Pain relief is a basic human right. One does not need to endure pain as it is well established that untreated pain can lead to a range of physical and psychological ill effects. Present day medical management dictates that when a disease cannot be cured, one should at least attempt to reduce his/her suffering by making symptoms endurable. The specialty of chronic pain management specifically aims to achieve this objective. It significantly improves the quality of life by alleviating pain, which is the most distressing symptom.
A much needed comprehensive pain clinic was launched at the Jaslok hospital to help patients with chronic pain in July 2001. This was one of the first comprehensive multidisciplinary pain clinics in the city of Mumbai.
Which Patients can benefit from Chronic Pain Clinic?
Patients suffering from pain that cannot be addressed by direct medical and surgical treatment and pain lasting for more than three months are the ideal candidates for referral.
Some of the common conditions are :
- Back pain +/-Sciatica, Small Disc Prolapse and Facetal Arthropathy
- Post Laminectomy pain
- Cancer Pain involving various regions
- Trigeminal Neuralgia / Occipital Neuralgia / Post herpetic Neuralgia
- Myofascial Pain Syndromes
- CRPS [Reflex Sympathetic Dystrophy]
- Peripheral Vascular Disease pain
- Diabetic Neuropathy pain
- Post Thoracotomy pain
- Post-Inguinal Hernia Repair pain
- Phantom Limb pain
Dr Preeti Doshi Consultant Pain Specialist M.D; D.A [U.K.]; FRCA II is In-charge of the Specialty Pain Clinic. It is unique in the sense that, it offers a comprehensive spectrum of treatment modalities from simple OPD procedures to advanced pain therapies including availability of neurosurgical options for truly intractable pain all under one roof. This also has a much needed back-up support of experts in Physiotherapy, Neurology, Neurosurgery, Psychiatry, Orthopaedics and Oncology as and when required.
Dr Doshi has gained confidence and support of many senior colleagues over the years spent at Jaslok hospital and has treated more than two thousand patients with satisfaction.Dr Doshi conducted a very successful International CME focusing on advanced pain therapies called “Comprehensive Review of Interventional Pain therapies” to update Pain Physicians of entire India with all different advanced modalities in 2007.
What are the options to treat chronic pain?
Since there are so many different causes of pain, there cannot be a single option for everyone. An individualized treatment plan is developed based on assessment of patient’s condition and needs in the Pain clinic which is regularly held twice a week at Jaslok hospital. By and large a multimodal approach is advocated to give the optimum pain relief.
Drugs :
- Regular Pain killers - Paracetamol, NSAIDs
- Strong Painkillers - Morphine and similar drugs for terminally ill patients with intractable pain.
- Additional medications - Antidepressant [small doses] or Anticonvulsant drugs for some neuropathic pain syndromes.
Interventional Techniques :
- Forms a very crucial component of management which aims to block the conduction of painful impulses.
These can be categorised into different varieties as follows.
Minor Procedures
Performed in the minor OT
- Trigger Point Injections
- Peripheral Nerve Blocks
- Ileo-Inguinal blocks, Lateral Cutaneous Nerve of Thigh block, etc
- IV Regional Blocks
- Intra Muscular Stimulation [IMS]
- Refill of Port-a-Cath and Intrathecal Drug Pumps.
Major Procedures
These are performed either on daycare basis or sometimes as indoor patients to monitor or to titrate pain relief.
These procedures are performed in the main operation theatre with fluoroscopic Guidance. Majority of these are performed under local Anaesthesia with minimum sedation .We have the state of the art infrastructure with the latest radiofrequency lesion generator.
List of Major Procedures performed by our Department :
Spinal Pain
- Epidural – Lumbar / Caudal / Thoracic Iinjections
- Cervical Epidural Injection
- Transforaminal Epidural / Selective Nerve Root Blocks
- Facet joint Injections
- Percutaneous [Racz] Epidural Adhesiolysis
- Discography / IDET / Pulsed RF
Head, Neck, Face, Arm and Chest Pain
- Intercostal Nerve Blocks
- Piriformis Muscle Injection
- Mandibular / Maxillary / Glosso-Pharyngeal Nerve Block
- Trigeminal / Sphenopalatine Ganglion Blocks
- Stellate Ganglion Block
- Brachial Plexus Block / Catheter
- Suprascapular Nerve Block
Abdomen, Pelvic and LE pain
- Lumbar Sympathetic Block
- Coeliac Plexus Block/Splanchnic Nerve Ablation
- Superior Hypogastric Plexus Block
- Ganglion Impar Block
Advanced Pain Therapies
- Radiofrequency Rhizotom[Facet/Stellate/Sacroiliac/Trigeminal/Sphenopalatine]
- Trial of Intrathecal pump or Spinal cord/Peripheral nerve stimulator
- Permanent Implantation of Intrathecal pump/Spinal cord Stimulator/Peripheral Nerve Stimulator
Interventional Pain management has evolved as a separate specialty with a distinct role in comprehensive patient management and adds immense value to a superspeciality tertiary referral hospital like Jaslok hospital, Mumbai.