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Global Hospital, Mumbai

Global Hospital

  4.5  (59 ratings)

Pain Management Specialist Clinic

No.35, Dr. E Borges Road, Opposite Shirodkar High School, Parel Mumbai
1 Doctor · ₹1750
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Global Hospital   4.5  (59 ratings) Pain Management Specialist Clinic No.35, Dr. E Borges Road, Opposite Shirodkar High School, Parel Mumbai
1 Doctor · ₹1750
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We like to think that we are an extraordinary practice that is all about you - your potential, your comfort, your health, and your individuality. You are important to us and we strive to ......more
We like to think that we are an extraordinary practice that is all about you - your potential, your comfort, your health, and your individuality. You are important to us and we strive to help you in every and any way that we can.
More about Global Hospital
Global Hospital is known for housing experienced Pain Management Specialists. Dr. Kailash Kothari, a well-reputed Pain Management Specialist, practices in Mumbai. Visit this medical health centre for Pain Management Specialists recommended by 85 patients.

Timings

MON, WED, FRI
09:00 AM - 10:00 AM

Location

No.35, Dr. E Borges Road, Opposite Shirodkar High School, Parel
Parel Mumbai, Maharashtra - 400012
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Videos (4)

To treat the pain, your specialist needs to know how you have been feeling between visits. This w...

To treat the pain, your specialist needs to know how you have been feeling between visits. This will help in prescribing the right kind of exercise so that your muscles get their strength. Keeping a log or diary of your everyday "pain score" will help you track it. Towards the end of every day, take note of your agony level on the 1 to 10 pain scale.

read more
If you are suffering from back pain, you should know that the tiniest of movements can trigger th...

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.

read more
Hello,<br/><br/>I am Dr. Kailash Kothari, Pain Management Specialist. We treat every type of pain...

Hello,

I am Dr. Kailash Kothari, Pain Management Specialist. We treat every type of pain and maximum patients are coming to us with knee, back and neck pain. So, today I will tell you about knee pain. So many patients are visiting the hospital because of knee pain and not only old but young people are also suffering from knee pain. The knee is the part of the body which works continuously during the regular walk, running, frequent sitting and then getting up from the place, sitting on the floor with folded legs. This causes strain to ligaments, muscles and cartilage. In our knee, we are having 3 types of joint: femur, tibia and fibula. A part in the knee is patella. Patella, we call vatti in marathi and katori in hindi. Patella is a muscle which slides over the knee joint and helps us in bending knee. So many things are there in the knee which can affect our knee badly. Injury to patella can cause arthritis, friction and inflammation.

The types of ligaments in our knee: ACL and PCL. These ligaments control flexion and extension of the knee while bending and straightening the leg. In the knee, between 2 bones, there is a meniscus which functions as a cushion to the knee. Apart from these, there is a quadriceps muscle which is a group of 4 muscles which holds the knee from the front and hamstring muscle which supports knee from the back. We also have muscles at the sides of the knee.

Many types of problems are there which affect knee and maximum patients are coming to us for osteoarthritis. As we get older, our ligaments, muscles, cartilage start getting weak and thin. This may result in the swelling of the knee and it gives problem at the time of the knee or leg movement. At an older age, the patient is not able to fold his legs. They suffer from problems while sitting, getting up, walking. In such situations, the patient takes anti-inflammatory medicines which only reduce the swelling. By taking these anti-inflammatory medicines, the regeneration of cells in the knee gets reduced. For that particular time, the patient gets relief and able to do all the activities but these medicines are not at all good for knee. So, we stimulate the regeneration of the cells at the time of the treatment. For this, the therapy is called prolotherapy. This therapy helps our body in increasing cells capacity. This treatment is called dextrose prolotherapy.

We prepare a combination of dextrose and local anesthesia and inject the same into the knee. This is 100% side-effect free treatment. This procedure stimulates our body tissues, cartilage, ligaments, muscles and this also reactivates the synovial fluid which gets dried in osteoarthritis patients. Prolotherapy is the only way to recreate the cells and strengthen our muscles, ligaments, cartilages. This gives stability to your joint. 30-40% of patients are coming to us to get rid of osteoarthritis and till date, we have given successful results to over 1000 patients. Now they are able to do their regular activities and avoided knee surgeries successfully.

We also have many patients who are in sports. Mostly we have seen that sportsmen are getting more affected with knee injuries as they do physical activities. There is a knee problem in sportsmen and we call it runner's knee. Sometimes our ligaments get twisted into the knee which causes pain. In such cases, prolotherapy helps to proliferate the normal cells, strengthen the muscles, ligament. If we will not keep our knee strengthen then it will cause instability which causes the problem to the patient in walking, running and routine activities. This treatment is not for the short term. People who play cricket, basketball, football can suffer from ligament injury or ACL & PCL tear and sometimes meniscal tear. This is a problematic situation in which if the patient straightens his legs, the knee gets locked and it becomes impossible for the patient to bend it again. We call this lock knee. It becomes difficult for us to pull the same back.

It also happens when our ligament gets damaged and we are able to move tibia, this is called instability of the joint. This instability causes pressure over the bones and also it creates osteophyte to create the new bone formation. Due to this new bone formation, our knee gives more pain. The best part of the treatment is that it gives you pain-free life for the longest time and makes the knee more stable. We repair the ligaments and cartilage with the help of prolotherapy. We stimulate the cells so as to build cartilage or fibrous tissues. This is the very common treatment which is not done pan India. We are known for this prolotherapy in India. These details can be found online and it has lots of successful evidence also. There is another therapy called PRP which helps in regenerating our tissues but for this dextrose prolotherapy is equally important and we treat the patient with both the therapies. Combination of these therapies gives better results.  If you want to know more about this, contact me through Lybrate.

Thank You.

read more
Hello,<br/><br/>I am Dr. Kailash Kothari. I am an interventional pain management specialist. So w...

Hello,

I am Dr. Kailash Kothari. I am an interventional pain management specialist. So we have this pain management centers who caters to chronic pain in patients and I am also attached to KEM Hospital which is one of the pioneer municipal hospitals in India and it has a very good pain department. So I am one of the consultants there. I also visit Fortis Hospital & Global Hospital in Mumbai and we try to manage these patients who are coming from all over India for their chronic pain conditions. So today what I am going to talk to you about certain pain conditions what we treat and we try to manage their pain so that the quality of life improves. Now one of the most common conditions for which patients come to us is back-pain. I am sure you must have heard many of the videos you must have read many books or many articles on back pain how they manage it. So basically at pain clinic when we treat patients when we see patients they come with years of pain sometimes one year sometime 15 or 30 years of pain.

And they are in so much pain that there are some patient who actually tell me that they want to die, they don’t want to live with the pain. Now, this is the fact most of the time our science present science is not able to diagnose what is happening with this patient why they are in pain. Inspite of managing them with conservative line of management like medicines, physiotherapy, some people go for ayurvedic some people go for homeopathic, still their pain is not diagnosed well from where it is coming and many time the pain is so severe that they want to die. So we come across so many patients and when pain becomes so chronic they also have a lot of psychological issues. So many time the patient who comes to us and he has chronic pain our main target our main idea of treating them is to diagnose the source of pain from where the pain is coming from. Because we believe that diagnosis is of utmost importance. If you cannot diagnose the source of your pain then we would not be able to manage your pain. It is like you are just doing the things and treating you with a blind eye.

So you are not able to see what is happening and we are just giving you treatment which might be effective which might not be effective. So it is fluke, we don’t believe in fluke. We just go for a diagnosis. And there are various ways by which we diagnose a patient. So when patient comes to us for example if the patient is having backpain with a pain going down in the leg we know back-pain and leg pain can be caused by something which is happening in the back. So if you see this so this is your spine. So there are a lot of vertebras there are a lot of discs between 2 spine there are a lot of nerves behind and between 2 vertebra there is a joint which is called facet joint. And there are a lot of muscles and a lot of ligaments which are lying in front of that. So it is the muscles are supporting the back of the spine and in front of the spine. So when you bend and when you do an extension that is when you bend backward or bend sideways these muscles and ligaments they hold your spine in right place so you don’t fall at the same time it gives you strength to move. So the spine it is at risk of getting damaged by these repetitive movements because there is the opposite force which is acting from the front and from behind.

So there is a lot of traction which is happening on the spine and that is the main reason why the spine is very very vulnerable to damage. Now suppose you have back pain which is here and there is a pain going down in the leg. So the most common situation is because of the slip disc. If you see here there is a bone this is called vertebra and in between the disc and the disc if it bulges it slips this is how it slips here it compresses the nerve here. And this nerve is like a wire which is supplying a particular area of the leg. So if you have a pressure here there is an inflammation there is a swelling of this nerve and this can cause pain going down in the leg. Now, what happens when there is an inflammation that your pain become chronic if it is not relieved in time. And this bulge may increase over time. So this can produce lot of space reduction so we many patients come to me and say my gap is reduced so this is what is the gap when the disc comes out this gap reduces.

Nerve does not get much of the place to come out from the spinal canal. Now here most of the people say surgery is the only answer and most people don’t want to go for surgery. So we have a treatment where we can give painkillers where we can give physiotherapy if that doesn’t improve we directly go for surgery. And most people don’t go for surgery and keep on suffering they keep on suffering from chronic pain. Now there is a huge gap between just a simple medical therapy and surgical therapy. There is nothing in between.so this pain management this pain clinics they offer something in between which can avoid your major surgery and this is what we do. We first do a simple injection hereunder X ray control we locate where the compression is happening. Under X ray control we give some small injection called selective nerve root block or trans permanent epidural injection.

This is a X ray guided injection. We put the needle we inject a small contrast which can be seen on MRI sorry on the SIUM which is a X ray machine. Once we see where the drug is spreading is it spreading in the right area which nerve it is spreading to whether it is the same nerve which is getting compressed by the disc that we confirm then we inject our drug which is a small dose of corticosterone. So once the corticosterone is injected you will have immediate relief of symptom. Sometimes pain is relieved in 2 or 3 days sometimes it takes up to 1 week. But the idea here is to reduce the pain by reducing the inflammation. So once it is reduced sometimes it works for a long long time, you don’t have to come back and you can go on doing your routine work without any trouble of pain caused by slip disc. Sometimes the pain comes back and you might have to take repeat injections which is ok.

There is no problem in taking repeat injection as long as your pain is reduced and weakness in your legs. Then you can always go for injection. So usually we repeat this injection once or twice. If it is working well and you have months and years of pain relief. You are not bothered you don’t have to do any other treatment except for physiotherapy and exercises. But if the pain comes back inspite of this injection we know where the pain is coming from now. Because after this injection if you have good relief that confirms the pain source if in this area then we have certain advanced therapies. And these advanced therapies are called intradiscal therapies. So we have certain we can say minimal invisible techniques by which without cutting the body without putting any cut on the skin we can just through the needle we can remove the disc. These are techniques which are called bikeloplasty disc effects or sometimes we do something called Endoscopic Discectomy. And in all these treatments we don’t have to give any anesthesia except local anesthesia in the same area. And that’s the beauty of pain management.

We can reduce your pain without doing any major surgery. So, friends, this was about slip disc or herniated disc what I was talking about. But there are many other situations which can cause back pain. One of the most common is facet joint problem. This is the joint between 2 vertebra and this is called facet joint. A similar problem can be there in si joint this is sacroiliac joint. Many times there are muscles which can cause pain. We don’t know where the pain is coming from. Most of the time this all pain which is coming from the different structure they may have a similar presentation. So what we do in this case is we do a simple injection to diagnose by injecting a local anesthetic in a particular area.

If I give injection here and I make patient stand up after the injection he should be pain-free if the pain is coming from here. And that is what is called a diagnostic block. Once we get the diagnosis if we don’t get a diagnosis here pain is not relieved we go to another structure. So by doing a differential block of diagnosis we can find out which is the source of your pain and we can apply different treatment modalities most common is radiofrequency ablation. Basically, it is the radiofrequency current which is applied to the particular structure to block the pain coming and you are relieved off your pain for one and a half to 2 year. So one of this beauty of pain management is without surgery we manage your pain and we make sure that your quality of life is very very good and you enjoy your life with your family. And if you want more information then always contact us on Lybrate.com thank you very much for watching and I hope you will see more videos like this which will be informative for your pain condition.

Thanks!

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Doctor in Global Hospital

Dr. Kailash Kothari

MD - Anaesthesiology, MBBS
Pain Management Specialist
Book appointment and get ₹125 LybrateCash (Lybrate Wallet) after your visit
89%  (59 ratings)
27 Years experience
1750 at clinic
₹300 online
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Sciatica Pain - How To Get Relief From It?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Sciatica Pain - How To Get Relief From It?

Ever faced a nagging low backache that just won't quit? You could be dealing with sciatica. Sciatica or sciatic nerve pain is not a diagnosis in itself but is a symptom of a deeper problem. 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 practising 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 to relieve sciatic pain involves putting pressure on the inflamed part of the back and the piriformis muscle. This is the muscle that sits over the sciatic nerve and triggers 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.

Pain - How To Get Rid Of It?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Play video

To treat the pain, your specialist needs to know how you have been feeling between visits. This will help in prescribing the right kind of exercise so that your muscles get their strength. Keeping a log or diary of your everyday "pain score" will help you track it. Towards the end of every day, take note of your agony level on the 1 to 10 pain scale.

3489 people found this helpful

Knee Pain - How To Subdue It?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Knee Pain - How To Subdue It?

Knee pain is a common phenomenon that plagues most of the people irrespective of their age. It can be the outcome of a torn cartilage or a ruptured ligament. Medical complications, such as infections, gout or arthritis (painful inflammation and stiffness of the joints) can also give way to knee pain. Minor knee pain can be eased by self-care remedies such as physical therapy or by putting on knee braces. However, few complications might demand surgical repair. Pain can be managed by pain management specialists.

Tips to manage knee pain

1. Medications such as naproxen, ibuprofen and acetaminophen can be administered to help remedy knee pain.
2. You can seek relief by massaging your knees with ointments constituting of a number of agents such as capsaicin or lidocaine.
3. Keep away from your usual chores to prevent repetitive strains on the knees, thus, allowing the injury to heal as well as to stay safe from further damage.
4. Applying an ice pack in a towel can ease inflammation and pain. But do not extend its usage for more than 20 minutes because that might harm the skin and nerves.
5. Compression bandages can inhibit fluid accumulation in the damaged tissues aiding knee alignment stability. Ensure that it is tight enough to render support to your knees without actually obstructing blood circulation.
6. To pacify the swelling, try resting your sore leg on a pillow (the idea here is to keep the affected leg elevated to reduce further pain).
7. Shed off your extra pounds as being overweight increases chances of other disorders such as osteoarthritis.
8. Go for regular workouts to enhance and maintain the flexibility of your muscles as excessively weak or abnormally tight muscles can contribute to injuries. Be smart while choosing your method of exercise based on the condition you are suffering from.

3390 people found this helpful

Chronic Pain - Why Does It Occurs?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Chronic Pain - Why Does It Occurs?

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. The 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.
3601 people found this helpful

Pain Management - Things You Should Know About

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Play video

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.

3551 people found this helpful

How To Treat Knee Pain?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Play video

Hello,

I am Dr. Kailash Kothari, Pain Management Specialist. We treat every type of pain and maximum patients are coming to us with knee, back and neck pain. So, today I will tell you about knee pain. So many patients are visiting the hospital because of knee pain and not only old but young people are also suffering from knee pain. The knee is the part of the body which works continuously during the regular walk, running, frequent sitting and then getting up from the place, sitting on the floor with folded legs. This causes strain to ligaments, muscles and cartilage. In our knee, we are having 3 types of joint: femur, tibia and fibula. A part in the knee is patella. Patella, we call vatti in marathi and katori in hindi. Patella is a muscle which slides over the knee joint and helps us in bending knee. So many things are there in the knee which can affect our knee badly. Injury to patella can cause arthritis, friction and inflammation.

The types of ligaments in our knee: ACL and PCL. These ligaments control flexion and extension of the knee while bending and straightening the leg. In the knee, between 2 bones, there is a meniscus which functions as a cushion to the knee. Apart from these, there is a quadriceps muscle which is a group of 4 muscles which holds the knee from the front and hamstring muscle which supports knee from the back. We also have muscles at the sides of the knee.

Many types of problems are there which affect knee and maximum patients are coming to us for osteoarthritis. As we get older, our ligaments, muscles, cartilage start getting weak and thin. This may result in the swelling of the knee and it gives problem at the time of the knee or leg movement. At an older age, the patient is not able to fold his legs. They suffer from problems while sitting, getting up, walking. In such situations, the patient takes anti-inflammatory medicines which only reduce the swelling. By taking these anti-inflammatory medicines, the regeneration of cells in the knee gets reduced. For that particular time, the patient gets relief and able to do all the activities but these medicines are not at all good for knee. So, we stimulate the regeneration of the cells at the time of the treatment. For this, the therapy is called prolotherapy. This therapy helps our body in increasing cells capacity. This treatment is called dextrose prolotherapy.

We prepare a combination of dextrose and local anesthesia and inject the same into the knee. This is 100% side-effect free treatment. This procedure stimulates our body tissues, cartilage, ligaments, muscles and this also reactivates the synovial fluid which gets dried in osteoarthritis patients. Prolotherapy is the only way to recreate the cells and strengthen our muscles, ligaments, cartilages. This gives stability to your joint. 30-40% of patients are coming to us to get rid of osteoarthritis and till date, we have given successful results to over 1000 patients. Now they are able to do their regular activities and avoided knee surgeries successfully.

We also have many patients who are in sports. Mostly we have seen that sportsmen are getting more affected with knee injuries as they do physical activities. There is a knee problem in sportsmen and we call it runner's knee. Sometimes our ligaments get twisted into the knee which causes pain. In such cases, prolotherapy helps to proliferate the normal cells, strengthen the muscles, ligament. If we will not keep our knee strengthen then it will cause instability which causes the problem to the patient in walking, running and routine activities. This treatment is not for the short term. People who play cricket, basketball, football can suffer from ligament injury or ACL & PCL tear and sometimes meniscal tear. This is a problematic situation in which if the patient straightens his legs, the knee gets locked and it becomes impossible for the patient to bend it again. We call this lock knee. It becomes difficult for us to pull the same back.

It also happens when our ligament gets damaged and we are able to move tibia, this is called instability of the joint. This instability causes pressure over the bones and also it creates osteophyte to create the new bone formation. Due to this new bone formation, our knee gives more pain. The best part of the treatment is that it gives you pain-free life for the longest time and makes the knee more stable. We repair the ligaments and cartilage with the help of prolotherapy. We stimulate the cells so as to build cartilage or fibrous tissues. This is the very common treatment which is not done pan India. We are known for this prolotherapy in India. These details can be found online and it has lots of successful evidence also. There is another therapy called PRP which helps in regenerating our tissues but for this dextrose prolotherapy is equally important and we treat the patient with both the therapies. Combination of these therapies gives better results.  If you want to know more about this, contact me through Lybrate.

Thank You.

4595 people found this helpful

Slip Disc - Treating It With Sciatica!

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Slip Disc - Treating It With Sciatica!

Introduction 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.

Symptoms -

This protrusion 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.

Causes of weak disc -

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).

How to deal with it?

- The first step to deal with a herniated or prolapsed lumbar disc is conservative management.

- Rest,

- Analgesic

- Anti-inflammatory medication

- Physical therapy.

At this point, Sometimes 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.

What to do if pain does not improve?

If in a few weeks (4 weeks) 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 pathology, the space behind it (Spinal canal) and the nerves. In some instances, the EMG (electromyography) is also of great value, as this will show the functionality of the nerves and muscles.

Diagnosis -

Using precision diagnostic & therapeutic blocks in chronic LBP, the following pain generators in lower back have been found:

- 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.

Treatment -

Once the diagnosis has been confirmed, there are a variety of treatment options which are non-surgical:

First Method:

  • Image-guided Epidural injection (70% of patients do very well with this)
  • 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.

Second Method:

If pain doesn't subside and diagnosis is in doubt we perform Provocative Discography - Coupled with CT.

A diagnostic procedure & prognostic indicator is necessary for the evaluation of patients with suspected discogenic pain. This test has the ability to reproduce pain on injection of the affected disc, to determine type of disc herniation/tear by performing post discography CT scan.

Once we know which disc is painful and what type of disc prolapse it is, we may plan further intradiscal treatments.

Third Method:

One of the best alternatives existing today is the Disc Fx and disc biculoplasty RF ablation, as the results obtained are excellent and practically has minimal to no complications. This novel treatment avoids the use of surgery in 80% of those who needed it. The popularity of this technique is that it achives similar or better success rates in well selected patients.

Fourth Method:

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 multilevel cervical & lumbar disc herniation with radiculopathy.

The total cost of these procedure is much less than that of surgical discectomy. All these facts have made this procedure very popular. 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.

Fifth Method:

Nucleoplasty and Dekompressor discectomy are other common techniques in some patients. This helps in debulking the disc and thereby reduces the nerve compression.

Sixth Method:

Epidural Adhesiolysis or Percutaneous Decompressive Neuroplasty for Epidural Fibrosis or Adhesions in Failed Back Surgery Syndrome (FBSS). A spring-loaded catheter is inserted in epidural space via caudal/interlaminar/transforaminal approach.

After epidurography, testing volumetric irrigation with normal saline/LA/hyalase/steroids/hypertonic saline in different combinations is then performed along with mechanical adhesiolysis with spring loaded or stellated catheters or under direct vision with epiduroscope.

Seventh Method:

Some patients (less than 2 %) do need surgery if pain doesn't improve. In today's time, open surgery is not required in most cases. Percutaneous endoscopic discectomy is most advanced and stitchless surgery which is done under local anesthesia. Patients recover very fast and go home on same or next day.

Conclusion - In today's time, back pain due to disc herniation is managed best by pain management doctors as they offer range of nonsurgical of minimally invasive surgical options with better success rates and minimal complication rates. The patients do recover very fast without the need to be in the hospital.

4809 people found this helpful

Lower Back Pain - How Can You Handle It Well?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Lower Back Pain - How Can You Handle It Well?

Pain, experienced in the lumbar area, is generally referred to as lower back pain. This kind of back pain may happen due to a variety of reasons including hereditary conditions as well as accidents and sports injuries. These pain generally leave your body in a state of chronic pain, depending on the area that was affected. This lumbar area is a complex of joints, nerves, ligaments and muscles which go towards providing support and posture to the human body. Here are the various ways in which you can deal with lower back pain-

  1. Heat and Ice Therapy: One of the most recommended forms of treatment includes heat and ice therapy. You can use a warm bath or a heat compress and heating pad to soothe the area and bring down the pain. Ice packs can be used for inflammation and swelling. While the previous method can be used for chronic pain, the latter can be used for acute pain and more recent accidents. These methods are known to increase the blood flow to the affected area and hence bring much relief when there is pain and stiffness.
  2. Choose your Activity with Caution: There are a number of activities that one can carry out even when you are suffering from lower back pain. Mild to moderate exercise that has been approved by your physician can help in soothing the area. The trick in such cases to move at frequent intervals so that stiffness and further pain does not set in. You can embark on walks and even water exercises that will help in soothing the stiff muscles. Having said that, one must remember to avoid exercises that will involve bending and standing for too long as this can aggravate the pain.
  3. Rest: It is essential to sleep in the correct position and get the best amount of rest so that the muscles and joints of this area can get the required comfort and rest before being put to work again. Yet, too much inactivity is also not recommended in such cases, and hence one must not rest for too many days at a time. Further, it is important to rest in the correct position so that the lumbar area does not twist and there is no pressure on the same. It would be best to lie down on the back without crossing the ankles.
  4. Pain Medication: You can get a prescription for pain medication in case the pain is unbearable. It would be advisable to take medication after consultation with a doctor. One can have oral medicines or take topical application gels and ointments that will numb the area. One can have ibuprofen, acetaminophen, aspirin and other such medicines to get relief from the pain.

Interventional pain management

Finding the right relief can be tough for patients living with chronic pain. It involves a lot of trial and error to find the therapy that works for you. The Interventional Pain Management is one therapy that is aimed to reduce your pain, as well as provide options for preventing pain in the future. It adopts a comprehensive and holistic look to treat pain with lesser risk and morbidity when compared with surgical interventions.

Benefits of interventional pain management

  1. Surgery cannot be a solution to every health problem, the minimally invasive procedures of interventional pain management are cost-effective
  2. Lower risk for infections and complications
  3. Lower recovery time as they don’t employ large incisions or anesthesia
  4. It identifies the source of pain and comes up with the right solution to alleviate pain

Types of interventional pain management

  1. Epidural Steroid Injections: The prime aim of these injections is to identify the site of pain and reduce inflammation in the nerve roots as they exit the spine. A local anesthesia is administered and a steroid is injected into the epidural space. More than one injection is needed until there is a significant reduction in pain.
  2. Facet Joint Injection and Medical Branch Blocks: This technique helps the patient to manage and tolerate their pain better. A steroid is directly injected into the facet joint to reduce pain. Medical branch blocks target i.e. the nerve that detects the painful sensation and sends messages to the brain. These blocks help further denervation procedure and provide long term relief.
  3. Sacroiliac Injections: These injections are administered directly on the sacroiliac joint of the spine which is the cause of lower back pain.
  4. Peripheral Joint Injections: Joints like shoulder, knee and hip are injected with medicines that aim to reduce painful inflammation at the source of joint dysfunction.
  5. Radio frequency Ablation: This involves the use of radio waves to create an electrical current that delivers heat to the targeted nerve tissues. It results in the impairment of the nerves to transmit pain signals to the brain
  6. Rhizotomy: This is another procedure where the pain signals are turned off. Heated electrodes are applied to the specific nerves to cut off the transmission.
  7. Spinal Cord Stimulation: This uses electrical impulses to block pain from being perceived by the brain
  8. Nucleoplasty: This is a procedure in which a which tissue is removed from the disc of the spinal cord to decompress and relieve pressure
  9. Intrathecal Pump Implantation: A pain pump is placed under the skin that directly delivers pain medication to the targeted area.

These are some of the procedures of interventional pain management that aim to reduce pain, without the need of surgery or other conservative pain medications.

4752 people found this helpful

Neck Pain & Stiffness - Ways You Can Get Rid Of Them!

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Neck Pain & Stiffness - Ways You Can Get Rid Of Them!

Neck pain and stiffness can give you a harrowing time. From children to aged people, the condition is a common problem that can affect all and sundry. In addition to the pain and discomfort, the condition also restricts the head movement. The neck bones and muscles are important as they not only give support to the head but also ensures its free and unrestricted movement.

Stiff neck and neck pain can be an amalgamation of various factors such as -
Our professional commitments often demand spending hours before the computer. The sedentary lifestyle is the main wrecker in chief, giving rise to many health complications, with neck pain and stiffness being one amongst them. Sitting in one position for long often results in muscle pull (tension) and strain. The muscle tension can also be an outcome of incorrect sleeping posture.

  • Neck injury and inflammation sustained during an exercise or due to an accident can also result in neck pain.
  • Neck injury followed by pain and stiffness can also be an outcome of Whiplash (a condition where a person suddenly jerks the head).
  • Stiffness and neck pain can also be triggered by medical conditions such as MeningitisRheumatoid Arthritis (of the neck), Heart attackFibromyalgia(muscular pain particularly in the shoulder and neck area), Cancer (of the spine), Spondylosis, and Spinal stenosis, to name a few.

Seek medical assistance in case

  • The condition aggravates and persists for long.
  • The pain and stiffness are sudden and unexplained.
  • Pain that slowly moves down the arms and legs.
  • In addition to the neck pain and stiffness, a person complains of a headache, nauseavomitingfever, difficulty in eating food, a bowel disorder.
  • A lump (in the neck) accompanied by pain and stiffness needs immediate and thorough investigation.

Diagnosis and treatment
Neck pain and stiffness are often diagnosed by

  • Physical examination.
  • A lumbar puncture can also aid in the diagnosis.
  • Imaging tests such as X-rays, MRI, CT scans, Electromyography
  • Blood tests.

Depending on the severity, a doctor decides upon the course and mode of treatment

  1. The use of ice packs or heat pads (avoid very high temperature) on the affected area every 2-3 hours (for 15-20 minutes) can provide great relief.
  2. Gentle massaging can go a long way to relieve the pain and stiffness. It only helps to improve the blood circulation.
  3. Neck exercises and stretching play a pivotal role in strengthening the neck muscles, thereby reducing the pain and stiffness. However, in an endeavour to achieve maximum results, do not overdo yourself.
  4. Medicines such as Nonsteroidal anti-inflammatory drugs (NSAID), Tylenol, Advil, corticosteroid injections, come in handy in case of severe pain and inflammation.
  5. Use of a neck collar provides support to the affected area.
  6. Surgery may be recommended (very rare) in the case of serious complications.
  7. Some patients also benefit from Acupuncture and Chiropractic (alternate medicines).
4421 people found this helpful

Knee Osteoarthritis - How Does PRP Therapy Help?

MD - Anaesthesiology, MBBS
Pain Management Specialist, Mumbai
Knee Osteoarthritis - How Does PRP Therapy Help?

Knee osteoarthritis is a common condition affecting the knee joints. This condition results from age related degeneration of joint cartilage and synovial fluid. This results in excessive stiffness, swellingpain and decreased mobility due to loss of lubricant functions of joint cartilage.

Treatment for Knee Osteoarthritis:

Treatment for knee osteoarthritis consists of anti inflammatory drugs, lifestyle modifications and knee exercises. In advanced stages where pain is severe or conservative therapy fails, replacement of knee joint is required. In many cases, knee replacement is not feasible or desired due to various reasons. For such cases, other treatment option is available in form of Platelet rich Plasma (PRP) injection in knee joint.

How is PRP therapy done?

The procedure involves drawing a sample of blood from the patient and then placing it in a Centrifuge machine which extracts the Platelet rich plasma (PRP) constituent from blood.The sample constitutes of platelets (blood cells) which consist of numerous healing and inflammatory chemicals. This PRP sample is injected in the knee joint under sterile precautions. This decreases inflammation, and promotes healing.

Benefits of PRP therapy:

  1. The body’s first response to soft tissue injury is to deliver platelets. Platelets carry cells, proteins, and other growth / healing factors that initiate repair and recruit stem cells. PRP therapy’s natural healing process intensifies the body’s efforts by delivering a higher concentration of platelets within the damaged joint. Research has shown PRP therapy to be very effective at relieving pain and returning patients to their normal activities. Both Ultrasound and MRIimages have shown definitive tissue repair after PRP therapy, confirming the healing process.

  2. The need for knee replacement can also be greatly reduced by promoting repair of cartilage before joint damage becomes extensive. In fact PRP therapy works best when done in early stages of Knee Osteoarthritis.

  3. Relieves pain without the risks of surgery or general anesthesia.

  4. No hospital stay is required. The procedure is performed safely and takes approximately two hour including preparation and recovery time. In fact, most people return to their jobs or usual activities right after the procedure.

  5. Most patients require 2 to 3 sessions of knee PRP therapy.

Side effects of PRP Therapy:

The procedure is free of side effects when done by experienced pain specialists. Since the therapy involves injecting patient's own blood derivative, it is a safe procedure.

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