Common Specialities
{{speciality.keyWord}}
Common Issues
{{issue.keyWord}}
Common Treatments
{{treatment.keyWord}}
Dr. Neeraj Jain - Pain Management Specialist, New Delhi

Dr. Neeraj Jain

87 (19 ratings)
MBBS, MD, FIMSA, FIPP

Pain Management Specialist, New Delhi

36 Years Experience  ·  500 - 600 at clinic  ·  ₹300 online
Dr. Neeraj Jain 87% (19 ratings) MBBS, MD, FIMSA, FIPP Pain Management Specialist, New Delhi
36 Years Experience  ·  500 - 600 at clinic  ·  ₹300 online
Submit Feedback
Report Issue
Get Help
Feed
Services
Reviews

Videos (1)

Why is pain management so important?

Why is pain management so important?

read more

Personal Statement

Pain Is Real & Treatable; There is no merit in Suffering! Enjoy a pain free Life!!!...more
Pain Is Real & Treatable; There is no merit in Suffering! Enjoy a pain free Life!!!
More about Dr. Neeraj Jain
Having been in the field for over 35 years, Dr. Neeraj Jain has dealt with thousands of pain management cases with varying pains - from normal to the severe ones. He is an MBBS, MD, FIMSA, FIPP. Book an appointment online with Dr. Neeraj Jain on Lybrate.com. Lybrate.com has an excellent community of Pain Management Specialists in India. You will find Pain Management Specialists with over 38 years of experience on Lybrate.com. Find the best Pain Management Specialists online in New Delhi. View the profile of medical specialists and their reviews from other patients to make an informed decision. Dr. Jain is a Senior Consultant Interventional Spine & Pain Specialist Of International repute, represented India in International World Congress. He acquired his training in pain management from AIIMS, New Jersey & Pain Centre, Texas, USA, he is fellow of Interventional Pain Practice (FIPP) from Cleveland Clinic, USA. He was conferred Fellowship Of International Medical Sciences Academy (FIMSA) held at Ajman. Dr. Jain graduated from AIIMS. He completed basic training from John Hopkins, Spine Clinics and attained specialist postgraduate qualifications from New Jersey & Pain Centre, Texas, USA - fellow of Interventional Pain Practice (FIPP) from Cleveland Clinic, USA and fellow of International Medical Sciences Academy (FIMSA) held at Ajman. He subsequently completed advanced training on spine endoscopy at Miraj and Stitch Less Lumbar (MISS) disc surgery at Pune by Dr. Gore accredited by Asian Academy Of Minimally Invasive Spinal Surgery, International Musculoskeletal Laser Society And International Intradiscal Therapy Society. He also contributed in “Dannemiller Intensive Pain Review Course 2010” at Chicago, USA. Dr. Jain made more than 150 National & International presentations & guest lectures. Dr. Neeraj Jain actively participated in First World Pain Symposium 2013, world congresses on pain 2012, in Miami, USA, 2010 in Montreal, Canada, 2008 in Glasgow, UK, and 2005 in Sydney, Australia. He was delegate at revered “International Pain Summit 2010” at Canada, for “Montreal Declaration” of “Pain Relief Is Human Right” which was a combined effort of IASP (International Association For Study Of Pain) and un human right group. He has received many accolades both for his academic & social works. He has been pivotal in many National & International Pain Conferences as speaker, panellist, chairman, judge of competitions & trainer of cadaver workshops. Furthermore, Dr. Jain has pioneered ultrasound-guided or CT-guided pain management interventional procedures for chronic pain, fractured spine, spine disc pain, or cancer. He has a large series of successful Percutaneous needle Discectomy with Balloon Neuroplasty, Vertebroplasty & Kyphoplasty to his credit. He has done an excellent work of six level vertebroplasties in a single sitting presented in World Congress on Pain in Miami, USA. His innovative work on balloon neuroplasty is biggest series in the world followed by a South Korean group. You can consult Dr. Neeraj Jain personally at Spine Disc & Pain Clinics, Pitampura, New Delhi or online at Lybrate.com through the medium of text or phone consultation.

Info

Education
MBBS - Maulana Azad Medical College, New Delhi - 1982
MD - Delhi University - 1988
FIMSA - Gulf University, Ajman - 2012
...more
FIPP - Cleveland Clinic Ohio - 2010
Past Experience
Senior Consultant at Rajiv Gandhi Cancer Hospital
Senior Consultant at Sant Parmanand Hospital
Incharge at Spine & Pain Clinic, Max Hospital, Pitampura
...more
Incharge at 2007 - 2016 Balaji Action Medical Institute & Action Cancer Hospital
Incharge at Spine & Pain Clinic, Max Hospital, Shalimar Bagh, New Delhi
Incharge at Spine & Pain Clinic, Ayushman Hospital, New Delhi
Languages spoken
English
Hindi
Punjabi
Awards and Recognitions
Best New Innovation Paper Award
Best Endoscopic Spine Surgeon Award
Professional Memberships
WIP world Institute of pain 582
International Association of Study of Pain 09271
Indian Medical Association (IMA)
...more
ISSP J70
MAMCOS

Location

Book Clinic Appointment with Dr. Neeraj Jain

Spine Disc & Pain Clinics

RU-23 PitampuraNew Delhi Get Directions
  4.3  (19 ratings)
500 at clinic
...more

Spine Disc & Pain Clinics

RU - 23 Pitampura , Near Power House,Delhi Get Directions
  4.4  (19 ratings)
500 at clinic
...more

Max Hospital Shalimar Bagh

FC-50, C & D BlockNew Delhi Get Directions
  4.4  (19 ratings)
500 at clinic
...more

Max Hospital Pitampura

HB Twin Tower, Near TV Tower, Wazirpur District CentreNew Delhi Get Directions
  4.4  (19 ratings)
600 at clinic
...more
  4.4  (19 ratings)
600 at clinic
...more
View All

Consult Online

Text Consult
Send multiple messages/attachments. Get first response within 6 hours.
7 days validity ₹300 online
Consult Now
Phone Consult
Schedule for your preferred date/time
10 minutes call duration ₹500 online
Consult Now
Video Consult
Schedule for your preferred date/time
10 minutes call duration ₹800 online
Consult Now

Services

View All Services

Submit Feedback

Submit a review for Dr. Neeraj Jain

Your feedback matters!
Write a Review

Patient Review Highlights

"Very helpful" 1 review "knowledgeable" 1 review

Reviews

Popular
All Reviews
View More
View All Reviews

Feed

Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Vertebroplasty (PVP) / Kyphoplasty - Approach To Management Of Vertebral Body Fractures!

As life expectancy is increasing so is the incidence of vertebral body (VB) fractures now being the commonest fracture of the body. PVP is an established interventional technique in which bone cement is injected under local anaesthesia via a needle into a fractured VB with imaging guidance providing instant pain relief, increased bone strength, stability, decreasing analgesic medicines, increased mobility with improved quality of life and early return to work in days.

In this era of minimally access surgery replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression fracture spine.

Morbidity & consequences of spinal fracture:

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory & GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc element
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.
  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Results / Outcome

  • PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral.
  • Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  • PVP does augment height of VB but ideal would be kyphoplasty
  • Patient is either off medicine or on reduced doses.
  • Patient feels so well that he almost forgets if he had VB
     

Percutaneous Vertebroplasty (PVP) is an emerging interventional technique in which surgical polymethyl methacrylate bone cement is injected under local anaesthesia via a large bore needle into a vertebral body (VB) under imaging guidance providing increased bone strength, stability, pain relief, decreased analgesics, increased mobility with improved QOL and early return to work. Started in 1984 by Galibert PVP is done in host of indications.

Senile osteoporotic compression remains the commonest Indication. Other indications are  Metastatic VB,  Multiple myeloma VB, VB haemangioma,  Vertebral osteonecrosis & for strengthening VB before major spinal surgery. The benefit has been extended to the traumatic stable uncomplicated VB compression (VCF)   which is commoner in younger age group with active life profile and prime of their career where strict bed rest and acute or chronic pain are unacceptable and they are more demanding for proactive treatment approach so as to be back to work ASAP.

Discovering the fact that VB is the commonest of body, its incidence >the hip, it becomes imperative to take it more seriously. With increasing life-span there is more of aged osteoporotic population, more so due to sedentary indoor lifestyle and post menopausal osteoporosis.  Diabetics, smokers & alcoholics are at higher risk of developing osteoporosis. I have seen such alcoholic patient developing six spine fractures in just three months time from a single fracture being on complete bed rest.

Quick fix of fracture spine makes patient walk back same day instead of bed rest of months together avoiding morbidity & mortality of prolonged bed rest, making bedridden patient walk, in a way bringing patient  back to normal life.

In this era of MAS replacing open surgeries, PVP is a novel procedure & should be in the first line of management in place of conservatism or major spine surgery for painful uncomplicated compression.

Morbidity & consequenses of spinal 

  • Traumatic VB is a painful condition requiring bed rest restricting daily activities markedly.
  • Left untreated it can cause DVT, increase osteoporosis, loss of VB height, respiratory &
  • GI disturbances, emotional & social problems secondary to unremitting pain, loss of independence with high cost of rehabilitation.
  • High risk of primary or consequential damage to neural, bony or disc elements.
  • Increased wedging, deformity & increase incidence of adjacent VB
  • Chronic pain of altered spine mechanics.
  • Uncomfortable braces & sleep disturbance because of pain & discomfort with its sequels.

Morbidity and complication of spinal surgery 

  • Cost of surgery and hospital treatment
  • Cost of implants
  • Phobia of surgery
  • Prolonged recovery period & Extensive rehabilitation
  • Changed spinal mechanics & transition syndrome
  • Major surgery & anesthesia with its own complications

Preparation & Procedure:
X-ray spine in a/p & lat view. CT is more informative of bone & morphology. MRI is good for soft tissue injuries. Ask for pedicle size in all dimensions and construct a 3D image aiming needle placement and cement filling in scan room itself as rehearsal of PVP. This reduces operative time & gives better results. Conventionally PVP is done by hammering the vertebroplasty needle through the bone. Here we use light weight drill to bore through the vertebra. It is important to set the needle at exact entry site & side with right trajectory aiming the defects.

In lateral view needle should go through middle of the pedicle going up to anterior 1/3 of VB. In P/A view the needle can be in midline or paramedian depending upon & if uni/bipedicular approach is planned. Approach varies as per location of vertebra, anterolateral in cervical, costotransverse/parapedicular in thoracic & transpedicular in lumbar vertebra.

Do bone biopsy if there is any doubt about lession. Do dye test (vertebral venography). Make cement more radiopaque by adding barium /or tungsten. Inject cement with 1or2 ml luerlock syringes strictly under fluoroscope in lateral view & cross checking in P/A view. Stop injecting either there is adequate filling or at the first sight of ectopic cement leak. Keep sample cement to see for hardening. Remove needle with rotational movement before cement hardens.

Pain relief is by virtue of different mechanisms postulated :

  • Cementing of fragments.
  • Thermal neurolysis of VB nerve ending due to heat of polymerization.
  • Washing away of nociceptor chemicals.
  • Neurolytic action of liquid monomer.
  • By allowing early ambulation decreasing pains of immobility & bed rest.

Complications 

  1. PVP is generally safe with low risk.
  2. Ectopic cement leak is frequent but generally inconsequential.

Outcome 

  1. PVP is a novel procedure with high benefit to risk ratio, which is highly underutilized in relation to the high prevalence of the vertebral
  2. Different studies show an immediate pain relief in (85 – 90)% of patients with low complication rate ranging from (1-5)% depending upon the type of lesion.
  3. PVP does augment height of VB but ideal would be kyphoplasty.
  4. Patient is either off medicine or on reduced doses.
  5. Patient feels so well that he almost forgets if he had VB

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

4342 people found this helpful

Texting Non Stop - Can It Be The Reason Behind Your Sore Thumb?

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Texting Non Stop - Can It Be The Reason Behind Your Sore Thumb?

All you teenagers, young guns and cell phone addicts out there! Next time you are exchanging any text message with your friends or colleagues, beware! You may end up suffering from sore wrists & thumbs and repetitive strain injury. Every year, more than 3 million people across the globe complain of injuries resulting from text messaging. People tend to hold the device in their fingers and press the tiny keys with their thumbs which results in numb fingers, painful thumb and aching wrists. It is a signal to stop.

Blackberry Thumb and iPhone finger are few of the hand ailments caused by this method of typing or pressing your phone keys. At first, you will feel a slight discomfort in your thumb and ignoring it would soon lead to its painful swelling. Following are some tips that would help you get some relief from this condition before you consult a pain specialist:

  1. Outward thumb bending: Bend your thumb towards the outward direction applying resistance until you feel the stretch or pull.

  2. Thumb Rotation: Rotate your thumb in both clockwise and anti-clockwise movement to loosen the stiffened joints and relieve pain.

  3. Hot Fermentation: Treat your aching thumb with hot water fomentation to increase blood circulation and help the joint muscles to relax. Add 1 teaspoon Epsom salt in a small vessel of hot water. Soak a towel in the saline water. Squeeze out excess water and place the towel on the affected area. Repeat this 5 times.

  4. Wrap your thumb safely: To avoid any pressure on your paining thumb, keep it safe and padded at night by wrapping it in a soft bed of cotton.

Rest: Stop doing what makes your thumb hurt. Put a halt to your daily routine of texting. It won’t do any harm. This important pause will, in fact, allow the thumb to start healing otherwise surgery may be required which also doesn’t guarantee a cure.

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

4162 people found this helpful

Procedures That Can Help Treat Slip Disc & Sciatica!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Procedures That Can Help Treat Slip Disc & Sciatica!

The intervertebral discs are made-up of two concentric layers, the inner gel-like Nucleus Pulposus and the outer fibrous Annulus fibrosus. As a result of advancing age, the nucleus loses fluid, volume and resiliency and the entire disc structure becomes more susceptible to trauma and compression. This condition is called as degeneration of the disc. The disc then is highly vulnerable to tears and as these occur, the inner nucleus pulposus protrudes through the fibrous layer, producing a bulge in the intervertebral disc. This condition is named as herniated disc. This can then cause compression to the spinal cord or the emerging nerve roots and lead to associated problems of Sciatica radiating pain from back to legs in the distribution of the nerve. Other symptoms could be a weakness, tingling or numbness in the areas corresponding to the affected nerve. Sometimes bladder compromise is also present, which is made evident for urine retention and this need to be taken care as an emergency.

Excessive weight, bad postures, undue movements, improper weight lifting and other kinds of traumas may weaken the intervertebral discs. When this occurs the pulpous nucleus will bulge against the annulus, or even be squeezed through it (extruded disc).

The first steps to deal with a herniated or prolapsed lumbar disc are conservative. These include rest, analgesic and anti-inflammatory medication and in some cases physical therapy. At this point, it is convenient to have some plain X-rays done, in search of some indirect evidence of the disc problem, as well as of degenerative changes on the spine.

If in a few days these measures have failed, the diagnosis has to be confirmed by means of examinations that give better detail over the troubled area, as the MRI, CT which will show the disc, the space behind it and in the first case, the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Once the diagnosis has been confirmed, one of the best alternatives existing today is the Ozone Discolysis as the results obtained are excellent and practically has no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. In most patients left with painkillers as the only treatment, the symptoms eventually disappear, only that this could take weeks to months. Ozone speeds up these developments, see the same result in a few weeks. The problem has to be seen and approached integrally and frequently the combination of therapies has to be used, most frequently physiotherapy. Also, it has to be known that those who had a herniated disc have 10 times more chances of having another herniation than the rest of the population.

If despite the ozone therapy the symptoms persist, Drill Discectomy/ Laser Discectomy are good alternatives before open surgery (Discectomy) which has to be contemplated in those true emergencies, as mentioned above, this is possibly the first choice.

Once the conservative treatment fails:

Early aggressive treatment plan of pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only 5% of total LBP patients would need surgery & 20% of discal rupture or herniation would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then.

Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon pt`s pathology & response to treatment.

Using precision diagnostic & therapeutic blocks in chronic LBP, isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed.

LESI: Lumbar Epidural Steroid Injection

Indicated in – Acute radicular pain due to irritation or inflammation.

  • Symptomatic herniated disc with failed conservative therapy
  • Acute exacerbation of discogenic pain or pain of spinal stenosis
  • Neoplastic infiltration of roots
  • Epidural fibrosis
  • Chronic LBP with acute radicular symptoms
  • Epidural- lumbar injection

ESI Treatment Plan

Compared to interlaminar approach better results are found with a transforaminal approach where drugs (steroid+ LA/saline +/- hyalase) are injected into anterior epidural space & neural foramen area where herniated disc or offending nociceptors are located. Whereas in interlaminar approach most of drug is deposited in posterior epidural space.Drugs are injected total 6-10 ml at lumbar, 3-6 ml at cervical & 20+ ml, if caudal approach is selected. Lumbar ESI is performed close to the level of radiculopathy, often using paramedian approach to target the lateral aspect of the epidural space on involved side. Cervical epidural is performed at C7-T1 level.

SNRB- Selective Nerve Root Block 

Fluoroscopically performed it is a good diagnostic & therapeutic procedure for radiculopathy pain if

  • There is minimal or no radiological finding.
  • Multilevel imaging abnormalities
  • Equivocal neurological examination finding or discrepancy between clinical & radiological signs
  • Postop patient with unexplainable or recurrent pain
  • Combined canal & lateral recess stenosis.
  • To find out the pathological dermatome for more invasive procedures, if needed

Intradiscal Procedures 

Provocative Discography - Coupled with CT

A diagnostic procedure & prognostic indicator for surgical outcome is necessary for the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines.

Percutaneous Disc Decompression (PDD)

After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed

Ozone Discolysis: Ozone Discectomy a revolutionary least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a daycare setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. The total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no postoperative discomfort or morbidity and low cost.

Dekompressor: A mechanical percutaneous nucleosome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression.

Epidural Adhenolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS)

A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

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

4492 people found this helpful

Chronic Pain - Understanding Complex Regional Pain Syndrome (CRPS)!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Chronic Pain - Understanding Complex Regional Pain Syndrome (CRPS)!

Pain is one of the most common reasons for patients to seek medical attention and one of the most prevalent medical complaints in today’s world. Chronic pain has many causes and can affect any part of the body. Conditions most associated with pain include arthritis, headache, neck and back problems, cancer, neuropathies eg. Diabetic, chronic regional pain syndromes (CRPS), pelvic pain disorders, fibromyalgia, myofacial pains, herpes and trigeminal neuralgias.

Chronic pain can lead to depression, anxiety, marital & interpersonal problems, decreased productivity, unemployment, compromised social roles, isolation, financial burden, dependence, prolonged analgesics usage, decreased self-esteem with behavioral changes adversely affecting mental and physical abilities, activities of daily living & ruining quality of life.
Pain still remains inappropriate & inadequately treated. Although tremendous scientific & technological advances have been made, the knowledge & techniques are highly underutilized. Untreated pain destroys people’s lives. I have had patients come in who couldn’t work or sleep or play with their children. Good pain management gave them their lives back. It is cruel to deny people in pain access to effective pain treatment. People should not be suffering needlessly.

Thus, pain clinics are specialized areas that are now assuming the role of an essential service as they meet a need unmet by any previously existing medical facility. They help by simultaneously treating the physical, emotional, cognitive, behavioral, vocational and social aspects of chronic pain cost-effectively.

Our ultimate goal is to cure & care people suffering from pain, make them productive human beings for the society and increase their self-esteem so that they can live life as normal individuals.
Interventional pain procedures scores over both medicine and surgery, as they do not have side effects like medicines. Surgeries for pain, have now limited indications, usually as a last resort.
The interventional pain procedures produce immediate pain relief, can be performed with ease by pain physicians without anesthesia as outpatient or daycare and adequate duration of pain relief obtained and suitable for surgically unfit & debilitated patients, procedure can be repeated safely if required.

In the absence of proper education among health care professionals and lack of awareness in the public mind in India, there is misuse of painkillers resulting in high incidence of complications like gastritis, kidney failure, bone marrow depression and bleeding from gut which can be catastrophic.


Carpal Tunnel Syndrom : It is neuralgic / tingling pain in hand & forearm caused by the pressure on supplying Median Nerve in carpal tunnel, aggravated during sleep or heavy exertion. It can be treated effectively with medicines. Non responders can go for simple injection treatment with dramatic results. Surgery remains the last choice only.

Fibromyalgia and Myo-fascial pain syndrome: These are conditions characterized by pain in the muscles following severe spasm associated with morning stiffness, disturbed sleep, a feeling of swelling and have clear trigger points. These points are tender and when palpated produce the typical pain.


Complex Regional Pain Syndrome (CRPS)
CRPS is a chronic progressive disease characterized by severe pain, swelling and changes in the skin. Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic improvement or remission of the syndrome in some patients. The International has divided CRPS into two types based on the presence of nerve lesion following the injury.

  • Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck’s atrophy, reflex neurovascular dystrophy (RND) or algoneurodystrophy, does not have demonstrable nerve lesions.
  • Type II, formerly known as causalgia, has evidence of obvious nerve damage.

The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although there are documented cases that have no demonstrable injury to the original site. The symptoms of CRPS usually manifest near the site of an injury, either major or minor. The most common symptoms overall are burning and electrical sensations, described to be like “shooting pain.” The patient may also experience muscle spasms, local swelling, abnormally increased sweating, changes in skin temperature and color, softening and thinning of bones, joint tenderness or stiffness, restricted or painful movement.

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

4327 people found this helpful

Pain Management

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Play video

Why is pain management so important?

2 people found this helpful

Non-surgical Treatment for Cervical Spondylosis - Tips!

MBBS, MD, FIMSA, FIPP
Pain Management Specialist, Delhi
Non-surgical Treatment for Cervical Spondylosis - Tips!

Spondylitis includes swelling of the vertebra. It happens because of wear and tear of the ligament and bones found in your cervical spine, which is in your neck. While it is to a great extent because of age, it can be brought on by other reasons too. Side effects incorporate pain and stiffness starting from the neck to the lower back. The spine's bones (vertebrae) get fused, bringing about an unbending spine. These changes might be mellow or extreme, and may prompt a stooped-over posture. Some of the non-surgical methods to treat spondylitis are as follows-

  1. Exercise based recovery/physiotherapy: Your specialist may send you to a physiotherapist for treatment. Non-intrusive treatment helps you extend your neck and shoulder muscles. This makes them more grounded and at last, relieves pain. You may neck traction, which includes using weights to build the space between the cervical joints and decreasing pressure on the cervical disc and nerve roots.
  2. Medications: Your specialist may prescribe you certain medicines if over-the-counter medications do not work. These include:
    1. Muscle relaxants, for example, cyclobenzaprine, to treat muscle fits
    2. Opiates, for example, hydrocodone, for pain relief
    3. Epileptic medications, for example, gabapentin, to ease pain created by nerve damage
    4. Steroid infusions, for example, prednisone, to decrease tissue irritation and diminish pain
  3. Home treatment: In case your condition is less severe, you can attempt a couple of things at home to treat it:
    1. Take an over-the-counter pain reliever, for example, acetaminophen or a calming medication, for example, Advil or Aleve.
    2. Use a warming cushion or an ice pack on your neck to give pain alleviation to sore muscles.
    3. Exercise routinely to help you recover quickly.
    4. Wear a delicate neck prop or neckline to get transitory help. In any case, you shouldn't wear a neck brace for temporary pain relief.
  4. Acupuncture: Acupuncture is a highly effective treatment used to mitigate back and neck pain. Little needles, about the extent of a human hair, are embedded into particular points on the back. Every needle might be whirled electrically or warmed to improve the impact of the treatment. Acupuncture works by prompting the body to deliver chemicals that decrease pain.
  5. Bed Rest: Severe instances of spondylitis may require bed rest for close to 1-3 days. Long-term bed rest is avoided as it puts the patient at danger for profound vein thrombosis (DVT, blood clots in the legs).
  6. Support/brace use: Temporary bracing (1 week) may help get rid of the symptoms, however, long-term use is not encouraged. Supports worn for a long time weaken the spinal muscles and can increase pain if not continually worn. Exercise based recovery is more beneficial as it reinforces the muscles.
  7. Lifestyle: Losing weight and eating nutritious food with consistent workouts can help. Quitting smoking is essential healthy habits to help the spine function properly at any age.

ONCE THE CONSERVATIVE TREATMENT FAILS:

Early aggressive treatment plan of back & leg pain has to be implemented to prevent peripherally induced CNS changes that may intensify or prolong pain making it a complex pain syndrome. Only approx 5% of total LBP patients would need surgery & approx 20% of discal rupture or herniation with Neurologically impending damage like cauda equina syndrome would need surgery. Nonoperative treatment is sufficient in most of the patients, although patient selection is important even then. Depending upon the diagnosis one can perform & combine properly selected percutaneous fluoroscopic guided procedures with time spacing depending upon patient`s pathology & response to treatment. Using precision diagnostic & therapeutic blocks in chronic LBP , isolated facet joint pain in 40%, discogenic pain in 25% (95% in L4-5&L5-S1), segmental dural or nerve root pain in 14% & sacroiliac joint pain in 15% of the patients. This article describes successful interventions of these common causes of LBP after conservative treatment has failed. 

NEED FOR NON-SURGICAL OPTIONS: Outcome studies of lumber disc surgeries documents, a success rate between 49% to 95% and re-operation after lumber disc surgeries ranging from 4% to 15%, have been noted. “In case of surgery, the chance of recurrence of pain is nearly 15%. In FBSS or failed back surgery the subsequent open surgeries are unlikely to succeed. Reasons for the failures of conventional surgeries are:

  1. Dural fibrosis
  2. Arachnoidal adhesions
  3. Muscles and fascial fibrosis
  4. Mechanical instability resulting from the partial removal of bony & ligamentous structures required for surgical exposure & decompression
  5. Presence of Neuropathy.
  6. Multifactorial aetiologies of back & leg pain, some left unaddressed surgically. 

EPIDURAL ADENOLYSIS OR PERCUTANEOUS DECOMPRESSIVE NEUROPLASTY is done for epidural fibrosis or adhesions in failed back surgery syndromes (FBSS). A catheter is inserted in epidural space via caudal/ interlaminar/ transforaminal approach. After epidurography testing volumetric irrigation with normal saline/ L.A./ hyalase/ steroids/ hypertonic saline in different combinations is then performed along with mechanical adenolysis with spring loaded or stellated catheters or under direct vision with EPIDUROSCOPE Sciatica gets complicated by PIVD with disco-radicular conflict causing radicular pain sometimes disabling. In this era of minimally invasive surgery lot many interventional techniques have evolved to address the disc pathology. We are still working for the ideal, safe & effective technique to tackle disco- radicular interphase. Here now we have devised a mechanical neuroplasty or foraminoplasty technique using an inflatable balloon tip catheter with guide wire via targeted transforaminal or interlaminar route aided by drugs instillation. Selected patients are procedured fluoroscopic guided with local anesthesia under prescribed sedation aseptically via preselected route depending upon location & type of PIVD causing root insult. First a suitable size needle is placed at desired site confirming with radiolucent dye through which hyaluronidase with saline or LA was injected. A flexible guide wire is passed at selected location & direction on which the inflatable balloon is threaded to the area of interest.

Adhesiolysis is achieved mechanically with inflating balloon for 10 seconds at a time & location. We inflated the balloon with contrast agent to have visualization of adhesiolysis & opening up of adhesions or root route. Here the balloon pressure & time has to be kept in minimum to avoid neurological damage, for which we inflate balloon for 10 seconds at a time. Close observation is made to balloon shape, pressure & patient`s response. Once dilatation is done the drug mixture of steroid with LA & or hynidase/ hypertonic saline is instilled over nerve in epidural space. We have logically used same approach for our Balloon Neuroplasty & foraminoplasty as it is safe & targets exactly the area of disco-radicular interphase or conflict. We can manage to address both the exiting and traversing nerve roots with single entry just by manipulating our guide wire to the place of offence. The procedure can be done via transforaminal route at level or level above or below, especially via S1 foramen. Now we are employing this technique for fresh cases coupling with Intradiscal decompression aided by instant disc retrieval by epidural balloon inflation with good results. The IDD is done by Coblation/ Laser/ DeKompressor or RF Biacuplasty. There is scope of coupling this technique with endoscopic spine surgery. By adding “Balloon Neuroplasty” to the armamentarium of the interventional pain management many patients can be benefited & relieved of previously interventionally unmanageable disco-radicular pain including FBSS sufferers. 

INTRADISCAL PROCEDURES:

PROVOCATIVE DISCOGRAPHY: coupled with CT A diagnostic procedure & prognostic indicator for surgical outcome is necessary in the evaluation of patients with suspected discogenic pain, its ability to reproduce pain(even with normal radiological finding), to determine type of disc herniation /tear, finding surgical options & in assessing previously operated spines. 

PERCUTANEOUS DISC DECOMPRESSION (PDD): After diagnosing the level of painful offending disc various percutaneous intradiscal procedures can be employed.

OZONE-CHEMONEUCLEOPLASTY: Ozone Discectomy a least invasive safe & effective alternative to spine surgery is the treatment of choice for prolapsed disc (PIVD) done under local anaesthesia in a day care setting. This procedure is ideally suited for cervical & lumbar disc herniation with radiculopathy. Total cost of the procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular at European countries. It is also gaining popularity in our country due to high success rate, less invasiveness, fewer chances of recurrences, remarkably fewer side effects meaning high safety profile, short hospital stay, no post operative discomfort or morbidity and low cost. If despite the ozone therapy the symptoms persist, Percutaneous intradiscal decompression can be done via Transforaminal route with Drill Discectomy/ Laser or Coblation Nucleoplasty/ Biacuplasty/ Disc-FX / Endoscopic Discectomy are good alternatives before opting for open surgerical Discectomy; which has to be contemplated in those true emergencies, as mentioned above as the first choice. In Biacuplasty radiofrequency energy is used in bipolar manner heating & shrinking the disc & making it harder as well for weight bearing. It also seals the annular defect & ablates annular nerves relieving back pain. In Laser or Coblation Nucleoplasty energy is used to evaporate the disc thereby debulking it to create space for disc to remodel itself assisted by exercises. 

DEKOMPRESSOR: A mechanical percutaneous nucleotome cuts & drills out the disc material somewhat like morcirator debulking the disc reducing nerve compression. A mechanical device cuts & drills out the disc material debulking the disc reducing nerve compression curing Sciatica & Brachialgia. It comes in needle size of 17G for lumbar discs & 19 G for cervical discs. In lumbar region postero-lateral approach is used & in cervical discs anterolateral approach is used. 

DISC-FX & ENDOSCOPIC DISCECTOMY: In this novel technique A wide bore needle is inserted & placed sub-annular in post disc just under the disc protrusion. Disc is then mechanically extracted with biopsy forceps to empty the annular defect. This painful & sensitive annular defect supplied be sinuvertebral nerve is thermo-ablated with radiofrequency which also seals the defect to prevent & decrease recurrences. Next Higher procedure, Endoscopic Discectomy is done with endoscope put through sheath inserted via posterolateral transforaminal or posterior interlaminar approach. Mostly done under local anaesthesia its fast becoming standard of care for disc protrusion & extrusions causing spinal canal stenosis with root or cord compression with leg pain.

LASER DISCECTOMY done for closed bulging discs is an outpatient procedure with one-step insertion of a needle into the disc space. Disc material is not removed; instead, nucleus pulposus is debulked by evaporating it by the laser energy. Laser discectomy is minimally invasive, cost-effective, and free of postoperative pain syndromes, and it is starting to be more widely used at various centers. 

SELD: Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low back and/or lower extremity pain, including lumbar disc herniation, lumbar spinal stenosis, failed back surgery syndrome with morbid adhesion neuritis that cannot be alleviated with existing noninvasive conservative treatment. This Procedure is done under vision via an epiduroscope inserted via Caudal canal or Transforaminally employing front or side firing Laser fibers &/or fine instruments. If you wish to discuss about any specific problem, you can consult a Pain Management Specialist.

3721 people found this helpful
View All Feed