Treatment Offered

The goal of pain clinic is to manage acute or chronic pain by reducing pain frequency and intensity. Besides addressing pain issues, a multidisciplinary pain management program may address your functional goals for activities of daily living. Overall, a pain medicine program aims to give you a feeling of well-being, increase your level of activity (including return to work), and reduce or eliminate your reliance on medication.We use multidisciplinary approach to treat all pain conditios.

Your appointment with a pain management specialist is much like other doctor visits. focus is on your pain, the cause or contributing factors, and quickly managing it.Pain medicine doctors perform a physical and neurological examination, and review your medical history paying particular attention to pain history. You may be asked many questions about your pain, including:

• On a scale from zero to 10, with 10 being the worse pain imaginable, rate your pain.
• When did pain start? What were you doing when pain started?
• Does pain spread into other areas of the body?
• Is its intensity constant, or is it worse at different times of the day or night?
• What helps to relieve the pain? What makes pain worse?
• What treatments have you tried? What worked? What failed?
• Do you take over-the-counter medications, vitamins, or herbal supplements?
• Do you take prescription medication? If so, what, how much, and how often?

Most pain medicine specialists use a standardized drawing of the front/back of the body to enable you to mark where pain is felt, as well as indicate pain spread and type (eg, mild, sharp). You may be asked to complete the form each time you visit the pain doctor. The completed drawing helps to evaluate your treatment progress.

Accurate Diagnosis Key to Treatment
Pain medicine involves diagnosing the cause or origin of pain. Making the proper diagnosis may involve obtaining an X-ray, CT scan, or MRI study to confirm the cause of your neck or back pain. Other tests, such as discography, bone scans, nerve studies (electromyography, nerve conduction study)may be performed. The correct diagnosis is essential to a successful treatment plan.

What is Intervention Pain Management?

Interventional Pain Procedures are minimum invasive percutaneous procedures which are performed to block the nerves which carries pain signals.These are done in conjunction with a program stressing muscle flexibility, strengthening, and functional restoration.

The goal of these injections is to facilitate an active exercise program and to progress patients through the pain and inflammation stage of recovery as quickly as possible. As with all injections, it should be part of a comprehensivePain treatment plan.

How the Injection Is Performed?

To ensure proper needle placement fluoroscopic or Ultrasound guidance is recommended during the injection to ensure the needle is going on the right place.If needed, an IV will be started so that adequate relaxation medication can be given. After lying on table, the skin over your lower back/buttock will be well cleansed. Next, the physician will numb a small area of skin with local anaesthetic.The physician then will use x-ray guidance to direct a very small needle into the joint. He will then inject several drops of contrast dye to confirm that the medication only goes into the joint. A small mixture of numbing medication (anesthetic) and anti-inflammatory cortisone will then be slowly injected.

What should I do and expect after the procedure? 

Twenty to 30 minutes after the procedure, we will monitor you.You will report your remaining pain, (if any) and also record the relief you experience. On occasion, you may feel numb, slightly weak or have an odd feeling in your leg for a few hours after the injection. Ice will typically be more helpful than heat in the first 2-3 days after the injection. You may begin to notice an improvement in your pain 2-5 days after the injection. You may take your regular medications after the procedure.

On the day of the injection, you should not drive and should avoid any strenuous activities. On the day after the procedure, you may return to your regular activities. When your pain is improved, start your regular exercise/activities in moderation. While many patients will be successfully relieved of their symptoms, not everyone is cured.

How many Injections given?

Usually one injection for diagnosis followed by therapeutic injection. Some patients may require more than one injection. Repeat injections should be based on pre-treatment goals and the therapeutic response following the injection.

• rigger Point Injection/dry Needling
• Intra articular Injections-Shoulder, Elbow, Knee, Elbow, Foot
• Peripheral Nerve Blocks (Click to expand/collapse)
  • Suprascapular Nerve block
  • Intercostal nerve block
  • Maxillary, Mandibula
  • Occipital Nerve Block
• Sympathetic Blocks (Click to expand/collapse)
  • Sphenopalatine Block
  • Stellate Ganglion Block
  • Trigeminal Block
  • T2-T3 Sympathetic Block
  • Coeliac Block/Splanchnic Nerve Block,
  • Lumbar Sympathetic block
  • Superior Hypogastric Block
  • Ganglion Impar Block
• Epidural Injections –Cervical/Dorsal/Lumbar/Caudal (Click to expand/collapse)
  • Although epidural steroid injections (also called epidural corticosteroid injections) may be helpful to confirm a diagnosis, they should be used primarily after a specific presumptive diagnosis has been established. Also, injections should not be used in isolation, but rather in conjunction with a program stressing muscle flexibility, strengthening, and functional restorationEpidural injections is used in the treatment of non-radicular degenerative disc disease with limited success.In addition, epidural steroids have been used in patients with neurogenic claudication from spinal stenosis with mixed results. A limited number of injections can be tried in these patients to reduce pain thought to be at least in part mediated by inflammation.
• Pyriformis muscle,Psoas,Quadratus Lumborum injection
• Nerve root block/ Transforaminal Epidural Injection
• Facet joint blocks,Median Nerve block (Click to expand/collapse)
  • Many patients will complain of back and often lower extremity pain with standing, walking, and extension-type activities. The neurologic examination is normal, and provocative tests for nerve root inflammation are usually negative. Many patients will have increased pain on passive extension, and/or extension and rotation; less often patients will complain of pain with flexion.In addition, radiographic and bone scan imaging has not been helpful in diagnosis of Facet arthropathy.Therefore, the primary role of facet injections remains diagnostic. The goal of facet injections is to verify the diagnosis and perhaps assist with pain reduction in order to facilitate an active physical therapy program
• Sacroiliac Joint Injection (Click to expand/collapse)
  • The sacroiliac joint is a large joint in your lower back and buttocks region. When the joint becomes painful, it can cause pain in its immediate region or it can refer pain into your groin, abdomen, hip, buttock or leg.A sacroiliac joint injection serves several purposes. Diagnosis, reduces inflammation, which on many occasions can provide long-term pain relief.sacroiliac joint injections work powerfully to reduce your inflammation and they can provide months of relief.

OZONE IN DISC PROLAPSE

Oxygen-ozone therapy for herniated discs has gained traction in Europe and Asia since it was first introduced in the 1980s. Current research on oxygen-ozone therapy shows that 65% to 80% of patients have reduced herniated disc symptoms after the treatment. Moreover—and arguably as important as the success rate—patients experience few complications with oxygen-ozone therapy.
Benefits of Oxygen-Ozone Treatment
Besides a shorter recovery time and lower complication rate than surgery, other benefits of oxygen-ozone injections include:
• It is minimally invasive.
• It is an outpatient procedure.
• It takes little time to administer.
• It costs much less than surgery.
• It is a pain-free procedure.
Under fluoroscopy guidance a very thin 22/25-gauge needle is introduced in affected disc.. Once the needle is safely placed in position, ozonucleolysis is completed in only another 2 to 3 minutes.Patient can be discharged in 2 hrs.patient can go to work next day.

PLATELET RICH PLASMA(PRP)

Recently, emerging evidence has suggested that Platelet Rich Plasma (PRP) may also be of assistance in the treatment of osteoarthritis and other degenerative conditions of joints. It is felt that the growth factors may assist in cartilage regeneration and also mediate benefit by providing an immune modulating effect, whereby the inflammatory cascade is dampened. Thus, PRP may act as a natural anti-inflammatory substance to result in symptomatic pain relief of sore arthritic joints.The procedure typically takes a couple of hours, including preparation and recovery time. Performed safely without the risks of surgery, general anesthesia, or hospital stays and without a prolonged recovery. In fact, most people return to their jobs or usual activities right after the procedure.it typically has long-lasting results. Research studies and clinical practice have shown PRP therapy to be very effective at relieving pain and returning patients to their normal lives. To create PRP, a small sample of your blood is drawn (similar to a lab test sample) and placed in a centrifuge that spins the blood at high speeds, separating the platelets from the other components. The process is handled manually by a lab technician, producing higher concentrations of platelets and a much more pure concentration of the beneficial blood components .The PRP is then injected into and around the point of injury.Because the patient’s own blood is used, there is no risk of a transmissible infection and a low risk of allergic reaction.

Conditions treated using PRP Therapy

1. Tennis elbow
2. Plantar fascitis
   1. Plantar fasciitis is inflammation of the thick, fibrous band of tissue that reaches from the heel to the toes, supporting the muscles of the bottom of the foot. “Plantar” refers to the bottom of the foot; “fascia” is supportive tissue. When the plantar fascia becomes overly stretched, tiny tears can riddle its surface. The band of fascia can ultimately swell and become quite painful. While some people have attributed this type of pain to bony growths called heel spurs, it’s now believed that heel spurs are usually just a coincidental finding in people with plantar fasciitis. it is more common in women. You’re also more likely to suffer from this condition as you age or if you:
      1. • Are overweight.
         • Take up a new form of exercise or suddenly increase the intensity of your exercise.
         • Are on your feet for several hours each day.
         • Have other medical conditions, such as rheumatoid arthritis or lupus (systemic lupus erythematosus).
         • Tend to wear high-heeled shoes, and then switch abruptly to flat shoes.
         • Wear shoes that are worn out, with weak arch supports and thin soles.
         • Have flat feet or an unusually high arch.
         • Have legs of uneven lengths or an abnormal walk or foot position.

         Treatment

         • If you are participating in sports, it is very important to warm up and do stretching exercises before your sport.
         • ice your heel to help relieve pain and inflammation.
         • Wear good sports shoes,No bare foot.
         • Massage Therapy
         • Laser Therapy and Manual Therapy

         PRP injection

3. Osteoarthritis knee (mild to moderate)
4. Adhesive capsulitis of shoulder
5. Retrocaneal bursitis
6. De Quervain’s tenosynovitis
7. Golfer’s elbow
8. Trigger finger/thumb
9. Achilles tendonitis

Botulinum Toxin (BOTOX) Type A is a muscle relaxant derived from the bacterium Clostridium Botulinum. In controlled doses, it can provide safe, effective relief from a number of conditions.

Pain management with BOTOX injections allows pain physicians to effectively treat many forms of chronic pain. Because treatment involves just a few simple injections, most patients are eligible for treatment. The best way to determine if BOTOX therapy can be used as an alternative to other forms of chronic pain control is to discuss your individual case with a physician. By carefully analyzing your nerve pain, back pain, or other chronic ailment, a physician will be able to determine if botulinum toxin, the protein that makes up BOTOX injections, can help ease your pain and give you the relief you need. BOTOX treatment is distinctive because of its ability to treat a specific target area. These injections can be administered quickly and have fast-acting, long-lasting results.

Nearly 1 million people worldwide have experienced pain relief from BOTOX. Long-term therapy with BOTOX has been found to be safe and very effective.

Conditions treated using BOTOX Therapy

1. Headaches & Migraines
2. Trigeminal Neuralgia
3. Myofascial Spasm
4. Spasticity
5. Cerebral Palsy

Vertebroplasty/Kyphoplasty

1. Used to treat fracture of vertebra(Spine) due to osteoporosis or cancer metastasis.
2. Bone cement is injected into the diseased vertebra and normal shape is achieved.
3. Performed under local anaesthesia as a daycare procedure.

Much safer than traditional major surgery, in these elderly patients who generally have many associated medical conditions

COOLIEF provides significantly greater and longer- lasting pain relief, improved physical function, and higher patient satisfaction

The COOLIEF radiofrequency generator transmits a small current of thermal energy through a water- cooled electrode placed within the  tissue to safely and effectively deactivate difficult-to-reach sensory nerves, relieving pain for up to a years.

Coolief is used in OA Hip and Knee Pain ,Back pain Due to Sacroilitis and Lumbar Facet Pain and Neck Pain due to Cervical Facet Pain.

What is regenerative therapy?

 This procedure helps in regeneration of degenerated cartilages which has occurred due to ageing, obesity, trauma.

What are the types of regenerative therapy?

Platelet-rich plasma (PRP) and stem cell therapy are two modes of regenerative therapy.

What is platelet-rich plasma?

Patients blood is taken out and processed which will lead to the formation of plasma which is rich in growth factors. These growth factors will lead to a generation of degenerated structures.

What is stem cell therapy?

Stem cells are the mother cells from which new cells are formed. Bone marrow aspirate is taken and processed to form stem cell. These stem cells are injected in the area of degeneration.

Which is better among the two?

Among the two, stem cell is the mother cell so is more efficacious in regeneration. Only disadvantage of stem cell is it is more expensive and more invasive procedure compared to PRP therapy.

How is the procedure done?

The procedure is done in operation theatre under local anesthesia. The affected part identified using ultrasonography and fluoroscopy and the growth factor is injected.

What are the post-procedure recommendations?

Physiotherapy is to be started immediately after the procedure to achieve maximum response.

In which conditions this procedure can be done?

Shoulder pain-Patients with osteoarthritis, tendinosis,  partial muscle tear, bursitis, labral tear.

Knee Pain-Patients with osteoarthritis, tendinosis,  partial muscle tear,Bursitis

Hip Pain- Patients with osteoarthritis of hip joint and avascular necrosis of the joint.Bursitis

Planter Fasciitis

Tennis Elbow

Ankle Pain

Tendo-Achilis Pain