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Cancer Pain Treatment in Gurgaon

Struggling With Severe Cancer Pain In The Middle Of Night?

Learn More About Breakthrough Pain In Cancer

Medical advancement has transitioned cancer from being a rapidly fatal disease to chronic disease. Cancer pain, however, still remains a major problem affecting 30–40% at the time of diagnosis, and 75% of those with advanced cancer. Although it may not always be possible to relieve cancer-related pain completely fortunately it can be effectively managed in most individuals with appropriate therapy. Effective pain control has been shown to improve the quality of life in all stages of the disease. Breakthrough pain is one pain that troubles even those cancer patients whose pain is otherwise well controlled. Its management requires careful evaluation by specialists with attention to detail. In the subsequent section we discuss more breakthrough pain and commonly asked questions.

What is breakthrough pain?

Breakthrough cancer pain (BTcP) is a transient exacerbation of pain superimposed on the background of controlled persistent pain. In simple words it refers to the sudden, relatively short-lasting severe pain episodes one experiences from time to time, often catching one unprepared, despite having background pain well controlled.

Here are a few characteristics of breakthrough pain

Pain is of moderate to severe intensity (between 4-10/10, average score 7/10)

Onset is rapid (between 3 to 5 minutes) or in some cases more gradual reaching peak intensity within a few minutes. In about two-thirds of the patients, the time to maximum pain intensity is less than 10 minutes

The duration of an untreated episode can be between 1 min and 4 h (average 30 min)

Multiple, predictable (in one-third of patients) or unpredictable episodes throughout the day

Effective pain management requires assessment of responsible factors and having a management plan rather than trying to reach out for emergency services during unsocial hours in a panic mode.

How common is breakthrough pain and what causes this pain?

BTcP is a common problem with studies reporting the incidence as approx. 50% to 75%. This is despite using strong painkillers to control the baseline pain. Patients with severe persisting pain, advanced cancer disease, and aggressive anticancer treatments are more likely to experience breakthrough pain.

BTcP may result from cancer itself (70–80% of cases) or the anticancer treatment (10–20% of cases) and is seen more commonly associated with certain cancers like head and neck cancer (70%), gastrointestinal (59%), lung (55%) and breast cancer (52%). Common examples of BTcP include mouth pain on swallowing due to inflammation of mouth lining (mucositis) or bone pain due to movement.

BTcP can originate from numerous sources (somatic, visceral, or neuropathic) and the cause may be different from the sources of persisting background pain. It may be associated with

Voluntary movements like sitting, standing

Involuntary movements like intestinal distension or

May occur spontaneously

This distinction is relevant as it may encourage more targeted treatment approaches. Up to half of the patients may experience two or more types of BTcP. Sometimes the term episodic pain is used synonymously with breakthrough pain although some researchers ascribe a different meaning to this term.

Another type of BTcP that one commonly encounters is the increased pain that can occur when the effect of painkillers is wearing off, just before the next dose is due. This is addressed as the “end of dose failure.” Some studies include this as a type of breakthrough pain whereas others do not.

Why do we need to treat breakthrough pain?

Breakthrough cancer pain is a common problem and can be associated with a variety of physical, psychological and social complications. Persisting pain often robs the sufferers of their independence and their ability to perform routine tasks, adversely affecting the quality of life. Besides causing suffering, the severity and unpredictability of breakthrough pain can adversely impact one’s confidence level, emotional health, and social interactions. Moreover, it is associated with increased utilization of healthcare and social care services with obvious financial implications.

How do we address this type of pain?

All cancer pain patients should be specifically assessed for the presence of BTcP. Standard pain management & palliative care practice is to prescribe medications for the constant background pain and a separate on-demand dose of pain-relieving measures for breakthrough pain. In BTcP there is no one treatment that works universally and the treatment needs to be individualized.

Selecting the right option requires a fair amount of expertise and familiarity with all the available options. There are a number of factors that need to be taken into account when deciding on the treatment and these include

The underlying cause of pain

Type of pain (nerve pain, nociceptive, mixed)

Pain characteristics (onset, duration, severity)

Predictable or unpredictable

Previous response to pain-relieving medications including opioids (efficacy, tolerability)

Background analgesic medications (may need to be adjusted) and drug interactions

Patient-related factors include age, other organ function, stage of cancer and individual preferences

Cost, availability, and safety aspects

Opioids (morphine-like drugs) are considered the preferred medications for treating BTcP. The profile of the drug selected to treat the BTcP needs to mirror the pain profile one is experiencing. For example, in cases of sudden onset short-lasting pain episodes, drugs like oral morphine may prove to be ineffective as they take 30 to 45 minutes to work. In such a situation rapidly acting drugs are more likely to be useful. A mismatch between pain profile and drug selected is likely to produce poor relief and/or more side effects

The route of drug administration is important as it controls how quickly the pain-relieving effects are apparent. Drugs given directly into the veins have a rapid effect although it requires an intravenous cannula to be present. Alternative routes such as through the nose or by intraoral route (sucking on tablets) of the rightly chosen drugs work within 5 -15 min. The dose of ‘rescue medication’ is determined by individual titration to ensure maximum relief with minimal side effects and may be subject to change over time.

A predictable episode of BTcP triggered by known factors, for example, eating can be managed by a planned administration of medicine prior to the activity taking into account the time taken for the medication to work. Some patients choose to restrict activity to reduce the number of  BTcP episodes.

Once the trial medication has been started, dose titration and regular reassessments are essential. All patients with new BTcP medications should be reevaluated within 48–72 h. Patient education regarding the correct and appropriate use of medications is essential as research evidence demonstrates incorrect usage, misuse/abuse, and underuse in a significant proportion.

Other non-opioid drugs are also useful in the management of BTcP. Examples include anti-inflammatories, benzodiazepines, paracetamol, etc. Preventing and treating BTcP is not just about medications as interventional techniques and non-pharmacological methods are other options that can be helpful.

Tags = Cancer Pain Treatment in Delhi, Pain Management in Delhi, Pain specialist in Gurgaon

Struggling With Severe Cancer Pain In

The Middle Of Night?

Learn More About Breakthrough Pain In Cancer

Medical advancement has transitioned cancer from being a rapidly fatal disease to chronic disease. Cancer pain, however, still remains a major problem affecting 30–40% at the time of diagnosis, and 75% of those with advanced cancer. Although it may not always be possible to relieve cancer-related pain completely fortunately it can be effectively managed in most individuals with appropriate therapy. Effective pain control has been shown to improve the quality of life in all stages of the disease. Breakthrough pain is one pain that troubles even those cancer patients whose pain is otherwise well controlled. Its management requires careful evaluation by specialists with attention to detail. In the subsequent section we discuss more breakthrough pain and commonly asked questions.

What is breakthrough pain?

Breakthrough cancer pain (BTcP) is a transient exacerbation of pain superimposed on the background of controlled persistent pain. In simple words it refers to the sudden, relatively short-lasting severe pain episodes one experiences from time to time, often catching one unprepared, despite having background pain well controlled.

Here are a few characteristics of breakthrough pain

Pain is of moderate to severe intensity (between 4-10/10, average score 7/10)

Onset is rapid (between 3 to 5 minutes) or in some cases more gradual reaching peak intensity within a few minutes. In about two-thirds of the patients, the time to maximum pain intensity is less than 10 minutes

The duration of an untreated episode can be between 1 min and 4 h (average 30 min)

Multiple, predictable (in one-third of patients) or unpredictable episodes throughout the day

Effective pain management requires assessment of responsible factors and having a management plan rather than trying to reach out for emergency services during unsocial hours in a panic mode.

How common is breakthrough pain and what causes this pain?

BTcP is a common problem with studies reporting the incidence as approx. 50% to 75%. This is despite using strong painkillers to control the baseline pain. Patients with severe persisting pain, advanced cancer disease, and aggressive anticancer treatments are more likely to experience breakthrough pain.

BTcP may result from cancer itself (70–80% of cases) or the anticancer treatment (10–20% of cases) and is seen more commonly associated with certain cancers like head and neck cancer (70%), gastrointestinal (59%), lung (55%) and breast cancer (52%). Common examples of BTcP include mouth pain on swallowing due to inflammation of mouth lining (mucositis) or bone pain due to movement.

BTcP can originate from numerous sources (somatic, visceral, or neuropathic) and the cause may be different from the sources of persisting background pain. It may be associated with

Voluntary movements like sitting, standing

Involuntary movements like intestinal distension or

May occur spontaneously

This distinction is relevant as it may encourage more targeted treatment approaches. Up to half of the patients may experience two or more types of BTcP. Sometimes the term episodic pain is used synonymously with breakthrough pain although some researchers ascribe a different meaning to this term.

Another type of BTcP that one commonly encounters is the increased pain that can occur when the effect of painkillers is wearing off, just before the next dose is due. This is addressed as the “end of dose failure.” Some studies include this as a type of breakthrough pain whereas others do not.

Why do we need to treat breakthrough pain?

Breakthrough cancer pain is a common problem and can be associated with a variety of physical, psychological and social complications. Persisting pain often robs the sufferers of their independence and their ability to perform routine tasks, adversely affecting the quality of life. Besides causing suffering, the severity and unpredictability of breakthrough pain can adversely impact one’s confidence level, emotional health, and social interactions. Moreover, it is associated with increased utilization of healthcare and social care services with obvious financial implications.

How do we address this type of pain?

All cancer pain patients should be specifically assessed for the presence of BTcP. Standard pain management & palliative care practice is to prescribe medications for the constant background pain and a separate on-demand dose of pain-relieving measures for breakthrough pain. In BTcP there is no one treatment that works universally and the treatment needs to be individualized.

Selecting the right option requires a fair amount of expertise and familiarity with all the available options. There are a number of factors that need to be taken into account when deciding on the treatment and these include

The underlying cause of pain

Type of pain (nerve pain, nociceptive, mixed)

Pain characteristics (onset, duration, severity)

Predictable or unpredictable

Previous response to pain-relieving medications including opioids (efficacy, tolerability)

Background analgesic medications (may need to be adjusted) and drug interactions

Patient-related factors include age, other organ function, stage of cancer and individual preferences

Cost, availability, and safety aspects

Opioids (morphine-like drugs) are considered the preferred medications for treating BTcP. The profile of the drug selected to treat the BTcP needs to mirror the pain profile one is experiencing. For example, in cases of sudden onset short-lasting pain episodes, drugs like oral morphine may prove to be ineffective as they take 30 to 45 minutes to work. In such a situation rapidly acting drugs are more likely to be useful. A mismatch between pain profile and drug selected is likely to produce poor relief and/or more side effects

The route of drug administration is important as it controls how quickly the pain-relieving effects are apparent. Drugs given directly into the veins have a rapid effect although it requires an intravenous cannula to be present. Alternative routes such as through the nose or by intraoral route (sucking on tablets) of the rightly chosen drugs work within 5 -15 min. The dose of ‘rescue medication’ is determined by individual titration to ensure maximum relief with minimal side effects and may be subject to change over time.

A predictable episode of BTcP triggered by known factors, for example, eating can be managed by a planned administration of medicine prior to the activity taking into account the time taken for the medication to work. Some patients choose to restrict activity to reduce the number of  BTcP episodes.

Once the trial medication has been started, dose titration and regular reassessments are essential. All patients with new BTcP medications should be reevaluated within 48–72 h. Patient education regarding the correct and appropriate use of medications is essential as research evidence demonstrates incorrect usage, misuse/abuse, and underuse in a significant proportion.

Other non-opioid drugs are also useful in the management of BTcP. Examples include anti-inflammatories, benzodiazepines, paracetamol, etc. Preventing and treating BTcP is not just about medications as interventional techniques and non-pharmacological methods are other options that can be helpful.

Tags = Cancer Pain Treatment in Delhi, Pain Management in Delhi, Pain specialist in Gurgaon

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Know more about our successful treatments by Pain specialists in Gurgaon 

Visit our official website - https://www.removemypain.com/Tags = Pain management center in Delhi, Back Pain Treatment in Gurgaon

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Back Pain Treatment in Gurgaon

Back Pain Which Should Not Be Ignored

Back pain is a common problem affecting 8 out of 10 people at some point in their life. It can affect people of all ages and is a common reason for seeking medical assistance. Back pain can arise due to many reasons and accounts for significant suffering & financial loss worldwide. Many people choose to treat their back pain at home with pain-relieving medications, heat, ice, or stretching. So, if it’s so prevalent what are the warning signs of something serious which requires medical attention. Some of these are addressed as red flags in medical terminology to warn the clinician of the possibility of serious underlying pathology.

Persistent or worsening back pain. Back pain often goes away in a few days or weeks but if it is persisting or progressively increasing then it's a reason to seek medical attention.

Back pain is associated with progressive numbness, tingling, or weakness. This could be a symptom of a pinched nerve, slipped disc, or narrowing of the space in the spine (slipped disc) and requires medical attention

Inability to control your bowels or urination (incontinence) Spinal nerve compression can have an impact on one’s ability to control bladder and bowel function, leading to incontinence. This is a severe symptom and requires immediate medical attention.

Back pain starts after an accident. If your back pain began after a fall, accident, or an injury

Back pain that is worse at night

Back pain associated with unexplained weight loss.

Back pain with Fever. This could be a sign of infection or ongoing inflammation

Back pain in extremes of ages (too young or too old patients) or in high-risk individuals such as those with severe osteoporosis or prolonged use of steroids or drug abuse history.

Know more about our successful treatments by Pain specialists in Gurgaon

Visit our official website - https://www.removemypain.com/

Tags = Pain management center in Delhi, Back Pain Treatment in Gurgaon

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Trigeminal Neuralgia – Causes, Symptoms, diagnosed and Treatments In Delhi By Dr Amod Manocha

What is Trigeminal Neuralgia?

TRIGEMINAL NEURALGIA = Trigeminal nerveis the main nerve of the face + Neuralgia is pain coming from a nerve

As the name signifies, Trigeminal neuralgia (TN) is a nerve pain condition affecting the main nerve of the face (trigeminal nerve) and causing repeated sudden attacks of severe pain generally on one side of the face.

There is one trigeminal nerve on each side. It carries touch and pain sensations from your face and controls the muscles used in chewing. The nerve divides into three main branches

1st branch- V1 (ophthalmic branch)goes to the scalp, forehead, and the region around the eye

2nd branch- V2 (maxillary branch) goes to the cheek area

3rd branch- V3 (mandibular branch) goes to the jaw area

TN more commonly affects the 2nd and 3rdbranches causing pain over the jaw and the cheek area. The patient generally experiences a severe, sudden, sharp, stabbing, burning, or shock-like sensation lasting for a short duration with frequent episodes throughout the day.

What are the symptoms of Trigeminal Neuralgia?

TN pain is typically described as

Sudden, sharp, stabbing, piercing, burning, or electric shock-like sensation over the face lasting for a short duration (few seconds to minutes)

Frequent episodes of severe pain can occur throughout the day. The episodes usually do not occur when one is asleep

Pain can be triggered by talking, chewing, washing the face, brushing, drinking, shaving, or cold. Trigger areas are sensitive areas that when touched can trigger episodes of pain and are commonly observed around the nose, mouth, chin, and cheek close to the midline

Pain may be associated with spasms

After repeated attacks, dull ache and tenderness in the affected area can persist

Usually, one side of the face is affected although rarely both sides (in approx. 3% of TN cases) can be involved

Episodes can last for days, weeks, or months at a time

There may be no symptoms between attacks and the pain can disappear for months or years

The pain can worsen over time with fewer and shorter pain-free periods

Such extreme pain can often trigger secondary problems such as

Low mood or anxiety

Poor oral hygiene

Weight loss

Reduced social withdrawal, impact on the job, family life, etc.

Why does it happen?

About 10 people in 100,000 develop TN each year. This condition is more common in women and is generally seen after the age of 50 years. There is some evidence that the disorder can run in families. Although sometimes debilitating, the disorder is not life-threatening.

Causes of TN include

Compression of the nerve by a blood vessel can lead to damage to the covering of the nerve(demyelination)

TN may be a symptom of another condition like a tumor or multiple sclerosis

In some cases (approximately 10%), the underlying cause remains unknown

How is Trigeminal Neuralgia diagnosed?

The diagnosis is based on the typical symptoms and there is no diagnostic test for trigeminal neuralgia. Physical examination in classic TN is generally normal and as facial pain can be caused by a large number of conditions, sometimes the diagnosis can be challenging. Branches of the nerve can be damaged with facial trauma, dental procedures, or surgery causing similar symptoms.

MRI scans are considered especially when

The symptoms are atypical casting a shadow on the diagnosis

If the presentation is in a younger adult

The response to treatment is not as expected

To assess if a blood vessel is pressing on the nerve prior to surgery

What are the treatment options for Trigeminal Neuralgia?

There are many options available to control the pain in TN including medications, interventional pain procedures, and surgery.

Medications. Common pain relief medications or simple painkillers like paracetamol or ibuprofen are not effective in controlling TN pain. Different types of pain-relieving mediations which work on nerves by quietening nerve impulses are more effective. These medicines are started on low doses and gradually escalated depending on one’s response and the severity of the problem. Starting at high doses straight away can lead to more side effects and may sometimes be counterproductive. Some of the medicines need monitoring and regular blood tests. One medicine may not work for everyone and different options or combinations may need to be explored to get the best pain control.

Interventional pain procedures. If medication fails to relieve pain or is poorly tolerated due to side effects, then interventional pain procedures can be considered including

Local nerve blocks– this involves blocking the individual nerves or their branches affected and is a safe procedure with minimal risks/ side effects. The effects may sometimes be short lasting but can help to break the pain cycle and sometimes that is all that is required for one to go into remission.

Radiofrequency treatment– A number of treatment options involve damaging the trigeminal nerve cells to interrupt the transmission of pain signals to the brain, thereby producing pain relief. These include – radiofrequency treatment (using controlled heat), glycerol injection (using chemicals), balloon compression (using mechanical pressure), and stereotactic radiosurgery (or Gamma Knife, which involves using a form of radiation therapy).

The radiofrequency treatment does not involve any cuts or incisions and is minimally invasive. In this treatment, a needle applies heat directly to the nerve cells. The resulting relief is of quick onset and can last for a long duration.

Other options include-

intravenous drug infusions

Botox injections (for trigger points)

Surgery. If an MRI scan shows that there is a blood vessel pressing on the nerve, microvascular decompression or moving the blood vessel away from the nerve to relieve the pressure off the nerve may be an option. This can offer long-term relief but is however a major undertaking as it involves brain surgery to reach the problem site. There are pros and cons to each treatment and the best option is decided in consultation with the concerned individual.

What can I do?

Maintain good oral hygiene. If brushing is not possible then alternative options such as antibacterial mouthwash can be considered

Avoid triggering factors such as

Hot, cold, or spicy foods

Avoid touching the triggering areas

Other triggering factors such as cold weather

Take regular medications as suggested by your doctor

How long does it last and what can I expect from the future?

Trigeminal neuralgia is not life-threatening although can adversely impact the quality of life and the fear of impending attacks can have a debilitating impact on all aspects of one’s life. The course of TN is variable with frequent recurrences and remission(symptom-free intervals) lasting for months and years. With our current knowledge and research evidence, it is not possible to predict the timing or the frequency of attacks or the future course of the condition, but correct diagnosis and proper management can be beneficial to the patients and leads to a good prognosis. In many cases, it has been observed that the bouts of pain tend to become more frequent as one age. Controlling the pain symptoms is possible in most patients with appropriate specialist guidance.

Know more about our pain treatments by Dr. Amod Manocha visit our official website - https://www.removemypain.com/

Tags = Pain management centre in Delhi, Pain Treatment in Delhi, Pain specialist in Gurgaon

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Dr. Amod Manocha is the Head of Pain Management Services at Max Super Speciality Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals. Dr. Manocha believes in multidisciplinary approach and providing evidence-based treatments at par with international standards. He is committed to providing quality care and believes in building long-term relationship with patients based on honest communication and keeping their interests foremost

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Pain Specialist In Delhi and Gurgaon - Dr. Amod Manocha

Dr Amod Manocha is The best  Pain Treatment Specialist in Delhi & Gurgaon, India

Dr Amod Manocha is the Head of Pain Management Services at Max Super Speciality Hospital, Saket. He is trained as a Pain Management Specialist and an Anaesthetist in the UK. He has over 13 years of work experience in the UK including working as a Chronic Pain Consultant in many UK hospitals. Dr Manocha believes in a multidisciplinary approach and providing evidence-based treatments at par with international standards. He is committed to providing quality care and believes in building long-term relationships with patients based on honest communication and keeping their interests foremost.

Know more about the Pain management centre in Delhi visit our official website - https://www.removemypain.com/

Tags = Pain management centre in Delhi, Pain specialist in Gurgaon