Tier One Therapies

· Over the counter pain medications.

· Exercise programmes.

· TENS - Transcutaneous electrical nerve stimulation.

· Self-management programmes.

· Cognitive & Behavioral modification.

· Rehabilitation Therapy.


Tier Two Therapies


· Pharmacotherapy.

· Physiotherapy.

· Neural Blockade.

· Thermal Neuroablation.

· Radiofrequency Neuroablation.

· Neurolysis.

· Systemic Opioids

· Regional nerve blocks.

Tier Three Therapies


· Pain Managment programmes.

· High Frequency Spinal Cord Stimulation (SCS)

· Conventional SCS. 

· Intrathecal Drug Pumps

· Prometra Pump by Flowonix

· Deep Brain Stimulation.

Patients referred under HSE Treatment Abroad Scheme to Professor Aziz, University of Oxford, Neurosurgery Department, John Radcliffe Infirmary.

What is Chronic Pain?


Chronic pain can manifest in many ways. It could begin with an injury, or medical procedure - that over time develops into a persistent painful condition. Sometimes even the cause of pain can be uncertain. At Dr. Declan O'Keeffe’s Practice we strive to understand the factors that cause pain and implement treatments to help our patients. We also work tirelessly to prevent acute pain from becoming chronic.


Chronic pain is a long-term, complex condition, it is biopsychosocial, meaning that it effects people biologically, psychologically and socially. Indeed it may interfere with many aspects of a person’s life - the ability to work, to maintain personal relationships, and it is harmful to both physical and mental health.


Empathy and understanding are key elements in a patient’s recovery. Unfortunately stigma and misperceptions lead many to suffer more than they need. The work of the Practice is rooted in changing cultural attitudes about chronic pain, removing stereotypes and myths. 


Our goal is for our patients to live productively and with dignity. We offer the chronic pain sufferer a layered and integrated series of treatment therapies. We break these therapies into three tiers.