Multimodal And Multidisciplinary Therapy For Postoperative Pain Management

I am Dr. Preeti Doshi. I am the in charge of pain clinic at Jaslok Hospital and Research Centre, Mumbai.

In a pain clinic, we generally advocate a multimodal and multidisciplinary approach to get the best possible outcome. These patients can be offered multiple different modalities to get the best possible outcome.

So, we start mainly with pharmacotherapy in the form of various drugs as appropriate for the type of pain that the patient is present with. Besides this, we also got a spectrum of intervention right from basics to the advance intervention which can be offered to the patients as appropriate for their particular pain syndrome.

So, here we target the nerves or the pixies which are responsible for causing this particular pain and the interventions are done ideally under image guidance and nowadays we definitely prefer to offer interventions under image guidance in form of fluoroscopic or ultrasound guidance. This is to reach the target precisely with minimum side-effects. We also have physical, psychological and occupational therapies and several other complementary therapies.

Overall we can achieve the best outcome if we combine more than one modality depending on individual pain syndrome. So, the most common interventions that we perform as pain specialist are directed towards the spinal pain such as low back pain in which we most commonly perform transforaminal epidural injections under guidance or facet joint injection in form of medial branch diagnostic block or frequency ablation. And these are all performed under local anesthesia and on day care basis.

So, these patients can go home within a couple of hours after these procedures. Besides this, we also have several other options as required for the patients with failback surgeries, we perform a procedure called Epidural Adhesiolysis because they are found to often have fibrosis and scarring around the nerves after having undergone spinal surgery. If the patient fails to respond to the conservative line of management and they have severe pain, we also have the option of advanced pain therapies in the form of neurostimulation or intra-thical drug delivery system.

They have a good success rate with a good evidence in literature for the use in common clinical practice. The complications are very rare if it's been performed with all the due precautions. However, there is the remote possibility of infection occasionally or hematoma or nerve injury and the patient have to be explained about this but these are extremely rare performed by an experienced operator with all due precautions.