Criticare Hospital

Hi,

I am Dr. Kailash Kothari, Pain Management Specialist, Mumbai. I am interventional pain and spine pain management specialist. So, in pain clinic, we identify that what is the cause of your pain by the specialized treatment called diagnostic nerve blocks or diagnostic block of particular structure which all examination we feel might be a cause of pain. So, coming one by one. I will just tell you, how we diagnose it. So, if the disc is coming back again and it is compressing the nerve, the procedure called discography. So, we just put the small needle in the disc, we try to see whether the disc is causing pain. If the disc is painful, the patient will feel a lot of pain, so, we can identify whether the disc is causing pain or not. There are various treatments option like decompressor, disc affects, which are non-surgical and kind of injection technique through which we can remove the bad disc and we can cure disc without doing any open surgery.

Another is inflammation of nerves because of the fibrosis the procedure called transforaminal epidural dialysis. In that, what we do, there is a small catheter which is inserted through the tailbone. The area which is operated where the fibrosis is happening or the nerve is getting compressed, we put the catheter and that catheter we inject, open up space, then injecting certain medicines, editions are broken and the nerve is freed. That is very effective and post-operative editions. So, this is about nerve. If we have joint pain, we do test injection of the joint under x-ray control. We block that medial branch. We ask immediately to the patient, whether they have pain or not. If the patient has pain because of the facet joint, they will immediately say that they have pain relief. They can stand, sit, move, the activities they were not able to do, they can do all those activities. We can do level 1, 2 & 3 blocks and we can see that how many joints patient have which are bad. If we have confirmation, we can start radiofrequency ablation of the nerve which is causing pain. The best part about pain management technique is, these are all daycare procedure. You come in the morning, get the procedure done and you will be back within a few hours. It will not cause you to go on the bed. You don't need any rest.

You can go back to your work immediately after the procedure or maybe next day depending upon what procedure are we doing. These are very good to improve the quality of your life without surgery. In certain cases, where the muscles are involved which is causing pain. So, similarly, as we did for disc, nerve, for facete joint we can also block the muscles with a local anesthetic. And we see whether you have pain or not. If you have pain, we can confirm that muscles are having pain. And there are certain symptoms, we identify what muscle or joint or disc might be causing pain. By examination, we pinpoint, what is the area or which is the structure which might be causing pain and then we do a diagnostic injection or block that area and confirm our clinical diagnosis by diagnostic injection. Once we get confirmation, we do the therapeutic treatment by injecting some kind of steroids, radiofrequency ablation. But a few patients are really bad. They have so much pain. They have pain 10/10. We tell the patient to identify what is the level of their pain. And if your pain is not improving after trying everything, this is not the end of your treatment.

So, there are certain patients, who do not respond to surgery, to nerve blocks or radiofrequency ablation. For them, there is a certain specialized treatment called neuromodulation. Basically, pain is what? Pain is carried by nerves to the spinal cord and from there it goes to the brain. So, we need to identify the pain pathway and you can block the pain going to the brain. So, we put a small electrode or a small wire through a small needle. This is called spinal cord stimulator. And that wire is connected to a small battery which is implanted in the abdomen just under your skin. Wire applies the current over the spinal cord. We call it spinal cord stimulator. So, in the area where the pain is going will be replaced by some tingling or soothing sensation. This is a very effective treatment especially for the patient who does not respond to any kind of treatment. Some patient comes to us with 2-3 surgeries, even I have treated the patient with 6 surgeries they have in the past. And they have responded really well to spinal cord stimulator. So, this is a very effective treatment which is available in our clinic.

The 2nd is called morphin pump implantation in short, it is called intrathecal pump implantation. A catheter is being inserted through the needle. It is implanted just below your belly. It is under the skin. It is superficial. Then the drug is directly delivered to the spinal cord in microquantity. So, you do not have any side-effects of the drug. It is very safe. It is a very effective treatment. So, these are a few treatment options which are available and if you want you can always call us. You can go on websites and find out more information about these procedures. And I am sure that you will get very good relief. You will be back to your quality of life to be achieved by these procedures. You do not need any further surgery. If one surgery has not worked then there is no chance that another surgery will work for you. So, better to identify the pain structure, go for pain management treatment which is not surgical. Do call us if you have any query.

Thank You!

Hello friends,

I am Dr Kailash Kothari. I am Interventional Spine & Pain management Specialist . Hum ye pain ki treatment karte hain aur hamare jo doosre centres hain usme K M Hospital jahan pe mein honorary physician hoon. Wahan par bhi hum kafi patient jo hain pain ke wo treat karte hain. Hamare paas kafi tarah ke patient atey hain usme hamari jo back pain aur neck pain ke patient hote hain wo kafi hote hain. Aur ek bada percentage hota hain jo hamare ghootno ke dard ka hota hain knee pain. To aj maine socha ki knee pain ke jo treatment hain uske barey mein hum kuch baat karein. To knee pain jaisa aap ko sabko pata hain ki yeh ek bada karan hain jiske liye log hospital mein atey hain. Aur yeh knee pain aisa nahi hain ki aapko jo umar jyada hoti hain unhi logo mein hogi wo. Wo pain aapko young patient mein bhi ho sakti hain wo aapko umar darar logo mein bhi ho sakti hain. Aur iska karan yehi hain ki knee hamari ek continuosly kaam karnewali ek part hain body ki.

Yahan par hum chalet hain byath te hain bhagte hain aur uthte hain niche jamin pe byatna parta hain to har cheez mein ghutna apna kaam ata hain. To iski wajey se uski jo ligamants hain muscles hain cartilages hain wo sab under strain hotey hain unke upar kafi pressure hota hain. To uski wajey se kafi logo mein ye samasya ati hain. Aj mein jo aapko batane wala hun yeh knee, knee hamri ek simple sa joint hain jisme aapko upar femur yeh bone hota hain iske niche tibiaaur yeh fibula. Yeh 3 bono ka ek joint hota hain jisko hum knee joint kahatey hain. Uske ilava hamare ek doosra bone bhi hota hain jisko hum Patela bolte hain. Isko hum Marathi mein wati bolte hain aur hindi mein katori bolte hain jo jiske upar yeh muscles slide hotey hain aur hamare ghutne ko modne ka kaam karti hain.

Toh hamare jo ghutne hotey hain usme kaafi cheezey hoti hain jo hamare knee ko dard pain kar sakti hain. Jaise yeh ligaments hain yeh hum medial collateral ligaments usme kabhi kabhi sprain ata hain toh use pain ho sakta hain. Yeh jo patella hain iske liye ek special grove hota hain. Patella agar right ya left mein convert slip ho jaata hain toh yahan pe friction ho sakta hain yahan pe arthritis develop ho sakti hain yahan par aapko inflammation ho kar pain ho sakta hain. Uske ilava humare ghutno mein andar ki taraf kaafi ligaments hotey hain ACL aur PCL anterior cruciate ligament aur posterior cruciate ligament. Yeh ghutne ko friction aur extension matlab aap jab pura ghutna modte ho matlab jab aap pura sidha karte ho tab usko excessive friction aur excessive extension issey rokta hain taki aapka ghutna jyada extension ya jyada flexion na ho. To yeh limit karta hain at the same time stability deta hain. Uske ilava joy eh dekh rahey hain aap, do ghutney ke beech mein do bone ke beech mein yeh hain meniscus yeh kaafi logo mein meniscal injury ho jati hain aur yeh meniscus cartilages hotey hain jo cushioning effect dete hain apne ghutne ko. Yeh itni saari cheesey hoti hain jo ghutne ke andar aur uske aas paas ki jagayon mein pain kar sakti hain. But uske ilava yahan pe muscles hoti hain jo quadriceps muscles jisme 4 muscle ka ek group hota hain jo agey ki taraf ghutne ko pakarke rakta hain aur piche ki taraf hamstring muscles hoti hain toh hamstring muscles bhi ghutno ko support karti hain.

Uske ilava side se bhi muscle hoti hain dono bahar ki taraf aur andar ki taraf dono sides mein muscles hoti hain. Toh ye knee joint jiske upar kaafi dependent hotey hain hum chalet hain phirte hain baithte hain uthte hain usko support karne ke liye kaafi kaafi cheesey hoti hain. Koi bhi ek cheez agar damage ho jaye toh hamare ghutna sahi dhang se kaam nahi karega aur humko taklif dega. Toh humare paas jo ghutne ki itni saari bimariyan hain jisme sabse jo common bimari hain jiske liye log hamare paas atey hain uska naam hain osteoarthritis jo jaise umar badti hain humare ghutno ki cheesey jo ligaments muscles or cartilages hotey hain wo dhire dhire kamjor hotey jaatey hain wo patley hote jaatey hain thin out. Uski wajey se kya hota hain ki knee joint ka jo cushioning aur oiling effect hain jo fluid hain knee joint ke andar wo fluid kaafi kam ho jata hain. Aur uski wajey se hamare ghutney sooj jatey hain aur movement karne mein kaafi dikkat ati hain. Hamarey old age patient jo hotey hain wo ghutna fold nahi kar patey hain baithte hain to uth nahi patey hain uthte hain to chalne mein dikkat hoti hain thoda chalne mein pyarr dard hone lagta hain aur kabhi kabhi aas paas mein sujan a jati hain.

Toh aise situation mein normally hum kya karte hain anti inflammatory medicine lete hain. Anti inflammatory medicine yane sujan kam hone ki dawai sujan a gayi hain to doctor kya karte hain sujan ki dawai dete hain. Par kya yeh treatment hain? Sujan ki wajey se jo aapka regeneration process hain naye cells jo banna chahiye wo aur kam ho jata hain. Jaise umar badti hain humara nayi cells generation capacity kam ho jati hain aur hum kya kar rahey hain anti inflammatory medicine de rahey hain. Use hamari joy eh capacity aur bhi kam ho jayegi. Toh agar kisiko hum anti inflammatory medicine dete hain toh wo sochta hain mera pain kam ho gaya aur wo bohut khush ho jata hain. Kya arey wah main to chal sakta hun main baith bhi sakta hun niche par actually wo cheese ghutne ke liye achhi nahi hain. It is not good for your knee. Because it hampers further regeneration of the knee so we don’t want that. Toh hum kya karte hain. Hum aise treatment karte hain jiski wajey se apke jo ghutne mein ghisao ho gaya hain naya cells banne nahin ho raha hain regeneration nahi ho raha hain us regeneration ko hum stimulate karte hain. Aur uske liye ek treatment hotey hain jisko hum bolte hain prolotherapy.

Prolotherapy yaney proliferative therapy. Jo cells wapas nahi ban rahey hain hamare body ki capacity utni nahi rahi wo stimulate nahi kar pa rahi hain because of ageing umar ke hisab se toh ye therapy us chees ko stimulate karti hain. Toh hum kya karte hain hum ek simple sa treatment karte hain jisko bolte hain dextrose prolotheraphy jisme hum ek glucose jaisa substance hota hai dextrose it’s a sugar, uski ek particular concentration aur local anaesthetic injection isko hum ek combination banate hain aur us combination ko ghutno mein hum alag alag jagah par jahan pe uski jarurat hoti hain wahan pe inject karte hain. Aur sugar hamare body ke liye kuch damage nahi kar sakta it is very safe. It is a 100% side effect free treatment aur isme jo hamare body ke jo tissues hain usko wo stimulate karti hain cartilages ko ligaments ko muscles meniscus aur andar jo sinural fluid, jo fluid suk chukka hain hum kafi time sunte hain osteoarthritis mein ki fluid andar ekdum suk chukka hain andar oiling nahi hain toh us oil ko wo create karta hain kyon. Kyon ki yeh cells ko regenerate karta hain. Jo ghutne ke andar fluid hota hain usko bolte hain synovial fluid aur synovial fluid banta hain synovial cell se. us cells ko wapas banana ka kaam prolotherapy karti hain.

Aur ye koi doosri therapy nahi kar sakti hain. Uske ilava jab prolotherapy karte hain to humare muscles ligaments cartilages ye sab majboot hotey hain, kyun hote hain kyonki unke naye cells nirman hotey hain aur because of that they become more stronger. So you feel good aap ki joint ka stability a jati hain apko achha lagta hain pain kam hota hain aur wo pain killer je waje se nahi hota hain because of your knee which is getting better by recreating new cells. So yeh ek bohut bara part hain jo osteoarthritis ke patient mein hum karte hain. Aur hamare pas almost 30 to 40% patient hotey hain jo osteoarthritis ke patient atey hain. Aur hamare paas hazaro se jyada patient treatment le chukle hain aur unko kafi fayda hua hain. So this is one of the very very common treatment which is not done commonly anywhere in India but we are known for this therapy called prolotherapy. You can go on internet you can find a lot of papers research papers and there are lot of evidence about this therapy. Toh aur bhi information agar apko iske barey mein chahiye toh aap Lybrate dot com pe jakar apni queries daal sakte hain. Aur hum aapke queries ko answer karne ke liye will be more than happy. Humko bohuti khushi hogi ke hum apke queries ko answer karey. Hopefully apko yeh video pasand aya. Thank you very much and visit us on our website also.

Thank you.

Hello,

I am Dr. Kailash Kothari, Pain Management Specialist. We treat every type of pain and maximum patients are coming to us with knee, back and neck pain. So, today I will tell you about knee pain. So many patients are visiting the hospital because of knee pain and not only old but young people are also suffering from knee pain. The knee is the part of the body which works continuously during the regular walk, running, frequent sitting and then getting up from the place, sitting on the floor with folded legs. This causes strain to ligaments, muscles and cartilage. In our knee, we are having 3 types of joint: femur, tibia and fibula. A part in the knee is patella. Patella, we call vatti in marathi and katori in hindi. Patella is a muscle which slides over the knee joint and helps us in bending knee. So many things are there in the knee which can affect our knee badly. Injury to patella can cause arthritis, friction and inflammation.

The types of ligaments in our knee: ACL and PCL. These ligaments control flexion and extension of the knee while bending and straightening the leg. In the knee, between 2 bones, there is a meniscus which functions as a cushion to the knee. Apart from these, there is a quadriceps muscle which is a group of 4 muscles which holds the knee from the front and hamstring muscle which supports knee from the back. We also have muscles at the sides of the knee.

Many types of problems are there which affect knee and maximum patients are coming to us for osteoarthritis. As we get older, our ligaments, muscles, cartilage start getting weak and thin. This may result in the swelling of the knee and it gives problem at the time of the knee or leg movement. At an older age, the patient is not able to fold his legs. They suffer from problems while sitting, getting up, walking. In such situations, the patient takes anti-inflammatory medicines which only reduce the swelling. By taking these anti-inflammatory medicines, the regeneration of cells in the knee gets reduced. For that particular time, the patient gets relief and able to do all the activities but these medicines are not at all good for knee. So, we stimulate the regeneration of the cells at the time of the treatment. For this, the therapy is called prolotherapy. This therapy helps our body in increasing cells capacity. This treatment is called dextrose prolotherapy.

We prepare a combination of dextrose and local anesthesia and inject the same into the knee. This is 100% side-effect free treatment. This procedure stimulates our body tissues, cartilage, ligaments, muscles and this also reactivates the synovial fluid which gets dried in osteoarthritis patients. Prolotherapy is the only way to recreate the cells and strengthen our muscles, ligaments, cartilages. This gives stability to your joint. 30-40% of patients are coming to us to get rid of osteoarthritis and till date, we have given successful results to over 1000 patients. Now they are able to do their regular activities and avoided knee surgeries successfully.

We also have many patients who are in sports. Mostly we have seen that sportsmen are getting more affected with knee injuries as they do physical activities. There is a knee problem in sportsmen and we call it runner's knee. Sometimes our ligaments get twisted into the knee which causes pain. In such cases, prolotherapy helps to proliferate the normal cells, strengthen the muscles, ligament. If we will not keep our knee strengthen then it will cause instability which causes the problem to the patient in walking, running and routine activities. This treatment is not for the short term. People who play cricket, basketball, football can suffer from ligament injury or ACL & PCL tear and sometimes meniscal tear. This is a problematic situation in which if the patient straightens his legs, the knee gets locked and it becomes impossible for the patient to bend it again. We call this lock knee. It becomes difficult for us to pull the same back.

It also happens when our ligament gets damaged and we are able to move tibia, this is called instability of the joint. This instability causes pressure over the bones and also it creates osteophyte to create the new bone formation. Due to this new bone formation, our knee gives more pain. The best part of the treatment is that it gives you pain-free life for the longest time and makes the knee more stable. We repair the ligaments and cartilage with the help of prolotherapy. We stimulate the cells so as to build cartilage or fibrous tissues. This is the very common treatment which is not done pan India. We are known for this prolotherapy in India. These details can be found online and it has lots of successful evidence also. There is another therapy called PRP which helps in regenerating our tissues but for this dextrose prolotherapy is equally important and we treat the patient with both the therapies. Combination of these therapies gives better results.  If you want to know more about this, contact me through Lybrate.

Thank You.

Hello,

I am Dr. Kailash Kothari. I am an interventional pain management specialist. So we have this pain management centers who caters to chronic pain in patients and I am also attached to KEM Hospital which is one of the pioneer municipal hospitals in India and it has a very good pain department. So I am one of the consultants there. I also visit Fortis Hospital & Global Hospital in Mumbai and we try to manage these patients who are coming from all over India for their chronic pain conditions. So today what I am going to talk to you about certain pain conditions what we treat and we try to manage their pain so that the quality of life improves. Now one of the most common conditions for which patients come to us is back-pain. I am sure you must have heard many of the videos you must have read many books or many articles on back pain how they manage it. So basically at pain clinic when we treat patients when we see patients they come with years of pain sometimes one year sometime 15 or 30 years of pain.

And they are in so much pain that there are some patient who actually tell me that they want to die, they don’t want to live with the pain. Now, this is the fact most of the time our science present science is not able to diagnose what is happening with this patient why they are in pain. Inspite of managing them with conservative line of management like medicines, physiotherapy, some people go for ayurvedic some people go for homeopathic, still their pain is not diagnosed well from where it is coming and many time the pain is so severe that they want to die. So we come across so many patients and when pain becomes so chronic they also have a lot of psychological issues. So many time the patient who comes to us and he has chronic pain our main target our main idea of treating them is to diagnose the source of pain from where the pain is coming from. Because we believe that diagnosis is of utmost importance. If you cannot diagnose the source of your pain then we would not be able to manage your pain. It is like you are just doing the things and treating you with a blind eye.

So you are not able to see what is happening and we are just giving you treatment which might be effective which might not be effective. So it is fluke, we don’t believe in fluke. We just go for a diagnosis. And there are various ways by which we diagnose a patient. So when patient comes to us for example if the patient is having backpain with a pain going down in the leg we know back-pain and leg pain can be caused by something which is happening in the back. So if you see this so this is your spine. So there are a lot of vertebras there are a lot of discs between 2 spine there are a lot of nerves behind and between 2 vertebra there is a joint which is called facet joint. And there are a lot of muscles and a lot of ligaments which are lying in front of that. So it is the muscles are supporting the back of the spine and in front of the spine. So when you bend and when you do an extension that is when you bend backward or bend sideways these muscles and ligaments they hold your spine in right place so you don’t fall at the same time it gives you strength to move. So the spine it is at risk of getting damaged by these repetitive movements because there is the opposite force which is acting from the front and from behind.

So there is a lot of traction which is happening on the spine and that is the main reason why the spine is very very vulnerable to damage. Now suppose you have back pain which is here and there is a pain going down in the leg. So the most common situation is because of the slip disc. If you see here there is a bone this is called vertebra and in between the disc and the disc if it bulges it slips this is how it slips here it compresses the nerve here. And this nerve is like a wire which is supplying a particular area of the leg. So if you have a pressure here there is an inflammation there is a swelling of this nerve and this can cause pain going down in the leg. Now, what happens when there is an inflammation that your pain become chronic if it is not relieved in time. And this bulge may increase over time. So this can produce lot of space reduction so we many patients come to me and say my gap is reduced so this is what is the gap when the disc comes out this gap reduces.

Nerve does not get much of the place to come out from the spinal canal. Now here most of the people say surgery is the only answer and most people don’t want to go for surgery. So we have a treatment where we can give painkillers where we can give physiotherapy if that doesn’t improve we directly go for surgery. And most people don’t go for surgery and keep on suffering they keep on suffering from chronic pain. Now there is a huge gap between just a simple medical therapy and surgical therapy. There is nothing in between.so this pain management this pain clinics they offer something in between which can avoid your major surgery and this is what we do. We first do a simple injection hereunder X ray control we locate where the compression is happening. Under X ray control we give some small injection called selective nerve root block or trans permanent epidural injection.

This is a X ray guided injection. We put the needle we inject a small contrast which can be seen on MRI sorry on the SIUM which is a X ray machine. Once we see where the drug is spreading is it spreading in the right area which nerve it is spreading to whether it is the same nerve which is getting compressed by the disc that we confirm then we inject our drug which is a small dose of corticosterone. So once the corticosterone is injected you will have immediate relief of symptom. Sometimes pain is relieved in 2 or 3 days sometimes it takes up to 1 week. But the idea here is to reduce the pain by reducing the inflammation. So once it is reduced sometimes it works for a long long time, you don’t have to come back and you can go on doing your routine work without any trouble of pain caused by slip disc. Sometimes the pain comes back and you might have to take repeat injections which is ok.

There is no problem in taking repeat injection as long as your pain is reduced and weakness in your legs. Then you can always go for injection. So usually we repeat this injection once or twice. If it is working well and you have months and years of pain relief. You are not bothered you don’t have to do any other treatment except for physiotherapy and exercises. But if the pain comes back inspite of this injection we know where the pain is coming from now. Because after this injection if you have good relief that confirms the pain source if in this area then we have certain advanced therapies. And these advanced therapies are called intradiscal therapies. So we have certain we can say minimal invisible techniques by which without cutting the body without putting any cut on the skin we can just through the needle we can remove the disc. These are techniques which are called bikeloplasty disc effects or sometimes we do something called Endoscopic Discectomy. And in all these treatments we don’t have to give any anesthesia except local anesthesia in the same area. And that’s the beauty of pain management.

We can reduce your pain without doing any major surgery. So, friends, this was about slip disc or herniated disc what I was talking about. But there are many other situations which can cause back pain. One of the most common is facet joint problem. This is the joint between 2 vertebra and this is called facet joint. A similar problem can be there in si joint this is sacroiliac joint. Many times there are muscles which can cause pain. We don’t know where the pain is coming from. Most of the time this all pain which is coming from the different structure they may have a similar presentation. So what we do in this case is we do a simple injection to diagnose by injecting a local anesthetic in a particular area.

If I give injection here and I make patient stand up after the injection he should be pain-free if the pain is coming from here. And that is what is called a diagnostic block. Once we get the diagnosis if we don’t get a diagnosis here pain is not relieved we go to another structure. So by doing a differential block of diagnosis we can find out which is the source of your pain and we can apply different treatment modalities most common is radiofrequency ablation. Basically, it is the radiofrequency current which is applied to the particular structure to block the pain coming and you are relieved off your pain for one and a half to 2 year. So one of this beauty of pain management is without surgery we manage your pain and we make sure that your quality of life is very very good and you enjoy your life with your family. And if you want more information then always contact us on Lybrate.com thank you very much for watching and I hope you will see more videos like this which will be informative for your pain condition.

Thanks!