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

Ask a Doctor Forum › Category: Anaesthesiology & Critical Care › Ask a Pain Specialist and Anaesthetist: Dr Thor Timothy Anuntapon Chutatape from Mount Elizabeth Novena Hospital Singapore

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dr. Thor Timothy Anuntapon Chutatape asked 2 years ago

I am Dr Thor Timothy, Anuntapon Chutatape, Pain Specialist and Anaesthetist based in Mount Elizabeth Novena Hospital and Farrer Park Hospital. Ask Me Anything! 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 me here: https://patients.smarterhealth.sg/specialist-doctor/timothy-thor-anuntapon-chutatape/ I am excited to be here to share/discuss pain management with everyone. I will be actively answering questions. 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.

37 Answers

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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

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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.

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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.

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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?

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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.

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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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.

dr. Thor Timothy Anuntapon Chutatape replied 2 years ago

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.

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