Arthritis, Knee joint pain & Shoulder joint pain

Arthritis is the swelling and tenderness of one or more of your joints. The main symptoms of arthritis are joint pain and stiffness, which typically worsen with age. The most common types of arthritis are osteoarthritis and rheumatoid arthritis.




Pain affecting shoulder is often due to impingement or rotator cuff tendinitis/tendinopathy or bursitis. The conditions cause swelling, pain and difficulty in movements of your arm.




Treatment options: Oral medications, exercise, life style modification and interventional techniques i.e. Hylan-gel injection, Platelet rich plasma (regenerative therapy), Radiofrequency ablation/Neuromodulation.

Backaches

Low back pain is the commonest type of pain suffered by all. Common causes include improper lifting, poor posture, lack of regular exercise, a fracture, a ruptured or desiccated disc or arthritis.

Upper back pain (pain in the upper and/or mid back) is less common than lower back or neck pain. The upper back pain is caused by diseases affecting thoracic spine, ribs costal cartilages and muscles. Compression fracture in vertebrae is another cause of severe back pain in elderly population caused by trivial trauma in the background of osteoporotic bones. It needs urgent medical attention and usually results in satisfactory pain relief with early intervention.

Treatment offered: medications, exercise, Radiofrequency neurotomy, life style changes. For compression fracture in suitable cases percutaneous vertebroplasty is recommended and yields wonderful pain relief.

Neck pain

For most people, cervical spondylosis causes no symptoms. When symptoms do occur, they typically include pain and stiffness in the neck. Other cause of neck pain are narrowing of the disc space, facet joint arthropathy, muscle sprain and myofascial components.

Treatment offered: Proper exercise, rest/support, postural corrections, Interventions: epidural injections, Radiofrequency neurotomy, dry needling and physical therapy.

Cancer pain

If the pain is from the cancer itself, it can be from the cancer growing into or destroying nearby tissue. As a tumour grows, it can press on nerves, bones or organs. The tumour can also release chemicals that can cause pain or your body's reaction to the chemicals can cause pain. Sometimes, chemotherapy causes nerve damage and severe neuropathic pain. Even radiotherapy or surgery to remove diseased organ causes pain.

Management options: Total pain alleviation in the form of addressing physical, social, emotional and spiritual reasons behind.

Interventions: Neurolytic block of nerves and plexuses i.e. celiac plexus, splanchnic nerves, hypogastric plexus, ganglion impar, intercostal nerves; intrathecal neurolysis.

Providing Morphine and other opioid medications.

Psychological evaluation and counselling. Evaluation and determination of palliative measures.

CRPS I & II (complex regional pain syndrome)

Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to or malfunction of the peripheral and central nervous systems.

Treatment available: Proper assessment, evaluation of the condition, prescribing drugs as appropriate.

Intervention: sympathetic block or neurolysis i.e. stellate ganglion, lumber sympathetic, T2-T3 block

Psychological evaluation and guidance for Cognitive behavioural therapy, mindfulness meditation.

Atypical Facial Pain, Trigeminal Neuralgias

Trigeminal neuralgia is a unilateral painful disorder characterised by brief, electric shock like pain and is abrupt in onset and termination and is limited to distribution of one or more divisions of the trigeminal nerve. A less common form of the disorder, called atypical trigeminal neuralgia, causes a less intense, constant, dull burning or aching pain. This pain sometimes occurs with occasional electric shock-like stabs that may last a day or more. Atypical facial pain is more difficult to treat.

Treatment available: apart from oral medications definitive intervention i.e. Radiofrequency neurotomy or balloon catheter ablation is recommended.

Fibromyalgia / Myofascial / Musculoskeletal Pain

Fibromyalgia or the Fibromyalgia Pain Syndrome (FPS) is a chronic and widespread musculoskeletal pain and fatigue disorder. It is defined as a long-term, body-wide pain in muscles, ligaments and tendons, the soft fibrous tissues in the body without apparent tissue damage or inflammation mostly found in female and difficult to cure.

Myofascial pain syndrome is a chronic local/ regional musculo-skeletal pain disorder that may involve either a single muscle or a muscle group without systemic features usually. The pain may be of a burning, stabbing, aching or nagging quality. Presence of trigger points in muscle belly is diagnostic and it is more common in male & Curable.

Treatment available: Oral medications, psychotherapy like meditation, coping skill; patient education, intervention like trigger point needling, desensitisation.

Headaches

Migraine is a type of headache characterised by unilateral pulsating moderate to severe pain aggravated by routine activities and associated with nausea/vomiting, photophobia/phonophobia may or may not be with aura.

A cluster headache strikes quickly, usually without warning, although you might first have migraine- like nausea and aura. Common signs and symptoms during a headache include excruciating unilateral pain that is generally situated in, behind or around one eye, but may radiate to other areas of your face, head and neck. Headache is often accompanied by conjunctival redness, nasal congestion, eyelid edema with restlessness or agitation.

Tension headache occurs at least 10 episodes on less than one day per month or more than fifteen days per months, bilateral pressing/tightening in quality and mild to moderate at intensity not aggravated by physical activities.

Treatment offered: appropriated medications, patient education, meditation and behavioural therapy.

Failed back surgery syndrome

Failed back surgery syndrome (FBSS, or failed back syndrome) is a misnomer, as it is not actually a syndrome - it is a very generalized term that is often used to describe the condition of patients who have not had a successful result with back surgery or spine surgery and have experienced continued pain.

Treatment offered: medications, behavioural therapy, mindfulness meditation, intervention like caudal epidural injection, epidural adhesiolysis.

Pelvic and abdominal pain

In women, pelvic pain may be a sign of menstrual cramps, ovulation, or a gastrointestinal issue such as a food intolerance. It can also develop due to a more serious problem. Sometimes, pelvic pain is an indicator of an infection or issue with the reproductive system or other organs in the area. Chronic abdominopelvic pain may be defined as non-menstrual pain of 6 or more months duration that localizes to the anatomic pelvis, anterior abdominal wall below the umbilicus, or the lumbosacral back and causes functional disability or requires medical or surgical treatment.

Treatment recommended: medications, patient education, relaxation techniques, mindfulness meditation etc.

Herniated Disc, Sciatica (Radiating Pain From Back to Legs)

Sciatica is a shooting pain that begins in the lower back, radiates into the buttock and down the back of one leg. The pain is often caused by pressure on the sciatic nerve root from a herniated disc, bone spurs or muscle strain. Similar pain may arise from disc prolapse, protrusion or even disc bulge condition.

Discogenic pain is due to tear in the disc outer annulus due to degenerative disc disease or disc desiccation.

Treatment offered: medication, exercise, interventional technique i.e. epidural injections, radiofrequency rhizotomy, annuloplasty.

Sports Injuries

Sports injuries are injuries that occur when engaging in sports or exercise. Bruises, strains, sprains, tears, and broken bones can result from sports injuries. Soft tissues like muscles, ligaments, tendons, fascia, and bursae may be affected. Traumatic brain injury (TBI) is another potential type of sports injury which often needs surgery.

Treatment available: medication, patient education, modulated exercise, physical therapy and intervention techniques like ultrasound guided injections to bursa, tendon; Platelet rich plasma therapy (regenerative therapy) etc.