Mitigate Pain Clinic – Dr Jeshnu Tople – Pain Management Specialist In Nagpur
FAQs
A. About chronic pain and pain management
There are different school of thoughts about defining chronic pain.
Any pain lasting more than 3 months or 6 months is considered chronic pain.
Also any pain which lasts beyond the time of healing of the disease is considered chronic pain.
Everyone experiences pain. Pain is necessary to attract our attention towards the ongoing disease process. But any pain which lasts for prolonged period or beyond the healing time of the disease is considered bad.
Chronic pain is considered a disease in itself. Chronic pain is harmful, it affects us physically, emotionally as well as socially. So, thorough assessment and treatment of chronic pain is necessary by pain management specialist a.k.a. interventional pain and spine specialist.
Pain medicine is a medical speciality that deals with the treatment of all types of chronic pain.
Interventional pain and spine specialists a.k.a. pain management specialists are MBBS graduates who have done post graduation in Anaesthesiology and after that sub-specialization in Interventional Pain Medicine.
These doctors are well trained to treat chronic pain by various ways such as oral medications, counselling and interventional treatments. They also understand the need for comprehensive integrated approach of chronic pain management and thus involves various specialists such as physiotherapist, occupational therapist, psychologists, psychiatrist when deemed necessary.
Interventional pain and spine specialist a.k.a. pain physicians are the doctors who have undergone a structured rigorous training for the assessment and treatment of all chronic pain ailments including but not limited to back pain, neck pain, sciatica, joint pain, nerve related pain, cancer related pain.
Based on the meticulous assessment of the patients, interventional pain and spine specialist provides treatment such as medicines, counselling and interventions as well as involve other specialists for the treatment of chronic pain whenever required.
Interventions are of different types such as regenerative treatment for various degenerative pain conditions; various types of nerve blocks, neurolysis and radiofrequency ablation; different joint injections; intrathecal pump implantation; spinal cord implantation; vertebroplasty and kyphoplasty; etc. Most of the pain and spine interventions are primarily needle or injection based treatments.
B. Neck Pain
Neck pain can be due various problems, common among which are muscle spasm, facet joints, slipped disc and whiplash injury. Pain management specialist examines the patient to find out the cause of pain. Sometimes investigations are needed to confirm the diagnosis.
Blankly treating the chronic neck pain is not an advisable approach. Instead of providing non-targeted random treatment, finding out the cause of neck pain and treating it appropriately is advisable approach.
We first need to identify the cause of neck pain. The treatment can be then done aptly based on the underlying cause of neck pain.
Neck/cervical disc prolapse can be treated with various ways such as medicines, interventions and surgery. Acute condition can be treated with medicines, cervical collar and rest, provided patient do not have serious symptoms like decreased or loss of muscle power, bladder and bowel impairment, etc. If it is serious, then emergency surgery may be needed.
Cervical epidural injection is a very good treatment option if medicines are not effective and there are no serious symptoms. In selected cases, ozone therapy is also very useful.
Yes, cervical epidural is very safe when performed with all due precautions. Not only that, it is very effective treatment for cervical disc prolapse and can help avoiding surgery in select patients. However it should be kept in mind that any interventional procedure or surgical procedure has some inherent adverse effects or side effects; those should be discussed with your treating doctor.
Neck collar can be useful for acute severe neck pain only for initial 3-5 days. But for chronic pain neck collar as such do not have role in treatment.
In fact, if used for longer duration neck collar may cause more harm than benefit and hence it must be avoided for longer duration.
Definitely, interventional pain and spine specialist/pain physician/pain management specialist will help the patient to get rid of neck pain occurring due to neck muscle soreness or neck muscle spasm. Treatment for the same may include medicines, physiotherapy, dry needling and trigger point injection.
Facet joint pain can be treated with different ways such as medicines, physiotherapy and interventions.
Interventional pain management for facet joint syndrome includes injection at the nerve supplying the facet joint and radiofrequency ablation (RFA) of the nerves supplying the facet joint.
Yes, radiofrequency ablation (RFA) of cervical facet joint useful to get rid of neck pain if pain is arising from the cervical/neck facet joint. It is one of the common interventions done for neck pain patients.
In this intervention, nerves supplying the affected facet joint are ablated using the specialised needles. This a safe technique.
C. Back Pain
Finding out the reason behind the back pain is like solving the riddle. There are numerous structures in lower back, all of which can lead to back pain and finding them out and treating them appropriately is a task. It requires lot of knowledge and experience.
Commonly lower back pain can be due to small joints of the spine namely facet joints or sacro-iliac joints; disc prolapse/ slipped disc; sore muscles of the back, injury to the structures of back; fractures; nerve compression; arthritis; slipping of one vertebra over the other; tumour; etc.
Blankly treating the back pain is not an advisable approach. Instead of providing non-targeted random treatment, finding out the cause of back pain and treating it appropriately is advisable approach.
We first need to identify the cause of back pain. The treatment can be then done aptly based on the underlying cause of back pain.
Lumbar belt can be useful for acute severe back pain only for initial few days. But for chronic low back pain lumbar belt as such do not have role in treatment.
In fact, if used for longer duration lumbar belt may cause more harm than benefit and hence it must be avoided for longer duration.
Sciatica is nothing but the radiating pain along the lower limb. It primarily results due to irritation or inflammation or injury to the nerve which supplies to leg and foot.
Sciatica primarily results due to irritation or inflammation or injury to the nerve which supplies to leg and foot. This is commonly due to slipped disc/ disc prolapse of the lower back. But it can also be due to various other causes like muscle tightness, cyst in the spine, over-riding or slipping of the vertebra one above the other, etc.
Sciatica pain can be relieved by finding and treating the underlying cause.
Slipped disc can be treated by various means including medicines, physiotherapy, interventional treatments and surgery. Various interventional pain treatments can be done such as ozone therapy, transformational epidural intervention, caudal epidural injection, IDET, biacuplasty, RFA of ramus communicans, Disc-Fx, endoscopic discectomy, etc.
Things that should be avoided if someone is suffering from sciatica are –
– Avoid prolonged sitting, take frequent breaks from sitting, stand or walk a little at least every 20-30 minutes of sitting
– Avoid heavy exercises
– Avoid lifting heavy weights
– Avoid walking too far
– Avoid bumpy rides
– Avoid jumping
– Avoid too much of bending forward
– Avoid bending for prolonged time
Slipped disc is one of the common cause for back pain and leg pain. But other important sources of lower back pain are facet joints, sacro-iliac joints and vertebral bodies. Thorough assessment of the patient is needed by pain management specialist to find out the cause, sometimes certain investigations may also be required which may include diagnostic blocks.
Pain arising from facet joints of lower back i.e. lumbar facet joint can be treated by various ways such as medicines, physiotherapy and interventions.
Interventions for facet joint pain are intra-articular injection or block of the nerves supplying the facet joint. But these interventions give short lasting relief. Radiofrequency ablation of the nerves supplying the facet joint give longer lasting pain relief. All these interventional procedures are safe, inexpensive and effective.
Pain arising from sacro-iliac joints can be treated by various ways such as medicines, physiotherapy and interventions.
Interventions for sacro-iliac pain include intra-articular injection. But this interventions give short lasting relief. Radiofrequency ablation of the nerves supplying the facet joint give longer lasting pain relief. Both these interventional procedures are safe, inexpensive and effective.
Tailbone pain a.k.a coccydynia is one of the those painful conditions which affects day-to-day life badly. It can result as a consequence of injury such as fall from height, obesity, poor posture or fracture of tailbone, etc.
Tailbone pain can be treated with medicines, coccydynia pillow and physiotherapy but all of these have limited role to relieve the pain.
Interventional pain management to great extent help to relieve the pain of tailbone a.k.a. coccydynia by blocking ganglion impar which provides nerve supply to the tailbone.
Vertebral body fracture after a minor fall or trauma is fairly common in elderly population. Majority of these patients have osteoporosis or these patients are also cancer survivors. A small subgroup of elderly complaining of general spine pain, can have previously undiagnosed vertebral body fracture.
Vertebral compression fracture can be treated with minimally invasive needle based technique namely vertebroplasty. It helps to get relief from the pain but it can be done only in patients who do not have neurological deficit. If there is neurological deficit, emergency surgery is needed to avoid serious consequences.
D. Joint Pain
Osteoarthritis is nothing but normal ageing process wherein the aging related degenerative changes occur at joint structures including cartilage and bones. It initially presents as pain, but if not taken care of, it may progress to deformity of the affected joint, increase in pain, muscle wasting and also poorly affects the lifestyle.
In early stages of osteoarthritis of knee joint or hip joint, regenerative treatment like PRP (platelet rich plasm) help to reduce the pain and even help to regenerate the damage cartilage.
Injection of gel-like material in to the joint also helps to reduce the friction between the bones and thereby reduces the pain and slows down the degenerative process.
In late stage of osteoarthritis of knee joint or hip joint, joint replacement surgery is advisable. But due to some reason patient can not undergo surgery, RFA (radio-frequency ablation) of the nerves supplying the joint can be a good alternative to knee replacement or hip replacement surgery.
Yes, intervention pain management provides an option. Total knee replacement is usually advised in advanced stage of osteoarthritis knee. However all patients may not be medically fit to undergo such an operation or some may not want to undergo surgery. In such cases, intervention pain management provides a treatment namely radiofrequency ablation which will take away the patient’s pain so that one can lead a pain-free life.
Frozen shoulder also known as adhesive capsulitis is due to problem in the tendons of the shoulder joint. It can be treated with medicines, physiotherapy and intervention.
Physiotherapy plays a vital role in the treatment of frozen shoulder.
But due to pain sometimes physiotherapy is not possible. In that case interventional pain management is necessary. Interventional pain management of frozen shoulder includes hydro-dilatation, which will help to reduce the pain and improve joint movement. After that physiotherapy can be resumed.
In few unfortunate patients, even after all these treatments pain may not reduce. In such cases, RFA (radio-frequency ablation) of the nerves supplying the shoulder joint can be done.
Yes, interventional pain management can help to heal the partial tear of ligaments. PRP (platelet rich plasm) has very good result in healing and relieving the pain caused due to partial tear of ligaments. PRP injection in such cases is required for 2-3 times usually.
Elbow pain can be commonly due to fracture or tendinitis. Fracture can be easily identified on X-ray.
Tendinitis include lateral epicondylitis a.k.a. tennis elbow and medial epicondylitis a.k.a. golfers elbow. For both the conditions, medicines and physiotherapy are useful. But in some refractory patients intervention like PRP injection or steroid injection may be needed. Inaterventional treatment has good outcome in such patients.
The symptoms you are telling are typically suggestive of carpel tunnel syndrome. Carpel tunnel syndrome is the compression of the nerve at the level of wrist. This nerve supplies to the hand and fingers also.
Oral medicines can be administered for carpal tunnel syndrome, but they are seldom very effective. Carpel tunnel syndrome can be treated with intervention in which medicine is injected at the affected wrist usually under ultrasonography guidance. The interventional treatment has very good outcome. Otherwise surgery is also one of the treatment.
Trigger finger can be treated well with physiotherapy and medicines. But some refractory patients need to undergo interventional pain management. In trigger finger there is friction between the soft tissue of the affected finger and intervention helps to reduce the friction and soothen the movement of the finger.
Heel pain is commonly due to planter fasciitis. However it can also be caused due to fracture, tendon injury, bony deformity, tumour, etc.
Heel pain is most commonly due to plantar fasciitis. It can result from anything but not limited to aging, arthritis, obesity, ill fitted footwear, calcaneal spur.
PRP injection over the affected heel help to reduce the pain. Apart from this, medicines and physiotherapy are also helpful to reduce heel pain of plantar fasciitis.
Any sports injury can lead to soft tissue damage or even fracture. For fracture, plaster/slab/cast or surgery is needed.
For most of the soft tissue injuries such as injury to ligaments, menisci, tendons or muscles, interventional pain specialist will be of great help to the athlete to get rid of sport injury related pain.
Failed back surgery syndrome is the term often used for patients who have undergone back surgery for any reason of back or back + leg pain and did not have relief. Also failed back surgery term is used for those patients who had undergone back surgery, had relief for sometime and then pain comes back which may or may not be similar to the previous pain.
Reasons for failed back surgery can be anything like recurrence of the previous disease at the same site or the other site, presence of new pathology, incomplete removal of the underlying pathology during the surgery (incomplete removal of the underlying pathology during the surgery can be due to serious risk posed), etc.
There is no clear cut answer for the treatment to be offered to such patients. Treatment options can thought of only after thorough evaluation of the patient. Broadly speaking the available treatment options for such patients may include medicines, physiotherapy, occupational therapy, repeat surgery and interventional pain modalities.
E. Nerve Pain
Pain for prolonged duration after an episode of herpes zoster is considered as post-herpetic neuralgia. Post herpetic neuralgia can be treated with anti-neuropathic medicines. But sometimes these medicines may not be helpful to relieve the pain.
In such patients, interventional pain management such as epidural steroid injections, paravertebral injections, nerve blocks, radiofrequency and spinal cord stimulator are useful to get relief from the pain.
Patients with uncontrolled diabetes or those with long standing diabetes may suffer from lot of problems, one of them is painful diabetic neuropathy. In painful diabetic neuropathy, the patient may have pain, burning tingling, pin-pricking and crawling of ants like sensation. This typically, though not always, starts at feet to gradually involve legs and hand as glove and stocking like pattern.
The first and foremost step for the treatment is strict control of sugar level. Apart from this, some anti-neuropathic medicines are needed to reduce the pain. Sometimes this much of remedies are not useful and interventional treatments such as radiofrequency ablation may be needed.
Trigeminal neuralgia is a painful condition which presents as excruciating pain over the face as well as frontal or temporal region of the head, usually on one side only. Pain is also associated with electric shock like sensation, burning sensation or sometimes crawling of ants like sensation. Pain is usually short lasting with pain-free periods in between.
Trigeminal neuralgia can be treated with medicines or interventional pain management like radiofrequency ablation or balloon compression of the affected branches of trigeminal nerve.
Sometimes it may happen that even after removal/amputation of the affected limb patient may feel the pain over the amputed limb or the remaining limb. This phenomenon is known as phantom limb pain. Sometimes patient may feel certain sensations only and not the pain, this is known as phantom limb sensation.
Phantom limb pain or phantom limb sensation can be treated with various nerve related medicines as well as certain interventions. Medicines may not be effective in many of such patients and interventional pain treatments play a good role to get relieved from such pain. Among interventional pain management sympathetic nerve radiofrequency ablation and spinal cord stimulator have relatively better patient outcome.
The pain describe here is suggestive of complex regional pain syndrome (CRPS); however you need to get it confirmed from your pain management specialist. CRPS is a result of complex changes at different levels of nervous system following any injury, even including any surgery.
CRPS can be treated with medicines, physiotherapy and interventions. Sometimes interventions are necessary to relieve the pain and promote physiotherapy. Interventional pain management for CRPS primarily includes sympathetic blocks, radiofrequency ablation and spinal cord stimulator.
The pain describe here is suggestive of complex regional pain syndrome (CRPS); however you need to get it confirmed from your pain management specialist. CRPS is a result of complex changes at different levels of nervous system following any injury, even including any surgery.
CRPS can be treated with medicines, physiotherapy and interventions. Sometimes interventions are necessary to relieve the pain and promote physiotherapy. Interventional pain management for CRPS primarily includes sympathetic blocks, radiofrequency ablation and spinal cord stimulator.
The pain describe here is suggestive of complex regional pain syndrome (CRPS); however you need to get it confirmed from your pain management specialist. CRPS is a result of complex changes at different levels of nervous system following any injury, even including any surgery.
CRPS can be treated with medicines, physiotherapy and interventions. Sometimes interventions are necessary to relieve the pain and promote physiotherapy. Interventional pain management for CRPS primarily includes sympathetic blocks, radiofrequency ablation and spinal cord stimulator.
The things described here are typically suggestive of entrapment or pressure over the nerve of the foot; however you need to get it confirmed from your pain management specialist.
Such nerve related problems can be treated with medicines and interventions. Interventional pain management for such conditions includes injection around the affected nerve using ultrasound.
The symptoms described are suggestive of fibromyalgia; however you need to get it confirmed from your pain management specialist. Fibromyalgia is a disease due to complex changes occurring at nervous system. It can be treated with life style modification, medicines, exercise, physiotherapy and sometimes interventions may also be needed.
Among exercise the best, inexpensive, easy to do and feasible for everybody is walking; morning or evening walk can help a lot to such patients. Life style modification primarily includes discipline about daily routine activities. Physiotherapy also play an important role apart from anti-neuropathic medicines. Sometimes interventions may be required.
F. Cancer Pain
Pain related to cancer is not uncommon. To quantify it, about 30-60% of the cancer patients in early period and almost 90% of the cancer patients in advanced stage of the diasese suffer from mild to excruciating pain.
Cancer pain can result from various things like the disease itself, complications of the disease, treatment of the cancer such as surgery, chemotherapy or radiotherapy.
The pain related to cancer can present at the site of the cancer or even at distant site.
Treatment for the cancer pain include various options such as
– Oral medicines like simple pain killers
– Oral opioids like morphine
– Patches of the opioids
– Various types of nerve blocks and radiofrequency ablation
– Intra-thecal pump implantation
– Spinal cord stimulator
Pain related to cancer is not uncommon. To quantify it, about 30-60% of the cancer patients in early period and almost 90% of the cancer patients in advanced stage of the diasese suffer from mild to excruciating pain.
Cancer pain can result from various things like the disease itself, complications of the disease, treatment of the cancer such as surgery, chemotherapy or radiotherapy.
The pain related to cancer can present at the site of the cancer or even at distant site.
Treatment for the cancer pain include various options such as
– Oral medicines like simple pain killers
– Oral opioids like morphine
– Patches of the opioids
– Various types of nerve blocks and radiofrequency ablation
– Intra-thecal pump implantation
– Spinal cord stimulator
G. About some interventional techniques
Trigger point injection is an interventional pain management treatment wherein the trigger points i.e. the painful points of the affected muscles are identified and local anaesthetic is injected in a specific manner. This effectively helps to reduce the refractory muscle pain/ muscle soreness.
Ozone therapy is one of the interventional pain management treatment done for pain arising from or due to disc of the spine.
In this treatment, a gaseous mixture of ozone & oxygen is injected in to the affected disc, it is done under local anaesthesia and patient can be discharged on the same day of the intervention. It safe, efficacious and inexpensive treatment modality. It may help to avoid spine surgery in many cases.
PRP is platelet rich plasma. For this procedure, the patient’s blood is drawn and then processed to prepare PRP. It is a regenerative therapy.
PRP is useful for treatment of various conditions such as joint pain due to osteoarthritis, partial tears of tendons or menisci or ligaments and bursitis.
PRP is commonly used for various painful degenerative conditions of joints like knee, hip, ankle, shoulder, elbow, wrist.
Radiofrequency ablation is one of the very common procedures done as a part of interventional pain management by interventional pain and spine specialist.
In this procedure, specialised needles are inserted after giving local anaesthetic. The needle are inserted under X-ray guidance in operation theatre such a that needle tip should be lying very close to the small nerves which supply the painful structure. Once the needle position is confirmed, thermal energy is provided to these needles so that small nerve supplying the painful structure gets ablated and thereby pain is reduced.
Intrathecal pump is a medical device wherein a small metallic pouch like reservoir a.k.a. pump is kept in flank of the patient. This reservoir is connected to the small tubing which opens in to the spine (in to the intrathecal space, so the name intrathecal pump).
The medicine present in the reservoir gradually gets its way in to the spine (intrathecal space) at set concentration and speed. The drug helps to relieve the pain or relieve the muscle spasticity. The reservoir can be filled externally several times if the medicine in it gets exhausted. The medicines used for intrathecal pump are morphine, baclofen and ziconotide.
Patients with spasticity (tightness) of muscles or patients with intractable cancer pain are good candidates for intrathecal pump implantation.
If put in a simple words spinal cord stimulator is a pacemaker of spinal cord. Like pacemaker of the heart, it consist of few small wires and a battery which is implanted in to the tissues. This device sends signal to the spinal cord and nerves arising from it; by this it dampens the bad pain signals of the nerves which get replaced by some pleasant sensation. It is useful for lot of conditions with refractory pain where pain is not getting relieved with medications and even other interventions pain management modalities.