Dr. K J Choudhury

Pain management, pain medicine, pain control or algiatry, is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with chronic pain.

Lower back pain is fast becoming an epidemic not just among elderly, but across all age groups. Primary causes of back pain are quite a few including lumbar hernia, disc degenerative disease (DDD), spondylosis etc., but the symptoms are usually the same excruciating pain in the lower region of the spine, followed by stiffness. Since back pain is caused due to a number of spinal problems, it manifests differently in different patients. The pain may be dull, burning or sharp. It could also be felt at a single point or over a broad area and could be accompanied by muscle spasms or stiffness or even shooting pain in one or both legs.

Back pain can also be differentiated according to time period:

1. Acute: Pain lasts for less than three months.
2. Recurrent: Acute symptoms reoccur over time.
3. Chronic: Pain lasts longer than three months.

Sometimes symptoms resolve on their own, but in many cases conservative treatment, such as physiotherapy, which often work better than surgery, becomes essential. Alternate therapies like surgery, acupressure, acupuncture as well as yoga and Ayurveda also help.

Physiotherapy - Exercises that work
Since the reason for low back pain is not always same, a patient’s treatment too should be tailored for his specific symptoms and condition. This is what the physiotherapist will do design an exercise plan based on the patient’s specific problem and its cause.

Physiotherapy treatments may include:

1. Manual therapy, which includes direct spinal manipulation aimed at improving the mobility of joints and soft tissues
2. Strengthening and flexibility exercises
3. Education about what do and what not to do
4. Training for proper sleeping positions, lifting, bending, and sitting as well as for working at home and at work
5. Use of heat/cold treatments or electrical stimulation to help relieve pain

Physiotherapy exercises help support the back and strengthen muscles so that the spine is cushioned properly. This is why physiotherapy is relevant as a treatment for backache. Treatments like traction help in lengthening the spine and relieving compression of nerves that cause sciatica, radiating pain into legs largely due to lumbar herniation. If back pain is extreme, a patient will require physical therapy along with medication, which will help in managing pain and bringing inflammation down. But in the long term, being physically active, going for walks, sitting properly and maintaining a good posture will help the most. In case you have a concern or query you can always consult an expert & get answers to your questions!

I am Dr. K J Choudhury, senior consultant in pain management and in charge of pain clinic in Indraprastha Apollo Hospital, New Delhi.

Many people don't know what pain management is about. Though people know that pain is the issue with every family. And I am sure, in every family, there must be a member who is suffering from pain from 2-3 months like joint pain, headache, neck & back pain. Generally, the treatment given for any pain or painkillers is given for a time period, and if they don't subside, they seek surgical opinion from an orthopedic or neurosurgeon. But every pain does not require the surgery. So, pain management, or as we call it interventional pain management, delivers the medications where the problem is without cutting.

The drugs you normally use by mouth, they circulate all over the body through blood. But the area that requires the treatment may be a 1 mm area, so the whole body is loaded with medications. If we misuse the painkillers, it becomes an important cause of kidney failure and liver failure.

What does a pain physician do? They look at the exact source of pain. They use the specialized technique to teat the pain. And they deliver the medications mostly through needles using specialized equipments like x-ray or ultrasound to reach to the target so as they stay where it is required. So, the rest of the body is safe from the ill effect of painkillers. But all the patients do not need any surgical interventions. It is not necessary that all the painkillers will work for every painful condition. So, the pain specialist also knows that what kind of painkillers or what exponents are required.

So, I will tell you about back pain. It is common today amongst those who are not physically fit and use wrong posture while using computers, bicycles. They stress on the muscles and that could be because of pain. But if it doesn't subside with medication and physiotherapy, you can go to a surgeon who will ask you for the MRI.

Now the question is whether the disc is the cause of the pain. So, what we do is, between the 2 vertebrae, it contains a gel. When the covering breaks down because of the poor body strength then these gel causes irritation of the nerves that are going down to the legs and it is called sciatica. The most common thing is that we enter into the place where the disc material is irritating the nerve and put the healing agents.

We don't have to treat inflammation with a surgical technique. But if the patient has the unstable spine or there is a tumor or there is the narrowing of the bony canal in the spinal cord then it needs a surgical intervention. My idea is to educate you that not every patient who fails medications, require surgery. There is a much safer procedure to take care of pain anywhere in the body. Thank you very much.