Dr. Ashok Rattan

Persistence of pain even after full healing of an affected area after injury or ailment is known as chronic pain. Chronic pain can also occur due to an undiagnosed underlying condition within the body. Any form of pain which lasts for more than 6 months can be categorized as chronic pain. Chronic pain might be continuous or episodic, excruciating or mild, totally incapacitating or merely inconvenient.

Symptoms of Chronic Pain include:
1. Light to severe pain that keeps occurring from time to time and cannot be relieved easily.
2. Occurrence of pain that can be described as burning, shooting, aching or even, electrical.
3. Constant feelings of discomfort. This includes stiffness, tightness or soreness in the affected area.

Chronic pain usually does not occur alone and is often accompanied by other problems such as:
1. Lack of sleep
2. Fatigue
3. Weakened Immune System
4. Disability
5. Mood Swings that include depression, fear, hopelessness, anxiety, stress, irritability, etc.

Reasons behind it
There are a number of different factors that can cause chronic pain. Some of them are:

1. Aging: Common conditions associated with normal aging can have an effect on joints and bones, giving rise to chronic pain.
2. Incorrect treatment and improper healing: Bad diagnosis or incorrect medications or procedures may cause improper healing of injuries as well as damage to nerves leading to chronic pain.
3. Underlying disorders or diseases: Diseases are also capable of causing chronic pain. Conditions like osteoarthritis, rheumatoid arthritis and fibromyalgia are some well-known diseases that cause chronic pain. However, persistent and chronic pain might occur due to sicknesses like multiple sclerosis, cancer, AIDS, stomach ulcers as well as gallbladder disease.

In most of the cases, the reasons behind chronic pain can be rather complex. Sometimes, even though the chronic pain begins with an illness or an injury, the ongoing pain is capable of developing into a psychological aspect even after the physical issues have been healed, thus making treatment tricky.

Treatment
Chronic pain is usually managed using a combination of physical therapy, medications and exercises, which helps in reducing the pain. Examples of pain relieving medications include ibuprofen and aspirin. Day-to-day activities can be performed only if this pain is adequately controlled. Additional techniques include:

1. Radiofrequency Ablation (RFA): The target of this technique to address the nerves that are responsible for sending pain signals to the brain. This is achieved by placing the heated tip of a needle in a region which is extremely close to the nerve. The heat renders the nerve incapable of sending the pain signal.
2. Pain Shots: This is used to deliver medications to the exact site of the pain. Nerve blockers are also used to block signals from reaching the brain.
3. Alternative approach: These include acupuncture, massages and yoga along with other treatments from alternative medicine.

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!