Pain Management

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!