Slipped Disc/ Sciatica Treatment: Non Surgical Pain Relief

Tags >> Non Surgical Slipped Disc Treatment in Delhi, Sciatica Treatment in Delhi

Sciatica is term used to describe pain that travels down the leg from the lower back or buttock. It is a type of nerve pain commonly caused by pressure on the nerves in the back by a disc bulge/ herniation (slipped disc).

Symptoms. Most patients complain of a sharp, burning, electric shock like pain in one or both legs and back pain/ stiffness. This is often accompanied by tingling sensation, numbness and/or leg weakness. Movement, coughing and sneezing may intensify the pain.

Treatment

Pain management specialists focus on holistic management and use a combination of injections, medication and physiotherapy in most cases. Injections are safe, effective, non-surgical interventions and the options include nerve root blocks and epidurals.

Injections for Sciatica/ Slipped Disc

These involve placing needles under x-ray guidance, close to the site of actual problem. Once in the correct place, a mixture of medicines is injected to reduce the pain and inflammation. The resulting pain relief is generally quicker and can be long lasting, giving time to patients to to engage in physiotherapy and strengthen the supporting muscles. Asthese injections deliver the medication close to the problem site, more drug reaches where it is required thereby increasing the chances of successfully reducing the leg and back pain

For more information on sciatica please follow the link below
All You Want to Know About Sciatica

For more information on injections please follow the link below
Epidural Steroid Injections can provide quick relief in cases of pain originating from the spine

Treatment Modalities in Chronic Pain Specialist in Gurgaon

Tag: Pain Specialist In Gurgaon

Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.

Chronic or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes that remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after the amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.

The impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspects of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends, etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.

The management varies depending on the actual pathology, severity, comorbidities, patient preferences, available resources/ expertise, and many other factors. At your first consultation with me, you can expect a detailed assessment including history, examination, and review of investigations. This is aimed at identifying the underlying reason for pain so that an appropriate personalized management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:

Medical management

I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in the right doses for the required duration are unlikely to be effective.

Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which helps to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.

Interventional procedures

In certain situations, I suggest procedures such as

• Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain
• Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm the diagnosis

Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.

Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi-specialty team approach based on the biopsychosocial model of pain you have the best chances of managing your pain.

Role of Physiotherapy

There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than physiotherapy. They play an important role in

• Patient education regarding their condition, do’s and don’ts specific to their condition,
• Setting realistic goals-dividing exercises into smaller achievable steps
• Help patients understand and implement pacing of activities
• Promoting compliance, increasing confidence and making you self reliant
• Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation

Role of Psychology

Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by

• Teaching coping and self-help strategies
• Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain
• Cognitive Behavioural Therapy (CBT)

All you need to know about Sciatica

1. What is sciatica?

Sciatica is term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to disc bulge in the low back. This is most commonly seen in middle-aged adults and men are more susceptible. The term sciatica originated from the sciatic nerve, which is the single largest nerve in our body. This nerve is responsible for a significant proportion of leg sensation and movement. Sciatica represents pain in the area supplied by the sciatic nerve.

Radicular pain/ radiculopathy are medical terms which doctors use when describing this condition. There are numerous reasons for having leg pain and every leg pain is not sciatica. Commonly people misinterpret sciatica as a disease and need to be explained that it is a symptom of the underlying problem.

2. What are symptoms of sciatica?

The severity and symptoms many vary considerably. In severe cases the affected individual may find it difficult to walk or even stand up straight.

Some of the commonly observed symptoms include

• Sharp, burning, stinging, shooting, electric shock or cramps like pain in one or both legs often as far down as the foot. Movement, coughing and sneezing can intensify the pain
• Tingling, pins and needles and/or numbness in leg or foot
• Muscle weakness with difficulty in weight bearing or walking.
• Buttock/low back pain and stiffness.

3. What causes sciatica?

• Disc herniation: Spine is formed of many bones called vertebrae arranged one above the other. In between these vertebrae are discs, which are like cushions or shock absorbers. The discs are made up of an outer tough substance and an inner soft jelly like substance. Herniation of the disc can occur if there is splitting or crack in the outer layers allowing the inner jelly like substance to protrude through the crack. This can cause inflammation and compression of the nerve roots in the vertebral column. Slipped disc is a commonly used term for this condition. There is an increased susceptibility to disc herniation as we age because the soft, jelly like substance dries out and shrinks with time, making the disc more fragile.

• Spinal stenosis: Stenosis means narrowing. The narrowing can be of the central canal of the spine or the passageways/ tunnels from which the nerves exit the spine. Besides disc problems, arthritis of the spinal joints or thickening of ligaments can also cause/ contribute to the narrowing.

• Spondylolisthesis: In this condition there is a problem with the alignment of vertebrae, where one vertebra is more forward or backwards, which can narrow the spaces for nerves and produce sciatica as a result.

• Piriformis syndrome: In this condition piriformis muscle in the pelvis is responsible for pressure on sciatic nerve.

• Trauma/ fractures

• Spinal tumors and infections are rare causes of sciatica

4. Can it resolve on its own?

Fortunately most cases of sciatica resolve within a period of weeks to months with conservative treatment. Specialist input and treatment can help. Painkillers, heat or cold pack, altered activity levels and physical therapy may be suggested depending on your condition. An injection of steroids into the epidural space within the spine can provide short-term pain relief in sciatica. Persistent pain can lead to changes in the nerves (referred to as plasticity). This can be a source of persistent pain even if the original inciting event is resolved … hence the importance of managing these sooner than later.

Having seen numerous cases over the years, I would say that it is not easy to predict the course. It can resolve but to what extend depends on numerous factors- some are modifiable and others are not. The recovery period varies from individual to individual.

5. What are the warning signs I need to be watch for?

Some symptoms point towards a serious problem and require urgent medical attention. Ignoring these could lead to permanent nerve damage. Some of these include

• Loss of urinary control/ inability to pass urine
• Loss of control over stools
• Numbness around the bottom
• Worsening leg weakness / loss of control

6. What can I do to reduce my risk of having sciatica?

Though it’s not possible to completely eliminate the risk of sciatica, however adopting a healthy life style can help in reducing the risk. This includes

• Giving up smoking
• Regular exercises
• Right posture and work ergonomics
• Healthy diet and maintaining weight in the normal range
• Using proper manual handling techniques while lifting to avoid back injury
• Stress Management

7. What investigations are generally considered for sciatica?

Your doctor may request for investigations such as magnetic resonance imaging (MRI) scan and blood tests. Sometimes computerized tomography (CT) scans may also be required. X-rays are not as helpful and they can provide only limited information.

Bulging discs on an MRI scan are not an uncommon finding. It is important not to get fixated on the MRI findings. A bulging disc is not permanent and can reverse. The investigation results should be interpreted in combination with patient history, examination findings to assess their significance.A number of patients with severe MRI findings may be asymptomatic and vice versa.

8. What are the other treatment options?

Sciatica is different from common ailments we all suffer and hence taking professional help is recommended. Your doctor can help to confirm that you have sciatica and help identify the cause. A range of different options- non surgical (such as injections- nerve root blocks, epidurals, piriformis injection etc) or surgical may be considered. There is no one solution for sciatica pain and the options are numerous – some with good evidence and others with not so robust evidence.

Generally a multimodal multidisciplinary approach is preferred as this helps in addressing not only the pain but also the impact of pain on one’s life. I ensure that the patient understands the nature or problem and the do’s and don’ts. Time spent in explaining the conditions and the expected course goes a long way in fostering realistic expectations. I generally use a combination of the modalities mentioned below to enhance the chances of quicker recovery.

Pain relief:
Pain reduction achieved by medicines help to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms and individual factors such as co morbidities and allergies. Some of the commonly prescribed pain killers include

• Non steroidal anti-inflammatory drugs (NSAIDs)
  This includes drugs such as DIclofenac, Naproxen, Aceclofenac, Ibuprofen etc. NSAIDs are prescribed to reduce the pain and inflammation during periods of acute sciatica although the evidence supporting their use is not very robust. The risk benefit ratio needs to be evaluated while prescribing any drugs.
• Neuropathic pain killers
  This group includes antidepressants and anticonvulsants both of which are well known painkillers for nerve pain. It generally takes a few weeks for the full effects of these drugs to become apparent. Effects such as reduced anxiety and sedation can be used beneficially by tailored selection to suit individual patients. Their use is supported by the NICE guidelines, UK.
• Opioids
  Weak opioids such as tramadol are often prescribed during pain flare up episodes. It is a good practice to be aware of the side effects of a medicine prior to using it.
• Muscle relaxants
  These are used for short duration to relieve any muscle spasm contributing to the back pain.

Spinal Injections:

The use of epidural steroids/ Nerve root blocks has been shown to have beneficial improvements in leg pain and disability scores in short term. Steroids help by their anti-inflammatory and analgesic (pain relieving) effect. Epidural steroids are preferred to oral steroids as they are given close to site of actual problem and have less adverse effects.

Physiotherapy:

Physiotherapy is an essential component of sciatica treatment. Your physiotherapist can help with posture advice, do’s and don’ts relevant to your condition, understanding the concept of pacing of activities, setting practical goals, teaching strengthening exercises for core, leg muscles and manual handling techniques.

Surgery:

If a combination of above fails to provide adequate relief then surgical options such as discectomy (operation to remove bulging part of the disc or separated disc fragments) and microdiscectomy can be considered for sciatica resulting from disc bulge. Surgical options will vary depending on the cause of sciatica and sometimes may be the first choice, depending on the actual pathology and its severity.

Tags = causes sciatica, risk of sciatica, Sciatica, symptoms of sciatica, Pain management centre in Delhi, Pain Management in Delhi

Postherpetic Neuralgia – Time heals… We are here if it fails…

What causes Postherpetic Neuralgia (PHN)?

Herpes Zoster infection (Shingles) is caused by the reactivation of the virus which causes chickenpox. If one has had chickenpox before, the virus that causes it remains inside the body in an inactive state till it gets an opportunity to spread once again. The reactivation may happen as one ages or as a result of reduced immunity. The virus spreads along a nerve producing the typical rash of Herpes Zoster in the area supplied by the nerve. Rash generally heals in 2-4 weeks and is accompanied by pain, numbness, itching and altered sensitivity in the area.

One out of five patients with Herpes Zoster may still have persisting pain after 120 days (90 days as per WHO) of rash onset and this condition is referred to as Postherpetic Neuralgia. In PHN the nerve cells can get damaged leading to increased excitability and persisting pain. Approximately 50% of patients recover within a year and the course is variable in the remaining. In one study it was observed that the proportion of patients with spontaneous resolution of pain decreased with increasing time since the onset of herpes zoster.

Who are at risk for developing persisting pain/Postherpetic Neuralgia after the Herpes Zoster (Shingles) infection?

The risk factors can be viewed as those relating to the

• Risk of developing Herpes Zoster infection– such as increasing age and low immunity. Low immunity may be secondary to diseases such as cancer or medications used to suppress immunity such as those used in organ transplant, treatment of inflammatory arthritis and chemotherapy. 
• Risk of persisting / non resolving pain– Pain preceding the onset of rash, severe pain at the time of rash onset, widespread rash and older age have been associated as risk factors for persisting pain (PHN). 

Early use of antiviral agents (within 72 hours of rash onset) & corticosteroids (if indicated), early aggressive pain control may offer some protection, reducing the risk of developing PHN after Herpes Zoster infection.

What are the symptoms of Postherpetic Neuralgia?

PHN generally presents as burning, shooting, throbbing or electric shock like pain occurring spontaneously or in response to stimuli such as touch. Commonly involved areas include the chest wall (thoracic dermatomes) and around the eye (ophthalmic branch of the trigeminal nerve). Pain may be more severe at night time and during periods of stress. The affected area may

• Be hypersensitive with daily activities such as taking bath, wearing clothes becoming difficult as the touch of clothes or water is painful. This is known as allodynia where non painful stimuli become painful. 
• Feel itchy
• Feel weak (muscle weakness)
• Develop skin pigmentation and scarring in the area of rash 

How is Postherpetic Neuralgia diagnosed?

PHN is rare in the age group below 50 years and incidence increases after the age of 60 years. Generally the diagnosis can be made clinically as most patients would give the history of Herpes Zoster Infection/ typical painful rash in the affected area. In many cases the persisting skin colour changes and scarring also aid the diagnosis. The rash generally involves only one side and does not cross the midline.

Which medications can help to reduce the pain in Postherpetic Neuralgia?

Different types of medication are used to control pain in PHN and these include:

Neuropathic Agents

PHN pain does not respond well to the usual painkiller and special types of painkillers known as the neuropathic painkillers may be required. This includes medications such as 

• Anticonvulsants
• Antidepressants

These are well known painkillers commonly used for nerve pain. The choice of drugs best suited for an individual is made after a thorough assessment and taking into account a number of factors such as age of patient, pain severity, other medical problems, general health etc. The dose of the selected medications is increased gradually giving the body a chance to adapt and reducing the side effects. These medications may take a few weeks to produce their full effects and hence it is important that you stick to the schedule recommended by your pain physician. Often a combination of different agents is utilised to maximise your gains and to keep the individual drug doses low so that the side effects are minimised. These medications not only help with the pain but can also help in improving sleep, mood, and quality of life.

Opioids

This class includes morphine like drugs which are often used for severe pain, in combination with the above mentioned medications. Opioids can be classified as weak opioids (like tramadol) and strong opioids (fentanyl patches, morphine, oxycodone etc). Some of these are available in long acting and short acting formulations. These drugs are best prescribed by a specialist who is well versed with the available options and the limitations /advantages of each of them. It is important that you adhere to the schedule as prescribed by your pain specialist. Whilst deciding on medications the side effects should be kept in mind and discussed with the patients. Sometimes the side effects are used as an advantage like sedation with night time medications to improve sleep. 

Topical agents

These have the advantage of fewer side effects and are sometimes used preferentially in the elderly/ frail patients and when side effects of oral medications limit their usage. They include various types of gels, creams and patches. Some contain local anaesthetic and soothing agents. Local anaesthetic patches may be especially useful in cases of increased sensitivity to stimuli such as touch. Unfortunately some of the topical options such as 8% capsaicin patch are not available in India as yet.  A one off 60 minute application of Capsaicin 8% patch can provide significant pain reduction for a few months.

What other treatment options are available for pain control in Postherpetic Neuralgia?

A number of options are available to control PHN pain apart from the medications and these include: 

Drug infusions- These are commonly used in cases with severe pain, especially when the other measures have not been successful. They work by reducing the sensitivity of the nerves transmitting the pain signals. These infusions are generally administered in day care setting which means that you do not have to stay in the hospital overnight. These are low risk options with the potential of significantly reducing the pain for weeks/ months. They can help reduce the requirement of other regular strong medications thereby reducing the side effects. 

Nerve blocks, Dorsal Root Ganglion Block and Epidural injections can be considered based on the pain severity and the site involved. These procedures involve injection of local anaesthetic and steroids to reduce the pain and sensitivity of the nerves. They are generally performed as a day case using x-ray or ultrasound guidance with no requirement for overnight hospital stay. In severe acute cases however hospital stay may be required if continuous epidural drugs are administered to control the pain.

Sympathetic nerve blocks including stellate ganglion block are used for severe uncontrolled pain. Initially a diagnostic block is performed to assess if these special nerves (called the sympathetic nerves) are involved in transmitting the pain signals to the brain. These nerves do not carry pain signals normally but can get involved in chronic pain conditions. If the response to the diagnostic block is positive then other ways of prolonging the effect can be considered. Depending on the duration of the effect, these blocks and hence they may need to be repeated. 

Pulsed radiofrequency lesioning (PRF) is a safe, non-destructive modality that can help in reducing the PHN pain. This treatment is performed as a day case, using special equipment and requires  x-ray or ultrasound guidance. The treatment  involves modulating the way pain signals are transmitted and processed and the resulting pain relief can last for weeks/ months.

Neuromodulation including Peripheral Nerve Stimulation, Peripheral Nerve Field Stimulation ― Peripheral Nerve Stimulation (PNS) in a non invasive treatment that is performed by placing the stimulating electrode in close proximity to the involved peripheral nerve. The nerve can be easily located using ultrasound in most cases, with the stimulation performed transcutaneously. More invasive methods may involve placing electrodes through the skin or in the spine (Spinal cord Stimulators). In Peripheral Nerve Field Stimulation (PNFS), stimulating electrodes are placed below the skin (percutaneously) close to the painful area and are removed once the treatment has been performed.

Tags >> Post Herpes Zoster Pain Treatment, Post Herpetic Neuralgia, Postherpetic Neuralgia

Plantar fasciitis (Joggers Heel)

• Tags: Plantar fasciitis treatment in gurgaon, Pain Management in Gurgaon

What is Plantar fascia?

Plantar fascia is a long, thin strong band of tissue in the sole of foot, extending from the heel to the front of the foot. It acts like a shock absorber and supports the foot arch.

What causes plantar fasciitis?

It is believed that plantar fasciitis is caused by damage or irritation of plantar fascia due to excessive strain resulting in heel pain and stiffness. The pain is most often felt below the heel close to the site of attachment of plantar fascia to the heel bone. In majority of cases a specific cause or reason cannot be identified although certain factors can predispose one to the development of this condition. These include

• Obesity
• Constantly being on your feet, especially on a hard surface
• New/ increased activity or repetitive impact activity such as running/sports (especially involving hard surfaces /courts)
• Tight calf muscles
• High foot arches or flat feet

What are the symptoms of plantar fasciitis?

Plantar fasciitis is most common in people between the ages of 40 to 60 years, although it can occur at any age. It is twice as common in women compared to men.

Common symptoms of plantar fasciitis include:

• Sharp, burning or aching pain on the bottom of the foot near the heel. It can extend till the arch area of the foot.
• Pain with the first few steps in the morning or after period of rest. The pain generally subsides after a few minutes of walking 
• Increased pain after exercise or activity

How is plantar fasciitis diagnosed?

The diagnosis is made clinically based on the history and examination findings. In clinic ultrasound scan can help confirm the diagnosis.

X-rays are used for ruling out other causes of heel pain, such as fractures or arthritis. Heel spurs (small piece of bone that can grow on the underside of the heel bone) are often seen on an x-ray. Approximately 3 in10 people have a heel spur and few of them have heel pain

Magnetic resonance imaging (MRI) scan is sometimes requested to confirm diagnosis and rule out other conditions with similar presentation. 

What are the treatment options for plantar fasciitis?

Plantar fasciitis is commonly described in the literature as a self-limiting condition. A significant number of patients with improve within 10-12 months, although it can be disabling and impact negatively on the quality of life. Treatment options include

• Rest/ Activity modification. Decreasing or stopping the activities that make the pain worse especially activities such as running/ step aerobics where the feet pound on hard surfaces
• Ice. Rolling your foot over a cold water bottle or ice can help. Applying ice wrapped in a towel to the affected area helps reduce pain. This can be repeated 3 to 4 times in a day. Avoid using for too long or applying directly to the skin as it can cause ice burns.
• Nonsteroidal anti-inflammatory medication. Drugs such as ibuprofen or naproxen reduce pain and inflammation. These should be used as advised by your doctor.
• Exercise. Plantar fasciitis is aggravated by tight feet and calf muscles. Stretching the plantar fascia and the calf muscles several times a day, can help to relieve the pain. Night splints work by creating a constant mild stretch of the plantar fascia and they do need to be worn for some time before the effects become apparent. Tolerability can be an issue and in some cases even putting them on for 10 min before betting out of bed in the morning can be helpful in reducing the early morning symptoms.
• Weight management – healthy body weight can help by reduce the load on the plantar fascia.
• Supportive shoes and orthotics can help in reducing the impact / heel irritation especially in individuals with flat feet. Avoid walking barefoot and use supportive footwear with a stiff outer sole and a shock absorbing insole. Custom made orthotics are more likely to be better tolerated although there is no strong evidence to show that custom made orthotics lead to more improvement.
• Extracorporeal shockwave therapy (ESWT)– this option is utilised more for runners as there is some evidence of effectiveness in this subgroup.
• CORTISONE/ STEROID INJECTIONS – this is a common treatment choice for patients not resolving to simple measures. There is moderate quality evidence demonstrating the short term beneficial effects of these injections. It is best to perform the injections under ultrasound guidance as this increase the accuracy of injections. Using low doses of steroid can help limit the potential local side effects. You may be asked to avoid running and other high impact activities for some time (approx. 2 weeks) after the injection.
• PRP injections. Platelets are one of the blood components. They help in clotting and contain growth factors which promote the healing process. PRP is prepared from one’s own blood by placing it in a spinning machine to separate the platelets.  Growth factors released from the platelets influence and accelerate the repair process, utilising body’s natural healing ability. These injections are best performed under ultrasound guidance and have the potential of providing prolonged relief.
• 
  

Treatment modalities in chronic pain in Delhi

Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.

Chronic or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes which remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.

Impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspect of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.

The management varies depending on the actual pathology, severity, co morbidities, patient preferences, available resources/ expertise and many other factors. At your first consultation with me you can expect a detailed assessment including history, examination and review of investigations. This is aimed at identifying the underlying reason for pain, so that an appropriate personalised management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:

 

Medical management

I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in right doses for the required duration are unlikely to be effective.

Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which help to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.

 

Interventional procedures

In certain situations I suggest procedures such as

·         Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain

·         Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm diagnosis

Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.

Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi speciality team approach based on biopsychosocial model of pain you have best chances of managing your pain.

 

Role of Physiotherapy

There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than

physiotherapy. They play an important role in

·         Patient education regarding their condition, do’s and don’ts specific to their condition,

·         Setting realistic goals-dividing exercises into smaller achievable steps

·         Help patients understand and implement pacing of activities

·         Promoting compliance, increasing confidence and making you self reliant

·         Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation

 

Role of Psychology

Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by

·         Teaching coping and self-help strategies

·         Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain

·         Cognitive Behavioural Therapy (CBT)

Consult Best Pain Specialist In Delhi, Dr. Amod Manocha.

Tags = Pain Specialist In Delhi, Best Pain Specialist In Delhi, Pain Managment in Delhi