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Last Updated: Mar 24, 2023

Chronic Pain

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Dr. Sidharth VermaPain Management Specialist • 17 Years Exp.MBBS, MD - Anaesthesiology, DNB Anaesthesiology, PDCC - Pain Management

Hi, I am Dr Siddharth Sharma. I am an interventional pain specialist and I treat patients who are suffering from chronic pain.

Chronic pain as you know is any kind of pain which is more than 3 months of duration or 12 weeks of duration. I am often asked about back pain and its surgical treatment. Patients come to me who has been advised open surgery and they want to avoid it and they ask me whether we can avoid it or not. So yes we can avoid the surgery almost in 90% of cases but there are certain conditions where surgery must be done and these are medical emergencies. However, in the majority of cases, we are able to prevent the surgery from happening that is patient is relieved without surgery so if you have been advised any surgery from your back pain which is you are very concerned and you don't want to get operated so please seek an opinion from pain management specialist.

So what the pain management consultant will do he will just try to find it where the pain is coming from and treat you accordingly. So our back is the structure which is made up of bones known as vertebrates and muscles and there a small nerves which are coming out of the spinal cord. Now I will show you a model so this is how the lower back looks like you can see the Bone part. So this model shows the Bony part of the human lower back. So if you see these are small bones which are forming this back and you can very well see her probably that this yellow portion is nerves which are coming out of the spinal canal and these nerves if they are compressed, leads to pain and this pain may go to distribution area of nerves which may be back, lower back, hips, leg, calves or even toes and this may also lead to symptoms like tingling numbness and likewise. So the back pain has always been a puzzle for doctors and to relieve the patient from the symptoms doctor they started dissecting and seeing why this pain is actually happening and since the possible causes are compression of these nerves it was thought that if we somehow release that pressure then probably the pain will be relieved. So the surgery started happening and the purpose of surgery is to decompress nerves to take the pressure of these nerves and relieve the patient possibly from his or her pain. However, this surgery necessitated cutting and going through the back muscles and then readjusting the bones and then retracting and itself cause so much of trauma that post surgery patient started having other symptoms as well. So probably that level may be a little better but maybe on other side or maybe on one level up one Level down problem started happening. Similar thing started happening with screws fixation and so.

Therefore the results if you see the data the results are not very encouraging that's why probably there is fear of surgery in the patient because they have seen their relatives or maybe there known people that are suffering from back pain undergoing some surgery and they recovered somewhat but probably there just started with some other problem or maybe the same number of problem started with and number of days whatever. For non-surgical treatment there are variety of treatments available nowadays there are interventional pain physician or pain specialist that can provide you with advanced option which are Minimal invasive which cause minimum damage to your body to the back to muscles because they are not involved when you're cutting or any suturing or anaesthesia so it is very advanced procedure and give very good pain relief in majority of patients. However, the indications are very clear cut and we cannot do these procedures in each and every patient so it's better if you consult an interventional pain physician and he will see evaluate and tell you that whether you are suited for the procedure or not. To name this procedure there can be as simple as simple epidural injections in which we inject a steroid. At once I tell the name steroid people start thinking that it will be harmful to the body but it will not be the case because this is a very small dose of steroid which is directly directed near the route so that the inflammation subsides and there is relief from the pain.

Also the another method is to decompress the nerve with the help of percutaneous procedures. Percutaneous means the patient is awake under the local anaesthesia while these procedures are done we reach this panel at the intervertebral disc base with the help of the needle then we can take it out take the disc out and we can with the help of radio frequency current we can seal the region actually. And this will result in decompression of the nerve and relief from the symptom. However, the indications are very clear cut and you need to go to your interventional pain consultant. He will see if you are fit for those procedures and guide you for these procedures. Another important thing that is common is to post surgery pain. So if you have gone any back surgery and you still having pain then you must visit your interventional pain physician you must go to him and he will check and try and find out the possible cause for pain. It is also possible that before surgery you have a different kind of pain, after surgery you have a different kind of pain then your physician will often be able to diagnose and give a diagnostic procedure if required or maybe give you a curative procedure as required. So this was about the back pain.

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