dr-amod-manocha

[dr-amod-manocha]

PAINS ASSOCIATED WITH COVID-19 - Removemypain

WHO declared COVID-19 outbreak as a global pandemic on 11th March 2020. One year on and we are still haunted by the mysteries of this virus as more and more evidence accumulates supporting COVID-19 as a complex multisystem disease rather than just being restricted to the lungs.

The widespread perception is that COVID infection has the following probable outcomes – recovery in two to three weeks, hospital admission or mortality is severe cases. For some patients however, COVID 19 is not a discrete infection lasting a few weeks but marks the start of a long-term illness with ongoing and often debilitating symptoms. This is addressed as Long COVID. This diagnosis brings more uncertainty into picture and challenges the clinical, governmental assumptions about COVID.

Long COVID is perhaps the first illness name to be coined by patients themselves through social media. Persisting pain and fatigue is one of the prominent symptoms of Long COVID. This blog explores the relationship between COVID-19 infection and pain, including the pains related to acute infection and those persisting after the infection.

What type of pains does one experience at the time of acute COVID-19 infection?

Muscle pain and fatigue are commonly seen in acute COVID -19 infection with an incidence of approximately 44%. COVID-19 associated pain is described by most as a diffuse ache or soreness, similar to that one experiences after exercise. The difference being that these pains are not localised to one body part and take a longer time to resolve. Compared to the joint pains, muscle pains are more commonly seen in the acute phase.

Even the so called “mild COVID-19” cases can be troubled by miserable, debilitating symptoms such as headaches, body aches and extreme fatigue. Pains associated with acute COVID-19 infection and their incidence range are as follows

Muscle & Joint pain 1.5 – 61 %

Headaches1.7 – 33.9%

Sore throat 0.7 – 47.1%

Chest pain 1.6 – 17.7%

Abdominal pain 1.9 – 14.5%

What is the cause of COVID-19 infection associated pains?

The exact cause behind these pains remains unknown but generalise soreness, pain and fatigue are not uncommon with viral infections and most of us have experienced these with seasonal flu. Multiple mechanisms are postulated to be contributing to these pains such as

Virus triggered inflammation and body’s immune response

Direct muscle damage

Blockage of blood vessels by clots leading to the poor blood supply to the muscles etc.

The relative contribution of these factors remains unknown. Besides these, stress and low mood play a role in modulating the pain perceived by an individual.

How can we manage these pains?

For most people these pains respond to simple painkillers such as paracetamol. If this is not sufficient then other pain killers can be used after consulting a specialist, as these need to be chosen carefully depending on your current health status, organ function and severity of COVID infection. Simple measures such as ensuring adequate hydration, nutrition and adequate rest may be helpful in reducing the pain.

How long do these pains last for?

For most individuals these will get better as one recovers in 2-3 weeks. However, in some patients it may persist for longer periods.

What is Long-COVID and what are its symptoms?

A study conducted in Italy evaluated 143 patients for persisting symptoms, 60 days after the initial onset of COVID-19 symptoms. In this study joint pains and chest pain were present in 27.3% and 21.7% of patients respectively. Other commonly present symptoms included fatigue (53.1%) and dyspnoea (43.4%).

Another study from China, involving 1733 patients found that six months after discharge 76% of patients had at least one of the these symptoms- fatigue/weakness (63%), difficulty sleeping (26%), hair loss (22%), altered smell and taste (11 and 9%), and mobility issues (7%).

These persisting symptoms are addressed as Long COVID with as incidence of around 10% (varying between 10- 70 % in different studies). These studies highlight the impact of COVID even after the resolution of the acute phase. Other commonly observed symptoms include inability to concentrate, impaired memory, anxiety, and depression.

Why do some people get long lasting symptoms?

There is uncertainty regarding the underlying mechanisms responsible for Long COVID. Some of the possible causes include

A reduced response/ lack of immune response or long lasting changes in the immune system

Relapse or reinfection of the virus

New or relapsing inflammatory

Injury to multiple organs

Deconditioning

Treatment side effects

Post-traumatic stress.

What are the management options for Long-COVID?

Currently due to limited research and evidence, no specific treatments that can be offered as a cure. As the number of patients recovering from COVID-19 grows and research evidence accumulates, we may be able to answer this question better. Many patients, however, recover spontaneously with

Holistic support

Balancing rest with activity

Symptomatic treatment and gradual increase in activity

Individualized rehabilitation plans

Controlling other comorbidities such as diabetes, blood pressure, heart and breathing conditions etc.

One can make sensible lifestyle changes such

Following a healthy diet with weight management

Not smoking

Limiting alcohol and coffee

Getting quality sleep

Managing depression, anxiety and stress.

Protective role of supplements such as vitamins, if any remains unclear although maintaining normal levels is sensible.

Can Covid-19 infection cause flare-up of pre-existing arthritis?

Joint pains or arthritis after viral infections is not a new phenomenon with viral arthritis responsible for 1% of acute arthritis cases worldwide. In India joint pains after viral infections such as dengue and chikungunya are common. Concerns have been expressed regarding increase in severity of certain types of arthritis with COVID-19 infection, and how this unfolds in the future remains to be seen. Currently there are many published case reports with arthritic symptoms in lower limb and small joint of hand developing after COVID-!9 infection. Some of these patients have benefited from the use of anti-inflammatory medications and local joint injections.

Tag = Back Pain Treatment in India, COVID-19

[dr-amod-manocha]

Cervical Pain Treatment in India - Removemypain

Neck Pain is a pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life with high prevalence in middle ages. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic.

Neck pain may be a result of...

Local pathology

Whiplash (flexion-extension) injuries/ trauma

Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc.

Be a result of referred pain from neighboring areas for example the shoulder joint

Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety, depression, and stress can play a role in magnifying the perceived pain. Quite often the diagnosis of simple or nonspecific neck pain is used implying postural and mechanical causes; this is contrary to other serious causes of neck pain such as fracture, tumor, infection, etc.

Pain from the upper neck can radiate towards the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and scapula. Reduced neck movement along with localized areas of muscle tenderness known as trigger points are commonly observed along with pain.

For More Information click here http://bit.ly/Cervical-Pain-Treatment-in-India

Tag =  Cervical Pain Treatment in India, Removemypain, Neck Pain Treatment in Delhi

[dr-amod-manocha]

[dr-amod-manocha]

How To Communicate Regarding Your Joint Pain To Your Doctor - Removemypain

Joint pain can be a source of prolonged discomfort which one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments which can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR . But reaching out to the right centre with experienced and skilful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is

Joint pain can have numerous causes such as like age related wear and tear, injury, trauma, infections etc

Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology

Treatments offered depend on the severity of symptoms, their impact on your life, your age, activity levels and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors

These are some important points which may help your doctor to understand and treat your pain better:

Explain where the pain is; how long you have had the pain and how it started. If possible point the exact place, is it in the knee, ankle or shoulder pain?

The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shouting or stabbing pain? Is it present all the time?

Aggravating or reliving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?

It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

Applying ice or hot compression at the joint several times.

Avoiding activity that may cause the pain.

Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.

Tags = Joint pain treatment in Delhi, joint pain treatment in Delhi NCR, Joint pain treatment in South Delhi, Removemypain

[dr-amod-manocha]

Meralgia paresthetica treatment in delhi and gurgaon - Removemypain

What is Meralgia paresthetica (MP)?

Meralgia Paresthetica is a thigh pain condition that develops as a result of problems with a nerve called the lateral cutaneous nerve of the thigh. This nerve supplies sensation to the side and front of thigh. It originates from the spine and travels via the inside of the belly and groin to reach the thigh. Injury or pinching (entrapment) of the nerve can lead to numbness, pain and altered sensation in the area supplied by the nerve and this condition is called Meralgia paresthetica.

What causes this condition?

The most common cause for this condition is pinching (entrapment) of the nerve as it enters the thigh travelling in close relation to a thigh ligament called the inguinal ligament. The angle of the nerve changes as it travels into the thigh making it more liable to get pinched. Your pain specialist can further explain the anatomical details to help you understand the condition better.

MP generally affects one side although in up to 20% of patients both sides may be involved. Men are more likely to have MP with a peak incidence between the age of 40-60 years. It can be challenging to pinpoint the exact cause as to why this condition develops although it has been observed to occur more commonly in association with conditions such as:

Increased abdominal pressure as seen in pregnancy or distension of abdomen due to increased fluid in belly (ascites)

Obesity (BMI> 30)

Tight clothes/ belts in the waist area such as jeans, military armour and police uniforms

Diabetes and other conditions affecting nerves such as alcoholism

Underactive thyroid (Hypothyroidism)

Nerve injury due to seat belt injury or injury associated with surgeries such as hip or back surgery, surgeries requiring bone grafting, keyhole (laparoscopic) hernia repair

Growth/ swelling of the nerve (neuroma)

Difference in the length of the two legs

Activities involving repetitive leg motion for long hours such as walking or cycling. MP is seen associated with sports such as gymnastics, soccer and strenuous exercise, bodybuilding.

What are the symptoms of Meralgia paresthetica?

The main symptoms of this condition include

Pain, burning, aching or stabbing sensation in the front and outer side of the thigh, extending as far as the outer side of knee. This may be accompanied by groin and buttock pain

Altered sensitivity in the front, other side of thigh

Numbness, tingling sensation

Worsening of symptoms with certain positions such as squatting, walking or standing for long hours. Lying down with legs bent towards the tummy (hip flexion) or sitting may help to reduce the symptoms severity.

As this nerve does not control any muscles, there is no muscle weakness.

How is Meralgia paresthetica diagnosed?

In most cases, the diagnosis can be made by the history and examination. Simple tests such as altered sensation in the area supplied by nerve, pressure on the nerve in the groin, moving the hip backwards may reproduce the symptoms and help in establishing the diagnosis. An ultrasound scan can be useful. I have previously identified nerve abnormalities with ultrasound scans prompting other investigations.

Investigations such as MRI scans may be requested to confirm the suspicion or to rule out other conditions with similar symptoms. Other specialist investigations such as nerve conduction studies or neurography are sometimes required. Often an ultrasound guided injection is used to confirm the diagnosis and provide relief.

How is Meralgia paresthetica treated?

This condition has good prognosis and mild cased can resolve spontaneously or with conservative management. The treatment involves lifestyle changes, medications, physical therapy and ultrasound guided injections or radiofrequency treatment. Surgery is rarely required and is considered for chronic refractory cases not responding to other measures.

Lifestyle changes– these include

Avoiding tight clothes and belts

Weight loss (if indicated)

Rest and avoiding activities which provoke the symptoms

Medications. Different types of medications are used including neuropathic medications (painkillers used for nerve pain) and anti- inflammatories.

Ultrasound Guided Nerve Block

The involved nerve can be identified with the help of ultrasound and guided injections can help relieve the pain. It involves injecting local anaesthetics and a small dose of steroid close to the problem site. The combination helps to reduce pain and inflammation. The injection can be performed as an OPD/ day care procedure and it not only helps confirm the diagnosis but can also provide lasting relief. Skilled clinicians can identify individual branches of the nerve. Ultrasound guidance not only helps to ensure accuracy but also minimises the risk of complications.

Ultrasound Guided Pulsed Radiofrequency (PRF) Treatment

In cases where the effect of the nerve block does not last long, this option can be utilised to prolong the pain relief. The procedure involves identifying the nerve under ultrasound guidance followed by placement of a special needle close to the nerve. The needle is connected to a radiofrequency machine which is used to interfere with the pain signals being transmitted by the nerve. This procedure can provide lasting relief and I prefer this option over other options such as neurolysis as it is associated with less complications/ side effects.

Cryoablation

This method involves freezing of the affected nerve to interrupt the pain signals being transmitted to the brain resulting in pain relief. The procedure does not require any cuts or incisions and involves placing a small probe near the affected nerve. A pressurised coolant travels through the probe and creates an ice ball at the tip of the probe thereby freezing the nerve. As the nerve is not damaged during the process it can regenerate without any permanent damage. This procedure can provide prolonged pain relief, usually lasting 6-8 months although some studies have found even longer lasting benefits. If required repeat freezing of the nerves can be performed with good results.

Surgical management. This is rarely required and is considered for non-resolving severe symptoms. The options include

Decompression – this involves releasing the pressure off the nerve

Excision of part of the nerve (neurectomy). This can lead to permanent numbness in the area supplied by the nerve.

Tag = Meralgia paresthetica, Meralgia paresthetica diagnosed, Meralgia paresthetica treated, Meralgia paresthetica Treatment, symptoms of Meralgia paresthetica

[dr-amod-manocha]

Shoulder blade pain treatment in Delhi - Removemypain

Scapulae or shoulder blades are triangular bones in the upper back between the spine and the arms. Pain between shoulder blades is a common problem and is also addressed by various other names such as scapular pain or interscapular pain or upper back pain.The most common cause of pain in this region is muscular problems, however the list of possible causes is a long one and includes some serious causes as well.

Pain in this region may be like an aching, sharp, burning, throbbing or heaviness sensation and the underlying causes may be challenging to identify. The pain can interfere with daily activities and affect the shoulder and neck movements.

Causes

The common reasons of pain in this region, which I see in my day to day practice include

Pain originating from Slipped disc in the neck. I see this commonly in my practice.A bulging disc in the lower part of neck can compress the nerves coming out of the spine and lead to shoulder blade pain. The pain resulting from pressure on the nerve may be felt more in the areas supplied by the pinched nerve including the shoulder blade, shoulder and the arm. These pains can be helped by injections close to the bulging discs such as cervical epidural injections.

Pinched nerve in the Neck or upper body. Specific nerves which supply the muscles in this area can get entrapped in the neck and lead to pain. This includes the Dorsal scapular nerve, and the suprascapular nerve. Unfortunately, the awareness regarding these nerves being a source of pain is low and hence this diagnosis is often missed. Ultrasound guided injections of the involved nerve can produce good relief in this condition.

Pain originating from the Neck joints. Neck is made of seven bones called the vertebrae. These are stacked one above the other and join with each other at joints known as facet joints. Wear and tear or arthritis of the joints in the lower part of neck can give rise to pain in the scapular region. This condition can be present despite a normal MRI scan and the best way to diagnose this is diagnostic injections of the joints or the nerves supplying them. If the pain gets relieved after the injection then these joints are the likely source of one’s pain.

Post Herpetic Neuralgia (PHN or Shingles). PHN is an infection caused by the same virus that causes chickenpox. Although it may affect any body part, back of chest wall including the scapular region is commonly involved. This infection can cause severe burning pain with increased sensitivity in the area, which can persist for long. Diagnosis is generally made with the help of the typical rash which appears in the distribution of the involved nerve.

Pancreatitis and pancreatic cancer. This generally presents as abdominal pain associated with nausea, vomiting, constipation and increased pain with oral intake. The associated pain may be severe requiring strong painkillers. Shoulder blade pain is commonly seen with pancreatic disorders and is generallymore left sided although it may be located in the middle or may involve both sides.

Thoracic Spine issues such as a compression fracture, arthritis of spinal joints, disc bulges or a spinal curve (scoliosis)– Osteoporosis or trauma can lead to vertebral fractures and pain in the shoulder blade region. In severe osteoporosis the fractures can occur with minimal or no trauma and can take a long time to settle, requiring strong painkillers. Elderly and those on long term steroids are more prone to this problem.

Infections such as TB of the spine.

Intercostal Nerve problems such as intercostal neuralgia. Intercostal nerves travel in between the ribs, from the spine posteriorly towards the front of the chest wall. These can be damaged as a result of previous injuries such as fractured ribs or operations. Sometimes involvement is also seen secondary to cancers or metastasis in the chest wall region. Pain originating from these nerves can be treated with modalities such as nerve blocks, radiofrequency treatment or cryoablation.

Fibromyalgia and Myofascial pain syndrome. In these conditionspain is the shoulder blade region is observed as a part of widespread body pain.Multiple trigger points may be present which can be treated by physical therapy, pain medicationsand local injections.

Muscle injury or strain. Simple things such as poor posture, long sitting periods, improper lifting technique, sedentary lifestyle, unaccustomed sudden increase in physical activity, heavy lifting and sleeping in the wrong posture can predispose one to injury in this region. This is generally described as a pulled muscle sensation.

Pain in this area can be quite annoying and frustrating as it interferes with your daily chores and keeps coming back. Overuse of arms and upper half of body (torso) as during activities such as ironing, washing dishes, gardening etc is often blamed for increased scapular pain. Front focussed workouts can produce muscular imbalance predisposing the back muscles to injuries, strains andsprains.

Severe pain and localised spasm of muscles can be treated by trigger point injections. Physiotherapy is important in the long term strengthening of these muscles. To read more about trigger point injections click here

To read more about Cervical Epidural Injection click here

To read more about Dorsal Scapular Nerve Block and its treatment click here

To read more about Cervical Facet joint Injection click here

To read more about Post Herpetic Neuralgia and its treatment click here

To find out more about Pancreatic Cancer and its associated painmanagement click here

To find out more about Thoracic Spine pain generators and their treatments click here

To read more about Intercostal Nerve Blocks click here

To read more about Fibromyalgia and its treatment click here

Other causes include

Abdominal and Pelvic causes such as gallstones, stomach ulcers, acid reflux, and liver disease

Cancers such as lymphomas, abdominal cancers such as oesophageal, stomach, liver or pancreatic cancer can cause shoulder blade pain.Spread of cancers such as breast and colon cancer to the bones in the scapular area may also lead to shoulder blade pain.

Heart and blood vessel problems such as inflammation of the lining of the heart (pericarditis) or tearing of the blood vessels (aortic dissection)

Lung problems such as lung cancer, clots in the lungs (pulmonary emboli) or puncture of lungs(pneumothorax)

Treatment

As you can appreciate, pain is this region can result from numerous, varied causes. Identifying the cause is important as it determines thefurther course of action and thetreatment. Detailed history and examination can provide important clues to narrow down the investigations and the list of possible pain generators. Some of the treatments have been discussed in the links provided at the end of individual causes.

For the common muscular sprain or pulled muscle sensation, physical therapy can be helpful. Apart from that simple home remedies include

Giving rest to the area

Ice compression

Simple pain relief medications including medicated rubs and ointments

Massage and stretching may provide short term relief

Certain lifestyle modifications may be required as a part of long term management plan. These include

Adding exercise, stretching to the daily routine

Being more mindful of correct posture

Physical therapy aimed at strengthening of back muscles

Ergonomic changes to your workstation such as height of computer screen, chair type etc.

If the pain is severe or non-resolving or if there are any warning signs of a underlying serious problem, then its best to seek early help early from experienced medical professionals.

Tag = Shoulder blade pain treatment in Delhi, Removemypain, Pain Treatment in delhi

For More Information https://www.removemypain.com

[dr-amod-manocha]

Pancreatic Cancer Pain Management Coeliac Plexus & Splanchnic Nerve Blocks

What causes pain in pancreatic cancer?

One of the common presenting complaints of cancer is pain. Often pain is the reason behind a series of investigations culminating in the eventual diagnosis. Nearly 75% of pancreatic cancer patients suffer from pain at the time of diagnosis and these increases to over 90% in advanced stages.

The pain may be moderate to severe with adverse effect on quality of life, functional ability and mood. Most patients complain of intermittent or constant, deep pain in the upper part of tummy just below the ribcage. It may be squeezing, cramping, sharp, burning or aching in character. Pain is often more on the left and can spread towards the back. It is often aggravated by oral intake of fluids or solids.

Pain management in pancreatic cancer can be challenging because of the aggressive nature of the disease. There is evidence supporting earlier treatment of pain, so it’s better to seek help early.

Pain in cancer may be related to

Cancer itself due to

Increased pressure or the blockage of pancreatic ducts

Inflammation of the pancreas /nearby areas

Pressure/ spread to the neighbouring structures such as

Nerves (in approximately 70–90% of cases)

Blockage of the duodenum (the first part of the small intestine) impeding the flow of food

Liver

Bowel or peritoneum (inner covering of the tummy)

Bone (not very common)

Other associated problems such as constipation and digestion issues

Distension of abdomen due to increased fluid (ascites)

Irritation of diaphragm leading to the shoulder pain

Side effect of treatments such as chemotherapy, radiotherapy, surgery (as in peripheral neuropathy (nerve damage) /enteritis)

An unrelated coincidental problem such as arthritis of joints of the spine

What are Splanchnic nerves and Coeliac plexus?

Coeliac plexus is a network of nerves located in upper part of tummy (abdomen) just behind the pancreas. It lies deep in the tummy in front of spine and around a big blood vessel called aorta. This network of nerves plays an important role in sending messages from the upper abdominal organs to the brain.

Splanchnic nerves are a group of nerves located on both sides of the spine. They are closely related to the Coeliac ganglion and carry pain information from organs in your abdomen to the brain.

What kinds of procedures are performed to reduce pain in pancreatic cancer and how can they help?

The below mentioned procedures are utilised not only for pancreatic cancer but also for other upper abdominal cancers such as those of liver, gall bladder, stomach, some parts of intestine. These can also help in some non-cancer pains such as in chronic pancreatitis.

These procedures may not be a permanent cure for the pain but have the potential to offer significant & lasting relief. Nerve blocks work well for some people, but they don’t work for everyone and may take some time to show the full effects.

These procedures can be classified as

Diagnostic blocks– Blocking the coeliac plexus of the splanchnic nerves involves injecting local anaesthetic with or without steroids around these nerves to interrupt the pain signals being sent to the brain. This can reduce the pain one perceives and help in predicting if other procedures such as neurolysis will work or not.

Neurolytic blocks– these procedures involve use of chemicals such as alcohol / phenol to achieve prolonged interruption of pain signals being transmitted by nerves.

Radiofrequency procedures for splanchnic nerves– these procedures utilise radiofrequency energy to heat the needle tip which in turn reduces the pain signals being transmitted to the brain.

Which intervention and approach is most suitable for a patient will depend on individual factors such as the extent of disease, concomitant problems such as breathing issues or ascites, ability to lie on the tummy/ back etc. Sometimes multidisciplinary review is required (such as reviewing the scans with radiologists) for deciding on the most suitable option.

Depending on the approach chosen the procedure may require for the patient to lie on their back or tummy for a period of approximately 45 min to an hour. A guiding modality is used to accurately place the needles close to the target nerves. This may include

X Ray (Fluoroscopy) guidance

Ultrasound guidance

CT guidance

Endoscopic guidance

OR a combination of above mentioned modalities

Once the needles are in the correct place a dye may be used to assess how the medications would spread and to confirm the accurate placement of needles. An attempt is then made to reduce the pain signals being transmitted by these nerves via radiofrequency or drugs.

How much pain relief can be expected after the procedure and for how long will it last for?

The pain relief after the injection can vary depending on the cause of pain, location and extent of disease. In some studies it has been observed that the outcomes are better if the block is performed soon after the onset of pain asin advanced disease large tumours can act as mechanical barrier preventing the spread of the drugs hence achieving only partial relief.

These procedures have the potential of reducing the pain and the medication requirement for medium term. Overall, 70%–80% of patients undergoing these procedures report decreased pain for 1–6 months.

What are the risks of having these procedures?

No intervention is risk free. The decision to perform or not perform an intervention is taken by evaluating the risk/benefit ratio. The risks will vary depending on the intervention chosen and the patient’s medical issues. When performing these procedures, precautions are taken to reduce the risks as much as possible such as performing the procedure under guidance (x-ray, ultrasound, CT etc), use of contrast (dye) to assess the spread of medications and use of electrical stimulation in radiofrequency procedures etc.

Common side effects of these procedures include local pain (96%), lowering of blood pressure (10%) and loose stools (44%). Fortunately most of the common side effects are short lasting.

Some of the risks can be serious. Studies have reported the risk of serious adverse events as approximately 2%. It is best to discuss these with your treating doctor as the list of these can be long and vary with the intervention chosen.

What else can be done to reduce the pain?

Painkillers Medications

Different types of pain killers can be used based on the type of pain and other medical problems. Often the painkillers dose needs to be changed or new ones need to be added as the disease changes.

Morphine and Morphine like drugs (collectively known as Opioids) are one of the strongest pain killers. Other drugs in this class include fentanyl and oxycodone. These painkillers can be given by different routes lincluding orally, intravenously (directly into the veins), subcutaneously (below the skin) or as patches. Oral medications also come in a slow release form which provide more consistent pain relieve throughout the day. These drugs have often been in the limelight due to the wrong reasons such as addiction/ abuse potential and hence the social taboos associated with their use. Patients often do a disservice to themselves by harbouring preconceived notions and putting up barriers. It is important that you openly discuss any such issues with your Pain Specialist.

Other types of pain may require different class of pain killers such as anti-inflammatories for pain due to inflammation, neuropathic medications such as gabapentin and pregabalin for nerve type of pain etc.

As with any other medication there are side effects associated with all these medications and these can be dealt with in most cases by patient education, pre-emptive action, use of medications and lifestyle modification.

Pain control in cancer is not just about medications or injections… there is more to it. To achieve a satisfactory control it often requires addressing the concomitant factors which can serve to enhance the pain experienced. For example

Relationship between one’s emotional state such as low mood /anxiety and pain is well known. These factors can magnify the perceived pain and hence addressing them is important. Relaxation therapies such as meditation, mindfulness may help in managing thoughts, coping with feelings and produce a calming effect.

Abdominal and back pain worsen with coexisting problems like constipation and abdominal distension and hence the importance of addressing these.

Refractory end of life pain can be dealt by delivering pain killers directly into the spine by using intrathecal/ epidural route.

Tags >> Cancer Pain Management In Delhi, Cancer Pain Management In Gurgaon, Cancer Pain Treatment in Delhi, Cancer Pain Treatment in Gurgaon, pancreatic cancer pain management in Delhi

For More Information https://www.removemypain.com/

[dr-amod-manocha]

Widespread/Fibromyalgia Pain Treatment In Delhi

Tag:  Fibromyalgia Pain Treatment In Delhi

Fibromyalgia is one of the common causes of long-term widespread body pain. Pain may be accompanied by other symptoms including

Fatigue

Nonrefreshing sleep

Impaired concentration

Memory issues

Mood disturbances

Increased sensitivity

Numbness and tingling in hands and feet

Management

A pain clinic is an ideal place to manage fibromyalgia as it brings together the skills of a wide range of specialists working together as a team. This multi-disciplinary approach is essential to minimize the impact on the quality of life. A combination of drug and non-drug treatments can help manage the symptoms. I offer personalized pain management plans on lines of Pain Management Programme (PMP). I can help you

Understand the condition

By making a management plan and prescribing medications. When considering medications I take into account the latest evidence and individualize it keeping in mind your symptoms and other medical problems. The resulting pain reduction can enable active participation in physical therapies and rehabilitation.

Implement necessary lifestyle modifications

By involving other experts and coordinating your care with help from other specialists including

Physiotherapist– they will advise you on posture, physical function, the pacing of activities. There is good evidence supporting aerobic exercises and graded exercise program in fibromyalgia management

Psychologists- Cognitive behavioral therapy has been shown to improve function and decreased pain severity in fibromyalgia. Psychologists can help in reducing the impact of depression/ anxiety and in stress management by teaching relaxation, coping strategies

Occupational therapist

Nutritional specialist- dietary profiling and nutritional advice helping you eat a balanced diet and keep a healthy weight.

Complementary and alternative therapies including Acupuncture, TENS, meditation, Ayurveda, and wellness

[dr-amod-manocha]

Learn how to get the best out of your C- arm and simplify your procedures…… 1ST SESSION OF STEP (Simplifying Education & Training in Pain) & DISTANCE MENTORSHIP PROGRAM. Good fluoroscopy images are key to enhancing safety in pain interventions and reducing the radiation exposure. I hope that this video helps you in getting better images and making the best use of your fluoroscopy machines. Please feel free to post comments…….

[dr-amod-manocha]

Cancer Pain Treatment In Delhi

Tag: Cancer Pain Treatment In Delhi

Pain in cancer may arise due to many reasons and is often the presenting complaint leading to the diagnosis of cancer. It may be

Related to cancer itself or its spread to other body parts

A late presentation due to side effect of treatments such as chemotherapy, radiotherapy, and surgery

A result of extra stress placed on other body parts for example shoulder pain due to using of a stick for walking

A totally unrelated coincidental problem such as arthritis

Pain can be differentiated into background pain (which is always present in the background and is managed with regular medications) and breakthrough pain (pain which breaks through your regular pain relief). Breakthrough pain may occur unprovoked or may be triggered by external or internal factors. In cancer patients, different types of pain may coexist. It is not just limited to pain arising from inflammation and tissue damage for example cancer of pancreas spreading to neighboring organs and nerves leading to visceral and neuropathic pain respectively and a distant spread to bones producing bone pain. Different types of pain present differently for example

Neuropathic/ Nerve pain is generally described as burning, shooting, electric shock-like or stabbing pain with associated tingling or numbness. It may be a consequence of cancer itself or a result of treatments such as chemotherapy (chemotherapy-induced peripheral neuropathy- CIPN).

Visceral Pain originates from viscera (organs in the body cavity) and is generally described as deep aching, squeezing and cramping sensation

Bone pain presents as an aching, throbbing sensation. Some cancers have a preference to spread to bones

Pain ManagementPain relief needs to be tailored to the cause, severity, and duration of pain. In most cases, reasonable control can be achieved by using a combination of methods. Multimodal, Multidisciplinary approach provides the opportunity to maximize pain relief and provide support not only for the physical needs but also for the emotional, spiritual and social needs.  Some of the management options available via a pain clinic are

Medications management

This involves using different classes of medications to optimize pain control. Using a combination of drugs helps to minimize side effects and maximize the benefits. Whilst considering the drug therapy many factors need to be considered like the type of pain, cause and severity of pain, other medical problems and medications being used, medications tried previously, pre-existing nausea/vomiting, constipation, ability to take and absorb medications, liver and kidney function, etc. Apart from the standard medications mentioned in other sections some other medications are used more often in cancer pain such as steroids, bisphosphonates (for bone pain).Nerve blocks, Radiofrequency & Neurolytic procedures Nerves are commonly targeted in pain-relieving interventions, for example, pudendal nerve for perineal or rectal pain, suprascapular nerve for shoulder pain, intercostal nerves for chest wall pain, etc. The pain impulses being transmitted via the nerves can be temporarily blocked using local anesthetics. The transmission of impulses can be reduced for longer duration using Neurolytic procedures, which involve the injection of alcohol or phenol instead of local anesthetic. Examples of neurolytic procedures include

Coeliac plexus, splanchnic nerves neurolysis

Hypogastric plexus neurolysis

Lumbar sympathetic neurolysis

Radiofrequency procedures e.g.suprascapular nerve pulsed radiofrequency for shoulder pain involve exposure to high-frequency electrical current in the RF range (≈ 500 kHz). This exposure can be continuously generating high temperatures or pulsed where the temperature is kept below 42 °C. Pulsed RF can be used to target most nerves including those with motor components. The resulting neural modification effect’s the transmission of pain impulses producing pain relief. Spinal procedures e.g. epidural, intrathecal pumpsCertain procedures such as pumps to deliver medicines directly in the spine (intrathecal pumps) are performed more often for cancer pain. Drug infusions

Psychology

Cancer is often accompanied by anxiety, depression, and fear of the worst. A psychologist can help in analyzing these thoughts rationally and developing a positive approach. They can help by teaching relaxation techniques, coping strategies and by reducing the effect of mood on pain.

Physiotherapy

Complementary and alternative therapies including Acupuncture, TENS, meditation, Ayurveda and wellness. For more information on how these can be helpful please follow the respective links