Dr. K J Choudhury

Nagging headaches or facial pain is a common issue faced by many. They can be mild or severe that and can disrupt your routine to a significant extent. If you are experiencing a disturbed vision, an upset stomach, feeling nauseous or vomiting along with the pain, you must consult your physician to identify the cause and avail proper treatment. 

What are the factors that cause the issue?
Several underlying problems can be the reason for a facial pain including oral infections, a toothache, facial injuries, a skin abscess, nerve disorder or even an open sore. Sometimes constantly annoying headaches or sinusitis may also lead to facial pain. And some of the more commons issues that result in a headache are tension, anxiety, excessive stress, sleeplessness, migraines and sinus problems. A headache can also occur due to more severe causes such as tumor or cancer in the brain, neck issues, abnormalities of any kind in the blood vessels and muscles of the brain, etc.

When to seek medical help?
The symptoms of facial pain may vary depending on the factor that's triggering the pain. From swelling to open sores, redness, rashes on the skin, etc. are often associated with facial pain symptoms. People usually describe the facial pain to be an achy feeling or stabbing or cramp-like sensation on the different facial parts.

Headaches usually occur alone. However, some of its associated symptoms are blurry vision, difficulty in walking straight, confusion, trouble in speaking correctly, excessive sleepiness, neck pain, and neck stiffness. Sometimes, developing increased sensitivity to noise or light is also a symptom of headaches. Headaches can be mild to moderate to very excruciating. When the pain in the head becomes severe, it leads to vomiting and nausea.

What are the pain management strategies for this issue?
When it comes to headaches and facial pain management, the treatment options also vary depending on the causes of such pain. From stress reduction to, pain managing medications, elimination of particular foods from one's daily diet and biofeedback training are some of the most common ways of pain management. Regular exercise can also help in dealing with pain in some cases. However, if the cause of a face pain or headaches lies in some severe health diseases, prompt medical attention may be required for treating them first.

Remember, the moment you think that your quality of life is in some way impacted by head pain and facial pain, don't hesitate to look for medical assistance. Because, until unless, you do not consider undertaking proper methods of pain management suggested by a doctor, getting back to a healthy pain-free life and concentrating on your daily works may be impossible.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Pain is a perception by the nervous system. When a painful stimulus is applied to a body part, the nerve endings of that part will send the sensation all the way to the brain where it is perceived as pain. If the pain is experienced by the legs or hands, then the sensation travels via the spinal cord to be perceived as pain. In case of people suffering from nerve problems, there could be cases of chronic pain, therefore conservative treatment measures may fail at times. In these people, though the pain source cannot be reduced, the perception can be reduced. This is exactly what a spinal cord stimulator does, it masks the signals that are reaching the brain, and thereby reduces the perception of pain. 

What is it and how does it work?

Spinal cord stimulator is implanted in patients with chronic intractable neuropathic pain when other conservative or surgical treatment has failed. Trial electrode/s are placed in the outer covering (epidural space) of the spinal cord, higher than the level of pain. Correct placement of electrode is confirmed by stimulating the electrodes through an external generator and different modes/intensity of current are tried to get best pain relief. Pain message is electrical in nature and reaches pain center in brain through multiple relays. Spinal cord stimulator converts electrical energy to a different feeling called neuromodulation and usually pleasant. Upon relief of atleast 60%, the device is implanted in the body like pacemaker for heart. An external remote device allows the device to be used when it is required. It is very safe and free from sideeffects of medications as no drug is used with this device.

Benefits of using stimulator 

• Useful for people with prolonged case of sciatica and chronic regional pain syndrome
• It reduces pain significantly
• Improves a person’s quality of life by reducing pain (especially back and legs) which can be debilitating
• Useful when other modalities of treatment have failed
• Useful when surgery is not possible (either no response to prior surgeries or patient’s overall health does not allow for surgery)
• Is a reversible option, the stimulator can be removed any time the patient feels it is not working
• Requires minimal surgery and can be done as an outpatient procedure
• Once trained, patients can manage the stimulator on their own
• Is not affected by devices such as cell phone, microwaves and other electronic gadgets
• Can be used on a trial basis before a patient opts for a permanent stimulator.

In case you have a concern or query you can always consult an expert & get answers to your questions!

Vertebroplasty means shaping the backbone i.e. vertebra for backbone and plasty is related to shape. This is an outpatient procedure done to treat compression fractures of the spinal cord. The backbone is made up of multiple small bones which are stacked one on top of the other with a filling material in between that is known as vertebrae. The stack of bones are held in place by the soft, elastic vertebral material.

Vertebroplasty & similar procedure called kyphoplasty is a non-surgical procedure where collapsed vertebrae is brought back to shape by injecting medical bone cement under fluroscopy / image intensifier in OT, thereby relieving pressure on the spinal cord or spinal nerves with special canula directed to the core of vertebral body. Indicated in osteoporotic vertebrae, spinal fracture, metastatic tumour or primary tumour of spine. This technique has replaced major surgery done earlier to reshape & fix vertabrae.

Technique: Bone cement, in a semisolid state, is injected into the weakened or fractured bone space. Once this solidifies, it provides additional support to the spine, enabling normal movement. It also helps in reducing the pain significantly and improves the overall mobility.

Procedure:

In what takes about an hour, the following steps are done. Earlier, a few decades ago, this would be an open surgical procedure. However, with advance technology, now it is done using a small incision

• Local anesthesia is given in the area that needs to be operated
• A biopsy needle is inserted into the fractured space with the help of an X-ray
• The acrylic bone cement is injected into the bone space with a needle to fill up the space, once it solidifies, it stabilizes the vertebral space
• The needle is removed and the incision is covered with a bandage
• Usually the patient is sent home in an hour’s time unless the overall condition is really bad
• There could be some soreness at the site where injection is given, but one can notice a significant reduction in pain from the day of the procedure
• There is also improvement in mobility while doing daily chores
• The pain relief can last up to 3 years after the procedure
• Returning back to normal activities takes about 3 to 4 days after the procedure

When to use this procedure?

Vertebroplasty is usually done in case of non-radicular pain that is intractable. In most cases, they do not respond to traditional therapies including physiotherapy, pain medications and even surgery. The pain could be due to:

• Osteoporosis
• Cancer metastasis
• Myeloma
• Spinal hemangiomas
• Traumatic fractures

Benefits of using vertebroplasty for managing pain 

1. Minimally invasive
2. Effective way to get relief
3. Improves mobility
4. Cost-effective
5. Reduces need for long-term use of painkillers
6. Stabilizes the spine and prevents further collapse

In case you have a concern or query you can always consult an expert & get answers to your questions!

While injuries of any form can be painful, burn injuries are one of the worst to suffer from. While cuts and bruises can be temporarily assuaged with a proper dressing, burns are quite different in this regard. With burns, the damaged tissues will stay on the body and may cause continuous pain. Thus, burn injuries are difficult to treat and they require different strategies for pain management as well.

Treatment methods available for treating pain arising due to burn injuries

1. Apply an anesthetic cream or aloevera gel to soothe the burnt skin. Avoid exposing the skin to air as that will cause painful sensations.
2. Loose gauze or antibiotic ointment must be used to protect the influenced area.
3. Soak the burnt area wound in cold water for about five minutes or more.
4. If the burn escalates or affects a widespread area, seek medical attention immediately.

Pain management factors for burn injuries:

1. Relaxation: During the phase of recovery, burn injuries put immense stress on your body and continue for a long period. Muscle tension is caused by stress that increases pain. Some relaxation techniques are proven to be beneficial to reduce the stress on body.
2. Coping with your pain: Different people have different ways to cope with physical discomfort. Look out for situational aspects which are currently under your control and take it positively. The ‘what ifs’ or wishing that the burn didn’t occur in the first place will not help with your current situation. You should focus on things what you can control like self-rehabilitation, doing your daily exercises, physical therapy treatment or following a doctor’s suggestion of pain management strategies. This will help you cope with your pain to a greater extent.
3. Sleep medications: If your normal sleep routine is hampered, consult your physician for safe sleep medications. Proper sleep is very important for the healing process and even more so in the case of burn related injuries.
4. Antidepressants: Some people may not be suffering from depression, but they might still need antidepressants for relief and sound sleep. A health care provider might prescribe antidepressants as a way to deal with acute pain from burn injuries.
5. Increase the pace of your activities: If you want to rebuild your health and stamina and get back in form soon, focus on the regular physical and mental activities. Exercise regularly, but don’t push yourself too much. Increase your physical activities gradually over time. Unless and until you are fully comfortable, don’t strain yourself too much. Occupational and physical therapists can help you with an appropriate activity program. In case you have a concern or query you can always consult an expert & get answers to your questions!

Ever faced a nagging low backache that won't go away? You could be dealing with sciatica. Sciatica or sciatic nerve pain is not a diagnosis, but is a symptom of a deeper problem. Sciatica is a pain in the lower limb and back due to compression or inflammation of nerves exiting from the lower vertebrae due to disc prolapse/herniation/ protrusion. Discs in vertebrae provide cushioning to the vertebrae during movement. The spinal nerves of the lower limb emerge from both sides and get inflammed due to disc prolapse. Inflammation can be controlled by depositing anti-inflammatory drugs with a non-surgical technique using fluroscopy, called spinal root block. If the disc prolapse is severe it can cause weakness of the lower limb or difficulty in controlling bladder/ bowel movement, surgery is performed to remove offending disc. Many times symptoms dissolve with nerve medications along with physical therapy.

Conditions that trigger sciatica include degenerative discs, spinal stenosis, a herniated disc in the lumbar region or spondylolisthesis. Whether your sciatica pain is persistent or sporadic, it can make routine tasks difficult to perform. The good news is that there are a number of remedies to ease this pain and improve the health of your spine.

1. Hot and cold therapy: Sciatic pain that extends down to the thighs can be relieved by alternating between a heat pack and an ice pack. Each pack can be applied for about 20 minutes at a stretch every two hours. However, this does not treat the sciatic nerve itself.
2. Pain medications and steroid injections: Over the counter pain medication like ibuprofen or muscle relaxants can help alleviate pain and reduce inflammation. In chronic cases, epidural steroid injections may also be prescribed to address the inflammation and pain. Pain relief provided by medication and steroid injections can last for a few days or a few months depending on the person.
3. Yoga: Sciatica patients looking for long-term relief often turn towards alternative forms of treatment like yoga. Yoga helps strengthen muscles, increases flexibility and improves posture. This is more beneficial towards preventing sciatica problems from arising than treating ongoing sciatic pain. When practicing yoga with a sciatica problem, it is very important to understand your body's limitations and not overextend your back muscles.
4. Massage: A massage that treats sciatic pain is very different from the usual massage, you may get at a spa. A massage can be done to relieve sciatic pain involves putting pressure on the inflamed part of the back and the piriformis muscle. This is the muscle is located on the sciatic nerve and can trigger sciatic pain. In most cases, 3 to 4 massage sessions at intervals of 7 to 10 days can have effective results on sciatic pain.
5. Physical therapy: Sciatica patients often find the slightest movement extremely painful. While lying in a bad is tempting, it can actually worsen the pain. Exercise increases blood flow to the spine and helps flush out toxins. Going for a walk, light aerobics or swimming are ideal ways for a sciatica patient to exercise.
6. Chiropractic manipulation: This involves realigning the spinal column and is an effective way of treating underlying conditions that trigger sciatic pain. These spinal adjustments should only be performed by licensed chiropractors or osteopathic physicians.

In case you have a concern or query you can always consult an expert & get answers to your questions!

The neck and back are closely related, and pain in one area can easily affect the other. Both neck and back pain have become lifestyle problems, due to prolonged sitting and incorrect working postures. Treating one area can help in subtly treating the other and also reduce the onset of pain.

Pain in neck and back can be due to strained muscles, wrong posture, injury or stress due to knots in muscles and can be easily treated with a number of ways such as physical therapy, muscle relaxants and trigger point injection. Also, facet joint arthritis occurs due to degeneration of joints in elderly, excessive strain in some type of jobs or injury. Physical therapy along with injection in the nerves that carry a message from these joints to the brain along with medications that can numb sensation and Radiofrequency Rhizotomy for long-term relief is performed by pain specialists. Disc prolapse of neck/ lumbar vertebrae can also cause back pain.

Read on to know the best ways to manage back and neck pain, as the following techniques work for both.

• Ice and heat therapy: Alternating heat and ice therapy can help reduce pain. It helps by reducing the sensation of pain and improving blood flow, thereby providing relief.
• Physical therapy: Exercising and stretching, whether as a preventive measure or as a part of therapy, can work wonders. It improves the agility of the bones and tendons, improves movement, reduces stiffness, and relieves pain. A program should be drawn up based on the patient’s overall health condition and symptoms. Patients should be monitored for any improvements or changes in symptoms.
• Pain medication: When nothing else works, then pain medications become the next course of action. These can be taken for immediate relief, but cannot treat the pain permanenetly.
• Steroids: Injecting corticosteroids into the bone and joint spaces can help with acute pain management.
• Collar or brace: A neck collar or brace is used to keep the neck in place to reduce movement and provide support, thereby, it helps in reducing pain.
• Acupuncture: Each area has associated pressure points in the body. These pressure points are identified and needles are applied to provide relief from pain.
• Massage: The Massage can help by stimulating tissues, improve blood flow and also to relax muscles. The herbal oils that are used provide added benefit too, and so periodic massages are being widely used for pain management of neck and back.
• Chiropractic therapy: This involves manipulation of the spinal cord with the belief that the spinal cord could be incorrectly settled. The cord is manipulated to get it to the correct location, thereby relieving pain and stiffness and improving movement
• TENS (transcutaneous electrical nerve stimulation): The nerve in the affected area is stimulated by electrical impulses, thereby providing pain relief. This needs to be repeated at frequent intervals and is often reserved for acute cases.
• Surgery: Often, used as a last resort, where all other measures have failed. Whether it is a herniated disk or a pinched nerve, the cause is identified and then surgery planned. In case you have a concern or query you can always consult an expert & get answers to your questions!