Treatment Modalities in Chronic Pain Treatment 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 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 by Best Back Pain Doctor In Delhi

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 pain. 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.

Know What Pain Management Centre In Delhi Says About Frozen Shoulder

What is frozen shoulder?

Frozen shoulder is a condition in which there is significant loss of motion of shoulder joint accompanied by pain and stiffness. The movement involving reaching straight up and rotation of joint such as while reaching behind the backmay be affected first although with time all movements may get affected. Pain may be deep seated, poorly localised and constant or only at night when lying on the affected side.

To understand the condition better it is helpful to know about the basic anatomy of shoulder joint. The shoulder joint is formed by three bones – the arm bone (humerus), shoulder blade (scapula), and the collar bone (clavicle). Therounded head of the arm bone (humerus) is relatively large compared to the socket of the shoulder blade and this size discrepancy allows for thelarge range of motion of the shoulder. The shoulder joint is surrounded by the strong joint capsule and further supported by a group of muscles called the rotator cuff.

In frozen shoulder the capsule surrounding the shoulder joint becomes thickened and tight thereby limiting the movements of the joint. The joint may loose some of its lubricating fluid reducing the space for the arm bone ot move. Movement of shoulder causes pain, hence one tries to avoid this which leads to further contraction of the capsule. As the condition advances scarring or adhesions may develop between the capsule and the head of arm bone further limitating the movement. With time there may be relative weakening of the muscles with loss of muscle mass (atrophy).

What causes frozen shoulder?

The cause behind the condition is not well understood.This condition is estimated to affect 2-3 % of individuals although this may be an overestimation as previously many more conditions were labelled as frozen shoulder – with it becoming more like a waste bin diagnosis. The actual incidence may be around 0.75%.

It is seen more commonly in

• Women as compared to men
• People over the age of 40 years, most commonly between the age of 40-60 years
• Diabetics have approximatley five times more chances of developing this condition compared to non – diabetics. (10 – 20 percent of individuals with diabetes may develop frozen shoulderand about 30% of people with a frozen shoulder also have diabetes).
• Periods of shoulder immobilization like after a fracture or stroke (more like an under use injury)
• Patients with overactive or underactive thyroid
• Parkinson’s disease

How is frozen shoulder diagnosed?

Frozen shoulder is diagnosed clinically, however investigations are required to rule out other conditions which may present similar symptoms.

To diagnose frozen shoulder, your doctor will:

• Take detailed history of your condition and look for any predisposing factors
• Conduct a physical examination of your shoulders, arms and neck:
• The doctor will evaluate the range of shoulder movement. In frozen shoulder both the active movements (when you move your shoulder/ arm) and passive movements (when the doctor moves your shoulder /arm) are reduced.Examination may reveal tenderness in the front of shoulder at a specific spot called the coracoid process.
• The doctor may carry out other special tests to rule out other conditions which may present with similar symptoms
• He may conduct examination of your neck as neck problem manifests with shoulder pain frequently
• Investigations- X-rays of the shoulder may be requested to rule out arthritis, MRI scan and ultrasound may be requested to rule out  other problems such as a rotator cuff tear. Ultrasound scan can show thickening of coracohumeral ligament or the capsule
• Blood tests may be requested to check for diabetes / thyroid problems

Can a frozen shoulder recover on its own?

A significant number of cases improve with simple exercises and pain control, however, it can take a long time too and sometimes as long as 3 years. The limitaion of daily activities can have significant impact on the quality of life. It is often self-limited, however, some patients never regain full function of their shoulder.

Typically the condition is described to pass through three stages

Freezing stage

This is the initial stage where the pain and restriction of movement develops. Intitially pain may be only on movement or at night when lying on the affected side. Slowly, it can increase in severity, affecting the shoulder joint diffusely and often spreading towards the upper arm. This stage can last from 6 to 9 months.

Frozen stage

In this stage the pain may become better although the restriction of movement persists and may become worse. This stage can last 4-12 months.

Thawing stage

During this phase, the movements start to return slowly and it can last 6 months to 2 years.

What is the treatment for frozen shoulder?

The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder’s normal range of motion. Timely interventions can help control pain and restore function sooner. A pain clinic can play a significant role by prescribing medications, using timely interventions such as injections and providing supervised physiotherapy. This Multi discliplinary approach has the best chances of improving outcomes and reducing disability.

Treatment options are explained below and it is important to understand that they are to be used in tandem and not seen as alternatives to each other.

• MEDICATIONS– anti-inflammatory drugs can help reduce the pain and inflammation, although these should not be used without the advice from your doctor. Your pain specialist may consider other stronger medications depending on your pain severity and other medical comorbidities.
• INTERVENTIONS– This may include a shoulder joint steroid injection or hydrodistension of the shoulder joint. These injections can help reduce pain and improve range of movement, reducing disability.

Shoulder joint steroid injections- Steroid injections injected directly into the joint are preferred over the oral steroid as they are associated with fewer side effects. Some studies have found that oral steroids are as much as 5 times more likely to give you the typical steroid side effects when compared to the one with off joint injections. Also the lack of long-term benefits makes oral steroids a less attractive option in this condition. Some studies comparing physiotherapy with steroid injections have found no significant difference in pain relief or shoulder function whereas others have found improved shoulder function with steroid injections.

Hydrodistension of the joint involves injecting sterile water or local anaesthetic into the shoulder joint with the intention of stretching the joint capsule to improve range of motion. There is evidence supporting the use of a combination of hydrodilatation and corticosteroid injection, as it may expedite recovery of pain free range of motion compared to corticosteroid injection alone.

Both these procedures can be performed in OPD settings under ultrasound guidance. Ultrasound helps to improve accuracy, maximising the changes of getting benefit from injections.

• Physical therapy. This forms an essential component of frozen shoulder treatment and requires regular active participaton of the affected individual. The aim of physical therapy is to maintain, improve range of motion and help in strengthening of the joint,  Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone.
• Surgery. This is rarely necessary to treat frozen shoulder. It is considered when there is minimal improvement after 6 to 12 weeks of nonsurgical treatment. Options include manipulation under anaesthesia and arthroscopic capsule release. Shoulder manipulation  involves forcefully moving the shoulder under general anesthesia to loosen up your shoulder tissue and disrupt the adhesions. This needs to be supported by physiotherapy after the procedure.  Arthroscopic capsular release is considered in some cases when other treatments have failed to provide relief.

Effective Chronic Pain Management In Delhi

Pain can be a distressing and disabling experience. It can lead to loss of function and the accompanying disruption of normal life. The impact is not just limited to the sufferings of an individual but also affects one’s loved ones and the society as a whole. It may be easier to adapt if it is for a small finite period, however sometimes it’s challenging to bring things back to the relative normal. Loss of function in one part and adversely affect other body parts such as knee injury leading to developing of back pain as your weight bearing / walking is altered placing extra stress on your back and leading to development of back pain or shoulder pain developing as a result of using crutches for a knee injury. What may start as a small localised issue may progress to involve other body parts, if not managed in time. Effective pain management can help to reduce this impact and help you progress on the path of normality.

Conditions leading to chronic pain range from simple age related body changes to much complex conditions such as spinal cord damage after an accident. Do not underestimate the impact of simple knee or back arthritis as they can easily turn simple activities of daily living into big challenges. While it may not always be possible to reverse these changes, there is a lot we can do to control further damage and reduce the impact on our life.

Keep the hope alive:

Pain Medicine as a specialty had turned around the life of many and has given new hope to many others. Advances in the field of regenerative medicine means that we have lot more to offer now. It’s important to stay positive and not loose hope as most comprehensive management options require active patient participation. Whether that be physiotherapy or life style changes or remaining positive / motivated, patients have a significant role to play.

Treatment options:

Pain specialists use a combination of a variety of treatments for the effective management of chronic pain conditions. These start with

• Educating you about your problem and the do’s and don’ts. Do not underestimate the importance of the lifestyle changes and the things you can do to ensure that the problem resolves/ does not aggravate further.
• Medical management may involve a combination of medications, injections, physiotherapy, psychology and alternative medicine options. Often interventions such as injections into the area of problem play an important role in cutting the pain cycle and enabling to engage actively in other therapies such as physiotherapy. Steroids are often used for injections and when given directly close to the site of problem can be very effective. A portion of this does get absorbed into blood stream and reaches other sites but the resultant side effects are much less when compared to taking these orally as tablets.
• Other injection options such as Platelet Rich Plasma (PRP) are considered more natural and create an artificial inflammation promoting the process of healing.
• Nerve blocks involve giving an anesthetic agent+/- steroid close to the nerve carrying the pain sensations to block the sensation from travelling to your brain.
• Options such as Spinal Cord Stimulators (SCS) involve the use of low voltage electrical currents which applied to the spinal cord and they interfere with the transmission of the pain signals to the brain.
• Other than these, there are a variety of alternative therapies options which some individuals find beneficial such as massages, meditation, yoga, acupuncture and chiropractic medicine.

Your treating physician can help you decide on the best treatment for you, by explaining your condition and the evidence base supporting different modalities of treatments.


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How To Communicate Regarding Your Joint Pain To Your Pain Specialist In Delhi

Joint pain can be a source of prolonged discomfort which one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments which can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR . But reaching out to the right centre with experienced and skillful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

• Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is
• Joint pain can have numerous causes such as like age related wear and tear, injury, trauma, infections etc
• Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology
• Treatments offered depend on the severity of symptoms, their impact on your life, your age, activity levels and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors
• These are some important points which may help your doctor to understand and treat your pain better:

• Explain where the pain is; how long you have had the pain and how it started. If possible point the exact place, is it in the knee, ankle or shoulder pain?
• The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shouting or stabbing pain? Is it present all the time?
• Aggravating or reliving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?
• It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

• Applying ice or hot compression at the joint several times.
• Avoiding activity that may cause the pain.
• Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.


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Managing Chronic Back Pain Treatment In Delhi

We have all endured finite episodes of severe pain whether that is a fractured bone or severe migraine or throes of labour pains. While we may be fortunate enough to remember them as distant memories, those with constant pain are often denied this luxury of forgetfulness. Their lives often encompassed around managing pain. Leaving aside the distress/agony it causes, it can cause other harmful effects on most body systems whether it is your mental/ emotional well being or your heart or your quality of life. Hence it is import to control it sooner rather than later.

Pain, although distressing, has the benefit of bringing medical problems to our attention. It usually abates as healing occurs. Chronic pain is pain that persists beyond the period of healing. Traditionally pain is thought to represent ongoing damage in body. This is now considered incorrect especially in context of longstanding/ chronic pain. To simplify- CHRONIC PAIN DOES NOT ALWAYS SIGNIFY ONGOING DAMAGE.

The newer understanding of chronic pain

In the past patients who usually complained of long standing pain, were often dismissed by healthcare professionals and most patients accepted pain as a part of ageing. In many cases it was not easy to figure out the underlying cause of pain, as chronic pain was not well understood. Over the years, with the amount of research that has gone into the study of chronic pain, doctors now understand more about different facets of pain management – physiological, psychological, pharmacological, interventional etc. There is enhanced understanding of mechanisms which can cause amplification of perceived pain symptoms. These advances and technological developments have enabled pain specialists to offer more to their patients. This stands true for back pain as well. While a significant number of people in a population suffer from back pain, fortunately for most this will resolve with time. However a small proportion does go on to develop chronic pain. The severity can vary from mild discomfort to debilitating illness interfering with activities of daily living and limiting functionality. Pain management specialists use a combination of modalities and specialties known as multimodal multidisciplinary approach to effectively manage the back pain.

What do you understand by pain management?

The complexities of pain and the fact that surgery or pills cannot resolve all pain has been long recognised. Understanding and treating chronic pain is challenging as we all experience and process pain differently. Hence one therapy does not work for all. This has lead to the development of Pain Medicine as a separate speciality. In this speciality the doctors are trained specially to deal chronic pain conditions and develop a better understanding of pain, underlying mechanisms and ways of reducing its impact on life.  A good pain physician focuses on holistic management of patient rather than just treating the disease.

Pain medicine is branch of medicine concerned with evaluation, treatment, and rehabilitation of persons in pain.  It utilises a Multi –disciplinary approach with specialists from different fields working together help in managing your pain, restore functioning and improving quality of life. The team mostly comprises of Pain Specialists, Specialist Nurses, Physiotherapists, Occupational therapists, Acupuncturists, Psychologists and Dieticians.

Role of pain management for chronic back pain

When it comes to chronic back pain, there are a variety of ways in which pain clinic can help.  Most pain clinic interventions have the advantage of being low risk, minimally invasive, non-surgical options without any need for prolonged hospitalisation. The treatment plan is individualised and may include a combination of the following

• Patient Education 
• Medication Management
• Physiotherapy and rehabilitation
• Psychology input including relaxation therapy, coping and self-management skills, cognitive behavioral therapy
• Complementary and alternative therapies including Acupuncture, TENS, acupressure, meditation
• Dietary advice
• Interventions such as injections. These can be especially useful for people where the source of pain is not known despite extensive investigations. Diagnostic injections can help in reliably identifying sources of pain when investigations have been inconclusive. Some of the treatment options are not commonly available elsewhere and these include 

• X-ray/ ultrasound  guided injections like nerve blocks, epidurals, facet joint injections
• CT guided interventions in areas which require precision for accuracy and minimising risks
• Advanced techniques such as Radiofrequency treatment which can provide prolonged pain relief for common conditions arthritis of the joints in the spine

Research and technological developments have opened new avenues in pain management such as 

• Newer technologies – cooled radiofrequency and spinal cord stimulators
• Regenerative medicine options including stem cells and platelet rich plasma(PRP)

Asa vast majority of patients with back pain do not require surgery, a combination of above mentioned modalities can help in effective pain relief.  Pain clinic is also an option for patients who have had inadequate results from previous surgery or those who are not keen on surgery or not fit to have surgery.

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

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Cooled Radiofrequency For Knee Pain Treatment In Delhi

Why do you experience chronic knee pain?

Chronic knee pain troubles a significant number of people worldwide. It is a common problem amongst the aging population, and can indeed be very painful and debilitating, sometime even confining individuals to the bed. The most common cause of knee pain in elderly is osteoarthritis (OA), a condition where the cartilages of the knee joint have worn out due to wear and tear. This results in friction between the bones of the joint during movement which results in pain. The impact is more in overweight and obese because of the extra load on the knees. The risk of knee OA in overweight women is nearly 4 times and in overweight men is 5 times greater. It is not just the mechanical factors which promote OA in obesity but also the co-existence of disordered glucose and lipid metabolism and the highly metabolic and inflammatory environments have a significant role.

What can be done for chronic knee pain?

Initial management involves lifestyle modification, supplements, simple pain killers and physiotherapy. It is estimated that an extra Kg of weight exerts a force of nearly three to six times across the knee while walking. Thus, weight loss is an important modifiable factor in the treatment of knee OA which the affected individual can drive. Various studies have demonstrated that weight loss improves both pain and function in obese subjects with knee OA.

Local injections are considered depending on the severity of problem and other factors such as age, functional status etc. When the pain and discomfort is severe your doctor may offer you the option of undergoing a knee replacement surgery. This involves removal of the worn out part of joint, shaping the ends of the bone and placing a metal implant. This reconstruction of the knee joint allows for smooth, pain free movement for most individuals. However some, even following the rehabilitation process, continue to experience pain.

For those who are

• Not keen on the replacement surgery or
• Not fit to have one or
• Continue to have pain after knee replacement surgery

Cooled Radiofrequency is an alternative treatment. Details about this treatment can be found in the Knee pain section of the website and in old blogs.

What causes continued pain following surgery?

The causes of knee pain following replacement surgery can be located inside the joint (intra articular causes) or outside the joint (extra articular causes).

The intra articular causes include:

• Knee joint instability
• Loosening of the implant
• Infection of the bone or the joint space
• Problems related to the kneecap (patella)
• Osteolysis (loss of bone)
• Issues related to size or type of implant

It is important to rule out the extra articular causes when a patient complains of persistent knee joint pain following surgery, because they can have serious consequences if they are missed.

The extra articular causes include:

• Localized knee problems such as tendinitis and bursitis
• Pain radiating from the  nearby joints/body parts such as spine, hip and ankles
• People who have ongoing psychological illnesses will also tend to experience longer postoperative pain
• Nerve injuries/ problems

The focus of a recent research in Oxford, UK has been weather the knee replacement should be done earlier and not as a last resort. The authors suspected that long term persisting knee pain can lead to changes in the nervous system (nerves, spinal cord and brain) which can be responsible for persisting pain even if the original cause is corrected. 

Diagnosing the problem:

You doctor will go through multiple steps in order to evaluate the pain you are experiencing. This process includes, taking a detailed history of the pain, such as when what type of pain you are experiencing and when you experience it the most. Then your doctor will go on to examine the knee, which will help him/her to further narrow down on probable causes & identify problems such as stiffness, swelling, and issues with alignment of the joint.

You will be asked to undergo investigations such as, X-ray, MRI, blood tests including inflammatory markers such as CRP and ESR etc.

How to manage this condition?

Depending on the cause of your pain, you doctor may suggest a variety of treatment plans. On some occasions pain relief medication may help to control the pain, and even get rid of it completely. Physiotherapy is another option which has proven to be effective in managing pain following knee replacement surgery. Nerve blocks are sometimes offered if nerves are suspected to be the pain generator.  Cooled Radiofrequency of the nerve supplying the knee can help in reducing or resolving your pain issues.  Sometimes repeat surgery such as revision knee replacement is required If.

Tags >> Pain Specialist In Delhi, knee pain treatment in delhi, Cooled Radiofrequency Treatment In Delhi