Cervical Spondylosis is an age-related degeneration (‘wear and tear’) of the vertebrae and discs in the neck. To an extent, we all develop some degeneration in the vertebrae and discs as we become older. It tends to start sometime after the age of about 30. One feature of the degeneration is that the edges of the vertebrae often develop small, rough areas of bone called osteophytes.

Also, over many years, the discs become thinner. In many people, the degeneration does not cause any symptoms. For example, routine X-rays of the neck will show these features (osteophytes and disc thinning) in many people who do not have any symptoms.

However, in some people, the nearby muscles, ligaments, or nerves may become irritated or ‘pressed on’ by the degenerative changes. So, cervicalspondylosis can be a cause of neck pain, particularly in older people.

Not all types of neck mean that an individual is suffering from cervical Spondylosis.

But, if not looked after and treated carefully, neck pain may take the form of Cervical Spondylosis.

WHAT ARE SYMPTOMS OF NECK PAIN / CERVICALSPONDYLOSIS ?

Symptoms of Cervical Spondylosis may manifest differently in different individuals, varying from mild to severe. The most common of them being Neck pain sometimes headaches mostly in back of head (occiput) Movement of the neck makes the pain worse.

Occasional pain in the shoulders, Often accompanied by neck muscle stiffness.

Pain radiate to the upper arm, forearm or hand Giddiness & vertigo associated with pain and stiffness.

Fatigue, disturbed sleep, and impaired ability to work.

Pain in the upper arm.

WHAT ARE CAUSES OF NECK PAIN ?

Long standing degeneration (wearing away) of the vertebrae and the intervertebral discs is the primary cause behind this disorder. Now this can be triggered due to a number of reasons such as

• Advancing age
• Repetitive neck injury
• Poor Muscle tone
• Joint Problem – Cervical Facet Arthropathy
• Ligament or muscle injury
• Disc problem – slipped disc or tear in disc
• Occupational trauma – lifting heavy loads on head, gymnastics, working on the computer for long hours
• Occupations requiring minute concentration wherein people work with bent neck for long time
• Any kind of odd postures that put a strain on the neck
• Smoking

HOW NECK PAIN IS DIAGNOSED ?

The history of your complaints and the examination findings often provide most of the details necessary to diagnose Cervical Spondylosis. However, some tests may be required to confirm the diagnosis as well as to assess the extent of damage that has already occurred. It can also be used to track the progress of the condition over a period of time.

• Here are some of the tests that can be done to confirm the diagnosis
• X-ray of the Cervical spine (neck) – detects the development of spurs (bony outgrowths) on the vertebrae
• MRI (Magnetic Resonance Imaging) spine – determines the extent of neural damage, if any
• EMG – Electromyogram – to detect abnormal muscle electrical activity in case of nerve affection
• X-ray or CT scan after dye is injected into the spinal column (myelogram)

Diagnostic block : This is considered a gold standard test for diagnostic cervical facet pain. If we suspect that pain is coming from a cervical facet joint. We put some local anaesthetic around cervical facet joint. After injecting a local anaesthetic injection if patients has pain relief for the duration of that particular local anaesthetic. We can confirm our diagnosis of cervical facet pain. And we can consider these patients for radiofrequency ablation of medial branch.

WHAT ARE TREATMENT OPTIONS FOR NECK PAIN ?

EXERCISE YOUR NECK AND KEEP ACTIVE

Aim to keep your neck moving as normally as possible. During flare-ups the pain may be quite bad, and you may need to rest for a day or so. However, gently exercise the neck as soon as you are able to do. You should not let it ‘stiffen up’. Gradually try to increase the range of the neck movements. Every few hours Gently move your neck do isometric exercise several times a day. Often good physio can help you for this. Applying heat over painful area can be very helpful.

As far as possible, continue with normal activities. You will not cause damage to your neck by moving it.

MEDICINES

Painkillers are often helpful. Pain killer as well as anti-inflammatory medicine can help you to move your neck for exercise. As well as it help to reduce an inflammation in neck. Pain killer are good role in early spondylotic changes.

In advance stages pain killers are not much useful. Also in long run pain killers can have a adverse effect on Kidney, liver and other major organs. So you should not take pain killers by your own, consult your doctor for this.

INTERVENTIONS

If pain is not controlled with pain killer or exercise than role of intervention become important.

CERVICAL EPIDURAL INJECTION :

This is an x ray guided injection, where anti- inflammatory drug is injected around affected vertebrae and nerve in neck. This helps you to reduce inflammation and keeps neck relaxed and moving. Once a neck is relaxed you can do a good exercise and keep it more fit. This injection we give under local anesthesia and under continuous X ray guidance.

We are injecting a drug under x ray guidance so we are sure that we are putting our drug at exact site where pathology is and it also required a less amount of drug.

 RADIOFREQUENCY ABLATION

This is a newer technique. If cervical spondylosis is not getting cured with other sort of treatment. Than radio frequency ablation of nerve which carries pain sensation of that particular joint/s can be helpful. Under live X ray guidance we insert a radiofrequency needle in neck. Proper position is confirmed under x ray machine.

We also do proper sensory and motor stimulation to confirm our needle position. Once we confirmed needles proper position we use radiofrequency current to make it numb. This procedure only numbs sensory part of joint and nerve and does not affect any function of nerve.

WHAT ARE CAUSES OF BACK PAIN ?

There are many causes of back pain. Long standing degeneration (wearing away) of the vertebrae and the intervertebral disc is the primary cause behind this disorder.

• Advancing age
• Joint Problem  Lumbar Facet Arthropathy
• Ligament or muscle injury
• Disc problem slipped disc or tear in disc
• Repetitive back injury
• Repetitive stress Poor Muscle tone

Occupational trauma lifting heavy loads on head, gymnastics, working on the computer for long hours.

HOW BACK PAIN IS DIAGNOSED ?

Getting an accurate diagnosis of the cause of back pain is critical, because different diagnoses will require very different treatment approaches. And the sooner an accurate back pain diagnosis is made, the sooner the patient can find an appropriate treatment for pain relief and to improve his or her ability to enjoy everyday activities.

The most common diagnostic tests include

• X-rays
• MRI scans
• Blood Test
• TREATMENT BACK PAIN DRUG THERAPIES

Painkillers are often helpful. Pain killer as well as anti-inflammatory medicine can help you to move your back for exercise. As well as it help to reduce an inflammation in back. Pain killer has a good role in early stages back pain.

In advance stages pain killers are not much useful. Also in long run pain killers can have an adverse effect on Kidney, liver and other major organs. So you should not take pain killers by your own, consult your doctor for this.

EXERCISE AND PHYSIOTHERAPY

Some back exercises are very helpful in early stage of back pain and to maintain a muscle strength and tone for long term.

INTERVENTIONS

SPINAL BLOCK / INJECTIONS

As science advances treatment of back pain is becoming less and less invasive. Now a days for back pain treatment minimally invasive treatments are widely available. Back pain treatment in India is keeping pace with world. All advance and minimally back pain treatment also available in India.

If exercise and medicine are not working then your doctor might suggest you spinal blocks / injection. There are number of procedure for back pain. Your doctor will see all reports and then suggest you best treatment options for you. Interventions are small procedure done with a tiny needles to block pain generators or pain pathways.

All these blocks are very useful and make patient life more pain free. Mostly all back pain procedure are a day care procedure and patient can go back to home on same day. These all are procedure not a surgery so hospitalization required and not incision and no scar. Pain relief usually start within one week.

FACET JOINT BLOCK

When back pain originates from the facet joints (located in each side of the vertebrae), a specific type of injection called a facet joint injection may reduce inflammation and provide pain relief. Doctors use live X ray to ensure the needle is correctly placed before the medicines are injected

RADIO-FREQUENCY ABLATION

If facet joint injection successful and pain comes back within a short period of time you might get benefits from a radio frequency ablation of medial branch. Radio frequency ablation is a specialized procedure which causes a thermal lesion on the medial branch. This procedure can give a long term pain relief.

TRANSFORAMINAL BLOCK

During transforaminal block, medications are injected into the foraminal space which is also called an epidural space. Epidural space is the area between the spinal sac and spinal canal, which runs the length of the canal. As the medicine is injected into the epidural space it coats the nerve roots and outside lining of the facet joints.

To read more about back pain see the section of SCIATICA.

Osteoarthritis, a degenerative joint disease, is the most prevalent form of arthritis and the leading cause of disability in India affecting about 15 million Indians every year. About 20 years ago, osteoarthritis was known as a disease of the elderly affecting those above the age of 65. However, today, an increasing number of younger people in the age group of 35-55 are being diagnosed with Osteoarthritis. DR YUVRAJ PAIN CLINIC is one of the best Knee Pain Treatment clinic in Surat, Gujarat.

WHAT IS OSTEOARTHRITIS OF THE KNEE ?

Knee Osteoarthritis is caused when cartilage in the knee-joint wears away. Cartilage is a firm tissue in the human body, which is softer than bone and much more flexible. Cartilage helps in the smooth functioning of the joints.

WHAT ARE THE SYMPTOMS OF OSTEOARTHRITIS OF THE KNEE ?

Symptoms for Knee Osteoarthritis vary, depending on the age of the patient and severity of the problem. Here are some of the commonly found symptoms:

• Pain and stiffness of the knee
• Difficulty in movement
• Swelling in the knees
• Creaking/Grating sound or sensation during the moment of knees
• Stiffness in knees in the mornings or after a period of inactivity or during cold weather
• Extreme pain in the knee joints after being exerted
• Some patients may have alternating painful and pain-free intervals
• Formation of bone spurs around the knee – extra bits of bone which feel like hard lumps

WHAT ARE THE CAUSES OF OSTEOARTHRITIS OF THE KNEE?

There are a number of factors that could cause osteoarthritis. Below are a few common factors that increase the risk of developing this condition:

• Genetics
• Obesity
• Older Age
• Athletics and sports such as football, hockey, etc.
• Illnesses like diabetes
• Weak bones or low Vitamin-D levels
• Formation of bone spurs around the knee – extra bits of bone which feel like hard lumps

HOW IS OSTEOARTHRITIS OF THE KNEE DIAGNOSED ?

The patients’ medical and family history as well as a physical exam is the foundation of diagnosing Osteoarthritis. In order to confirm the diagnosis, patients may be asked to undergo :

• X-ray: For an idea about the abnormality in the shape of the bone and damage caused by the lack of Cartilage
• Blood test: To confirm if there are any other reasons for the complication

TREATMENT FOR OSTEOARTHRITIS OF KNEE

MEDICATION

Non-steroidal anti-inflammatory drugs (NSAIDs) are helpful in easing acute pain. Doctors are very careful while prescribing NSAIDs considering the risks of side effects usually suggest the lowest effective dose for a short period of time. Non-steroidal anti-inflammatory creams and gels are often prescribed as well.

EXERCISE AND WEIGHT LOSS

Nonsurgical management of Knee Osteoarthritis starts with weight loss and muscle strengthening. Muscle strength is also vital in combating osteoarthritis. The muscles surrounding the knee joint act as shock absorbers for the pressure that daily activities and sports place on the joint. The stronger the muscles are that surround the knee joint are, the more stress they can absorb for the knee joint. Increasing muscle strength will decrease pressure otherwise placed on the joint, thus decreasing symptoms. Knee braces may also help in reducing the stress on the knees.

TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS)

A TENS is an electronic device having pads which are placed on the skin and pulse signals are sent to the nerve endings. This helps modify the pain sensation in the brain with tingling sensation. The results for this method vary from person to person.

STEROID INJECTIONS

These injections are mostly given directly to the particular painful knee. They take effect in a day and help in relieving pain for weeks or even months. Steroid Injections are used in extreme scenarios only.

HYALURONIC ACID INJECTIONS (VISCOSUPPLEMENTATION)

Viscosupplementation is a procedure in which a thick fluid called hyaluronate is injected into the knee joint. Hyaluronic Acid is present in the body naturally and is found in the synovial fluid surrounding joints. It acts as a lubricant to enable bones to move smoothly over each other and as a shock absorber for exertions on the joints. People with osteoarthritis have a lower-than-normal concentration of hyaluronic acid in their joints.

Viscosupplementation was first used in Europe and Asia, and was approved by the U.S. Food and Drug Administration in 1997.

1) THE PROCEDURE

Hyaluronic acid, a gel like fluid, is injected in the knee joint to help lubricate it.

There may be a single or multiple shots of Hyaluronic Acid given to the patient, depending on the case.

The procedure is advised when steroid injections fail to show progress.

2) RESULTS

This procedure is best for patients with mild to moderate OA of the knee.

Not all patients are helped by the injections. Most patients report the greatest pain relief 8-12 weeks after beginning treatment, though some fee a difference within the first 3-5 weeks as well.

The length of pain relief varies; some patients have reported benefits for more than 6 months following the injections.

3) SIDE EFFECTS

The most commonly reported side effects associated with the hyaluronate injections are temporary injection-site pain; swelling, heat, or redness; rash and itching; bruising around the joint; and fluid accumulation in the injected knee.

These reactions are usually mild and don’t last long. Similar to steroid injections, rare complications include infection and bleeding.

KNEE-REPLACEMENT SURGERY

Knee-replacement Surgery is advised when the pain becomes severe enough to make daily tasks extremely painful and difficult. Majority of patients with Knee Osteoarthritis do not need Knee-replacement surgery.

STEM CELL THERAPY

Stem Cell Therapy is a non-surgical procedure which utilizes the stem cells from the patients’ own body reserves to help heal the injured area. This procedure has gained popularity in recent years due to its success ratio.

Read More

SYMPTOMS OF FROZEN SHOULDER

• Pain over shoulder
• Decrease movement of Shoulder
• Above head movement are painful or not possible at all
• Stiffness of shoulder joint
• Stiff Shoulder
• Night time pain in advance stage
• Patient find it difficult to comb his/her head, difficulty in getting dressed

RISK FACTOR

Capsule in the shoulder joint which hold bone together are made up of ligament. When this capsule becomes inflamed, shoulder bones are unable to move freely. Most of the time there is no known cause found, however risk factor includes

• Diabetes
• Shoulder injury
• Cervical disc disease in neck
• Shoulder surgery
• Any kind of surgery which required prolong bed rest
• Excessive strain on shoulder in patient with knee pain

SIGNS AND TESTS FOR FROZEN SHOULDER

Doctor usually decides by examining patient. X ray, sonography and MRI test are helpful to find out any cause. Mostly there is no cause found in such investigation except inflammation and some fluid collection in capsule.

TREATMENT OF FROZEN SHOULDER

Treatment usually starts with anti-inflammatory medicine and physical therapy. Shoulder mobilization therapy is useful in almost all cases. Many any of the patients respond well to such kind of treatment. It may take almost 4 to 8 weeks to get a good respond with medicine and physical therapy.

INTERVENTION FOR FROZEN SHOULDER

If pain does not improved with medicine and physiotherapy thenpain specialist can inject an anti-inflammatory drug inside the capsule. This ultimately reduces inflammation and fastens recovery. This injection helps patient in reducing pain as well as improving movement.

Doctor can inject a jelly kind of material inside a joint to get better results. Sometime doctor can do a force mobilization under general anesthesia. Jelly Kind of Injection is what we prefer because it helps us to reduce inflammation inside the joint and give better results.

WHAT TO EXPECT AFTER PROCEDURE ?

Patient will discharge after 10 to 20 minutes of procedure. Patient should take a rest for a day. He can resume an activity from next day. Patient needs to take a physical therapy as well as anti-inflammatory medicine for few days.

HOW TO PREVENT FROZEN SHOULDER ?

Keep your shoulder moving, do exercise particularly rotating and above head exercise. Rotate your arms in clockwise and anti-clockwise. Do strengthening exercise. Take medical attention in early phase of pain because advanced stages are more difficult to treat.

Patients with frozen shoulder are more prone to have other episodes of frozen shoulder in their life. To prevent reoccurrence of frozen shoulder patient needs to do regular exercise, keep shoulder moving and controlled diabetes and other disease which can contribute to frozen shoulder.

THE CONDITION

It is a kind of facial Pain. It has been described as among the most painful conditions known. Trigeminal neuralgia affects women more often than men, and it’s more likely to occur in people who are older than 50. Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from your face to your brain.

If you have trigeminal neuralgia, even mild stimulation of your face — such as from brushing your teeth or putting on makeup — may trigger a jolt of excruciating pain.

SYMPTOMS OF TRIGEMINAL NEURALGIA

Trigeminal neuralgia symptoms may include one or more of these patterns

• Episodes of severe, shooting or jabbing facial pain that may feel like an electric shock
• Spontaneous attacks of facial pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
• Bouts of facial pain lasting from a few seconds to several seconds
• Episodes of several attacks lasting days, weeks, months or longer —some people have periods when they experience no pain
• Pain in areas supplied by the trigeminal nerve (nerve branches), including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
• Pain affecting one side of your face.
• Pain focused in one spot or spread in a wider pattern
• Attacks becoming more frequent and intense over time

CAUSES OF TRIGEMINAL NEURALGIA

• Pressure of a blood vessel on the trigeminal nerve.
• Physical damage to the nerve caused by dental or surgical procedures, injury to the face or infections.
• Over time, changes in the blood vessels of the brain can result in blood vessels rubbing against the Trigeminal Nerve Root.
• Trigeminal neuralgia can occur as a result of aging, or it can be related to multiple sclerosis or a similar disorder that damages the myelin sheath protecting certain nerves
• Pressure of a tumor on the trigeminal nerve (rare)

TRIGGERS OF TRIGEMINAL NEURALGIA

A variety of triggers may set off the pain of trigeminal neuralgia, including

• Shaving
• Stroking your face
• Eating
• Drinking
• Brushing your teeth
• Talking
• Putting on makeup
• Encountering a breeze
• Smiling

DIAGNOSIS OF TRIGEMINAL NEURALGIA

A diagnosis of trigeminal neuralgia is primarily based on a description of your pain, including the

• Type- Pain related to trigeminal neuralgia is sudden, shock-like and brief.
• Location- The parts of your face that are affected will tell the doctor if the trigeminal nerve is involved

TESTS USED TO CONFIRM THE DIAGNOSIS MAY INCLUDE

A neurological examination. Touching and examining parts of your face can help the doctor determine exactly where the pain is occurring and

• — if you appear to have trigeminal neuralgia
• — which branches of the trigeminal nerve may be affected.

Magnetic resonance imaging (MRI). An MRI scan of your head can show if multiple sclerosis is causing trigeminal neuralgia.

Facial pain can be caused by many different disorders, so an accurate diagnosis is important. The doctor may order additional tests to rule out other conditions.

TRIGEMINAL NEURALGIA TREATMENT

Trigeminal neuralgia treatment usually starts with medications, and many people require no additional treatment. However, over time, some people with the disorder eventually stop responding to medications, or they experience unpleasant side effects. For those people intervention is required.

MEDICATIONS

Medications to lessen or block the pain signals sent to your brain are the most common initial treatment for trigeminal neuralgia.

ANTICONVULSANTS

ANTISPASMODIC AGENTS

RADIOFREQUENCY ABLATION OF TRIGEMINAL NERVE

This procedure selectively destroys nerve fibers associated with pain. At DR YUVRAJ PAIN CLINIC, we do all this pain procedure very routinely. Our expert hands at clinic do procedure in few minutes and you will become pain free.

This procedure can be done under local anesthesia. After giving local injection on patient cheek, Doctor insert radio frequency needle. Under constant CT Scan Guidance Doctor guides needle in proper direction.

Once need is at proper position(on foramen ovale) on nerve we give radio frequency current for 2 to 3 minutes, Which will destroy the selective sensory fibers of trigeminal nerve.

This procedure will take around 30 minute. Pain relief is immediate after procedure. This procedure is safer than major surgical procedure and gives good pain relief as compare to surgery. Our treatment for trigeminal Neuralgia is without Surgery.

This procedure is an USA,FDA approved procedure.

ALCOHOL INJECTION

Alcohol injections provide temporary pain relief by numbing the affected areas of your face. The doctor will inject alcohol into the part of your face corresponding to the trigeminal nerve branch causing pain. The pain relief isn’t permanent, so you may need repeated injections or a different procedure in the future.

Side effects may include infections at the injection site, bleeding and damage to nearby nerves.Alcohol injections are obsolete these days and very rarely some doctors are using it due to cost constrain.

SURGICAL INTERVENTIONS FOR TRIGEMINAL NERVE

MICRO VASCULAR DECOMPRESSION (MVD)

This is a major surgical procedure. It involves posterior fosse exploration in brain.

During MVD, the doctor makes an incision behind the ear on the side of your pain. Then, through a hole in your skull, part of your brain is lifted to expose the trigeminal nerve. Any artery in contact with the nerve root is directed away from the nerve, and the surgeon places a pad between the nerve and the artery.

While MVD has a good success rate, it carries risks. There are chances of decreased hearing, facial weakness, facial numbness, double vision, and even a stroke or death.

BALLOON COMPRESSION

In balloon compression of the trigeminal nerve, the doctor inserts a hollow needle through your face and into an opening in the base of your skull. Then, a thin, flexible tube (catheter) with a balloon on the end is threaded through the needle.

The balloon is inflated with enough pressure to damage the nerve and block pain signals. Balloon compression successfully controls pain in most people, at least for a while. Most people undergoing this procedure experience some facial numbness, and some experience temporary or permanent weakness of the muscles used to chew.

GAMMA-KNIFE RADIOSURGERY (GKR)

This procedure involves delivering a focused, high dose of radiation to the root of the trigeminal nerve.

Gamma-knife radiosurgery uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and can take several weeks to begin. side effects, which may include lasting loss of facial sensation.

WHAT IS SCIATICA ?

Sciatica is a symptom caused by lumbar disc herniation and the pain generally affects the back, hip and leg. In such a case, the disc between two lumber vertebra compresses over existing nerve roots and causes radicular pain in one or both legs. It results in the patient experiencing tingling, numbness and stretching kind of pain in either one or both the legs. The pain can radiate up to toe, fingers and ankle however sometimes pain may only radiate up to the thigh and above knee

WHAT ARE SYMPTOMS OF SCIATICA ?

• Tingling and numbness in one or both legs
• Ant walking sensation
• Radicular pain in leg
• Pain increase by walking and standing
• Partially or completely relieved by rest or lying down position
• Pain may provoke by coughing, sneezing or any kind of straining
• WHAT ARE CAUSES OF SCIATICA?
• Sciatica is mainly caused by the irritation of sciatic nerve or its fibers
• Lumbar disc herniation is the main cause of Sciatica
• Degenerative vertebra can causes Sciatica
• Muscle inflammation, injury or tumor can cause Sciatica

HOW SCIATICA IS DIAGNOSED ?

History and physical examination can give clues to suspect sciatica. X ray and MRI of lumbar spine can help to diagnose sciatica as well as help to find out causes of it. MRI also guides a treatment plan.

WHAT ARE TREATMENT OPTIONS FOR SCIATICA ?

CONSERVATIVE

For acute and less severe pain, rest and medicine can help few of patients. Avoiding forward bending, lifting weight, avoiding sitting on floor will help. If patient feels improvement in pain we can continue a conservative approach with medicine and exercise for four weeks.

INTERVENTIONS

As science advances treatment of sciatica is becoming less and less invasive. Now a day’s for sciatica minimally invasive treatments are widely available. Sciatica treatment in India is keeping pace with world. All advance and minimally back pain treatment also available in India.

If exercise and medicine are not working than your doctor might suggest you some intervetions. Pain Management treats such diseases with techniques called intervention. Intervention is a small injection technique which helps to get rid of root problem of Sciatica without surgery. Your doctor will see all reports and then suggest you best treatment options for you.

TRANSFORAMINAL BLOCK

Mild bulge (Slipped) Disc can cause a swelling on the existing nerve roots. Injecting a drug in to a foramen will reduce that swelling inside and help the patient by dissipating the pain.

Transforaminal Block is given under local anesthesia. It is given under live X-ray (C arm) guidance. Here we numb a part of the back and insert a thin needle inside. The needle is guided with the help of a Live X-ray Machine.

This is a 15 minutes procedure and patient can walk away after 2 hours.

PERCUTANEOUS DISC DECOMPRESSION / NUCLEOPLASTY

In this procedure we remove a part of the herniated disc through a needle. No incision or surgery is required for this procedure. We have latest equipments to do these procedures.

This procedure is recommended in Sciatica patients who have a significant disc herniation which is pressing on nerve roots and not responding to conservative treatment.

 We numb the skin of the back. Under live X- ray (under IITV) guidance, we insert a needle like instrument called Disc dekompressor or nucleoplasty in the back. This instrument goes in between vertebra in to a disc. Once we confirm an instrument position with a live X-ray (IITV) machine, we turn on the machine and use latest techniques to remove a significant part of the disc which is called Nucleus Pulposus. Usually we do this procedure for three minutes. Once significant amount of material is removed we remove the instrument and put a small dressing at the spot from where needle was inserted in the back.

ENDOSCOPIC DISC REMOVAL

For an endoscopic disc removal we remove a bulged disc through an instrument called endoscope. After numbing a skin and underlying muscles we insert endoscope inside a slipped disc. We remove a bulged disc under direct vision. It is an excellent procedure and we can remove a significant amount of disc material with this procedure. Patient can go home on same or next day. After seeing at all reports and MRI scan doctors can decide which procedure is good for patient.

WHAT TO EXPECT AFTER THE PROCEDURE ?

• Mild aching back, which will be relieved with medicine
• Improvement in pain will start after two to three days
• It is recommended that patients apply ice on the back for three to four days
• Patient must take rest for 1 to 2 days although no complete bed rest is required

ADVANTAGES OF THIS PROCEDURE

1. Get rid of Sciatica problem without surgery
2. Remove a part of disc
3. Procedure done under local anesthesia so we can avoid general anesthesia
4. No bed rest needed
5. Less post-operative pain
6. Short recovery period
7. Get results equal to surgery
8. Provide a disc sample for biopsy if required
9. Intense rehabilitation not required
10. Avoids surgery and consequences of surgery
11. No scarring after procedure
12. Cost effective due to reduced hospital stay
13. Can be done on elderly patients also

SURGERY

LAMINECTOMY

Sometimes due to severe Stenosis or loss of sensation in the leg / legs, the patient is required to go for an open surgery called Laminectomy. Laminectomy should be done under general anesthesia. Laminectomy is a surgery done to remove excessive pressure on the spinal cord and nerve roots. Laminectomy removes a portion of thin part of vertebra called lamina which forms a protective arch of vertebra. Laminectomy also removes a thick part of tissue around spinal cord on selected vertebra.

Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. Researchers believe that fibromyalgia amplifies painful sensations by affecting the way your brain processes pain signals.

Symptoms sometimes begin after a physical trauma, surgery, infection or significant psychological stress. In other cases, symptoms gradually accumulate over time with no single triggering event.

Women are more likely to develop fibromyalgia than are men. Many people who have fibromyalgia also have tension headaches, temporomandibular joint (TMJ) disorders, irritable bowel syndrome, anxiety and depression.

While there is no cure for fibromyalgia, a variety of medications can help control symptoms. Exercise, relaxation and stress-reduction measures also may help.

SYMPTOMS

Symptoms of fibromyalgia include :

Widespread pain The pain associated with fibromyalgia often is described as a constant dull ache that has lasted for at least three months. To be considered widespread, the pain must occur on both sides of your body and above and below your waist.

Fatigue People with fibromyalgia often awaken tired, even though they report sleeping for long periods of time. Sleep is often disrupted by pain, and many patients with fibromyalgia have other sleep disorders, such as restless legs syndrome and sleep apnea.

Cognitive difficulties A symptom commonly referred to as “fibro fog” impairs the ability to focus, pay attention and concentrate on mental tasks.

Fibromyalgia often co-exists with other painful conditions, such as:

• Irritable bowel syndrome
• Migraine and other types of headaches
• Interstitial cystitis or painful bladder syndrome
• Temporomandibular joint disorders

CAUSES

Doctors don’t know what causes fibromyalgia, but it most likely involves a variety of factors working together. These may include:

• Genetics : Because fibromyalgia tends to run in families, there may be certain genetic mutations that may make you more susceptible to developing the disorder.
• Infections : Some illnesses appear to trigger or aggravate fibromyalgia.
• Physical or emotional trauma : Fibromyalgia can sometimes be triggered by a physical trauma, such as a car accident. Psychological stress may also trigger the condition.

DIAGNOSIS

In the past, doctors would check 18 specific points on a person’s body to see how many of them were painful when pressed firmly. Newer guidelines don’t require a tender point exam. Instead, a fibromyalgia diagnosis can be made if a person has had widespread pain for more than three months — with no underlying medical condition that could cause the pain.

BLOOD TESTS

While there is no lab test to confirm a diagnosis of fibromyalgia, your doctor may want to rule out other conditions that may have similar symptoms. Blood tests may include :

• Complete blood count
• Erythrocyte sedimentation rate
• Cyclic citrullinated peptide test
• Rheumatoid factor
• Thyroid function tests

TREATMENT

In general, treatments for fibromyalgia include both medication and self-care. The emphasis is on minimizing symptoms and improving general health. No one treatment works for all symptoms.

MEDICATION

Medications can help reduce the pain of fibromyalgia and improve sleep. Common choices include :

• Pain relievers : Over-the-counter pain relievers such as acetaminophen (ibuprofen or naproxen sodium may be helpful. Your doctor might suggest a prescription pain reliever such as tramadol Narcotics are not advised, because they can lead to dependence and may even worsen the pain over time.
• Antidepressants : Anti-depressant may help ease the pain and fatigue associated with fibromyalgia. Your doctor may prescribe amitriptyline or the muscle relaxant cyclobenzaprine to help promote sleep.
• Anti-seizure drugs : Medications designed to treat epilepsy are often useful in reducing certain types of pain. Neuropathic pain medicine is sometimes helpful in reducing fibromyalgia symptoms,

THERAPY

A variety of different therapies can help reduce the effect that fibromyalgia has on your body and your life. Examples include:

• Physical therapy : A physical therapist can teach you exercises that will improve your strength, flexibility and stamina. Water-based exercises might be particularly helpful.
• Occupational therapy : An occupational therapist can help you make adjustments to your work area or the way you perform certain tasks that will cause less stress on your body.
• Counseling : Talking with a counsellor can help strengthen your belief in your abilities and teach you strategies for dealing with stressful situations.

Complex regional pain syndrome (CRPS) is a form of chronic pain that usually affects an arm or a leg. CRPS typically develops after an injury, a surgery, a stroke or a heart attack. The pain is out of proportion to the severity of the initial injury.

CRPS is uncommon, and its cause isn’t clearly understood. Treatment is most effective when started early. In such cases, improvement and even remission are possible.

SYMPTOMS

Signs and symptoms of CRPS include:

• Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
• Sensitivity to touch or cold
• Swelling of the painful area
• Changes in skin temperature — alternating between sweaty and cold
• Changes in skin color, ranging from white and blotchy to red or blue
• Changes in skin texture, which may become tender, thin or shiny in the affected area
• Changes in hair and nail growth
• Joint stiffness, swelling and damage
• Muscle spasms, tremors, weakness and loss (atrophy)
• Decreased ability to move the affected body part

Symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) usually occur first.

Symptoms may change over time and vary from person to person. Pain, swelling, redness, noticeable changes in temperature and hypersensitivity (particularly to cold and touch) usually occur first.

Over time, the affected limb can become cold and pale. It may undergo skin and nail changes as well as muscle spasms and tightening. Once these changes occur, the condition is often irreversible.

CRPS occasionally may spread from its source to elsewhere in your body, such as the opposite limb.

In some people, signs and symptoms of CRPS go away on their own. In others, signs and symptoms may persist for months to years. Treatment is likely to be most effective when started early in the course of the illness.

CAUSES

The cause of CRPS isn’t completely understood. It’s thought to be caused by an injury to or an abnormality of the peripheral and central nervous systems. CRPS typically occurs as a result of a trauma or an injury.

CRPS occurs in two types, with similar signs and symptoms, but different causes:

• Type 1 Also known as reflex sympathetic dystrophy (RSD), this type occurs after an illness or injury that didn’t directly damage the nerves in your affected limb. About 90% of people with CRPS have type 1.
• Type 2 Once referred to as causalgia, this type has symptoms similar to those of type 1. But type 2 CRPS occurs after a distinct nerve injury.

Many cases of CRPS occur after a forceful trauma to an arm or a leg. This can include a crushing injury or a fracture.

Other major and minor traumas — such as surgery, heart attacks, infections and even sprained ankles — also can lead to CRPS.

It’s not well understood why these injuries can trigger CRPS. Not everyone who has such an injury will go on to develop CRPS. It might be due to a dysfunctional interaction between your central and peripheral nervous systems and inappropriate inflammatory responses.

COMPLICATIONS

• Tissue wasting (atrophy). Your skin, bones and muscles may begin to deteriorate and weaken if you avoid or have trouble moving an arm or a leg because of pain or stiffness.
• Muscle tightening (contracture). You also may experience tightening of your muscles. This may lead to a condition in which your hand and fingers or your foot and toes contract into a fixed position.

DIAGNOSIS

Diagnosis of CRPS is based on a physical exam and your medical history. There’s no single test that can definitively diagnose CRPS, but the following procedures may provide important clues:

• Bone scan- This procedure might help find bone changes. A radioactive substance injected into one of your veins allows your bones to be seen with a special camera.
• Nerve conduction test- Some tests can measure working or non-working of nerve
• X-rays- Loss of minerals from your bones may show up on an X-ray in later stages of the disease.
• Magnetic resonance imaging (MRI) Images captured with an MRI test may show tissue changes that rule out other conditions.

TREATMENT

There’s some evidence that early treatment might help improve symptoms of CRPS. Often, a combination of different treatments, tailored to your specific case, is necessary. Treatment options include:There’s some evidence that early treatment might help improve symptoms of CRPS. Often, a combination of different treatments, tailored to your specific case, is necessary. Treatment options include:

MEDICATION

Doctors use various medications to treat the symptoms of CRPS.

• Pain relievers pain relievers — such as aspirin, ibuprofen and naproxen sodium — may ease mild pain and inflammation.Your doctor may prescribe stronger pain relievers if OTC ones aren’t helpful. Opioid medications might be an option. Taken in appropriate doses, they might help control pain.
• Antidepressants and anticonvulsants Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin, are used to treat pain that originates from a damaged nerve (neuropathic pain).
• Corticosteroids Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.
• Bone-loss medications Your doctor may suggest medications to prevent or stall bone loss, such as alendronate and calcitonin.
• Sympathetic nerve-blocking medication Injection of an anaesthetic to block pain fibres in the affected nerves may relieve pain in some people. Pulsed radiofrequency or conventional radiofrequency ablation may be helpful in few patients.
• Intravenous ketamine- Some studies show that low doses of intravenous ketamine, a strong anaesthetic, may substantially alleviate pain.

THERAPIES

Heat therapy Applying heat may offer relief of swelling and discomfort on skin that feels cool.

Topical analgesics Various topical treatments are available that may reduce hypersensitivity, such as over-the-counter capsaicin cream, or lidocaine cream or patches.

Physical or occupational therapy Gentle, guided exercising of the affected limbs or modifying daily activities might help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed; the more effective exercises might be.

Transcutaneous electrical nerve stimulation (TENS) Chronic pain is sometimes eased by applying electrical impulses to nerve endings.

Biofeedback In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.

Spinal cord stimulation at DR YUVRAJ PAIN CLINIC we are doing spinal cord stimulator to treat CRPS (Complex regional pain Syndrome). In this procedure we insert tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

Intrathecal drug pumps At DR YUVRAJ PAIN CLINIC we are doing intrathecal pump to treat CRPS (Complex regional pain Syndrome). In this therapy, medications that relieve pain are pumped into the spinal cord fluid.

Pain is a very common symptom in cancer. Approximately 30% to 50% of people with cancer experience pain while undergoing treatment, and 70% to 90% of people with advanced cancer experience pain. Fear of pain is sometimes very high in patient with cancer.

CANCER PAIN MANAGEMENT

Cancer Pain treatment is as important as disease. If we treat cancer pain and reduce cancer pain to an optimum level patient can lead a very good life. Our goal at LiveWell Pain & Spine Hospital is to provide most effective pain management and improve a quality of life of patient with cancer pain.

We work with patient and their oncologist to provide an optimum pain relief. Cancer pain can be managed with different approach. Definitely treatment of disease should be an utmost priority.

Our Dr Yuvrajsinh Chauhan is an expert in cancer pain management. He has treated number of patients for cancer pain. Oncologists refer him for pain management.

MEDICINE

There are various medicines for cancer pain. Administration of optimum dose of medicine like NSAID, Opioids and other drugs can be a great help to patient. Many a time patients are not even on optimum dose of medicine. At DR YUVRAJ PAIN CLINIC  we work with patient to have optimum relief of pain with minimal side effect.

PALLIATIVE CHEMOTHERAPY AND RADIO THERAPY

Chemotherapy and radio therapy can be very helpful for cancer pain. It has been given by oncologist and radio therapist.

PAIN BLOCK FOR CANCER PAIN

At DR YUVRAJ PAIN CLINIC various intervention options available for cancer pain management. If cancer pain is taken care, than treatment of cancer can be very smooth for clinician too.

CELIAC PLEXUS BLOCK

This procedure helps to treat the pain from malignancy involving pancreas, liver, gall bladder, stomach, intestine, colon and upper abdomen. At our pain clinic, we do this procedure under C arm Guidance.

It involves a 30-minute procedure in which under local anaesthesia and with the help of C –Arm (IITV), the pain specialist advances a needle to the correct location at Celiac Plexus. For Celiac plexus block we us 50% alcohol or we can do radio frequency ablation.

SUPERIOR HYPOGASTRIC PLEXUS BLOCK

The Superior Hypogastric Plexus Block helps to treat the pain from malignancy involving Uterus, Cervix, Ovary, prostate, bladder, rectum and all viscera from pelvis. At DR YUVRAJ PAIN CLINIC we do this procedure under C arm Guidance. It involves a 30-minute procedure.

In which under local anaesthesia and with the help of C –Arm (IITV), the pain specialist advances a needle to the correct location at superior hypogastric plexus. For hypogastric plexus block we us 50% alcohol we can do radio frequency ablation.

STELLATE GANGLION BLOCK

For malignancy involving head, neck and upper extremity stellate ganglion block will be very useful. We do this procedure under C arm Guidance. In Stellate Ganglion block we can use alcohol or can do radio frequency ablation.

T2 T3 SYMPATHETIC BLOCK

For malignancy involving chest, lung and any thoracic viscera T2 T3 Sympathetic block will be very useful. We do this procedure under CT Guidance. For T2 T3 Sympathetic block we can use radiofrequency ablation

INTRATHECAL IMPLANTS

In extreme painful conditions and with longer life expectancy we do use intrathecal implants. Intrathecal implants can be placed in intrathecal space. It delivers constant dose of fentanyl or morphine in intrathecal space.

There are four main types of diabetic neuropathy — nerve damage that can occur as a result of high blood sugar when you have diabetes. You may have just one type or symptoms of several types. Most types of diabetic neuropathy develop gradually, and you may not notice problems until considerable damage has occurred.

Talk to your doctor about any of the following symptoms. The sooner they can be diagnosed and treated, the better the chance of preventing further complications.

PERIPHERAL NEUROPATHY

Peripheral neuropathy is the most common form of diabetic neuropathy. Your feet and legs are often affected first, followed by your hands and arms. Possible signs and symptoms of peripheral neuropathy include:

• Numbness or reduced ability to feel pain or changes in temperature, especially in your feet and toes
• A tingling or burning feeling
• Sharp, jabbing pain that may be worse at night
• Extreme sensitivity to the lightest touch — for some people even the weight of a sheet can be agonizing
• Muscle weakness
• Loss of reflex response
• Serious foot problems, such as ulcers, infections, deformities, and bone and joint pain

DIAGNOSIS

A doctor can usually diagnose diabetic neuropathy by performing a physical exam and carefully reviewing your symptoms and medical history.

Your doctor will check your:

• Overall muscle strength and tone
• Tendon reflexes
• Sensitivity to touch and vibration

Along with the physical exam, your doctor may perform or order specific tests to help diagnose diabetic neuropathy, such as:

• Sensory testing This noninvasive test is used to tell how your nerves respond to vibration and changes in temperature.
• Nerve conduction testing This test measures how quickly the nerves in your arms and legs conduct electrical signals. It’s often used to diagnose carpal tunnel syndrome.
• Muscle response testing Called electromyography, this test is often done with nerve conduction studies. It measures electrical discharges produced in your muscles.

TREATMENT

Diabetic neuropathy has no known cure. The goals of treatment are to:

Slow progression of the disease

Relieve pain

Manage complications and restore function

SLOWING PROGRESSION OF THE DISEASE

Consistently keeping your blood sugar within your target range is the key to preventing or delaying nerve damage. Good blood sugar management may even improve some of your current symptoms. Your doctor will figure out the best target range for you based on factors including your age, how long you’ve had diabetes and your overall health.

Blood sugar levels may need to be individualized. But, in general, the American Diabetes Association recommends the following target blood sugar levels for most people with diabetes:

Between 80 and 130 mg/dL, which is 4.4 and 7.2 millimoles per liter (mmol/L) before meals

Less than 180 mg/dL (10.0 mmol/L) two hours after meals

RELIEVING PAIN

Many prescription medications are available for diabetes-related nerve pain, but they don’t work for everyone. When considering any medication, talk to your doctor about the benefits and possible side effects to find what might work best for you.

Pain-relieving prescription treatments may include:

• Anti-seizure drugs. Some medications used to treat seizure disorders (epilepsy) are also used to ease nerve pain. The American Diabetes Association recommends starting with pregabalin. Gabapentin also is an option. Side effects may include drowsiness, dizziness and swelling.
• Antidepressants. Some antidepressants ease nerve pain, even if you aren’t depressed. Tricyclic antidepressants may help with mild to moderate nerve pain. Drugs in this class include amitriptyline, desipramine and imipramine . Side effects can be bothersome and include dry mouth and drowsiness.Serotonin and norepinephrine reuptake inhibitors (SNRIs) are another type of antidepressant that may help with nerve pain and have fewer side effects. The American Diabetes Association recommends duloxetine (Cymbalta) as a first treatment. Another that may be used is venlafaxine (Effexor XR). Possible side effects include nausea, sleepiness, dizziness, decreased appetite and constipation.
• Sometimes, an antidepressant may be combined with an anti-seizure drug. These drugs can also be used with pain-relieving medication, such as an over-the-counter medication including acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin IB, others) or a skin patch with lidocaine (a numbing substance).