Ask a Pain Specialist and Anaesthetist: Dr Thor Timothy Anuntapon Chutatape from Mount Elizabeth Novena Hospital Singapore

Ask a Doctor ForumCategory: Anaesthesiology & Critical CareAsk a Pain Specialist and Anaesthetist: Dr Thor Timothy Anuntapon Chutatape from Mount Elizabeth Novena Hospital Singapore
I am Dr Thor Timothy, Anuntapon Chutatape, Pain Specialist and Anaesthetist based in Mount Elizabeth Novena Hospital Singapore and Farrer Park Hospital Singapore I am accredited as a Fellow of the Faculty of Pain Medicine Australian and New Zealand College of Anaesthetist (FFPMANZCA), as well as a Fellow of Interventional Pain Practice (USA). I am also Fellow of the Academy of Medicine in Singapore (FAMS) and one of the founding members of its Pain Chapter. I specialise in non-surgical management of chronic pain conditions involving but not limited to :
  • Headache such as trigeminal neuralgia, tension type headache, migraine.
  • Shoulder pain such as frozen shoulder.
  • Back pain which is caused by hernia nucleus pulposus, annular tear, spine degeneration.
  • Knee pain which is caused by osteoarthritis, ligament & meniscus problem.
  • Leg pain such as plantar fasciitis
  • And many more
I do this using evidence-based treatment that synergizes therapeutic medications with specialized minimally-invasive pain procedures (radiofrequency, annuloplasty, nucleoplasty, etc) that can be done as an outpatient basis. I was the previous Director of Acute Pain Services in Singapore General Hospital. I am consulted on cases and do procedures in the Parkway Hospitals, Mt Alvernia, Farrer Park Hospital and at major day surgery centres. Learn more about Mount Elizabeth Novena Hospital here: https://patients.smarterhealth.my/hospital/mount-elizabeth-novena-hospital-singapore/ and Farrer Park Hospital here: https://patients.smarterhealth.my/hospital/farrer-park-hospital-singapore/ Learn more about me here: https://patients.smarterhealth.my/specialist-doctor/timothy-thor-anuntapon-chutatape/ I am excited to be here to share/discuss pain management with everyone. Whether you've got questions about how to deal with and manage pain in the following areas: back, face, foot, head, knee, neck, shoulder, ask me anything! === Want to ask a question? Submit your question at the bottom of this page. Don’t forget to include your name and email address to get notified when the doctor answers your question.
16 Answers
Wuri Nurandini answered 2 years ago
Doctor, I have pain on my shoulder, sometimes it gets stiff. Usually I apply muscle balm. What medicine should I take? When do I need to see a doctor?

You are not alone as shoulder pain is very common. Stiffness can be because of bones and arthritis or the wear and tear of muscles and their attachment to the bones. Sometimes the result can be stiffness. Ointments and balms help with muscle aches and pains but if If there is increasing pain or stiffness or numbness that doesn’t resolve in a week or 2, it will be helpful to have a work up done.

Faisal answered 2 years ago
Doctor, I love playing futsal. Once, after a training session, my thigh was cramping. But then it got better. However, now my thigh hurts quite often, sometimes to the point when I can’t stand. I feel like something is pinching it. Is this still related to my cramp at the training session, Doc?

In this context the pain is almost always of a torn muscle or ligament. More rarely it is because of a problem with the hip or knee joint. It is important to give the thigh time to heal and rest and you will need to stop futsal for up to 4-6 weeks. If the symptoms persist it would be best to consult with a specialist and get either an MRI or ultrasound to exclude more serious injuries.

Ulfa answered 2 years ago
Doctor, is a recurring migraine dangerous? I often have migraines. Usually I just take medicines for my headache. Sometimes it hurts so much, but then it fades away naturally. When should I worry about dangerous migraines, Doc?

A migraine can cause severe throbbing pain, usually on one side of the head. It can be accompanied by sensitivity to light and sound, nausea and vomitting. For some people, an aura occurs which represent changes in vision and hearing before the attack.

Lying down in a dark and quiet room may relief migraines. Taking over the counter pain killer may help but do pay attention on the dosage and the frequency. If you need to take pain killer for more than 10 days in a month, it is better to consult a doctor.

If you have any of the following signs, please see your doctor immediately. It may indicate a more serious medical problem :
•A sudden severe headache
•Headache with fever, stiff neck, mental confusion, seizures, double vision, numbness, weakness, trouble speaking.
•Headache after injury

Vegi rafensca gustan answered 2 years ago
Good afternoon, Doc. I did an x-ray. The result showed lumbarization of S1. The symptoms I feel are pain from my butt to my feet, cramping feet, and stretched veins. It hurts so much.

Lumbarisation is where the first sacral segment has the appearance if a lumbar vertebrae which may give an impression of a 6th lumbar vertebra. Please find the picture attached. It rarely causes a medical problem.

The pain on your buttock goes down to your feet is a condition called sciatica. You may develop this pain when part of the sciatic nerve near your spinal canal is pinched. I suggest you to get a lumbar MRI to find out the cause of the impingement.

One of the most common cause of sciatica is a herniated disc. A rubbery pad between every vertebrae may protrude and put pressure on nearby nerve.

For this condition, there is a non surgical procedures called nucleoplasty. By using a special needle, it allows doctor to reach the disc core and reduce the pressure inside so it will relief the pressure on the nerve.

Here's the nucleoplasty video link. Hopefully it can give you more insight.
https://www.youtube.com/watch?v=W34ddv3Co-0

Dedi Hardani answered 2 years ago
Hello Dr. Timothy. I have trigeminal neuralgia and am currently under treatment. The pain I feel on some spots of my face is like an electric shock. Usually I feel it if I walk faster and sit in a moving vehicle. The doctor said my condition is not severe and surgery is unnecessary. It is true that I feel the pain is not overwhelming. But I want to know, is this a normal condition that happens to elderly people like me (i am 60 years old) and can it be totally cured?

Trigeminal neuralgia is a chronic pain condition that affects trigeminal nerve. The pain typically involves lower face and jaw, sometimes it affects the area around nose and above the eye.

The pain may be triggered by:
•Touching or washing your face
•Shaving
•Brushing teeth
•Blowing the nose
•Drinking hot or cold beverages
•Smiling
•Talking

Several treatment options for trigeminal neuralgia:
1. Medications
2. Non surgical pain procedure using Radiofrequency
3. Surgical

If the medications do not provide a good relief, Radiofrequency treatment can be one of the treatment option. By using a special needle, a pain specialist is able to target the nerve and make it less sensitive to pain with radiofrequency.

Trigeminal neuralgia is not a normal consequence of aging. Nevertheless, glad to hear that your pain is not so severe. The trigeminal neuralgia prognosis may vary. In some cases, the pain does not occur for months even years. But for some patients, if the disease left untreated, the pain may become constant and severe.

Lenny Tumbuan answered 2 years ago
Doctor, why do I often feel dizzy and my feet feel weak? I've been taking medicines from my doctor but it is not totally cured.

Did you check your bank account balance too frequently? 😀
Well, maybe that's why you often feel dizzy…

There are many systems in human body which control balance and motoric strength.

Brain, eyes, cochlear organ inside the ear, spinal cord, peripheral nerves, and muscles. All involved in balancing function and strength.

You may come to your doctor for further check up.

Tjang krisya chaniago answered 2 years ago
Doctor, my fingers are stiff and it is painful to straighten them up. The pain even radiates through my palm. I often feel an electric shock in my fingers. And every morning when I wake up, I feel my hands and fingers are stiff. What is the solution, Doc?

From the symptoms you have mentioned, I suggest you to get a blood test (Rheumatoid Factor, Anti Nuclear Antibody) to rule out rheumatoid arthritis possibility. You may get the referral letter from your family doctor or any GP.

There are several possibilities:
1. If the blood test result shows rheumatoid arthritis, kindly get a treatment from rheumatology specialist.
2. If the blood test result does not show any rheumatoid arthritis signs, you need to see Orthopaedic for further check up. Orthopaedic specialist will examine whether you have a carpal tunnel syndrome or osteoarthritis. Your treatment will be based on the examination result.

Hopefully this will guide you.

Sitinorhayati Norhayati answered 2 years ago
Doctor, my hip often hurts. Sometimes the pain at my right stomach radiates through to my back. What is the medicine?

The pain at your hip area can be hip arthritis or other pathology such as right kidney stone. Pain in stomach can caused by gastric problem, pancreas, liver, gall bladder, etc.

Kindly check with your doctor to find out the root cause first.

Effendi KR answered 2 years ago
These 2 months, on my face between the upper lip and nose, and spreading to the cheek, I have been feeling pain. When it occurs, that part of my face will twitch. Someone said this is due to nerve problems. Is that so, Doc? Usually it happens after I talk a lot.

Is the pain and muscle twitching only at one side of the face?
If that is the case, you may have trigeminal neuralgia. The trigeminal nerve located in front of each ear providing sensation to the face. It has three branches which cover different face area. Please find the picture attached. The pain can be triggered by daily activities such as talking, brushing teeth, shaving, etc.

If the pain occurs on both sides of the face and not related to nerve distribution, it may be an atypical facial pain.

For both pain conditions above, doctor will start the treatment by prescribing some medications to control the pain. But if it doesn't give a good pain relief, a non surgery procedure called radiofrequency can be one of the treatment option. The goal of this treatment is to make the nerve less sensitive to pain signal.

You may need to consult with a neurologist if the pain is getting severe.

A. Firdaus answered 2 years ago
Doc, what is the cause of a persistent cramp on my calf? I am only 27 years old, but if I walk some distance, my calf cramps up.

Most of the time, a muscle cramp is harmless. However if your cramp:
– Happen frequently,
– Not associated with some activities, or
– Accompanied by muscle weakness
You may need a further check up.

The underlying medical conditions which related to muscle cramp are:
– Nerve compression in the spine.
– Peripheral arterial occlusive disease.
– Mineral imbalance such as low potassium, calcium or magnesium.

In your case, it would be better if you do MRI scan to detect the nerve compression, ultrasound or angiography to investigate the blood circulation and also blood test to check the potasium, calcium, as well as magnesium level.

Marwianti answered 2 years ago
Doctor, I have been feeling pain in my back for the past 7 months. I've seeked treatment everywhere but there is always no improvement. I had an x-ray done but the results didn’t bring any changes to my condition. Please give me a solution, what treatment should I do?

The human back composition is a complex structure built from nerves, muscles, discs, and bones. The problems with any of these components can lead to back pain.

Roentgen data alone may not be sufficient to see the detailed image required from the spines structures. Advance analysis of the spines structures will require an MRI scan.

Mulyadi answered 2 years ago
Doctor, what is likely the cause of pain in the back of the head, near the ears?

The common pain on the back of the head:

•Occipital neuralgia
Occipital neuralgia is characterized by piercing, throbbing pain in the upper neck, back of the head, and behind the ears, usually only on one side of the head.
Occipital neuralgia can be the result of nerves impingement or muscle tightness. It can also be caused by a head or neck injury.

•Cervicogenic headache
Cervicogenic headache is characterized by a dull, non-throbbing pain that radiates from the neck to back of the head. The pain may spread along the scalp and affect the forehead, temple, and area around eye or ear.
The cause is often related to excessive stress to the neck, cervical osteoarthritis (spondylosis), a damaged disc, or whiplash-type movement that irritates or compresses a cervical nerve.

•Tension type headache
Tension type headache is quite common and often described as a feeling like tightness on the back of the head. It is related to muscle tightness which can be a response to stress, depression, head injury, or anxiety.

Ricky Fardiansyah answered 2 years ago
The soles of my feet hurt when I walk, like as though there is something stabbing me, although I only walk inside the house. Why is this so, Doc? I don’t have uric acid problems.

Some possible stabbing foot causes:
1. Plantar fasciitis
Plantar fasciitis is an inflammation of the fibrous tissue (plantar fascia) along the bottom of your foot that connects your heel bone to your toes. (Please refer to the first picture)
The pain is usually worse in the morning when you take your first steps out of bed, or after you have been sitting for a while.

2. Diabetic foot pain
High blood sugar can damages the nerves that send signals from your feet. Diabetic neuropathy can cause numbness or tingling in your toes and feet. Another symptom is a burning, sharp, or aching pain.

3. Metatarsalgia
When the head of one metatarsal bone presses against another, the small nerve is caught between them and starts to become inflamed. This causes metatarsalgia.

Anna answered 2 years ago
Doctor, my left ankle has been swollen for the last 2 months. I have seen a doctor several times, but to no improvement. It hurts to walk. My feet are the flat feet type. What is the solution? I have been wearing sandals with bulges, the one that is for plantar feet.

For some people, flat feet may causes foot pain, particularly in the heel or arch area. Pain may worsen with activity. Ankle swelling can also occur.

What you can do:

•Rest, try to know your feet limit. Avoid activities that aggravate your condition such as : jogging, running, jumping and long walk. You may walk inside the swimming pool or swim.

•Continue to use your arch supports.

•Daily stretching. Some people with flatfeet also have a shortened Achilles tendon. Exercises to stretch this tendon may help. You may want to follow this video: https://youtu.be/KVqZXoOnaeU

•Medications. Over-the-counter pain relievers might help to reduce pain and swelling.

•Weight loss. Losing weight can reduce stress on your feet.

Mustika answered 2 years ago
Hello doctor. Why do I feel throbbing pain in between my toes? It makes me limp.

The possible causes include:

• Freiberg disease. A form of avascular necrosis in the metatarsal bone of the foot.
•Damage to the nerves in the foot (Morton neuroma)
•Metatarsal joint pain
•Sesamoiditis. Inflammation of the sesamoid bones and the surrounding tissues
•Age-related thinning of the fat pad cushion in the ball of the foot

You may need further check up to know the cause.

Ratnasari Pertiwi answered 2 years ago
Doctor, can acupuncture cure the pain in the shoulder? My shoulder aches. A friend of mine asked me to see an acupuncturist, but I am afraid.

Whether acupuncture will help or not it depends on the cause of your shoulder pain. It may help to relieve your pain but may not help in repairing the anatomy issue.

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