Apollo Hospital

Hi,

I am Dr. Sidharth Verma. I am a pain physician and I treat patients who are suffering from pain. Often patients ask me what is their diagnosis and I tell them and then they are confused because what I tell them is like you have C3, C4 disc problem and then we need to do this or that and they get very confused, so I thought I will make a video so that they can understand and all of you can understand what is this terminology.

So our spine is made up of small bones which is known as vertebrae. These bones they join together at various joints and then they make the whole spine. This spine is a very important organ because it is used in whether you are lying down, whether you are standing, whether you are sitting all the time you are using your spine and without your spine you cannot even stand, you see those people who have issues with spine they cannot even stand or cannot even work so it is a very vital organ in the body and traditionally it has also been emphasized on the health of the spine.

Now let's move to the constituents, the spine is mainly composed of the bone which are this vertebra, it can be divided into four major regions one is the cervical that is a spine of the neck. So the bones in the neck they are known as spine, the cervical spine. Now let's move a little below the bones of the thorax are known as the thoracic spine. Thorax means the area below from your neck to your lower back that is the area of your chest and upper back, so these bones are named as thoracic spine. Now let's move a little down this portion is known as the lumbar spine and I have explained about the lumbar spine in my other video which you can see on my lybrate website.

Now coming back to the cervical spine, if you see in the cervical spine and they are small bones which are joined together at three joints each and they are enclosing the spinal cord in between at various holes which is known as the foramen, the spinal nerves they come out and supply the various parts of the body. So if you see there are various pain generators which can be there in these bones but let us first label these bones.

So this model is a model of the cervical spine that is the bones inside the neck. So these are the bones and they are labelled as or named as cervical one or the C1, C2, C3, C4, C5, C6 and C7 so these 7 bones makeup the cervical spine and if you see the first one is very different than the rest of the other bones and that's why it is very atypical type of a vertebrate that is it is not like the others for all practical purposes it is labelled as C1, C2, C3, C4, C5, C6, C7. So when you see a report which mentions there is a C2-3 disc prolapse that means this is a second and third and this is the disc in between and that now the height has decreased and it has come off or it has been damaged and then it is pressing on the nerves.
So this is the disc in between the 3rd and 4th so C3-4, this C5-6 so this is a disc in between the C5 and C6. If you these vertebrae they also have small holes through which these nerves are coming out. so, this nerves are coming out of these small holes, these holes are known as the foramen or the intervertebral foramen.

So, there is another structure which is this artery which is going to the brain, so it takes the blood supply from the heart to the brain. It also passes very close, see how close these nerves are to this artery. So, it is very close and when your pain physician will explain to you some procedures they will tell you the risk involved with these procedures because this arteries very close by. So now if you see on the posterior portion there are two joints which is the right and the left facet joint and on the anterior there is one joint which is made up of this intervertebral discs. So, again like in lumbar, cervical also have 3 joints in between the two bones. So this front joint this position is known as the intervertebral disc and the posterior joints are the facet joint. This is a right facet joint, this is the left facet joint in between C2 and C3 cervical vertebra, this is the right facet joint and the left it is in between C3 and C4 cervical vertebra and these are the joints between C4 and C5, C5 and C6, C6 and C7 cervical vertebra. So if you see this structure is passing, that is a spinal cord is passing inside these bones through a canal and it goes down to the rest of the body.

Now the important thing to note here is there is one structure which is not seen here in this model and that is the muscles, so if you see for example a big muscle attaches from here and also here. So it is this thick and supports the whole of the cervical spine. It results in a lot of movement at this portion but can also cause pain if the person is not exercising or over using it or under using it and that can result in neck pain. Some types of neck pain can also radiate to the head because some of the portion of the head nerve supply comes from these neck nerves only.

I have explained to you the cervical spine in an easy and simple manner and now you will be able to understand after seeing your x-ray reports, after talking to a doctor, what is this C1, C2, C3, C4, C5 and what it means? and if you have any more queries you are most welcome to contact us. If you are suffering from neck pain please feel free to contact us. If you want to know more, you can visit our lybrate website and get in touch with us.

Thank you

Hi,

I am Dr. Sidharth Verma and today I will tell you about spine so many times we see patients who are confused about their diagnosis so we tell them that you have L4-5 or L2-3 or L1-2 problems or you have facet joint issues so they sound and look very confused because they don't know the terminology, so I thought I will explain to you what are these difficult terms so that you can understand what is happening to your body and then you can get treated properly.

So our human spine that is the back it consists of lots of small bones and these bones are known as vertebra so if you see it can be divided into various portions, one in the neck is known as the cervical spine, one from the area of the neck to the lower back is known as thoracic spine and one in the lower back is known as the lumbar spine and below that is the sacral spine. There is also another type of bones which are there that is coccygeal spine which have become fused now so you should understand that there are a lot of bones and the spine is made up of small bones.

Now these bones they are small and they are joined together by various joints, every two bones are joined by three joints, one is the joint wherein there is an intervertebral disk and there are two more joints which are known as the facet joints so if you see why these joints are required is because the spine is a mobile organ means it has a lot of mobility and it provides a range of motion to us so that we can bend, turn, twist and do a lot of other activities and why bone is required is because the spine essentially not only stabilizes the skeleton but also provides support and protection to the spinal cord which is a big nerve or collection of the nerves which passes from the brain to the periphery, that is this is the structure through which the brain controls all the other muscles and the organs of the body.

So you see this is a model of the human spine and if you see it shows a lot of different bones so these are the lumbar vertebrae and they are numbered in five and they are labelled as per their name so it is like L1, L2, L3, L4 and L5, so if you see between the L1 and L2 there is a disc which is known as the intervertebral disc that is the L1-L2 disc, this is the L2-L3 disc, this is the L3-L4 disc, this is the L4-L5 disc and this is the L5 and first sacral vertebra that is S1 so that is L5-S1 disk, so I hope now you are clear when your MRI reads L1, L2, L3, L4, L5 and it will not confuse you.

Now, what are these structures coming out? these are the nerves which are coming out from this hole. This hole is known as the foramen and since it is between the two bones that are vertebra it is known as the intervertebral foramen. These nerves leave the spinal cord and come out and then they go to the various organs. Now let us turn this model and see what is behind, behind each of these bones they are united at two joints, this is one joint and this is 2nd, so this is the upper bone and this is the lower bone and these two are the joints where they are uniting these are known as the facet joints, so this is the right facet joint, this is the left facet joint of the L1 and L2 vertebra similarly this one is another facet joint right one, left one of the L2 and L3 vertebra, so why this is important to know this is because these facet joints can become arthritic or with age this discs can reduce in height and puts more load on these joints and they can become damaged and then result in pain and such patients will also have back pain, so by knowing this, that they can cause pain, your pain physician can actually treat you and what they will do is they will numb the nerve which supplies this joint and then you will not have pain.

Now there are other structures also which can be resulting in the pain and these structures are not seen in this model but I will show you how they are attached so these structures are your muscles, so the muscles attachments if you see an average 80 kg adult will have a spine which will be only this much thick and as a result the remaining portion is occupied by the muscles, so muscles are huge like one of the muscles which starts from here and also from here so this big thickness is for a single muscle, so if you see they form a complete column and which supports the spinal cord and vertebra. So spinal cord is this one which is enclosed in this vertebra and the spine is enclosing this spinal cord and in turn, the muscles are around this vertebra or the spine and they provide support to the spine as well as they ensure there are movement and motion, so I hope you understand this common terminology.

Now your pain physician may also tell you that you are having a facet joint hypertrophy or facet joint arthropathy what does that mean? now with increasing age the height of this disc it reduces which puts more and more load on these joints also these joints become osteoarthritic means their age-related changes occur and they may become inflamed or even painful, if this happens then it is very difficult for the patient to extend or to cause any movement which results in motion at these joints, so in those cases we say that the patient has developed a facet joint arthropathy and the pain physician will tell you that you which level is involved and then he will do a procedure to relieve you from this kind of pain, now these bones are covered on all sides by big muscle, thick muscles so if I take an average adult who is 80 kg, the size of the bones will be similar to this only so although the person may be very thick but the his bones will be this much only so you can very well imagine that how thick the muscles will be, so for example in this particular model one of the muscle will start from here and here and it will go like this so you can understand that the muscle thickness is too much and they form a column so that is why your doctor will often tell you that you need to exercise so that you can develop your muscles properly.

Another thing which commonly people ask is listhesis. Listhesis is that the bones which are normally aligned one over the other, now the alignment is changed so this terminology is known as listhesis that means that in addition to other things this is one more component which can give rise to the pain in the particular patient. Now some patients will also have what is known as scoliosis. Scoliosis means there is a bending of the spine so what happens is because of various reasons the spine may not be straight but it may be bent like this so these patients will have more loading of the facet joints on one side, on the side which it is bent and this will lead to pain here and it can also lead to damage in the opposite joint and subsequently pain there also. So I hope these common terms have been explained to you and if you have any further doubts or any queries I will be very happy to answer, you can connect with me on my lybrate website and I would be very happy to answer your queries.

This is doctor Sidharth Verma and I am a pain physician and if you have any kind of queries please feel free to contact me.

Thank you

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist. Today I will tell you about the non-surgical treatment options trigeminal neuralgia without open surgery. There are many patients who are suffering from this disease which is known as the suicide disease or trigeminal neuralgia. So, this disease occurs because there is a pain in the trigeminal nerve which comes out of the brain and supplies most area of your face. Usually, it is unilateral which occurs on one side and the patient is having sharp shooting kind of pain and this pain may come at any time of the day. It may be very severe. If you touch the area of the face or if you eat something or if you brush your teeth. It is very severe. This may be triggered by these actions. Many patients come with this symptom and then they are adviced with the surgery and I am happy to tell that now with the latest technology, we have a treatment option available for this problem wherein you need not go with this surgery and you can have the good relief from the symptoms. What are these treatment options? Let's have a look.

So, the number 1 thing is done nowadays is radiofrequency ablation. It is a very high-frequency current to the Gasserian ganglion of the trigeminal nerve. If we go with a needle and give this radiofrequency ablation then the pain is taken care of and this result in relief of the symptom. Now, how is it done? It is done by a pain specialist or pain physician. They will first diagnose the condition properly then do an MRI to find out some other cause of the pain. It is always done under local anesthesia. However, the anesthesia may be required before the content is taken in hand. It is x-ray guided. It can also be done in a cath lab where we will have a higher resolution and we can control the results in a better way. So, with the help of the needle, the patient is made to lie down with his back to the table and then we use x-ray. This we use for an opening in the brain from where this nerve comes out. With the help of a fine needle after numbing the skin so that the patient does not feel any pain. Once the needle enters in foramen ovale, it is slightly advanced and now stimulation is checked.

With the help of a radiofrequency generator, the patient is made to have an understand a concordance stimulation. The stimulation is given and the patient is asked whether it is the same pain which he used to feel every day and then the patient replies. If the patient says, yes, means the needle tip has reached. Then the radiofrequency current is applied. And once it is applied, the patient's pain almost immediately goes. And post-procedure the patient may have immediate pain relief and the needle is withdrawn and then we shift him to recovery. This procedure has many advantages. It is done under local anesthesia, daycare procedure. The patient can go home the same day or the next day. It is a very cost-effective treatment. It hs very low incidences of complications. The success rate is very high. It also gives a decent amount o pain relief which lasts up to 5 years or more in many cases. Another technique which is also very popular is the pulsed radiofrequency. The technique is the same as radiofrequency ablation. The only difference is instead of the thermal ablation, this technique uses the pulse radiofrequency current.

This way the patient pain reduces. Now the evidence is also fast catching up. Another technique which is used and not open surgery is the balloon compression. In this case, the needle is advanced but in this case, we put one catheter. After putting it inside, it is made to inflate which can be seen in x-ray and it is kept for 90 seconds. It compresses the ganglion. This results in blocking of these fibers and the patient will have the relief from symptoms and pain. This is very effective in cases, where all the 3 divisions are involved. If we talk about the results, results are excellent and the patient gets the long-lasting results from their symptoms. So, if you have facial pain which is not going even the tooth pain and you have the electric current like sensation, tried everything, gone to multiple doctor, you want to avoid surgery, then definitely, you should visit our clinic. A pain physician would be able to help you with a lot of treatment option and which do not involve any open surgery.

Thank You!

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist. Today I will talk about back pain exercises. What is the evidence and what should you do if you have back pain whether you should do the exercises or not? If somebody has back pain, the kind of response depends upon the particular patient. Som people if have back pain, they will just not pay attention. They will keep on moving. Some patients will pay attention, take pain killers, take rest, and some patients will also do exercises. So, if you are wondering whether exercise is the help for back pain, so this video is the answer. Now we have a lot of studies which have been done and most of the results point out the fact that there is moderate evidence. In fact, one of the recent papers, they go on recommend that exercise is the first line of treatment in the management of back pain. I do not mean back pain which is due to some injury.

If you have injury, trauma, or you got hit by something, when I say back pain, that means which has come on its own. There is no other disease which has found accountable and this back pain ranging from one day to less than 3 months. So, if you have acute or sub-acute which means between 1 day to 3 months of back pain, then probably you should start with the exercise as the first line of the treatment. Now in the recent paper, in 2019 April which is in general of exercise rehabilitation and it says that you should start it as a first line of the management. Now what kind of exercise you should do and what kind of benefits you will have? So, on this, a lot of research has been done. So, scientists have said that you can be benefitted with any of the techniques, whether you do the isometric exercise, flexion, or strengthening exercises. Whatever kind of exercise you will do, it will help you.

There is no superiority of any exercise over the other. You can do swimming, walking, strengthening exercises. You may get a similar kind of benefit from each one of them. Now there is something which is very common, what about massage? Massage is going to help or not? In this also, scientifically exercises which have been found to be helpful is a cutaneous massage. It is also known as CTM. This is known to give a good result. It is a very beneficial massage. It is thought to act by neuro mechanism. This is the only kind of massage which has been found to be helpful. All other kinds of massage have been found either ineffective or it is having no result. So, CTM massage is going to give you a good result. Next topic is what about mindfulness like yoga. This also has been found to be helpful. There is a good amount of evidence which supports. If you have back pain and it is a recent onset, no other cause, and you feel it is muscular, so yoga may help. If you are finding that back pain is still not going so you can combine exercises, massage, yoga before you go to your physician and before you start your medications.

And the evidence also suggests in addition, that the combination of these will result in better output as compared to one individual technique alone. So, if you combine all these techniques then it will give you a good result in the treatment of your back pain. Now if you have a reasonable time and you are making good efforts still your pain is not relieved, so you can visit you, pain specialist or your physician, pain physician for further treatment. Then he will try to find out the pain generator means where your pain is coming from like bones, muscles or joints then he can suggest remedial treatments and you can have good relief. So, you want to know more about back pain, why it occurs, what are the latest treatments, how can you avoid the back surgery, please visit us in our clinic, or you also can see my Lybrate website. To know more, you can reach put to us.

Thank You!

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist and today I will talk about myofascial pain syndrome. Although this is a very uncommon term to the most patient. But this is the most common pain which we see in our OPD. So, this is so common that around 60% of the patients who come with the musculoskeletal pain are suffering from myofascial pain syndrome. So, my means muscles and fascial means facias. So, this is the soft tissue pain. Typically this presents when a patient suddenly complaints of pain in some muscle belly, some portion of his body. It persists for a long duration of time. The patient takes some painkillers, some tablets, get some massage and all done but he is not relieved typically. And the characteristic point for this myofascial pain is the presence of active and passive trigger points. There is a difference between trigger and tender points. In trigger points, the pain spread to the muscles.

And on the tender point, the pain is localized to the portion where you have applied the pressure. These trigger points are nothing but they are the areas of dysfunctional muscles because of various factors. The exact cause is not known. But some theories say that there is some dysfunctional blood flow to those areas and this results in ischemia, later on, the nerves fiber becomes hypersensitize. And this is how the pathogenesis occurs. And when there are multiple tender or trigger points throughout this belly of muscles then this results in a lot of pain and discomfort for the patient. This is usually not relieved by medications, massage, stretching, exercises. And then the patient goes for some investigation like MRI and that is also even normal. The patient is more confused as well as Dr. However if this syndrome is kept in mind then a lot of patients can get the benefit. It is also known as soft tissue pain.

Coming to the clinical features. This can vary from pain on touching, pain on activity, psychological symptoms like depression, loss of interest, this all can happen due to this syndrome. Because beyond the point when this persists the area or regional involvement starts recurring more and more and because of this muscles fibers are affected. This results in a lot of discomfort for the patient and the amplification of the symptoms. How to diagnose and treat it? When the patient comes to us with soft tissue pain, we immediately diagnose. It is a clinical diagnosis. However, the newer modality is the infra-red cameras pick up the areas with lesser temperature nowadays. And this is a clinical diagnosis. So, many of the good physiotherapists also pick-up this syndrome very well. They try to treat it with dry-needling, exercises, other physical activities. However, in many cases, the pain is still persistent. The syndrome still exists. That is when the patient comes to us. If patient early walk-in, we identify this and immediately give the treatment. So, the treatment here is very straight-forward. Almost gives the 100% result. However, the treatment needs to be repeated at frequent intervals.

It has to be clubbed to rule out the possible causes and eliminating them. Let's say that the patient comes with neck pain, if I examine, I find that they have a lot of tender points, the patient is having neck pain due to which he is not able to move. Then possibly I will try to find out what are his activities like long hour sitting, travels a lot or what are other activities which can possibly lead to this problem. Once I start treating the patient, simultaneously, we also try to take away this bad habit and inculcate good habits in the patient. We try to educate them about their symptoms in addition to the pharmacological treatment, interventional treatment. We add exercises so that the patient can have good strength. We add stretching. We may take the help of physiotherapists. This may result in complete resolution very fast. So, what are the interventions that we do in this syndrome? We do trigger points injection. Ultrasound-guided trigger points needling. In this, we locate the most tender points. Then we infiltrate with small anesthetic as well as sometimes we add a low dose of local anti-inflammatory agents.

What does this drug do? Helps in eliminating local inflammation and needling portion increases the blood flow which results in active healing. The patient develops the muscles strength and results in resolution to the symptom. Dry-needling is another symptom which is commonly used. It has a very specific indication. We can typically see the twitches which are present once the needle touches the tender points or the trigger zone. Once the needling is done, the resolution is very good and the results are very nice. This procedure is common in post-surgical patients like cancer and other patients who are suffering from other illnesses. Results are excellent. It is also helpful if we do the blood investigation also of these patients. Many of these patients have found deficient in vitamin-B & B12. This can be replenished. Bioenergiser also found to be helpful in these patients. So, if you are suffering from chronic muscle pain, you have a lot of massages, you went to a trusted physiotherapist but not able to help you fully. Earlier you used to get well but now you are not getting well. Again the pain is persisting. So, please don't suffer. Come to a pain relief centre. We will try our best to help you. And the earlier you, the better the results are. Don't ignore myofascial pain syndrome. It can magnify and often become very difficult to treat in the later stages. To know more you can visit my Lybrate website.

Thank You!

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist, Pain Relief Center, Mumbai. Today I will talk about cooled radiofrequency. It is a very advanced procedure. It was developed after the radiofrequency treatment. In this treatment, there is a higher success rate. There are very high chances of achieving good results with this treatment. There are a variety of reasons for that. The first advantage is that this treatment involves cooled radiofrequency. This means that the ablation which is done by a small needle which has a higher area. Because the heat is decapitated very fast. And this results in a higher area of effectiveness. Results in better targeting of the nerves. In this treatment, nerves are targeted which is giving rise to the pain. And you pain physician will target these nerves. He will ablate them with the help of the radiofrequency. And cooled radiofrequency is one step ahead. This gives much better control to your physician and longer lasting relief to the patient. So, the major application of this cooled radiofrequency is in the knee joint and facet joint. So, why knee and facet?

Because in the knee there are 3 genicular nerves which are generally targeted. These are very small nerves. And the indication is knee osteoarthritis. But these nerves are very small and difficult to locate them. So, if the cooled radiofrequency is used, this is very helpful in locating these nerves and destroying them. Hence, resulting in pain relief. The other possible application for this cooled radiofrequency in the facet joint. So, we often get patients who are suffering from back pain in whom the MRI is normal. So, most probably you are suffering from the myofascial syndrome or facet joint arthropathy or facet joint pain. These facets are small joints in the vertebrae. Between vertebrae, there are 2 joints, one on the left and one on the right side. Once the facet becomes hypotrophy or becomes arthritic, they give rise to facet joint pain. And this pain is reflected as back pain. It is a very characteristic pain, depending on the facet involved. If it is the upper level like 1, 2, 3, the pain mostly will be restricted to the back. But if it is in the lower level like 4 & 5, the pain will radiate to the posterior portion of the hip or just above the knee also.

This characteristic is known as facet pain. You can also identify it with a simple test. You can just try to extend your back and this pain typically aggravates. It also increases while you are turning your sides. This is treated by the median branch block. It is a nerve which supplies the facet joints and it passes to a very close junction. So, this is very difficult to locate these nerves because there is a lot of anatomical variation. And this is where cooled radiofrequency plays a big role. And this cooled radiofrequency equipment gives the bigger lesion. Hence, the finding out nerve chances is very high. It gives a better result and good long lasting results. So, if you are suffering from knee pain or back pain or if you don't want to undergo surgery of the knee joint and you want to explore the alternative option, so, this cooled radiofrequency is a very good option for you. Secondly, if you are suffering from back pain and your MRI is normal then you must immediately visit your pain physician. We are here to help you at the pain relief centre. And thereafter we can properly diagnose. And if you have facet joint as the possible cause then we can do cooled radiofrequency procedure for you. This can result in better relief in you symptoms. To know more, you can visit my Lybrate website.

Thank You!

Hi!

I am Dr. Siddharth Verma and you are watching this video on Lybrate. I practice at Pain Relief Centre in Chembur and the topic for this video is how can you avoid a spine surgery and when not to avoid it? So, many times many patients come to us with this option that they want a second opinion and they have been advised a spine surgery and they want to avoid it and how they can avoid it. Typically, we have seen in our patients that they don't want to undergo any surgery and they have seen the worst happened to their colleagues or friends or they have heard bad things about surgery and that's why they don't want to go for it. So yes, you can avoid a lot of times you can avoid this surgery and you can get rid of your pain but there are some instances where you probably cannot avoid surgery. So when you can avoid surgery is when the when the compression is not much on your nerve roots and when the damage is not much and it is reversible and pain is itself become a disease, there is a neuropathic pain so in those cases you can avoid surgery but the surgeon will not suggest surgery anyway in those cases.

In another approach which you can follow to avoid an open surgery at least is that you can go for minimally invasive procedures. So with your pain specialist or with your spine pain specialist at pain relief centre you have this option of undergoing a minimally invasive procedure and by minimally invasive I mean that there is no open surgery, no prolonged hospital stays, you can get discharge on the same or the next day and these procedures can also have good results or similar results to the open procedures and without any side effects or with minimal side effects and a very common example of this procedure is the spine endoscopy which is being done for a lot of spinal indications now.

It has still not replaced surgery per but it's a viable alternative to especially for those patients who want to avoid this surgery and still get cured of their back pain. This procedure is done under local anaesthesia and it is the patient comes to the hospital and is taken to the operation theatre and lies prone on an operation table and the local area is numbed and with the help of a needle we reach his problem area and there we put in our endoscope, we see it on a big TV and on that TV we see a very small nerve also which can be seen in a very big you can say screen and it appears very big and we can actually do very fine things there and take out the offending portion. If there is a disc compressing or if there is a portion of a tissue intruding or something, we can always clear it out and give relief to the patient and the patient walks almost instantaneously and can walk, do his go to the washroom, do his routine activities.

We advise rest which means that patient cannot go for strenuous activity, moderate activity, cannot bend and lift weights but other than that is perfectly fine to move and the patient is fairly mobile, he can take care of himself and can resume work after a few weeks; by resuming work means just like he used to do before he had this kind of pain. So, in many conditions, this surgery can be avoided. However there are some indications where you will you may require an open surgery for example in many cases of long-standing stenosis where the patient has or needs multiple level decompression or when there is trauma especially when there is a paresis, there is cauda; even many cases of cauda can be treated with nowadays with the endoscopy and however there are still indications for open surgery and you should consult your pain specialist who can guide you appropriately and advise you regarding that. We, at Pain Relief Centre, are ready to help you, so if you have been advised a spinal surgery and you want an opinion, we welcome you to come to us and seek our opinion.

Thank you!

Hi,

I am Dr. Sidharth Verma, Pain Management Specialist. Today I will talk about trigeminal neuralgia. It is also known as the suicide disease. In this patient experience the facial pain. it may also effect inside the mouth. It is important to treat the cause first. It may be the tumor, myeloma. It is rare disease. Patient experience sharp shooting, electric pain. It can also cause pain while touching the skin. The diagnosis is entirely clinical. The treatment is done pharmacological and interventionally also. In this problem few of the drugs cannot be continued for very long as they have certain side-effects. We give the treatment with radiofrequency ablation and balloon compression. This gives the excellent results. Once their are located then we give the radiofrequency current.

This relief is usually long lasting. In some cases their maybe relapse. It may also occur due to the inherent excitement of the nerve. Balloon compression often used at the time of first trigeminal nerves. This is used for the patients who have the major pain around the eyes or on the forehead. There are some side-effects of the procedure which are minor. This include minor bleeding, infection. There are some surgical options also and this can be better described by a neurosurgeon. This is day care procedure. Patient will be discharged on the same or the next day. If you are suffering with any facial pain, please contact us through Lybrate.

Thank You.

Hi,

I am Dr Siddharth Verma and welcome to this video. Today's topic is, how to avoid a spine surgery? So, you have been suffering from some kind of back pain, some injury or maybe the mixture of both. Maybe you didn't have anything but you still are undergoing a spine surgery. So don't worry, we are here to help you. Prevention is always better than cure, so you must stay fit. Most of the back injuries, strains and sprains occur because the person is not very flexible.

It might create big trouble for the back. This can also lead to a strain. Repetitive strain can lead to various issues with your back which can be as trivial as a myofascial syndrome, in which your muscles are affected or as severe as a disc herniation.In this video, we will concentrate on how to avoid this. So the first step is prevention which you can achieve by staying fit, by controlling your weight, by physical activities and by following the correct technique of lifting weights. This is the first step. Now the second step is early treatment. So if you know that you have been suffering from a backache but if the back pain is persisting over a week or two, then don't ignore and don't think. Immediately go and seek treatment from spine and pain specialist and talk to him about your problem and I am sure he will be able to sort it out. Now, the next step supposing you didn't pay heed to what your doctor said, you will continue to gain weight you continue to be lumber, resulting in the same kind of pain.

You will have this kind of pain and now the problem will increase. You go to a doctor one fine day and he suggests an MRI and there is a big bulging disc and it is compressing on your nerves and now your doctor says you need a surgery. So can you avoid the surgery? In many cases, yes you can and in many cases, you cannot. So, when you can and when you cannot, it depends on the opinion of your treating surgeon and your spine and pain specialist. There is some movement which is happening while you flex or extend your back. So, if this is not there then in most cases you can avoid an open surgery and how it can be done, it can be done with as trivial a procedure and as transforaminal neuroplasty procedure.

Number 2, nowadays we have a very nice procedure which is known as endoscopic foraminoscopy or foraminoplasty or endoscopic discectomy. This is a very noble procedure which is done by the spine and pain specialist and in this procedure we just give a small neck of the size of maybe smaller than a centimetre also. Then we reached this foramen from where this nerve comes out and we actually put in a camera through this small hollow tube, which is of the size of this pen, which is very hollow. The patient stays awake under local anaesthesia and doesn't feel any pain till the point. This hollow canal touches his nerves on his sensitive nerve fibre. Then we put our camera inside the foramen and we see the nerves, we see the disc and we take this material which is compressing on these nerves, we clean it, we wash it.We see very small tissue, we see these tissues under a big TV. So we can very accurately take out the tissues which are causing this compression and help you get relief from your pain. So need not go for any open surgery in these cases because in these cases we can help you by involving in this percutaneous procedure which is way less invasive than a surgery.

The main difference is that you don't get any general anaesthesia. You can walk on the same day of the procedure, you can go to the washroom, stay in a hospital for a couple of days, get a discharged and you can resume your active life in maybe 4-5 days or so. You will be given some precautions but more or less, your mobile, you don't have any loss of work hours and you can be very productive. Now another reason why people come to us is not to avoid the first surgery but how to avoid this second surgery? Because many of the patients have already undergone under 1 surgery and this still have this kind of pain which is left and the treating doctor has suggested them another surgery. Now they don't want to undergo a second surgery. In those cases, many of them provide there is no instability of these bony spines. We can help them with these procedures. If you want to know more you can also visit me on my Lybrate website which is www.lybrate.com/doctor/siddharthverma.

Thank you for watching, have a good day.

Hi!

So in this video I will be speaking about post-surgical pain management. Welcome to another set of educational video. So what is post-surgical pain? It is any kind of pain happens after surgery. Usually it is limited to few hours after surgery or may be a few days. But problem occurs when it continues for more than 2 months when it is known as chronic post-surgical pain or CPSP. So now what to do with this pain? Don’t worry because we international spinal pain are here to help you. So what we actually do is we take care of the patients who are suffering from chronic post-surgical pain. So how common is this chronic post-surgical pain? It is very common. In around the one study found that in around 20-30% of the patients this pain persist beyond 2 months. Yes in such a large number of patients they have this kind of pain. So what is the possible cause? There are many possible causes many theories and there are some which can be minimize some which cannot be minimize e.g. no matter what you do in patients who have undergone thoracotomy i.e. their thoracic cage or their chest has been cut the incidence is very high it is as high as 40-50%. Then almost every 5 patients out of 10 will have this kind of pain. So what can we do to manage this kind of pain and what can we do to prevent this kind of pain? Apparently there are many things which we can do and to manage these kind of pain you have to consult if it occurs you need to consult spinal pain specialist who can help you with this kind of pain. To prevent it you need to talk to your anesthesiologist and your surgeon. So that they can help you and take the best precautions so that they can prevent this kind of pain. So now what happens if you already develop this kind of pain? So when you go to spinal pain specialist so what he does actually is examine the possible cause of this kind of pain. Obviously you have already gone to your surgeon and there is no surgical cause which can be found which is a very definition of this pain because it is non-surgical cause related pain. So the pain is still persisted but the disease has healed the wounds have healed but the patient is still having pain or you still have having pain. So in these cases often there is something which is known as neuropathic pain which has sat in that means your body is everything is perfectly fine but the nervous system either the nerves which carries pain sensations or the brain which perceives this brain sensation has a problem. So now what to do with this type of problem? First we need to identify what is the possible problem and then we need to treat this cause. If the nerves are the causative factor then there are various techniques like radio frequency modulation, stimulation or the dorsal root ganglion stimulation. We can use various techniques to help you and to help these nerves carry proper sensations. Okay! Or the second possible cause is if your brain is responsible in that case we have many drugs which are available which act on the brain and reduce or eliminate these kind of sensations. So if you have undergone any type of surgery and 2 months have passed and your doctor says that you still have pain but there is no disease you have cure out of your disease and you are feeling that you are still have pain so don’t ignore it and don’t get distress don’t get you can say depress. Just visit spinal pain specialist or and evasion pain physician and I’m sure your pain will be sorted.

Thank you for watching this video and you can also visit my Lybrate website on www.lybrate.com/doctor/sidharthverma. Thank you!