Dr. (Maj) Pankaj N Surange

Hello! I am Dr. (Maj) Pankaj N Surange. I am intervention and pain specialist. And I am director of IPSC India - Pain and Spine Center. We have branches all over India. We have branches in Delhi, Gurgaon, Visakhapatnam, Jammu, and Hyderabad.

So, let me tell you about interfascial pain. This is a new type of pain. In this, we don't have to do the surgical treatments. Normally, when we go for pain management for chronic patient, we go for the medical management, physiotherapy, exercises. If that is not helping, then we have other options called interventions. We do this treatment under ultrasound guidance and CT guidance. We localise the painful area and we try to resolve that particular area.

Now I will give you some examples. We will take an example of compression fracture of the spine. Few years back, the only option with us was to open the spine and fix them with screws. So, that was the major surgical procedure. Now, with the help of the spine interventions, we can fix the same without opening it with the help of a new treatment. We can put cement inside and can fix the fractured vertebrae without opening the spine. Another example we can take of heart patients, patients with cardiac problems.

Earlier the option was bypass surgery. But now with the help of angioplasty, we can do the treatment under fluoroscopic guidance. We can go inside and can remove the damaged part. So, that is possible with the help of cardiology interventions. Another problem nowadays we are seeing with those people who have a sitting job for long hours, they have the problem of slip disc or prolapsed disc. A few years back, we had the option of conservative management. We used to give them the drugs for 2-3 months. But that is not possible nowadays.

A patient cannot sit at home for 2-3 months at home, as this is a competitive world. So, patient needs an urgent treatment which can be done without opening spine or any surgery. The pain is coming from the leg and going down in the legs. So this pain is because of the compression of the nerves. Now with the help of endoscopy which is called as spine intervention, we can go inside with a small hole, we can remove that damaged part and nerve can be decompressed without opening the spine. The same day patient can go home.

Even with the spine fracture, we can discharge the patient on the same day. The complications are less. Within 3-4 days patient doesn't feel any pain. Anther advantage is cost - the cost factor is very less.

So, don't worry about the back and chronic pain problems. Now you don't have to suffer with the pain for long. We are here to help you out. You can reach us via lybrate.com. You can book an appointment through Lybrate. You can also take the audio and video consultation through Lybrate. You can visit at our Delhi, Gurgaon, Visakhapatnam, Jammu and Hyderabad center.

If you suffer from rheumatoid arthritis, you may be at a high risk of developing Carpal tunnel syndrome. This is a very painful condition in which the hands and wrists are affected. The Carpal tunnel refers to a structure which is formed by the bones present in the wrist and the surrounding connective tissues, through which the nerves and tendons controlling the thumb movement pass. Carpal tunnel syndrome occurs when the connective tissues get swollen because of inflammation and the nerves passing through the tunnel are crowded and squeezed.

Ways to get relief from Carpal tunnel syndrome:

Here are some common ways by which a patient with Rheumatoid arthritis can get relief from any discomfort caused due to Carpal tunnel syndrome:

1. Get your Rheumatoid arthritis treated. Carpal tunnel syndrome is commonly caused because of an underlying sickness such as rheumatoid arthritis. Medicines such as disease modifying anti-rheumatic drugs are used to manage the condition and for reducing inflammation which causes carpal tunnel syndrome.
2. Getting enough rest is also very important. You must avoid using that hand or wrist, which has been affected for some weeks. This will allow the inflamed tissue to heal. 
3. You may wear a wrist splinter. A splint is suggested for resting your wrist therefore, it is kept in a neutral position. It can be worn during the day or when you are sleeping.
4. You can take prescribed non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief. These also help in reducing the swelling of tissues within the carpal tunnel.
5. A Cortisone shot may also be effective for easing the carpal tunnel syndrome. These steroid injections are given directly into the carpal tunnel. You will be able to get temporary relief from pain.
6. A set of Carpal tunnel exercises have been developed by doctors. These are designed for stretching the wrists and for keeping them limber. You must perform these exercises on a regular basis for best results. Yoga is also effective for easing carpal tunnel syndrome. Performing regular yoga will help you to improve your wrist pain. The upper joints of the body are strengthened. 
7. Take breaks at work on a regular basis. By changing your position and taking short breaks, your Carpal tunnel symptoms are bound to improve. This is more essential for people who do a job where great stress is placed on the wrists. If you are into typing, you need to take breaks and stretch your wrists.

There are several alternative therapies for easing carpal tunnel syndrome, which  are being studied and researched on. They include the likes of acupuncture, chiropractic care, magnets, botox treatments and vitamin B6 supplements. If you wish to discuss any specific problem, you can consult a pain management specialist.

If you suffer from chronic pain of any kind, it is important for you to know that it is associated and linked with your emotions. Other than your physical activities and personal relationships getting hampered, unwanted feelings like resentment, stress and frustration are also common. These emotions and feelings are capable of making your chronic pain condition more worse. 

The Relationship between your mind and body: Your mind and body work together and cannot be separated. Your mind controls all your thoughts and also affects the way in which pain is controlled or perceived by the body. Pain and the fear of pain may lead you to avoid activities. This may reduce your physical strength and cause disruption in the functioning of your body.

Stress: Stress affects your body both physically and emotionally. It may lead to an increase in your blood pressure, breathing rate, heart rate and muscle tension may also occur. These may lead to fatigue, appetite changes and sleep disruption. Stress also causes depression, anxiety, make you dependent on drugs and make you dependent on other people.

Depression: Depression is common among chronic pain patients. Chronic pain can make cases of existing depression much more worse and the existing pain is also worsened. There are chances of developing depression from chronic pain if depression runs in your family or genes. 

Symptoms of Depression are as follows:

1. Feeling sad, angry, worthless and hopeless frequently
2. Lack of energy
3. Lack of interest in regular activities
4. Difficulty in sleeping
5. An increase or decrease in appetite, which may lead to major weight gain or weight loss
6. Difficulty with concentration
7. Having suicidal thoughts and thoughts about dying or harming oneself

How to Handle your Emotions during Chronic Pain: A common therapy, which people with chronic pain undertake is called Cognitive Behavioural therapy. You should seek the help of a therapist. In this therapy, you will learn about thinking in a positive way instead of drowning in negative thoughts. Your fear of pain will be reduced and you will learn how to strengthen important relationships. You will be able to develop a sense of freedom from chronic pain. 

If your chronic pain occurs due to an accident or emotional trauma, you may be assessed for post-traumatic stress disorder (PTSD) by your healthcare provider. Many patients suffering from PTSD cannot deal with their pain until the emotional stress is dealt with. If you feel depressed and cannot control your emotions, you need to consult a doctor. If you wish to discuss any specific problem, you can consult a pain management specialist.

If you are suffering from back pain, you should know that the tiniest of movements can trigger the same. Back pain may occur due to several factors or reasons and it hampers your daily activities and standards of life to a great extent. However, you need to become active instead of being immobile for relieving back pain. There are several exercises which help in strengthening your back muscles and performing these on a regular basis will provide you relief from back pain drastically. Here are 7 common exercises which you should carry out:

1. Pelvic tilt: You have to lie on your back and keep your knees bend, but touching. Your feet should stay flat on the floor. By flattening your lower back against the wall and tilting your pelvis downwards, you must maintain the position for 20 to 40 seconds. Meanwhile, you must breathe slowly and deeply and then release. This stretch requires small movements for reducing tension, thereby easing your back pain.

2. Lumbar stretch: You need to sit on a chair, roll your head, chest, neck and lower back forward till your head gets between the knees. Hold the position and take deep breaths. Slowly, get back to the sitting position. Repeat this twice.

3. Cat position: You have to kneel on your fours and keep the knees and hip width separate. Keep the stomach muscles tense, arch your back like a cat does and maintain the position for five seconds. Repeat this and then allow your stomach to drop towards the floor direction and hold it for five seconds again.

4. Curl ups: For this exercise, you should lie on your back with the knees bent and your feet kept flat on the floor. Placing your hands behind the head will make the stomach muscles tense. Then, lift your shoulders, head and upper back from the floor. Do this around 10 times. This is ideal for strengthening your back.

5. Dry swimming: Begin by lying on your stomach, keeping a rolled-up towel under your belly for support. By tightening your buttocks, raise one arm and the opposite leg simultaneously. Switch your arms and legs and perform this for about two minutes.

6. Leg lift: For leg lifts, you should lie on your back with the knees kept bend and the feet kept flat on the floor. You have to press your lower back to the floor and straighten a leg with the knees aligned. After bending your leg, return to the starting position and repeat the exercise on the other side.

7. Cobra stretch: The cobra stretch is another ideal movement for stretching your tight abdominal muscles and lower back. You need to lie on your stomach with your legs extended and your palms planted on the sides of your head. If you wish to discuss about any specific problem, you can consult an orthopedist.

It is important for you to know about degenerative disc disease (DDD) and spondylosis. Spondylosis is an umbrella term for spine pain, which occurs because of degenerative conditions. Spondylosis refers to several conditions. They include spinal stenosis, which is the abnormal narrowing of the spinal canal, leading to leg pain, degeneration due to DDD and degenerative arthritis or osteoarthritis involving the spine. It may also include cervical osteoarthritis or neck arthritis.

About spondylosis

Spondylosis is a common condition, which is age related. The joints and discs present in the neck are specifically affected as a result of this condition. It commonly develops on account of the wear and tear of the cartilage and bones present in the neck. This condition, in spite of being common, worsens with age. In many patients, symptoms are not observed externally, but pain and muscle spasms are experienced.

Many people with spondylosis do not undertake treatment in spite of suffering from the symptoms and pain. In case the symptoms are prevalent over a long time and tend to worsen, you have several modes of treatment to choose from. They may include medicines, corticosteroid injections, physical therapy and even surgery in some extreme cases.

How does DDD or spondylosis occur?

DDD is a spinal condition. It is caused due to the breakdown of the intervertebral discs. With ageing, the spine starts to show signs of wearing and tearing. This happens on account of the discs drying out and shrinking. All these age-related changes are responsible for arthritis, spinal stenosis and disc herniation. Because of these factors, pressure is likely to fall on your nerves and spinal cords, which may further cause back pain. DDD or spondylosis also develops on account of these factors.

Treatment for DDD and spondylosis

There are various modes of treatment, which are available for you to choose from in order to get relief from the symptoms and pain associated with DDD or spondylosis. You may be prescribed typical painkiller medications, such as non- steroidal anti-inflammatory drugs or NSAIDS, muscle relaxants, epidural injections, ultrasound and massage, oral steroids, transcutaneous electrical nerve stimulation (TENS) and many more. Every mode of treatment has got its own benefits, but has its limitations as well.

If you experience any symptoms of DDD or spondylosis, you must consult a doctor immediately. Your pain management physician or doctor will be able to diagnose your condition properly and will determine the mode of treatment which will suit you best.

Poor posture while sitting, standing, lying down or moving around is a major cause for back pain. Sitting and standing for long time put considerable pressure on the lower back in fact, standing exerts up to five times more pressure than lying down, and sitting is even more strenuous.

Learn about the importance of good posture

Good posture can help prevent back pain, neck pain, muscle and ligament strains, compressed nerves and other injuries. It also has a number of other positive health effects and can be beneficial physically, mentally and emotionally. Good posture improves your appearance and helps you project self-confidence.

Recognize the symptoms of bad posture

Signs and symptoms of poor posture include slumped or rounded shoulders, protruding abdomen, excessive curve in the lower back (swayback) as well as back and neck pain and headaches. Problems in the neck is one of the major cause of headaches.

Maintain a healthy weight

Carrying excess weight can put extra strain on your back and abdominal muscles and lead to bad posture. Walking is one of the best ways to improve posture and lose weight.

Choose a firm mattress to support your spine

Try to avoid sleeping on your stomach the best sleeping position for your back is on your side with your knees bent. Make sure your pillow supports your neck in a straight position to prevent neck pain and sore muscles. Your mattress should not be too soft and too hard. Best is 40 density foam mattress.

Avoid wearing high heels and platform shoes

Make sure your shoes fit properly and offer good support especially when you're on your feet a lot during the day and when you're exercising. High heels throw your back out of line and adversely affect posture. They should be worn only for short periods of time, if at all.

Minimize stress on your lower back

Don't stand too long in one position. Rest one foot on a low stool or another stable object and frequently shift your weight from one leg to another. To relax, bend from your waist and let your head, neck, shoulders and arms hang down briefly.

Learn about sitting, posture and back pain

Extra pressure exerted on the back when sitting comes from the upper body shifting forward, forcing the back muscles to strain to hold you upright. Slouching increases pressure on your lower back 10 to 15 times more than lying down.

Choose a chair that firmly supports your lower back

For long periods of sitting, choose a straight chair without heavy padding. The chair should fit under your desk or table so that you maintain your upright posture. Armrests are helpful to support some of your weight, especially when shifting position.

Sit firmly back in your chair

Keep your shoulders against the chair back, your chest lifted, and your upper back straight. A rolled up towel or small lumbar pillow can provide extra support. When working at a desk, bring your chair close enough that you needn't lean over. Your feet should touch the floor comfortably.

Make adjustments while you work

If you're typing or working at a computer, make sure that all of your work is at a comfortable level. Looking up or down for long periods of time can put stress on your neck, shoulders and upper back muscles. If possible, get up, stretch and move around often.

Use proper techniques when lifting

Good posture is important—not only when sitting, standing or lying down, but also when moving and lifting whether at home or on the job. It's important to maintain good posture and lift with your legs and arms to reduce your risk for back pain.

Learn how to maintain good posture while driving

When driving, position your seat so that you can easily reach the steering wheel, brake and accelerator. If possible, try to adjust your knees slightly higher than your hips. On long drives, change your seat position occasionally and stop every couple of hours to stretch and walk around. Avoid slumping or sitting in a twisted position for example, with your elbow resting heavily on the windowsill. If your seat doesn't provide enough support, try a seat pad, rolled up towel or lumbar roll. Reposition your hands on the wheel frequently to reduce upper back and neck strain.

Know when to contact spine and pain specialist

If your back or neck pain worsens or becomes chronic in spite of home remedies to improve your posture, seek medical attention. Your doctor, on examination and depending on severity, may recommend diagnostic tests like x ray or mri. Physiotherapy and exercises should only be performed on advise of your doctor. You may ask your physiotherapist to discuss with your doctor.

Ozone in pivd/slipped disc

In case of prolapsed inter-vertebral disc (or, slipped disc) different other mechanism acts. Inter-vertebral disc is filled with nucleus pulposus which is a jelly like material which holds water (90% of disc material is water). When ozone is injected into the disc the proteo-glycan bridges in the jelly-like material are broken down and they no longer capable of holding water. As a result disc shrinks and mummified which is equivalent to surgical discectomy and so the procedure is called ozone discectomy or ozonucleolysis. It has been published in anesthesia and pain journals that up to 85% of disc operation can be avoided with these non-surgical interventions. Success rate is about 88% which is comparable to surgical discectomy (50% to 90%). Complications are remarkably low and much less than surgery.

Ozone therapy

Minimally invasive procedure using small needle and probe to remove disc material of prolapsed disc, releasing pressure on nerves and relieving pain in most of the patients of prolapsed / bulging / slipped disc.

Rotating probe is inserted through needle into the disc under x-ray/ fluoroscopic guidance

Rotating tip removes small portion of disc material. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable

Insertion site covered with bandage. Recovery is fast as unlike surgical decompression no bone or muscle is cut. 2-3 days of bed rest and may return to normal activity within one week.

Ipsc india has been pioneer in ozone discectomy or ozonucleolysis for slipped disc or prolapsed disc. We have treated thousands of patients not only from across india but also international patients from usa, uk, nigeria, afghanistan, iraq, bangladesh, nepal and saudi arabia. We have the original, closed circuit-self calibration ozone machine, imported from italy.