Back and Spine Problems
Disc Prolapse / Slipped Disc
Our back bone or the human spine is a beautiful structure – …. Read More
Degenerated disc disease is a term used to signify changes …. Read More
Facet Joint Problems
Facet joints are small joints in the back of the human spine… Read More
Sacro Iliac Joint Problems
Sacro Iliac joint arthropathy usually results in pain in lower back… Read More
Coccydynia (Tail bone pain)
Coccydynia is pain and discomfort in the tail bone region… Read More
Migraine is a type of headache, usually affecting one side of the head …. Read More
Cluster & Tension Headache
Cluster and Tension headaches are common primary headaches…. Read More
Trigeminal Neuralgia is an extremely painful condition affecting …. Read More
Facial pain could be caused by dental problems …. Read More
Neck And Shoulder Pain
- Cervical Disc Prolapse
- Cervical Spondylosis / Facet Problems
- Periarthritis Shoulder
Cervical Disc Prolapse
Cervical disc prolapse means the intervertebral disc is pressing on the nerve roots that usually go to the hands on both sides. Cervical disc prolapse can be caused due to lifting heavy weights or falls. Patients have pain in the neck, shoulder and also radiating along one or both hands. Sometimes other than pain radiating down the hands, patients may also have numbness and difficulty in holding things.
Most patients will benefit from cervical stretching and strengthening exercises, avoiding long travels, pain medication and muscle relaxants. Cervical epidural injections are very useful in treating radiating pain in the neck and shoulder region in most patients. Unlike spine surgeries, pain interventions like epidural injections are safer day care procedures. Patient with motor weakness and severe numbness will require surgical decompression and fusion.
Cervical Spondylosis / Facet Problems
Cervical facet joint pain is sometimes referred to as cervical spondylosis. It is caused by arthritis or dislocation of cervical facet joints. Usually this pain is more on neck extension and rotation. Neck and upper back pain can be persisting. Whiplash injuries can also affect cervical facet joints.
Usually treatment includes physical therapy (cervical stretching and strengthening exercises), pain medication, posture corrections and muscle relaxants. Some patients will require cervical facet joint injection or facet joint RF ablations. Cervical facet injections are safe, day care procedures intented to reduce neck pain.
Periarthritis shoulder is caused by arthritic changes in the shoulder joint. This results in severe pain during shoulder movements especially while lifting hands about the head. This is more common in diabetic patients. X ray can confirm shoulder arthritis.
Treatment includes anti inflammatory medication and physical therapy. If it is untreated, it can form adhesions inside shoulder joint capsule, leading to “Frozen shoulder”. Most patients will require shoulder joint intra articular steroid injection (under ultrasound guidance) followed by good manipulation of joint. Supra scapular nerve block along with shoulder joint injection gives good results for periarthritis shoulder.
Neuropathic Pain Syndromes
- Myofascial syndrome
Fibromyalgia is a condition that results in pain throughout the body. It is more common in women. Factors contributing include stress, hormonal imbalance, personality, etc. Usually the entire body includes hands, legs, back and head are pain. It also cause poor quality of sleep and depression. Usually X ray, CT, MRI are normal and it is a clinical diagnosis.Treatment options for fibromyalgia include reduction in stress levels, more social activity and medications. Usually medications useful are
pregabalin, gabapentin, duloxetine and TCAS. These medicines usually give reasonable control of fibromyalgia pain. Multi modal approach to treating pain gives best results in fibromyalgia.
Myofascial pain is an entity that caused wide spread muscle pain in different parts of the body. Usually, upper and lower back muscles are affected. Muscle spasm and pain could be secondary to a spine or nerve root problem. Muscle spasm may be felt as tight, swollen muscles besides the spine. Sometimes very tender spots called trigger points can be felt.
Good sustained stretch exercises of affected muscles will relieve myofascial pain. Muscle relaxants can hasten the recovery. Primary spine related problems to be addressed as well. Trigger point release / Trigger point injections will be required. Sometimes botox injections are given in the affected muscle to released spasm.
Complex Regional Pain syndrome is a sympathetically medicated pain, usually affected the hands or legs on one side. Other names for CRPS include Sudeck’s dystrophy, causalgia and reflex sympathetic dystrophy. The affected part of the hands or legs may be red, warm, swollen, shinny and very tender to touch. This pain may follow a trivial trauma or a period of immobilization of the limb. CRPS can be excruciatingly painful. Usually blood tests, X rays, CT and MRI scans are normal and it has to be diagnosed clinically.
Medications like pregabalin, gabapentin, TCAs, clonidine are helpful. Physical therapy is important. Diagnostic block of stellate ganglion for upper limb or lumbar sympathetic plexus for lower limbs will confirm the diagnosis. This is usually followed by radio frequency ablation of the respective sympathetic ganglion for long term relief. Severe disease may require a spinal cord stimulator.
Pain in cancer patients could be very debilitating and compromises the quality of life. Pain could be due to cancer itself or due to secondary metastasis. Chemotherapy can cause some peripheral neuropathy. Treating pain in cancer patients improves disease prognosis. While the oncologists treat the primary cancer, patients may require a pain and palliative care physician for supportive therapy during recovery.
Mainstay of cancer pain treatment is medications like narcotics (Morphine, Tramadol, Fentanyl), paracetamol and adjuncts. If the pain is localized, pain relieving nerve blocks like celiac plexus, stellate, lumbar sympathetic blocks may be useful. Your pain and palliative care expert will suggest what is best for your care. Advanced pain modalities like intrathecal pump implantation is sometimes useful in select group of patients. Palliative care is important to improve the cancer patient’s quality of life.
- Knee Joint Pain
- Elbow joint
- Ankle joint
Knee Joint Pain
Common cause of knee joint pain in patients in the 50+ age group is osteoarthritis. It is caused by general age related wear and tear leading to cartilage erosion and degenerative changes in one or both knee joints. Usually pain is felt while climbing stairs or walking. There may be difficulty in bending the knee fully. Mild form osteoarthritis is treated with weight reduction, quadriceps muscle strengthening and anti inflameatory medication. Genicular nerve Radiofrequency treatment is a good option to reduce knee pain. They are minimally invasive day care procedures in the form of injections around the knee. They are especially useful in patients who are not keen on surgery or who are unfit for surgery. In severe cases, total knee replacement has to be considered.Younger patients with knee pain could be due to ligament injuries (ACL & PCL) or meniscus tears. Arthroscopic repair is the best option in these patients. Sometimes bursitis, Iliotibial band syndrome, tendonitis can cause knee pain.
Elbow joint pain could be due to arthritis or fractures involving the elbow joint. More common in elbow joint is tendonitis involving the lateral epicondyle called Tennis Elbow and medial epicondyle called Golfer’s Elbow. For tendonitis the treatment involves Rest, Ice, Compression (bracing) and Elevation of the limb. Patients will require anti-inflammatory medications. Persistent tendonitis may require cortisone injections around the tendon under ultrasound guidance.
Conditions common to cause pain around the ankle joint include plantar fasciitis and Achilles tendonitis. Plantar fasciitis is an inflammation of the plantar fascia that cause pain in the heal region and also other parts of the sole. X rays may show boney spurs in the calcaneal bone. Your pain physicians may prescribe medication, plantar fascia stretching and strengthening exercises and medial arch supports. Some patients will require cortisone injections around the plantar fascia.
Advanced Pain Interventions
- Radio frequency treatments
- Spinal Cord Stimulators
- Intrathecal pumps
- Vertebroplasty / Kyphoplasty
Radio frequency treatments
Radio frequency treatments are used to relieving pain in the affected part of the body. Earlier, nerve blocks for pain relief were performed with local anesthetics and steroids and neurolytic agents like absolute alcohol or phenol. The duration of pain relief was limited with these blocks. Presently radio frequency ablation of the correct nerves is performed under image guidance. The advantages of radio frequency treatment include accurate placement of nerve blocks, more safety and longer duration of pain relief. RF treatment for pain is the standard of care in all western countries now. This treatment is available in the Back and Pain Centre. They are performed by trained pain physicians in a safe and effective manner. All RF procedures are minimally invasive day care procedures performed under local anesthesia or IV sedation. Open surgery and its complications can be avoided by using these radio frequency treatments. Most insurance companies cover this treatment.
Spinal Cord Stimulators
Spinal Cord Stimulators are used for treating long standing nerve related pain. This involves placing an stimulating electrode in the epidural space to block pain signals. This treatment is very effective in patients who have undergone previous spine surgeries and are still having persistent back pain. Failed back surgery patients will benefit from spinal cord stimulator implantation.
Intrathecal pump implantation is placement of a catheter into the spinal cord for continuous delivery of small amount of medication. This is useful in patients who have widespread pain throughout the body. Intrathecal morphine pumps are very useful in patients with widespread cancer related pain. Intrathecal baclofen pumps are useful in patients with spasticity. Your pain physicians will assess you and discuss the requirement for these pumps.
Vertebroplasty / Kyphoplasty
Patients with vertebral compression fractures have severe pain. This could be due to osteoporosis or metastasis. Vertebroplasty and Kyphoplasty are procedures that are used in the treatment of compression fractures of the spinal cord. These advanced pain procedures are performed routinely in the Back and Pain Centre. Qualified pain physicians, neurosurgeons are involved in accurate and effective performance of these advanced pain treatments.
Head And Neck Procedures
- Trigeminal Ganglion radio frequency ablation / glycerol injection
- Sphenopalatine ganglion RF ablation
- Botox injections for migraine
- Stellate ganglion RF ablation
- Shoulder joint injections
- Trigger point injections
- Supra scapular nerve injections
- Cervical epidural injections
- Cervical facet joint RF ablations
- Intercostal nerve blocks
- Splanchnic plexus RF ablation
- Celiac plexus Neurolysis
- Lumbar nerve root transforaminal injections
- Lumbar epidural injections
- Lumbar facet joint injections
- Facet joint medial branch RF ablations
- Lumbar discograms
- Percutaneous lumbar discectomies
- Endoscopic transforminallumbar discectomies
- Lumbar sympathetic plexus RF ablations
- uperior hypogastric plexus neurolysis
- Sacro Iliac joint injections
- Coccydynia injections
- Piriformis injections
- Lateral femoral cutaneous nerve blocks
- Trigger point injections
- Intraarticular joint injections
- Knee joint genicular nerve RF ablations
- Carpal Tunnel Injections
- Tennis elbow / Golfer’s elbow injections
- Platelet Rich Plasma (PRP) injections
- Visco supplementations