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)

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.

Carpal Tunnel Syndrome (CTS) Treatment In Delhi

What is carpal tunnel syndrome?

Carpal tunnel syndrome or ‘median nerve compression’ is a painful condition that develops as a result of excess pressure on a nerve (median nerve) as it travels into the wrist through the narrow passageway.

Median nerve of arm carries sensation from thumb, index finger, middle finger and a part of the ring finger to the brain and controls the movement of some important hand muscle.  This nerve arises from the brachial plexus which is formed by the joining of many nerve roots exiting the spine in the neck region.  Median nerve runs down the forearm and passes through a narrow tunnel like passageway (carpal tunnel) on the palm side of the wrist. Your pain specialist can further explain the anatomical details to help you understand the condition better.

What causes carpal tunnel syndrome?

CTS may affect one or both hands. Those, who are involved in jobs requiring repetitive movement of the wrist such as construction workers, manufacturers etc. are more likely to be diagnosed with CTS. Women are three times more likely to have CTS and the prevalence, severity increases with age. Some studies have observed a peak incidence between the age of 45 and 59 years and a second peak between 75 and 84 years. In most cases it is difficult to pinpoint the cause as to why this condition develops although many predisposing factors have been identified and these include:

• Fluid retention from pregnancy especially in 3rd trimester
• Diabetes
• Thyroid dysfunction
• Obesity
• Autoimmune disorders such as rheumatoid arthritis
• Fractures or trauma to the wrist
• Repeated over extension of the wrist or movement such as typing, working on computers for more than 20 hours/ week
• Hereditary factors and conditions such as polyneuropathy (where multiple nerves are affected)

What are the symptoms of carpal tunnel syndrome?

In the early stage the symptoms may be intermittent and only at night.  As the condition advances these may become constant with development of wasting and weakness of hand muscles. The common symptoms include

• Numbness, burning, tingling, shock like sensation, pain in the ring, middle, index fingers and the thumb.
• Affected individuals often have disturbed sleep with urge to shake out their hand to obtain relief from symptoms.
• Provocation of symptoms by sustained hand or arm positions especially those involving arm elevation and wrist flexion as while holding a phone.  Provocation may also be more noticeable after repetitive actions of the hand or wrist.
• Clumsiness and weakness of hand with difficulty performing simple tasks like buttoning clothes & opening jars.
• Losing grip over things/ difficulty to hold objects firmly in hand due to weakness.
• Burning sensation/ pain may involve forearm, upper arm.

How is carpal tunnel syndrome diagnosed?

Your doctor will take a careful history and perform examination of your hand, arm, shoulders and neck. The sensation and movements of the hand may also be evaluated. The doctor may also hold, bend your wrist in a flexed position to check if this increases/ brings on your symptoms as this position further narrows the space for the nerve temporarily.

He/she may request for investigations such as electrodiagnostic studies (nerve conduction studies and electromyography) and ultrasound. Electrodiagnostic studies can help determine severity and prognosis. Plain X-ray may be useful if bone or joint disease/ structural abnormalities are suspected. Magnetic Resonance Imaging is useful in picking up rare pathological causes of CTS such as ganglion or bony deformity and these can have bearing on the surgical plan.

How is carpal tunnel syndrome treated?

Management of CTS depends on the severity of symptoms. In mild to moderate cases your doctor may recommend the conservative approach which should result in improvement in a few weeks time. This includes

Non-surgical methods

Splinting or bracing – Wearing a splint or brace will keep you from moving or bending the wrist while you rest. One study has shown that using a neutral wrist splint is twice as likely to give symptom relief compared to a splint in extension position. This modality, in combination with other treatment modalities, can be especially useful in pregnancy. However not everyone is able to get accustomed to the splint.

Physical therapy – There is some evidence that physical therapy techniques are effective CTS treatments. Multiple sessions from specialist physiotherapists and treatment modalities include carpal bone mobilization, therapeutic ultrasound and nerve glide exercises.

Oral medications – Oral steroids have shown to improve symptoms for limited time but are less effective than local injections with more side effects. Anti-inflammatory medications (NSAIDS) and diuretics have questionable benefits. Similarly  research studies show that vitamin B-6 supplementation has a negligible therapeutic effect.

Ultrasound-guided local injections

This involves injecting local anaesthetics and a small dose of steroid close to the problem site under ultrasound guidance. Ultrasound helps to ensure accuracy and minimises the risk of complications. One study has estimated the risk of serious complication with these injections as less than 0.1%.  There is evidence suggesting that the local injection is effective for more than one month in patients with mild to moderate carpal tunnel syndrome and delays the need for surgery at one year. Some studies have demonstrated improvement lasting 10 weeks to more than one year. This option can help manage the symptoms, avoiding the need for surgery. Certain cases may require a repeat injection for more effective symptom control. Wrist injections may help to relieve inflammation of the affected nerves and the fibrous sheath and fasten the healing process.

Surgical management

This option is suitable for patients with severe carpal tunnel syndrome or when symptoms have not improved after four to six months of conservative therapy. It is an effective option and can provide a lasting relief in 70 to 90 % of cases. The procedure involves release of pressure by placing a cut on the fibrous sheath, which will provide more space for the median nerve to pass through.

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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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Pain Management In Delhi provides Fibromyalgia Pain Treatment In Delhi

Symptoms you should know 

Fibromyalgia is a chronic condition characterized by widespread body pain.  Other common symptoms in fibromyalgia include unrefreshing sleep, tiredness/fatigue, low mood and memory problems.  It is more common in women and is commonly known as ‘fibro’ or "fibrofog". No clear pathophysiological mechanism for fibromyalgia has been established, but there is evidence that patients have abnormality pain processing with increased sensitivity to various stimuli such as pressure.
As the symptoms tend to be non-specific, and there are no specific tests which can be carried out to diagnose, fibromyalgia can be challenging to diagnose. It is important that you explain your symptoms correctly and in detail to your doctor as it can aid in establishing the diagnosis.  Fibromyalgia often occurs in patients with other conditions, such as inflammatory arthritis and osteoarthritis and is not a diagnosis of exclusion.
So, if you are experiencing longstanding constant widespread body pain, with varying distribution and the cause for the pain cannot be explained by any other abnormality detected, then it might be possible that you are suffering from fibromyalgia. The symptoms are generally managed using a range of drug and non drug mechanisms. Some of the common symptoms in fibromyalgia include:

Widespread body pain and tenderness

This is the most common reason for which patients seek medical opinion/ vsit a pain specialist doctor in delhi. This differs from other conditions such as arthritis as the pain in not localised to one area or the joints only. Muscle and joint pain is commonly seen in majority of patients. The pain may vary in severity and nature (dull ache/ heaviness/ throbbing /burning) . Most often the pain is continuous although in some it may be intermittent; some others feel like the pain keeps travelling from one area of their body to another. Patients may have areas which are tender to touch with increased sensitive to pain. Long term persisting pain can lead to inactivity which can further promote deconditioning of muscles and worsening pain. It can also lead to physically inactive maladaptive posture & gait, bursitis and tendinopathies.

Fatigue

A constant feeling of tiredness is another common symptom present in majority of fibromyalgia patients. Even after adequate periods of rest fibromyalgia patients may feel like you don’t have the energy to get through the day. Intense workouts may be a thing of the past with basic daily chores becoming an uphill task. Slowly it may start to affect other dimentions of life such as relationships, social life, work etc.

Sleep disturbances

No restorative sleep, inability to sleep and fatigue are common in fibromyalgia patients. Patients generally feel tired in the mornings. Sometimes, because of the easy fatigability, even though you fall asleep quickly the sleep may be interrupted and non refreshing. Pain and emotional disturbances may contribute to the sleep disturbances.

Mood variations

More than half the patients diagnosed with fibromyalgia, suffer from mood disturbances such as depression or anxiety disorders. And it is no surprise that people tend to feel low and worried all the time when they are experiencing pain all over their body for a long period of time. When you are having a hard time managing your day to day life, when basic functionality is like a challenge to, it’s only natural that you are going to feel a little hopeless and anxious about it. Staying active and staying connected is something that you have to make a huge effort for.

Memory problems and impaired concentration

The name fibrofog comes from the memory issues seen in fibromyalgia. Fog represent the lack of clarity or haziness. It’s a very common symptom amongst patients, where they complain of forgetting basic things like where they have left their keys, and not remembering plans they have made.

Tingling sensation in extremities

Some experience tingling sensation in their extremities especially on their toes and fingers, while some others complain of numbness. The term paresthesia is sometimes used to address these symptoms. These symptoms tend to flare up from time to time, although in some cases they can be a constant feature.

Other associated problems

Headache
It is a common problem which tends to interfere with the individuals daily life, and can be debilitating. They often develop a migraine or tension headaches from time to time. Sometimes a headache can also be due to the stiffness of the muscles in and around your neck region and upper back.
Irritable Bowel Syndrome:
There are occasions when people suffering from fibromyalgia complain of abdominal pain, have a bloated sensation in the abdomen and experience episodes of constipation or diarrhea. All of this is because of a condition known as irritable bowel syndrome. Individuals can also experience a feeling of regurgitation following meals, which is due to gastro-esophageal reflux disease, which is also associated with fibromyalgia.
Restless legs & leg cramps
Since patients having fibromyalgia, complain of a variety of symptoms as mentioned above, it is not difficult to miss the diagnosis. Therefore it is very important that you discuss your symptoms at length with an experienced doctor.

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Pain Management Centre In Delhi For Chronic Pain Treatment In Delhi

Pain is a common reason for medical consultation. Over the years, studies evaluating the Global Burden of Diseases have found chronic pain conditions amongst the leading causes of disability worldwide. The impact of chronic pain can vary, ranging from an occasional distraction or discomfort to constant severe debilitation. Some examples of common chronic pain conditions include back and neck pain, sciatica, diabetic neuropathy, headache, frozen shoulder, persisting post surgical pain, cancer pain, abdominal pain, pelvic pain and fibromyalgia. Pain in a significant proportion of these conditions is amplified by stressful and sedentary life style with obesity, lack of regular exercise, smoking, poor workplace ergonomics contributing to the increasing incidence and severity.
Chronic or longstanding pain does not always signify ongoing damage. Conditions such as arthritic knee or back pain are often accepted as part of aging process, stopping people from exploring treatment options.  It can, however, cause significant distress and compromise the quality of life. With the correct help, you can control your pain better and make your life easier. A best pain specialist doctor in delhi can help to diagnose the cause of your pain and work towards relieving/ reducing it and minimise the impact on your daily routine. This is how the approach of pain management specialists is different:

Knowledge and experience

When you receive specialist training in a subject and deal with specific conditions on a daily basis (chronic pain in this case) your experience/ learning is bound to reflect your treatments and outcomes. The education and the training received helps in successfully diagnosing and treating pain issues. In India the opportunities for specializing in Pain Medicine are limited with no nationally ascribed curriculum. In the western countries pain medicine is reorganized as a separate specialty with numerous training and super specialization opportunities. Pain clinics form an integral part of most reasonable sized, good hospitals. Pain specialists generally undertake a detailed assessment of every aspect of pain and try to address problems comprehensively.
 I have spent a year doing pain research and another year in pursuing advanced training in the field of pain medicine in London, UK. This is addition to the basic and intermediate training in pain medicine during my 7 years of initial anaesthesia training in London, UK.  Subsequently I have worked as a Chronic Pain Consultant in UK.

Treating the cause of the pain and not just the symptoms

Pain specialists try to explore why a problem may have occurred as this is important to prevent reoccurrences. Once the underlying problem has been resolved, the pain may automatically ease off giving you lasting relief. This is better approach than just taking medications for temporary relief. Understandably this may not be possible in all cases but this should not become a deterrent to trying.

Treating the body as a whole

Pain management specialists are trained to visualize body as a whole and use a multidisciplinary approach while addressing chronic pain. They don’t concentrate on just controlling the pain, as they understand that pain can affect multiple facets of life from mental health to relationships to jobs to social life etc. Each person is unique and experiences/ processes pain differently and hence the need for individually tailored therapies. They use a combination of modalities including physiotherapy, medications, injections/ interventional therapies, psychological therapies, Complementary and alternative therapies including Acupuncture, TENS, acupressure, and meditation along with patient education to achieve the best possible results.

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Pain Specialist Doctor in Delhi, Dr. Amod Manocha is Innovating Pain Management Medicine Discipline to Improve Quality of Life