PAIN MANAGEMENT: A NEW SUPER-SPECIALTY
DR. NEERAJ JAIN M.D., FIMSA, FIPP (USA)
9810033800 (M) managepain@yahoo.com www.spinenpain.com
“Pain is real & treatable --- There is no merit in suffering!”
“For all the happiness man can gain, is not in pleasure but freedom from pain”.
“ON GLOBAL DAY AGAINST PAIN”
NONSURGICAL TREATMENT FOR LOW BACK PAIN AND SLIP DISC WITH SCIATICA
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A young lady came to me with disabling back pain for last 5 years which made her leave the job. She is not marrying due to same problem.
A schoolgirl of 12th class is not able to focus on studies since past 6 months because of back pain which she relates to dance competition preparation 7 months back. She has her board exams coming making her & family all the more worried.
“Because of my back pain I can’t play with my children or sleep comfortably.” Said a patient.
A patient had to change his job because he could not commute distances due to back pain.
I keep getting this neck pain as & when I have to spend extra hour on my computer at duty in the bank.
A patient requested me to get rid of her worsening back pain as her daughter was getting married in two months.
“Help me doctor, my married life is getting ruined” said a young back pain patient.
For all these and many like them Dr. Neeraj Jain`s massage is “pain is real and treatable- there is no merit in suffering, as so many good and effective treatments are now available at specialty pain clinics”. You must see a pain specialist if you still suffer from pain after a month of conservative treatment. Sooner your pain is managed better are the overall results.
Low back pain has 15-20% incidence in the population. Almost 80% of us are ought to suffer from nagging back pain at some time in life. “Do not take your back for guaranteed” says Dr. Jain who is heading pain clinic at Sri Balaji Action Medical Institute and Sant Parmanand Hospital in New Delhi.
One can avoid back pain with spine care and avoiding risk factors like osteoporosis, obesity, smoking, prolonged driving, sedentary lifestyle, too heavy or too little exercise, bad spine postures and wrong way of pushing or lifting heavy objects.
While spinal arthritis is the common reason of young age back pain at prime of their carriers including some bollywood celebrities, disc diseases including slip disc is prevalent in all age groups, in young age due to trauma & in old age due to degeneration.
With interventional pain management patients are getting back to life. It has both diagnostic and treatment value, as sometimes all investigations put together do not give the exact diagnosis.
Newer technologies like ozone injection & nonsurgical disc decompression cures most of the patients of slip disc & sciatica, as ozone’s nascent oxygen atom shrinks the disc so taking away pressure from pain sensitive nerves. It is a non surgical, outpatient procedure done under local anesthesia not requiring bed rest for more than day or two & prolonged absence from work realizing the importance of time, at much lower cost with almost no complications. This procedure is done under radiological guidance for precise needle targeting and best results. There after patient is given advice for spine care & healthy habits. This technology is latest & many people including medical caregivers don’t know about it. It has benefited millions in developed world and is now available in India also.
This novel treatment avoids the use of surgery in 80% of those who needed it. If despite the ozone therapy the symptoms persist, percutaneous Drill Discectomy/ Laser or coblation Discectomy are good alternatives before open disc surgery.
Dekompressor: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.
Intrathecal (Spinal) Pump Implants: Opted when oral narcotics provide insufficient pain relief or side effects are troublesome in intractable cancer & chronic pain patients. It delivers drug via an implanted catheter directly into CSF needing a very small dose (1/300 of oral dose). The programmable pump is implanted in ant. lower abdomen. It delivers the drug as per the patients needs. More powerful analgesia & spasticity control is achieved using lower doses, constant relief & fewer side effects as with oral doses e.g. Somnolence, mental clouding, constipation, euphoria with decreased chances of drug addiction or misuse.
Neuromodulation Techniques: Spinal Cord Stimulation (SCS) Implants: Done for FBSS (failed back surgery syndrome) & CRPS (complex regional pain syndromes) in USA. In Europe it is done for chronic intractable angina & pain of peripheral vascular diseases (PVD). The indications are expanding further in chronic pain states. A set of electrodes is placed in epidural space & connected to a pulse generator (like a cardiac pacing device) that is implanted in upper buttock. Low level of electric impulses replaces pain signals to the brain with mild tingling sensation. Trial stimulation is done before permanent SCS lead implant.
Percutaneous Vertebroplasty / Kyphoplasty: A Newer Approach to Management of Vertebral Body Fractures: As life expectancy is increasing so is the incidence of vertebral body (VB) # now being the commonest # of the body. PVP is an established interventional technique in which PMMA bone cement is injected under L.A. via a needle into# VB with imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work.
CHRONIC PAIN: A MENACE
Pain is one of the most common reasons for patients to seek medical attention and one of the most prevalent medical complaints in today’s world. Chronic pain has many causes and can affect any part of the body. Conditions most associated with pain include arthritis, headache, neck and back problems, cancer, neuropathies eg. Diabetic, chronic regional pain syndromes (CRPS), pelvic pain disorders, fibromyalgia, myofacial pains, herpes and trigeminal neuralgias.
Chronic pain can lead to depression, anxiety, marital & interpersonal problems, decreased productivity, unemployment, compromised social roles, isolation, financial burden, dependence, prolonged analgesics usage, decreased self esteem with behavioral changes adversely affecting mental and physical abilities, activities of daily living & ruining quality of life
Pain still remains inappropriate & inadequately treated. Although tremendous scientific & technological advances have been made, the knowledge & techniques are highly underutilized. Untreated pain destroys people’s lives. I have had patients come in who couldn’t work or sleep or play with their children. Good pain management gave them their lives back. It is cruel to deny people in pain access to effective pain treatment. People should not be suffering needlessly.
Thus, pain clinics are specialized areas that are now assuming the role of an essential service as they meet a need unmet by any previously existing medical facility. They help by simultaneously treating the physical, emotional, cognitive, behavioral, vocational and social aspects of chronic pain cost-effectively.
Our ultimate goal is to cure & care people suffering from pain, make them productive human beings for the society and increase their self esteem so that they can live life as normal individuals.
Interventional pain procedures scores over both medicine and surgery, as they do not have side effects like medicines. Surgeries for pain, have now limited indications & usually as a last resort. The interventional pain procedures produce immediate pain relief, can be performed with ease by pain physicians without anesthesia as outpatient or daycare basis and adequate duration of pain relief obtained and suitable for surgically unfit & debilitated patients & procedure can be repeated safely if required.
In the absence of proper education among health care professionals and lack of awareness in the public mind in India, there is misuse of painkillers resulting in high incidence of complications like gastritis, kidney failure, bone marrow depression and bleeding from gut which can be catastrophic.
The Indian health care scene has a curious mix of paradoxes. Advances in cardiovascular surgery or high-tech investigative facilities in India are on par with any advanced country, at least in some cities. Though skills, advanced equipments are available, still pain relief is not available to majority of needy population. At least a million people in India suffer unrelieved cancer pain. The number of people suffering other chronic pain conditions is anyone’s guess. Paradoxically, India stands high chance to become the health destination for pain management for the world, by using interventional pain therapies and very effective traditional therapies unique to India.
Cancer Pain
Pain is a major symptom of cancer and occurs at all stages of the disease. In addition, pain is usually a hallmark of progression or metastatic spread, and 65 to 85 percent of people with cancer have pain when they develop advanced disease. In 10 to 20 percent of cancer cases, pain is difficult to treat, frustrating, and poorly controlled. Currently, opioid pharmacotherapy is the principal weapon in the fight against cancer pain; but when less invasive treatments are unsuccessful, invasive interventions should be added to optimize pain relief. Interventional pain procedures target neural and non-neural pain generators and neural blockade techniques provide excellent pain relief for neuropathic, sympathetic, nociceptive somatic, or visceral pain. Neural blockade techniques are broadly categorized into non-neurolytic and neurolytic blocks.
The management of patients with cancer pain can be a challenging task, even for physicians trained in cancer pain management Effectively relieving pain in cancer patients requires a range of treatment alternatives, including neural blockade when the patient’s pain no longer responds to opioid analgesia. The type of neural block selected is determined by the location and mechanism of the pain, the physical status of the patient, the extent of tumor spread, and the technical skill and experience of the person performing the intervention. Non-neurolytic blocks can provide safe and effective analgesia for the less serious conditions indicated above. Neurolytic blocks, with their potential for complications, are reserved for select patients who are unresponsive to standard analgesic pharmacotherapy and/or are at a more advanced stage of disease. However, few would question that aggressive intervention is often appropriate. Neurolytic nerve blocks offer an excellent option for the physician in the fight to control cancer pain. Such blocks can be easily utilized to help provide cancer pain relief in most of patients at the utmost needed times.
DR. NEERAJ JAIN M.D., FIMSA, FIPP. (USA)
Senior Consultant Spine & Pain Specialist
Spine & Pain Clinics, RU-23 & LD-122Pitampura, New Delhi-110088
& HOD Spine & Pain Clinic, Max Hospital, Pitampura,
& Sri Balaji Action Medical Institute
& Action Cancer Hospital
98100 33800 (M), 27341685 (C)
Email – managepain@yahoo.com
Website: www.spinenpain.com
REMEMBER: NO ONE DIES OF PAIN BUT MANY DIE IN PAIN
AND EVEN MORE LIVE WITH PAIN!
“HELP THEM”
Advanced Pain Management done at Pain Clinics for:-
Chronic Intractable Pain Syndromes
Back Pain / Leg Pain (Discogenic/Spinal Canal Stenosis)
Facet Joint Syndrome/Spinal Arthritis
Spine (Axial) Pain (Cervical/Lumbosacral/Thoracic)
Sacroilitis / Strain & Coccydynia
Disc Diseases (Hernia/Prolapse/Rupture/Slipped)
Rediculopathy / Sciatica
Neuralgic Pains / Plexopathies
Herpes Zoster Pain /Neuralgia (PHN)
Trigeminal / Cranial Neuralgias
Spastic Cerebral/Spinal Palsy
Fracture Spine (Compression # of Vertebra)
Reflex Sympathetic Dystrophies (RSD)
Complex Regional Pain Syndromes (CRPS 1 & 2)
Failed Back Surgery Syndromes (FBSS)
Musculoskeletal / Myofascial Pain Syndromes
Vasospastic Ischemic Pains
Neurogenic Claudication
Cervicogenic / Tension/Cluster Headaches
Post Surgical / Post Traumatic / Sports Injury Pains
Central Pain States
Fibromyalgia
Cancer Pain/ End of Life Pain / AIDS Pains
Chronic Visceral / Pelvic Pain Syndromes
Osteoporosis / Metastatic / Paget`s Disease Bone Pains
Hyperhidrosis (Wet Hands/Underarms/Feet)
Non Surgical Techniques of Specialized
Fluoroscopic/Ultrasound/Nerve Stimulator/CT-Guided
Percutaneous Interventional Pain Procedures
For Diagnostic/Therapeutic/Neurolysis of:-
Diagnostic Epidurography Followed by
Transforaminal / Interlamminar Epidural Medication at
Cervical / Thoracic / Lumbar / Sacral / Caudal Levels
Selective Nerve Root Sheath Block (SNRB)
Provocative Discography & Intradiscal Interventions
Lumbar/Cervicothoracic Sympathetic Blocks / Neurolysis
Percutaneous Vertebroplasty (PVP)
Facet Joint/ Sacroiliac Joint / Piriformis Blocks
Decompressive Neuroplasty / Epidural Adenolysis
Intrathecal Opiate/Baclofen Pump Implants
Spinal Cord Stimulator/Neuromodulation Implants
Cranial Nerves Blocks / Neuroablations
Trigeminal Gangliolysis
Somatic Nerve / Myofascial / Myoneural Blocks
Trigger Point Injections With Steroids/Botox/Neurolytics
Stellate/Celiac Plexus/Hypogastric/Impar Neurolysis
Botox Chemodenervation
Prolotherapy/Mesotherapy/Intramuscular Stimulation
Interpleural Catheter /Splanchnic Blocks
Paravertebral / Psoas Compartment Blocks
Vertebroplasty, Kyphoplasty,
Shoulder & Knee Joints Blocks
Nerve Sheath & Plexus Catheterisation & Medication
Laser Lessioning / Radiofrequency (RF) Neuroablations