Lower back pain is a household condition in today’s times. It has become a concern to reckon with, thanks to all the different job descriptions which require sitting for long stretches in front of desks and computers. This automatically puts a pressure on our lower back, resulting in lower back pain.read more
I am Dr. Sidharth Verma, Pain Management Specialist and today I will talk about myofascial pain syndrome. Although this is a very uncommon term to the most patient. But this is the most common pain which we see in our OPD. So, this is so common that around 60% of the patients who come with the musculoskeletal pain are suffering from myofascial pain syndrome. So, my means muscles and fascial means facias. So, this is the soft tissue pain. Typically this presents when a patient suddenly complaints of pain in some muscle belly, some portion of his body. It persists for a long duration of time. The patient takes some painkillers, some tablets, get some massage and all done but he is not relieved typically. And the characteristic point for this myofascial pain is the presence of active and passive trigger points. There is a difference between trigger and tender points. In trigger points, the pain spread to the muscles.
And on the tender point, the pain is localized to the portion where you have applied the pressure. These trigger points are nothing but they are the areas of dysfunctional muscles because of various factors. The exact cause is not known. But some theories say that there is some dysfunctional blood flow to those areas and this results in ischemia, later on, the nerves fiber becomes hypersensitize. And this is how the pathogenesis occurs. And when there are multiple tender or trigger points throughout this belly of muscles then this results in a lot of pain and discomfort for the patient. This is usually not relieved by medications, massage, stretching, exercises. And then the patient goes for some investigation like MRI and that is also even normal. The patient is more confused as well as Dr. However if this syndrome is kept in mind then a lot of patients can get the benefit. It is also known as soft tissue pain.
Coming to the clinical features. This can vary from pain on touching, pain on activity, psychological symptoms like depression, loss of interest, this all can happen due to this syndrome. Because beyond the point when this persists the area or regional involvement starts recurring more and more and because of this muscles fibers are affected. This results in a lot of discomfort for the patient and the amplification of the symptoms. How to diagnose and treat it? When the patient comes to us with soft tissue pain, we immediately diagnose. It is a clinical diagnosis. However, the newer modality is the infra-red cameras pick up the areas with lesser temperature nowadays. And this is a clinical diagnosis. So, many of the good physiotherapists also pick-up this syndrome very well. They try to treat it with dry-needling, exercises, other physical activities. However, in many cases, the pain is still persistent. The syndrome still exists. That is when the patient comes to us. If patient early walk-in, we identify this and immediately give the treatment. So, the treatment here is very straight-forward. Almost gives the 100% result. However, the treatment needs to be repeated at frequent intervals.
It has to be clubbed to rule out the possible causes and eliminating them. Let's say that the patient comes with neck pain, if I examine, I find that they have a lot of tender points, the patient is having neck pain due to which he is not able to move. Then possibly I will try to find out what are his activities like long hour sitting, travels a lot or what are other activities which can possibly lead to this problem. Once I start treating the patient, simultaneously, we also try to take away this bad habit and inculcate good habits in the patient. We try to educate them about their symptoms in addition to the pharmacological treatment, interventional treatment. We add exercises so that the patient can have good strength. We add stretching. We may take the help of physiotherapists. This may result in complete resolution very fast. So, what are the interventions that we do in this syndrome? We do trigger points injection. Ultrasound-guided trigger points needling. In this, we locate the most tender points. Then we infiltrate with small anesthetic as well as sometimes we add a low dose of local anti-inflammatory agents.
What does this drug do? Helps in eliminating local inflammation and needling portion increases the blood flow which results in active healing. The patient develops the muscles strength and results in resolution to the symptom. Dry-needling is another symptom which is commonly used. It has a very specific indication. We can typically see the twitches which are present once the needle touches the tender points or the trigger zone. Once the needling is done, the resolution is very good and the results are very nice. This procedure is common in post-surgical patients like cancer and other patients who are suffering from other illnesses. Results are excellent. It is also helpful if we do the blood investigation also of these patients. Many of these patients have found deficient in vitamin-B & B12. This can be replenished. Bioenergiser also found to be helpful in these patients. So, if you are suffering from chronic muscle pain, you have a lot of massages, you went to a trusted physiotherapist but not able to help you fully. Earlier you used to get well but now you are not getting well. Again the pain is persisting. So, please don't suffer. Come to a pain relief centre. We will try our best to help you. And the earlier you, the better the results are. Don't ignore myofascial pain syndrome. It can magnify and often become very difficult to treat in the later stages. To know more you can visit my Lybrate website.
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I am Dr. Sidharth Verma, Pain Management Specialist, Pain Relief Center, Mumbai. Today I will talk about cooled radiofrequency. It is a very advanced procedure. It was developed after the radiofrequency treatment. In this treatment, there is a higher success rate. There are very high chances of achieving good results with this treatment. There are a variety of reasons for that. The first advantage is that this treatment involves cooled radiofrequency. This means that the ablation which is done by a small needle which has a higher area. Because the heat is decapitated very fast. And this results in a higher area of effectiveness. Results in better targeting of the nerves. In this treatment, nerves are targeted which is giving rise to the pain. And you pain physician will target these nerves. He will ablate them with the help of the radiofrequency. And cooled radiofrequency is one step ahead. This gives much better control to your physician and longer lasting relief to the patient. So, the major application of this cooled radiofrequency is in the knee joint and facet joint. So, why knee and facet?
Because in the knee there are 3 genicular nerves which are generally targeted. These are very small nerves. And the indication is knee osteoarthritis. But these nerves are very small and difficult to locate them. So, if the cooled radiofrequency is used, this is very helpful in locating these nerves and destroying them. Hence, resulting in pain relief. The other possible application for this cooled radiofrequency in the facet joint. So, we often get patients who are suffering from back pain in whom the MRI is normal. So, most probably you are suffering from the myofascial syndrome or facet joint arthropathy or facet joint pain. These facets are small joints in the vertebrae. Between vertebrae, there are 2 joints, one on the left and one on the right side. Once the facet becomes hypotrophy or becomes arthritic, they give rise to facet joint pain. And this pain is reflected as back pain. It is a very characteristic pain, depending on the facet involved. If it is the upper level like 1, 2, 3, the pain mostly will be restricted to the back. But if it is in the lower level like 4 & 5, the pain will radiate to the posterior portion of the hip or just above the knee also.
This characteristic is known as facet pain. You can also identify it with a simple test. You can just try to extend your back and this pain typically aggravates. It also increases while you are turning your sides. This is treated by the median branch block. It is a nerve which supplies the facet joints and it passes to a very close junction. So, this is very difficult to locate these nerves because there is a lot of anatomical variation. And this is where cooled radiofrequency plays a big role. And this cooled radiofrequency equipment gives the bigger lesion. Hence, the finding out nerve chances is very high. It gives a better result and good long lasting results. So, if you are suffering from knee pain or back pain or if you don't want to undergo surgery of the knee joint and you want to explore the alternative option, so, this cooled radiofrequency is a very good option for you. Secondly, if you are suffering from back pain and your MRI is normal then you must immediately visit your pain physician. We are here to help you at the pain relief centre. And thereafter we can properly diagnose. And if you have facet joint as the possible cause then we can do cooled radiofrequency procedure for you. This can result in better relief in you symptoms. To know more, you can visit my Lybrate website.
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I am Dr. Siddharth Verma and you are watching this video on Lybrate. I practice at Pain Relief Centre in Chembur and the topic for this video is how can you avoid a spine surgery and when not to avoid it? So, many times many patients come to us with this option that they want a second opinion and they have been advised a spine surgery and they want to avoid it and how they can avoid it. Typically, we have seen in our patients that they don't want to undergo any surgery and they have seen the worst happened to their colleagues or friends or they have heard bad things about surgery and that's why they don't want to go for it. So yes, you can avoid a lot of times you can avoid this surgery and you can get rid of your pain but there are some instances where you probably cannot avoid surgery. So when you can avoid surgery is when the when the compression is not much on your nerve roots and when the damage is not much and it is reversible and pain is itself become a disease, there is a neuropathic pain so in those cases you can avoid surgery but the surgeon will not suggest surgery anyway in those cases.
In another approach which you can follow to avoid an open surgery at least is that you can go for minimally invasive procedures. So with your pain specialist or with your spine pain specialist at pain relief centre you have this option of undergoing a minimally invasive procedure and by minimally invasive I mean that there is no open surgery, no prolonged hospital stays, you can get discharge on the same or the next day and these procedures can also have good results or similar results to the open procedures and without any side effects or with minimal side effects and a very common example of this procedure is the spine endoscopy which is being done for a lot of spinal indications now.
It has still not replaced surgery per but it's a viable alternative to especially for those patients who want to avoid this surgery and still get cured of their back pain. This procedure is done under local anaesthesia and it is the patient comes to the hospital and is taken to the operation theatre and lies prone on an operation table and the local area is numbed and with the help of a needle we reach his problem area and there we put in our endoscope, we see it on a big TV and on that TV we see a very small nerve also which can be seen in a very big you can say screen and it appears very big and we can actually do very fine things there and take out the offending portion. If there is a disc compressing or if there is a portion of a tissue intruding or something, we can always clear it out and give relief to the patient and the patient walks almost instantaneously and can walk, do his go to the washroom, do his routine activities.
We advise rest which means that patient cannot go for strenuous activity, moderate activity, cannot bend and lift weights but other than that is perfectly fine to move and the patient is fairly mobile, he can take care of himself and can resume work after a few weeks; by resuming work means just like he used to do before he had this kind of pain. So, in many conditions, this surgery can be avoided. However there are some indications where you will you may require an open surgery for example in many cases of long-standing stenosis where the patient has or needs multiple level decompression or when there is trauma especially when there is a paresis, there is cauda; even many cases of cauda can be treated with nowadays with the endoscopy and however there are still indications for open surgery and you should consult your pain specialist who can guide you appropriately and advise you regarding that. We, at Pain Relief Centre, are ready to help you, so if you have been advised a spinal surgery and you want an opinion, we welcome you to come to us and seek our opinion.
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I am Dr. Sidharth Verma, Pain Management Specialist. Today I will talk about trigeminal neuralgia. It is also known as the suicide disease. In this patient experience the facial pain. it may also effect inside the mouth. It is important to treat the cause first. It may be the tumor, myeloma. It is rare disease. Patient experience sharp shooting, electric pain. It can also cause pain while touching the skin. The diagnosis is entirely clinical. The treatment is done pharmacological and interventionally also. In this problem few of the drugs cannot be continued for very long as they have certain side-effects. We give the treatment with radiofrequency ablation and balloon compression. This gives the excellent results. Once their are located then we give the radiofrequency current.
This relief is usually long lasting. In some cases their maybe relapse. It may also occur due to the inherent excitement of the nerve. Balloon compression often used at the time of first trigeminal nerves. This is used for the patients who have the major pain around the eyes or on the forehead. There are some side-effects of the procedure which are minor. This include minor bleeding, infection. There are some surgical options also and this can be better described by a neurosurgeon. This is day care procedure. Patient will be discharged on the same or the next day. If you are suffering with any facial pain, please contact us through Lybrate.
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I am Dr Siddharth Verma and welcome to this video. Today's topic is, how to avoid a spine surgery? So, you have been suffering from some kind of back pain, some injury or maybe the mixture of both. Maybe you didn't have anything but you still are undergoing a spine surgery. So don't worry, we are here to help you. Prevention is always better than cure, so you must stay fit. Most of the back injuries, strains and sprains occur because the person is not very flexible.
It might create big trouble for the back. This can also lead to a strain. Repetitive strain can lead to various issues with your back which can be as trivial as a myofascial syndrome, in which your muscles are affected or as severe as a disc herniation.In this video, we will concentrate on how to avoid this. So the first step is prevention which you can achieve by staying fit, by controlling your weight, by physical activities and by following the correct technique of lifting weights. This is the first step. Now the second step is early treatment. So if you know that you have been suffering from a backache but if the back pain is persisting over a week or two, then don't ignore and don't think. Immediately go and seek treatment from spine and pain specialist and talk to him about your problem and I am sure he will be able to sort it out. Now, the next step supposing you didn't pay heed to what your doctor said, you will continue to gain weight you continue to be lumber, resulting in the same kind of pain.
You will have this kind of pain and now the problem will increase. You go to a doctor one fine day and he suggests an MRI and there is a big bulging disc and it is compressing on your nerves and now your doctor says you need a surgery. So can you avoid the surgery? In many cases, yes you can and in many cases, you cannot. So, when you can and when you cannot, it depends on the opinion of your treating surgeon and your spine and pain specialist. There is some movement which is happening while you flex or extend your back. So, if this is not there then in most cases you can avoid an open surgery and how it can be done, it can be done with as trivial a procedure and as transforaminal neuroplasty procedure.
Number 2, nowadays we have a very nice procedure which is known as endoscopic foraminoscopy or foraminoplasty or endoscopic discectomy. This is a very noble procedure which is done by the spine and pain specialist and in this procedure we just give a small neck of the size of maybe smaller than a centimetre also. Then we reached this foramen from where this nerve comes out and we actually put in a camera through this small hollow tube, which is of the size of this pen, which is very hollow. The patient stays awake under local anaesthesia and doesn't feel any pain till the point. This hollow canal touches his nerves on his sensitive nerve fibre. Then we put our camera inside the foramen and we see the nerves, we see the disc and we take this material which is compressing on these nerves, we clean it, we wash it.We see very small tissue, we see these tissues under a big TV. So we can very accurately take out the tissues which are causing this compression and help you get relief from your pain. So need not go for any open surgery in these cases because in these cases we can help you by involving in this percutaneous procedure which is way less invasive than a surgery.
The main difference is that you don't get any general anaesthesia. You can walk on the same day of the procedure, you can go to the washroom, stay in a hospital for a couple of days, get a discharged and you can resume your active life in maybe 4-5 days or so. You will be given some precautions but more or less, your mobile, you don't have any loss of work hours and you can be very productive. Now another reason why people come to us is not to avoid the first surgery but how to avoid this second surgery? Because many of the patients have already undergone under 1 surgery and this still have this kind of pain which is left and the treating doctor has suggested them another surgery. Now they don't want to undergo a second surgery. In those cases, many of them provide there is no instability of these bony spines. We can help them with these procedures. If you want to know more you can also visit me on my Lybrate website which is www.lybrate.com/doctor/siddharthverma.
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Treatment of Neurological Problems
Treatment of Hip Disorders
Back Pain Treatment
Neck Pain Treatment
Treatment of Spondylosis
Arthritis And Pain Management Treatment
Treatment Of Disk Slip
Chronic Pain Management
Treatment Of Herniated Disc
Treatment of Spine Injuries
Treatment of Disc Prolapse
Spinal Cord Injury Medicine
Treatment of Muscle Pain Skeleton System
Treatment Of Foot Infection
Cancer Pain Management
Epidural And Spinal Anesthesia Techniques
Treatment of Spinal Diseases
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Dr. Sidharth Verma Reviews
Even though I was fit and fine, but suddenly I started experiencing headache . Dr Sidharth is a well known doctor for pain management . The complete process of headaches treatment was so painless and quick, and i am so relieved that I chose to consult him. Thanks to him that the headaches treatment he gave me has given brilliant results.The lab in the Pain Relief Center was very clean and well managed.
I was suffering from migraine. So many doctors I consulted, but Dr Sidharth's treatment was the best. I am so happy with the results of my treatment, that I will surely recommend Dr Sidharth Verma to anyone gladly. My case was extremely serious, but he really handled it very nicely. Hygiene is very important, and I must say that "Pain Relief Center" was extremely clean.
It's been more than a year that I was experiencing Meningitis. I consulted Dr Sidharth, he is very courteous and behaves very aptly with elder patients. Everything was just spick and span in the Pain Relief Center. Dr Sidharth Verma is well aware about innovative techniques to treat problems. The overall Meningitis treatment was very effective and quick.
The symptoms were severe and unmanageable, as I was suffering from muscle cramps, but Dr Sidharth, i was able to handle it. I am almost my normal self post the treatment and for that he is the reason. I was quite impressed with his concept of holistic healing. During the complete muscle cramps treatment program he always supported and motivated me.
Overnite my lower back pain issue aggravated. I found the Pain Relief Center itself quite pleasant. In the past i consulted so many doctors, but nobody was able to help me with my lower back pain, but he has helped me immensely. I am so happy that I chose Dr Sidharth Verma for my treatment as now I am perfectly fine.