spinal bones and tissues.
Symptoms may range from muscle ache to shooting or
stabbing pain, limited flexibility and/or range of
motion, or an inability to stand straight.
Occasionally, pain felt in one part of the body may
‘radiate’ from a disorder or injury elsewhere in the
Some acute pain syndromes can become more serious if
Chronic back pain is measured by duration — pain
that persists for more than three months is
It is often progressive and the cause can be
difficult to determine.
The back is an intricate structure of bones,
muscles, and other tissues that form the posterior
part of the body’s trunk, from the neck to the
The centerpiece is the spinal column, which not only
supports the upper body’s weight but houses and
protects the spinal cord, the delicate nervous
system structure that carries signals that control
the body’s movements and convey its sensations.
Stacked on top of one another are more than 30
bones, the vertebrae that form the spinal column,
also known as the spine.
Each of these bones contains a round hole that,
when stacked in register with all the others,
creates a channel that surrounds the spinal cord.
The spinal cord descends from the base of the brain
and extends in the adult to just below the rib cage.
Small nerves enter and emerge from the spinal cord
through spaces between the vertebrae. Because the
bones of the spinal column continue growing long
after the spinal cord reaches its full length in
early childhood, the nerve roots to the lower back
and legs extend many inches down the spinal column
This large bundle of nerve roots was dubbed by early
anatomists as the cauda equina, or horse’s tail.
The spaces between the vertebrae are maintained by
round, spongy pads of cartilage called
intervertebral discs that allow for flexibility in
the lower back and act much like shock absorbers
throughout the spinal column to cushion the bones as
the body moves.
Bands of tissue known as ligaments and tendons hold
the vertebrae in place and attach the muscles to the
Starting at the top, the spine has four regions:
• the seven cervical or neck vertebrae (labeled
• the 12 thoracic or upper back vertebrae (labeled
• the five lumbar vertebrae (labeled L1–L5), which
we know as the lower back, and
• the sacrum and coccyx, a group of bones fused
together at the base of the spine.
The lumbar region of the back, where most back pain
is felt, supports the weight of the upper body.
Causes of lower back pain
As people age, bone strength and muscle elasticity
and tone tend to decrease.
The discs begin to lose fluid and flexibility, which
decreases their ability to cushion the vertebrae.
Pain can occur when, for example, someone lifts
something too heavy or overstretches, causing a
sprain, strain, or spasm in one of the muscles or
ligaments in the back. If the spine becomes overly
strained or compressed, a disc may rupture or bulge
This rupture may put pressure on one of the more
than 50 nerves rooted to the spinal cord that
control body movements and transmit signals from the
body to the brain.
When these nerve roots become compressed or
irritated, back pain results.
Low back pain may reflect nerve or muscle irritation
or bone lesions.
Most low back pain follows injury or trauma to the
back, but pain may also be caused by degenerative
conditions such as arthritis or disc disease,
osteoporosis or other bone diseases, viral
infections, irritation to joints and discs, or
congenital abnormalities in the spine.
Obesity, smoking, weight gain during pregnancy,
stress, poor physical condition, posture
inappropriate for the activity being performed, and
poor sleeping position also may contribute to low
Occasionally, low back pain may indicate a more
serious medical problem.
Pain accompanied by fever or loss of bowel or
bladder control, pain when coughing, and progressive
weakness in the legs may indicate a pinched nerve or
other serious condition.
People most likely to develop low back pain
Nearly everyone has low back pain sometime. Men and
women are equally affected.
It occurs most often between ages 30 and 50, due in
part to the aging process but also as a result of
sedentary life styles with too little exercise.
The risk of experiencing low back pain from disc
disease or spinal degeneration increases with age.
Low back pain unrelated to injury or other known
cause is unusual in pre-teen children. However, a
backpack overloaded with schoolbooks and supplies
can quickly strain the back and cause muscle
fatigue. Recently a study was done in Sri Lanka to
find out the strain of heavy backpacks on children.
To avoid back strain, children carrying backpacks
should bend both knees when lifting heavy packs, and
should minimise the load they are carrying.
Slowing the ageing process
are slowly unlocking the secrets of ageing, and some
suggest treatments may soon be at hand to slow or
even reverse the ageing process.
But what can science really achieve, and what are
the dangers of meddling with our biological clocks?
Could such treatments induce cancers in humans, for
example, and what about the world’s burgeoning
population and the West’s “pension time bomb”?
The ageing process is a complex one, and for long
remained an impenetrable mystery, but progress is
now being made.
Late last year, a team at the Dana-Farber Cancer
Institute in Boston published a Nature paper in
which they detailed the reversing of the ageing
process in mice.
They targeted the chromosomes that reside within the
nuclei of all cells, and specifically telomeres,
caps at the tips of chromosomes. The telomeres
protect the chromosomes from damage, but also
shorten with age, until the cells are no longer able
Professor Ronald DePinho and colleagues
manipulated the enzyme that regulates these tips –
known as telomerase – and witnessed dramatic
results. Boost the enzyme, and the mice appeared to
rewind the clock.
“What we were expecting was a slowing or
stabilisation of the ageing process,” he told the
BBC. “Instead we witnessed a dramatic reversal in
the signs and symptoms of ageing.”
“These animals had their brains increase in size,
they improved their cognition, their coat-hair was
restored to a healthy sheen and their fertility was
Of course, this was a story of mice, not men, and
applying such principles to humans could be an
altogether bigger challenge. Telomerase has been
linked with cancer, and there are likely to be many
other mechanisms involved in ageing.
Many believe mitochondria may play a bigger role
– genetic material contained within the cell but
outside the nucleus. Mitochondria are the “power
houses” of cells, but have also been seen to
generate harmful chemicals linked with aging.
Then there is the role played by free radicals,
highly reactive atoms or molecules that attack our
bodies. Stem cells, primitive cells which play a key
role in renewing the human body, are also likely to
But even though a comprehensive picture of how we
age is still to be constructed, there are scientists
who are already testing anti-ageing treatments on
Professor David Sinclair also works in Boston at an
ageing laboratory at Harvard Medical School. He and
his colleagues have been working on synthetic drugs
called “Sirtuin activating compounds” or STACs.
Animal studies have indicated STACs can restore the
health and life prospects of obese mice and
early-stage trials in humans are now underway.
The research follows earlier work on resveratrol,
a naturally-occurring ingredient of red wine. Both
resveratrol and STACs appear to mimic the effects of
restricting calorie intake, which has been seen to
slow ageing in animals.
“This isn’t going to be an excuse to eat French
fries all day and watch TV but is a way to augment
your healthy lifestyle and give you the ultimate
benefits of perfect health which your body is
capable of,” Professor Sinclair told the BBC.
gene stops cancer cells spreading
gene which encourages cancer to move around the body
has been discovered by the University of East
Experiments on tissue cultures, published in
Oncogene, suggest that blocking it would prevent
The researchers hope their work will lead to a new
generation of cancer drugs within the decade.
Cancer Research UK said the study improved
understanding of the disease, but was still at the
There are treatments for primary cancers, but
tumours have the potential to spread.
Cells can break off and travel around the body,
through the bloodstream or lymph fluid, and start a
new or secondary tumour where they land, a process
known as metastasis.
Breast cancers are known to spread to lymph
nodes, the bones and the lungs.
These secondary tumours are notoriously difficult to
The team at the University of East Anglia has found
a gene which helps the cancer spread.
The gene, WWP2, leads to the breakdown of an
inhibitor that normally keeps cells in check.
The researchers showed, in tissue cultures, that
without the inhibitor, Smad7, cancer progressed very
quickly and spread.
Blocking the gene prevented that spread.
Dr Andrew Chantry, who led the study, said: “I think
we’re really onto something important if we can put
a wall around a cancer and lock it in place.
“The discovery could lead to the development of a
new generation of drugs within the decade that could
be used to stop the aggressive spread of most forms
of the disease.”
The team are now recruiting chemists to help them
design a drug which could interrupt the gene’s
Dr Kat Arney, science information manager at Cancer
Research UK, said: “Over recent decades researchers
all over the world have discovered genes that drive
the growth and spread of cancer, and this research
adds one more to this ever-growing list.
“But, while these new results aid our understanding
of the complexities of cancer and could point
towards potential leads for future anti-cancer
drugs, the work is still at the laboratory stage.”