A recent US study has highlighted the dangers of opioid abuse in chronic pain management.

Data from American Addiction Centres shows approximately 1.2 million people will die from an opioid overdose by the end of the current decade. Yet, opioids continue to be a leading treatment for chronic pain.

Here, we look at what opioids are, their use in chronic pain management, and what options patients have if they develop an opioid use disorder.

What are opioids?

Opioids are a class of powerful pain-relieving medications that have been widely used for the management of chronic pain. They work by binding to specific receptors in the brain and spinal cord, reducing the perception of pain.

The medications are highly effective at relieving severe pain, but their use for chronic pain management has been a topic of controversy.

They have been used for many years to manage pain caused by chronic conditions such as back pain, osteoarthritis, and fibromyalgia. However, with increasing frequency of use alongside long-term use, concerns have been raised about the potential risks associated with opioids. These include addiction, overdose, and complications like respiratory depression.

The dangers of opioid use in the management of chronic pain

Although opioids can be an effective pain-relieving treatment for chronic pain, they pose several serious health concerns. These include:

  • Addiction: One of the most significant dangers of opioids is addiction. People who use opioids for a prolonged period may develop physical dependence on the drugs, which means that they will experience withdrawal symptoms if they stop taking them.
  • Overdose: Opioids can cause respiratory depression, which means that they can slow down or even stop a person’s breathing. This can lead to an overdose, which can be fatal.
  • Tolerance: With prolonged use of opioids, the body becomes accustomed to the drugs. This can lead to tolerance, which means that a person will need to take higher doses of the drug to achieve the same effects.
  • Interactions with other medication: Taking opioids with certain types of medication, such as sedatives, can increase the risk of serious side effects, including breathing problems and sedation.
  • Withdrawal: If someone stop using opioids suddenly after a period of heavy use, it can cause unpleasant and sometimes severe withdrawal symptoms, such as restlessness, muscle and bone pain, insomnia, diarrhoea, vomiting, cold flashes with goosebumps, and involuntary leg movements
  • Long term effects: Chronic use of opioids can also lead to a number of other negative health effects such as constipation, sleep apnoea, low testosterone levels, sexual dysfunction, and depression.

Despite these concerns, there are still many patients with chronic pain who can benefit from opioid therapy when used appropriately, with close monitoring by healthcare providers. It is important to consider the potential risks and benefits of opioid therapy on a case-by-case basis, and to carefully monitor patients for potential adverse effects.

Help when you have an opioid use disorder

If you do develop an opioid use disorder and you are suffering with chronic pain, help is available.

Dr Stoilova has got extensive expertise in managing patients with chronic pain and opioid misuse disorder. You will be able to book an appointment to discuss this problem. You will also be thoroughly assessed, and the steps of the management plan will be discussed and implemented.

Lipoedema, not to be confused with lymphedema, causes an excess build up of fat in the legs or arms. Despite affecting up to 10% of women in the UK, this common condition is highly undiagnosed.

Patients with the condition often experience severe pain, and it can greatly impact their daily life. Here, we look at what lipoedema is, and the best ways to treat it.

What is lipoedema?

Lipoedema is a condition where an abnormal level of fat builds up in the legs or arms. It is more prevalent in women, and it tends to mostly develop in the legs.

The root cause isn’t known, but it is thought to start during puberty. Patients may not be aware that they have it until they go through pregnancy or the menopause. These events can exacerbate the condition, making it much more noticeable.

Those with lipoedema will typically look out of proportion. You may have larger hips and legs compared to the rest of your body. Or your legs could appear swollen, whereas your feet remain unaffected.

In some cases, people with lipoedema also have a vein disorder, which can complicate the condition and its treatment.

How is lipoedema diagnosed?

There are no specific tests to diagnose Lipoedema. Instead, physicians look at the symptoms you are experiencing. The most common symptoms include:

  • An accumulation of fat in the legs and hips
  • Tender legs
  • Strange sensations within the legs
  • A heavy sensation
  • The legs become easily bruised

Lipoedema is known to run in families, and it can be difficult to diagnose. The main reason it is so highly undiagnosed is because it is mistaken for obesity. The trouble is, when left untreated, the condition tends to worsen over time. This can, in time, lead to permanent damage of the circulatory and lymphatic system.


There is no cure for lipoedema, but there are treatments available to ease its symptoms. Wearing compression stockings and undergoing liposuction are two options available. However, liposuction may not be available on the NHS, requiring more than one treatment, and it can result in a painful recovery.

The most common advice given to patients is to eat a healthy diet and exercise regularly. While this can help, in severe cases the condition will not clear up through dietary and exercise changes alone. This can impact on people’s quality of life as well as affecting their mental health. Support is available from the Lipoedema UK charity, which can put patients in touch with other people suffering from the condition.

In summary, lipoedema is a painful condition and the treatment for it can cause severe acute pain which on occasions continues as chronic pain. If you have been diagnosed with lipoedema, you will be able to see Dr Ivanova-Stoilova for assessment and treatment of your painful symptoms.

More than two million people in the UK now live with long COVID. Diagnosed when symptoms last weeks or months after the illness has passed, long COVID is estimated to impact 3% – 12% of those who have caught the virus, according to the Office of National Statistics.

Research into the condition is now underway, with experts hoping to find out more about why it occurs and how it can best be treated. The findings of this research could also help those suffering from other unexplained post viral illnesses.

Common symptoms of long COVID

While the full range of symptoms of long COVID are still being revealed, there are some common symptoms most patients experience. They include:

  • Brain fog
  • Chest pain
  • Chronic fatigue

Research into long COVID has shown that those aged 65 and over are at a greater risk of developing the condition. Approximately 1 in 4 patients over the age of 65 have at least one long COVID symptom.

Interestingly, the symptoms experienced are similar to those triggered by other chronic illnesses. Often caused by infections, millions of people currently suffer with unexplained chronic illnesses.

Could long COVID help solve the mystery of chronic illness?

As the rising number of long COVID cases continues, researchers are devoting their time into figuring out what is driving the condition. Why do some people get long COVID while others don’t?

The research being conducted could also help to solve the mystery of other chronic illnesses such as ME, fibromyalgia, and endometriosis. These conditions often begin in the same way as long COVID, causing many of the same unexplained symptoms.

In England alone, there are approximately 15 million people living with a chronic illness. Around 8 million people in the UK suffer from chronic pain. With no cure available, living with a chronic illness can negatively impact quality of life.

As more is discovered about long COVID and why it affects some people and no others, it could lead to a better understanding of other unexplained illnesses.

Treatments available to manage long COVID symptoms

There is no single treatment available to treat long COVID. Instead, patients are treated based on their individual symptoms. Medications, alongside diet and exercise, are most used to combat the common symptoms of the condition.

Symptoms such as brain fog, low mood, and memory problems, can be managed at home with a variety of techniques. Your doctor will be able to put together a treatment plan to help manage the condition.

If you are experiencing chronic pain, seeking help from a pain specialist can help. Dr Ivanova Stoilova will be able to assess the types of pain you are experiencing, and guide you to the most appropriate treatment, which is likely to be comprehensive.

She will be able to follow you and re-assess the medications, doses, the need for physical therapy, or pain relief interventions. Book a consultation today to begin your journey to a pain-free life.

Managing your blood sugar when you have Diabetes is essential. If your blood sugar levels are elevated for a long period of time, it can lead to a nerve-damaging condition known as Diabetic Neuropathy.

Currently, there is no cure for Diabetic Neuropathy. However, with the right treatment, it may be possible to reverse the condition.

What is Diabetic Neuropathy?

Diabetic Neuropathy is nerve damage caused by prolonged high blood sugar levels. There are different types of the condition which include:

  • Autonomic neuropathy
  • Peripheral neuropathy
  • Proximal neuropathy
  • Mononeuropathy

Autonomic neuropathy relates to damage of the nerves that control the organs. Peripheral neuropathy mostly affects the nerves of the legs and feet. Proximal neuropathy causes weakness in the thighs, buttocks, hips, and shoulders, and Mononeuropathy relates to damage of a single nerve.

Symptoms include shooting or burning sensations, heightened pain sensitivity, tingling, weakness or numbness, and foot or leg sores that are slow to heal.

When damage to the nerves occurs, it can lead to serious issues for those living with Diabetes. The risk of developing the condition increases with excessive drinking and smoking.

Preventing Diabetic Neuropathy

Diabetic Neuropathy can be successfully prevented by managing blood sugar levels. You should also get your cholesterol and blood pressure under control to reduce the risk. Some of the best ways to lower the risk include:

  • Quitting smoking
  • Eating a healthy nutrient-packed diet
  • Limiting your alcohol intake
  • Undergoing regular appointments with your healthcare provider

Can it be reversed?

With the right intervention, Diabetic Neuropathy can be reversed.

Dr Stoilova has established and affirmed the first UK Diabetic Polyneuropathy Pain Clinic in conjunction with the Wound Healing Institute and Secondary Diabetes Care for her NHS Trust. She has helped hundreds of patients with Diabetic Neuropathy and her extensive expertise shows that the condition can be halted and reversed.

Together with her team, Dr Stoilova has helped many patients to avoid amputations, and she is the recipient of several awards by her patients.

It is important to note that reversal of the condition can take some time. However, patients will feel the benefit as soon as they start treatment.

What treatments are available?

Treatments for Diabetic Neuropathy work to manage blood sugar levels. The symptoms can be managed with regular exercise, a healthy diet, Diabetic medications, and pain medications.

Dr Stoilova will go the extra mile to expertly diagnose the type of neuropathy and guide her patients to a better quality of life. She arranges annual seminars for patients and health professionals, and you can be a participant in those.

Education, practical help with medications, and life solutions, as well as getting together with and meeting other people that have neuropathy has been of invaluable help to patients and their treatment teams alike.

If you suspect you may have Diabetic Neuropathy, or you are worried about your risk of developing the condition, book an appointment with Dr Stoilova today.

For those living with chronic pain, medications including NSAIDS, anticonvulsants, antidepressants, weak and strong opioids are used to provide relief. However, multiple studies have revealed the dangers of these drugs often outweigh the benefits. In many cases, they also provide very little relief. One of the major components of chronic pain is its emotional impact, or suffering.

Now researchers are trying to determine whether music might be a safer way to reduce pain and suffering. So how might music help and could it be an effective alternative to treat pain?

The dangers of opioids

Opioids are pain-relieving drugs that interact with the cell’s opioid receptors. Between the years 1998 and 2016, research showed that opioid prescriptions within the UK rose by 126%. This is despite the dangers the drugs pose to patient health.

Some of the most common dangers of opioids include:

  • Addiction
  • Slower heart rate and breathing
  • Dizziness
  • Nausea/vomiting
  • Increased pain

Ironically, patients can develop worse pain after taking opioids. They are also at serious risk of developing a physical and psychological dependence on the drugs. The risk of addiction led the Medicines and Healthcare Products Regulatory Agency (MHRA) to issue a strong warning in September 2020. They advise healthcare professionals to discuss the risks with patients before prescribing opioid medication.

The pain relief benefits of music

In a bid to reduce dependency on opioid medication, researchers are constantly looking into new alternative treatments. The pain-relieving benefits of music have been studied since the 1960’s.

A group of dentists from Massachusetts in 1960 played music to their patients during 5000 operations. They discovered that it aided relaxation, and directly suppressed pain. In some cases, patients didn’t even need nitrous oxide or local anaesthetic for pain relief.

A recent Chinese study has also revealed the surprising pain relief benefits of music. They discovered the neural mechanisms that can lessen pain in mice. While human studies will need to be carried out to confirm the findings of the latest study, it does prove promising.

Other natural ways to treat chronic pain

While music is showing a lot of promise relating to pain relief, there are alternative treatment methods available right now. These include other (non-opioid) medications as well as non-drug treatments for effective pain management. Complimentary therapies such as yoga, acupuncture or acupressure can be tried to improve quality of life.

It always has to be remembered that any ongoing medications need reviewing for their safety and efficacy. Dr Stoilova’s clinical practice includes medication review and dose corrections and when adjustments are needed, you are counselled.

Dr Stoilova’s holistic approach strongly supports using music as listening to, playing or learning to play to express emotions and reduce suffering. This creates new brain interconnections that are favourably reducing the burden of pain. Get in touch to find out the best treatments to help you with your chronic pain condition.

When you are in constant pain, it’s only natural you’ll want to get to the root cause of the problem. However, for millions of people, there is no explanation for the pain they are experiencing. This is because the current investigation technique does not always show anything being abnormal or presumed to be the source of your pain.

For example, you may be having low back pain and leg pain but the X-rays, MRI and CT scans may not show any abnormality, or may show something unexpected but nor related or causing your symptoms.

Undiagnosed pain isn’t just frustrating, it can have a significant impact on a patient’s life and wellbeing. If you are struggling to get to the bottom of chronic pain, there are things you can do to get the answers you desperately need.

Seek help from a pain specialist

GPs do a fantastic job, but they aren’t specialists in pain. If you want to get to the root cause of the problem, it is worth seeking help from an actual pain specialist. Not only do they have more training in pain than general doctors, but they also have a wealth of information they can draw on from previous patients.

Dr Stoilova, who has years of experience treating undiagnosed pain, states:

I will be very happy to see patients with medically unexplained pain. Clinical examination will be vitally important, as well as details of how the pain started in the first instance, and how it is developing over time. Many types of pain are complex and involve muscles, ligaments, the periosteum of the bones, the traversing nerves and accompanying blood vessels. These are only in the domain of pain specialists to decipher and start targeted treatment. Such treatment may be complex and involve specialist medications, injection techniques, physical therapy and occupational therapy in the correct sequence.

When you visit a specialist, you are much more likely to get the answers, and the relief, that you need.

Journal your undiagnosed pain

When you do visit a pain specialist, they will require details of how the pain is progressing. Starting a pain journal is a great way to keep track of the symptoms, as well as identify potential triggers.

Begin by writing down when the pain started. What were you doing? How has it progressed since then? Each time you experience pain, write in your journal. Note the time it started, what you were doing, and how severe the pain was.

When you have a clear written journal documenting your pain, it makes it much easier for a specialist to identify the problem.

Become an active participant in your treatment

According to numerous studies, being active in your treatment makes you feel better. Although it might not eradicate the pain, it will help you to feel more in control and potentially find the answers you are looking for.

It could be trying out different exercises to reduce the pain or researching to see if there are any new studies or treatments available. It is also a good idea to find others who are going through a similar situation. Having support and understanding is important for your wellbeing when you are suffering with long-term pain.

If you are struggling to get to the root cause of undiagnosed pain, book a consultation with Dr Stoilova today.

Dr Ivanova-Stoilova will now be seeing patients for clinical diagnosis and treatment, as well as for medical reports in Fitzrovia Hospital, Central London 13-14 Fitzroy Square London W1T6AH.

The clinic timetable will be Thursday from 2-6 pm. Telephone 0207 0343301 to make a booking.

Dr Ivanova-Stoilova will continue seeing patients in Newport, Wales on Tuesdays at her Pain Clinic. For booking into this clinic, please use the appointment number 01633 820 344.

At the XI Congress on World Institute of Pain (WIP), Budapest, 25-27 August 2022 Dr Ivanova-Stoilova is presenting her 7-years experience in treating patients with nerve pain and she is discussing the short and long term benefits of this treatment.

You can find the program for this three day conference here.

Dr Ivanova-Stoilova will be happy to answer your questions in relation to this presentation. Call us on 01633 820 300 to arrange a consultation.

Dr Ivanova-Stoilova is also presenting on 17 September the symptoms and signs of piriformis syndrome at an Independent Doctors Federation Annual conference on Stratford upon Avon.

Anti-inflammatory medication is frequently used to relieve back pain. But, according to a new study, anti-inflammatory medication could make the problem a whole lot worse. In fact, the majority of people who take the drugs, report worsening pain over a long period of time.

Here, we will address what the study found and look at the best types of treatment to eliminate back pain.

Understanding the latest study

The latest study was carried out by researchers at the McGill University in Canada and it involved 500,000 patients. They wanted to determine the long-term effects of taking anti-inflammatory medications for chronic pain. The research included 98 patients with acute back pain, who were followed for a period of three months.

Mice were also studied during the research in a laboratory. It was discovered that the neutrophils saw a reduction in activity. When these cells were blocked with an antibody, pain was prolonged for a period of more than 10 times the standard duration. Although anti-inflammatory drugs showed to eliminate pain early on, they were shown to produce a similar effect.

The research suggests that common painkiller medications like Ibuprofen and steroids, could lead to long term chronic pain. However, further research will be required to confirm the results.

Non-steroidal anti-inflammatory medication for back pain

Non-steroidal anti-inflammatory medication is commonly prescribed for pain. This is because it is considered one of the most effective ways to treat chronic pain. However, as the latest study suggests, it can lead to long-term issues. Certainly, some of which can be more severe than the initial pain the medication was treating.

What researchers know now is that inflammation is a natural and necessary response for the body to heal. If you attempt to inhibit the inflammation, it can lengthen your recovery, as well as lead to a lot more pain.

So, if you aren’t supposed to use any form of anti-inflammatory medication, how can the pain be treated?

Alternative treatments

While anti-inflammatory pain medication brings relief in the short term, its long-term effects mean it is a much better idea to treat it in other ways. There are natural methods you can try to eliminate your back pain for good, alongside physical therapy. Complementary therapies, including yoga, acupuncture and acupressure, as well as neurostimulation treatments such as TENS, are all effective treatments that improve your quality of life.

To find out which type of treatment is right for you, book an appointment with Dr Stoilova today. She will examine you as well as carrying out a medication review to ensure your safety and their effectiveness. You will then be recommended the most effective pain management treatment programme including non-drug treatment options.

Dr Ivanova-Stoilova is at the vanguard of advanced interventional treatments for patients with recurrent and intractable pain. Some of the patients have suffered muscle pain for years after trauma, sports injury, operations, road traffic accidents.

A novel treatment with pulsed radiofrequency current was presented at a recent second international symposium in Madrid on 22 April 2022. Dr Ivanova-Stoilova was honoured to present her five year work on novel treatment of chronic muscle pain among many other leading experts in the field of pain management that spoke on the science and clinical application of PRF.

Take a look at her presentation here.

Dr Ivanova-Stoilova will be happy to answer your questions in relation to this presentation. Call us on 01633 820 300 to arrange a consultation.