Pain - How To Get Rid Of It?

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!