Pain Management Center

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The Centre for Pain Management at Da Medika Polyclinic

We offer the latest therapies for the treatment of chronic pain of malignant and non-malignant origin as well as of pain of unknown cause. The Centre is led by Prof. Predrag D. Stefanović, MD, PhD, a specialist in anaesthesiology, reanimatology and intensive therapy and a pain medicine subspecialist, who received special education in the area of pain medicine at the Medical School of Harvard University. Our approach to pain is comprehensive, multidisciplinary and specially adapted to the needs of each patient, regardless of the origin of pain (rheumatic pain, neuropathy and polyneuropathy, pain with oncology patients, migraines).

Pain management: comprehensive approaches to treatment of pain

Pain management is a key component of healthcare, the aim of which is to relieve suffering and improve quality of life of persons who feel pain. Understanding different aspects of pain and numerous treatment options which are available is of vital importance for the efficient pain management.

What is pain management?

Pain management comprises a series of treatments focusing on reducing or eliminating pain, thus helping persons to achieve better functionality and improved quality of life. It includes pharmacological and non-pharmacological approaches adapted to specific needs of patients.

The importance of pain treatment

Efficient treatment of pain is important as it does not only relieve suffering, but also improves an individual’s well-being on the whole. Pain management can prevent the escalation of acute pain into chronic pain, reduce the risk from psychological problems and improve daily functioning.

Types of pain

Acute pain – Acute pain is a type of pain which usually occurs suddenly and has a specific cause, such as an injury or an operation. It is often sharp and intense, but it usually wears off when the primary cause is cured.

Chronic pain – Chronic pain lasts for a long time, longer than three months, and it can be constant or occasional. It can be the consequence of various conditions, such as arthritis or fibromyalgia, and it often requires a comprehensive treatment approach.

Neuropathic pain – Neuropathic pain occurs as a result of the damaged nervous system. It is often described as burning or stabbing pain and it can be the consequence of the conditions such as diabetes, herpes zoster or a nerve injury.

Nociceptive pain – Nociceptive pain is caused by a tissue injury or an inflammation and it is usually experienced as throbbing or constant pain. It can result from injuries, operations or medical conditions such as arthritis.

Causes of pain

Injuries: injuries, such as fractures, sprains and cuts are frequent causes of acute pain. Pain signals the body to protect the injured area during the healing process.
Operations: Postoperative pain is expected after medical procedures and it can vary in intensity depending on the type and extent of the operation.
Medical conditions: chronic conditions, such as arthritis, cancer and diabetes, can cause constant pain which requires long-term treatment strategies.
Psychological factors: emotional stress, anxiety and depression can intensify the experience of pain, which renders treatment more difficult.

Pain diagnosis

In order to establish an accurate diagnosis, it is necessary to look at the general health condition, which a specialist does in several steps:

– Medical history helps in understanding the onset, duration and characteristics of pain, which is essential for correct diagnosis and treatment planning.

– Physical examination can reveal the signs of an injury or the primary medical conditions which contribute to pain. This assessment is of key importance for determining an adequate course of treatment.

– Diagnostic tests, such as numerous radiological procedures, blood tests and other diagnostic tools help in identification of the primary cause of pain, enabling targeted and efficient treatment.

Pain management techniques

Each treatment is adapted to the specific cause and type of pain, aiming to achieve the maximum relief of symptoms and improve the patient’s quality of life.

Pharmacological treatments

Medications are often used for treating pain, ranging from options involving over-the-counter medicines to stronger drugs which can be issued on a prescription only. Stronger analgesics, including opioids and certain types of antidepressants and anticonvulsants are prescribed for more sever pain. Opioids are powerful analgesics which are used for intense pain, but bear the known risks which are reduced to a minimum through the correct use and for that reason they require the doctor’s supervision while being taken.

Non-pharmacological treatments

Treatments which do not involve drugs play an important part in treating pain, offering alternatives which can complement or replace treatments based on drugs.

Physical therapy includes exercise and techniques designed for enhancing mobility and reducing pain. It is often used for chronic pain and the post-injury recovery.

Acupuncture is a traditional Chinese treatment which involves inserting thin needles into specific points on the body in order to alleviate pain.

Chiropractic can help in alleviating pain, especially in the back and the neck, through correction of spinal irregularities.

Massage helps in reducing the muscle tightness and relaxation, which can reduce pain and improve the overall well-being.

Advanced pain management (minimally invasive treatment) involves nerve blocks (i.e. injecting anaesthetics in the vicinity of specific nerves so as to block painful signals, providing temporary relief for various types of pain), epidural injections (used for the administration of drugs directly into epidural space around the spinal cord and most often used for back and leg pain), spinal cord stimulation (involving implantation of devices which send electrical impulses into the spinal cord, interrupting pain signals and providing relief), integrative pain management (involving the combining of different treatment modalities so as to achieve the best possible outcomes in terms of pain relief and functional improvement).

What types of therapeutic interventions does a specialist in pain management conduct at Da Medika Polyclinic?

Diagnostic and therapeutic interventions:

Infusion involves intravenous administration of fluids, drugs or nutrients directly into the bloodstream with the help of a needle and a catheter, usually through the vein in the arm. It is used for rehydration, administration of antibiotics, chemotherapy and other therapies.
An intramuscular injection at a doctor’s surgery is administered by injecting a drug directly into a muscle, usually into a deltoid muscle of the arm, gluteus or quadriceps. It is used for quick absorption of drugs, such as vaccines, antibiotics and analgesics.
An ultrasound-guided suprascapular nerve block in the shoulder region pain management includes the use of ultrasound for guiding a needle to the suprascapular nerve, where an anaesthetic or a steroid is then injected for pain relief in the shoulder region.
A puncture and administration of drugs with the use of ultrasound (a unilateral and bilateral nerve block) is performed by using ultrasound for precise guiding of a needle to the targeted place where the puncture and administration of drugs is done, usually to the joints or soft tissues, for alleviating pain and reducing inflammation.

An ultrasound-guided diagnostic or therapeutic block of one peripheral nerve uses ultrasound for the precise locating and blocking of a specific peripheral nerve by having an anaesthetic or a steroid injected for diagnostic or therapeutic purposes.
An ultrasound-guided diagnostic or therapeutic nerve block of the knee (unilaterally) involves the use of ultrasound for guiding a needle to the knee joint so that an anaesthetic or a steroid would injected to reduce pain and inflammation in the knee.
Ultrasound-guided radiofrequency ablation of the knee (standard, unilateral) is used for guiding a needle to the nerve in the knee, following which radiofrequency energy is applied for selective destruction of the neural tissue which transmits pain, providing long-term relief.
Ultrasound-guided „Coolief“ ablation of the knee joint (unilateral and bilateral) uses ultrasound for guidance and a specialised catheter which cools the tissue while applying radiofrequency energy, thus reducing pain in the knee. It can be performed on one or on both knees.
Ultrasound-guided radiofrequency ablation of the knee (standard, unilateral and bilateral) uses ultrasound for precise guidance, but it can be performed on one or on both knees for long-term pain relief.
Ultrasound-guided diagnostic or therapeutic shoulder block uses ultrasound for precise guidance of a needle to the shoulder nerve or joint, where an anaesthetic or a steroid is injected to relieve pain and enhance mobility.
Ultrasound-guided radiofrequency ablation of the shoulder (standard, unilateral and bilateral) uses ultrasound for guiding a needle to the nerve in the shoulder, where radiofrequency energy is applied to reduce pain; it can be applied to one or both shoulders
Ultrasound-guided „Coolief“ ablation of the shoulder is a procedure which uses ultrasound and a specialised catheter which cools the tissue while applying radiofrequency energy for long-term shoulder pain relief.
Application of corticosteroids into the epidural space of the spine for reducing pain and inflammation with conditions such as a spinal disc herniation or spinal stenosis.
Application of pumps with malignant pain by having small pumps which continually deliver analgesic drugs directly into cerebrospinal fluid or the bloodstream implanted, thus enabling better management of chronic malignant pain.

Experts Specializing in Pain Therapy at Da Medika Polyclinic

Our team at Da Medika Polyclinic which is devoted to pain management is led by Prof. Predrag D. Stevanović, MD, PhD, an anaesthesiologist and a subspecialist in pain medicine.

Our Pain Therapy Center team

Prof. Predrag D. Stevanović, MD, PhD

Subspecialist in Pain Medicine

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Impressions of our patients

Gaga305

2. July, 2024.

Wonderful and friendly staff, Doctor Victor so calm and devoted to the patient, thanks to you the headaches and pain are now under control. From the heart...

Branka Pavlica Petrović

26. June, 2024.

I had the honor to meet Professor Damjanov personally, a wonderful doctor and an expert in his work.

Dragica Vasić

19. June, 2024.

All commendation for prof. Ph.D. Raičević.

Milan Jakovljević

6. June, 2024.

Dr. Vesna is an exceptional expert and very kind during the examination.

Hatidja Marković

22. May, 2024.

Dr. Vesna is an exceptional expert and very pleasant.

Nada Spasojević Petričević

7. May, 2024.

Professor Jasmina Ćirić is exceptional, pleasant, all commendation for her.

Marina Savić

10. April, 2024.

Kind staff, pleasant space, and Dr. N. Dajanov, way to go. So devoted, proficient and ready to answer all the questions.

Stefan Prlja

1. March, 2024.

Very professional and kind staff. Communication and scheduling an appointment and check-ups very simple. Rheumatologist Prof. Damjanov is unrivalled, a kind-hearted man first and foremost, and then a doctor. Way to go Da Medika.

Jasmina Petrovic

29. February, 2024.

Strong recommendation ....a brilliant team. Prof. Damjanov with invaluable experience, he helped my husband who apart from Parkinson’s disease, has arthritis, which is now in remission... better walk and we are happy and overjoyed...Thank you!!!

Olika Drobnjak-Tomašek

20. February, 2024.

My regards to the entire team of dear colleague, you are brilliant! Special thank to Nemanja Damjanov for everything!

Snežana Đorđević

21. January, 2024.

My respect for Prof. Damjanov. An outstanding expert and a wonderful doctor. Way to go! I can say this from my personal experience, as his long-standing patients for more than 25 years.

Radivoje Simić

21. January, 2024.

I had pain in the thumbs of both hands and in the right shoulder for several months, and I was totally languid. I was treated with medication and physical therapy by many physiatrists and rheumatologists, but the pain did not stop. Then I addressed Professor Damjanov, who examined me and established that I had a swelling and the inflammation of both shoulders, but also the thickening of skin and the inflammation of both hands. After the ultrasound examination and lab tests, the Professor’s suspicion that I had an autoimmune diseases - vasculitis was confirmed. I was prescribed drugs and I was soon feeling much better. I feel like a new person! No more inflammation, so the Professor plans to discontinue my entire drug treatment soon. I am grateful to Professor Damjanov for establishing the real cause of my problems and giving me the right drugs.

Stojanka Popović

21. January, 2024.

Profesor Damjanov treated me at the Institute of Rheumatology ten years ago. At that time, the doctors in Šabac claimed that I would end up immobile and in a wheelchair. And here I am, after four fractures, Dr. Vidić and Prof. Damjanov have cured me. I am now entering the 78th year of my life, I walk and I do everything. I cannot thank Professor Damjanov enough! May God protect him.

Stefan Mihajlović

21. January, 2024.

I had constant pain in my lower back. Physiatrists treated my sciatica using physical therapy for years, but to no avail. I was not feeling better at all. Then I made an appointment with Prof. Damjanov, who finally discovered what I was suffering from. He established that rheumatic inflammation of the spine - spondyloarthritis was in question. He told me that this disease could only be treated with a biological drug, which I obtained through the Republic Fund of Health Insurance. Since being in this therapy, I have felt no pain and I live and work normally. I am indebted to Professor Damjanov.

Milena Đorđević (53)

2. November, 2023.

I had severe pain in the left arm. I could not bend it nor raise it. I made an appointment with Professor Damjanov, and based on physical and ultrasound examination, he discovered inflammation, rupture and fibroses in several places. He gave me an injection and advice on what I could and what I shouldn’t do during the recovery, and after that the pain stopped and I function normally now.

Jelena Veličković (41)

28. October, 2023.

I visited Professor Damjanov while he was working at the Institute. I suffered constant pain in my feet, on a daily basis literally. Apart from my feet, where the pain was most severe, all my muscle attachments ached. None of the painkillers would help me, while neither physiatrists nor orthopaedician could understand what was in question. Prof. Damjanov realized immediately that I had the syndrome of hypermobile joints and that I had to stop practising aerobics. He gave me advice on activities which are good for me and I have followed that for years. The pain i much less intense and much less frequent, while I do not have to take any medication. A exceptional diagnostician.

Dobrila Ivković (70)

23. October, 2023.

Prof. Damjanov saved my life. I was in great pain and moved with difficulty. During the ultrasound examination, the professor saw that the cup of my hip ruptured and that there was some strange mass next it. My hip was operated on and the benign tumour was removed. However, around ten days after the operation, my general health condition worsened. I was lacking energy completely, with swellings on my legs which did not subside. None of the specialists could establish the cause. I was then examined by Professor Damjanov, who established the right diagnosis, admitted me to hospital and started treatment immediately. I would have died in a day or two for unidentified pseudomembranose colitis. I am eternally grateful to him.