Pain Management- A Superspecialty

PAIN MANAGEMENT : A NEW SUPERSPECIALITY
DR. NEERAJ JAIN M.D., FIMSA, FIPP (USA)

SENIOR CONSULTANT SPINE & PAIN SPECIALIST
SPINE & PAIN CLINIC, RU-23 PITAMPURA, NEW DELHI-110088
& INCHARGE PAIN CLINIC SHRI BALAJI ACTION MEDICAL INSTITUTE
& ACTION CANCER HOSPITAL & MAX HOSPITAL, NEW DELHI.

“No one dies of pain but many die in pain and many more live with pain”

“It is easier to find a man who will volunteer to die, than to find those who are willing to endure pain with patience” Julius Caesar
“The neurosignature of pain experience is determined by the synaptic architecture of the neuromatrix”
Pain is 5th vital sign as per W.H.O. Pain is now understood as primary medical condition. Effective pain management presents a significant challenge for physicians, other healthcare professionals, and their patients.
Pain is one of the most common reasons for patients to seek medical attention and one of the most prevalent medical complaints in today’s world .The treatment of the acute, chronic & cancer pain is demanding & challenging. The clinicians must learn to make distinction between acute and chronic pain before embarking upon treatment. To both recover from, and to treat, chronic pain requires taking a different approach.
In one survey conducted for the American pain society, 47 per cent of those with moderate, severe or very severe pain had challenged physicians at least once since their initial visit for pain relief.
Still pain remains inappropriate & inadequately treated. Although tremendous scientific & technological advances have been made, the knowledge & techniques are highly underutilized. This is due to lack of dissemination of information to clinicians. “It’s easy to be paranoid when you hurt like hell and you are on the mercy of healthcare system” observed a doctor in chronic pain himself.

Chronic pain is a disease, a syndrome not just a symptom. Chronic pain can lead to depression, anxiety, marital & interpersonal problems, decreased productivity, unemployment, compromised social roles, isolation, financial burden, dependence, prolonged analgesics, decreased self esteem with behavioral changes adversely affecting quality of life (QOL) & activities of daily living (ADL).
There have been many advances in the understanding & usefulness of an intervention at right time in selective patients producing excellent results. Interventional pain procedures scores over both medicine and surgery, as they do not have side effects like medicines. Surgeries for pain now have limited indications & usually as a last resort.
The interventional pain procedures produce immediate pain relief, can be performed with ease by pain physicians without anesthesia as outpatient or daycare and adequate duration of pain relief is obtained and they are suitable for surgically unfit, unwilling & debilitated patients, procedures can be repeated safely if required.

Pain Clinics are specialized areas that are now assuming the role of an essential service as they meet a need unmet by any previously existing medical facility. They help by simultaneously treating the physical, emotional, cognitive, behavioral, vocational and social aspects of chronic pain cost-effectively. The very concept of a Pain Clinic is based on the conviction that the effective management of difficult pain conditions is possible only through well-coordinated efforts of a specialist possessing knowledge and skills to diagnose and treat pain.
With the advancement of technology and science, we have unveiled many aspects of the pain and its treatment. We have to work hard to spread the knowledge of interventional pain techniques. Our goal is to help people suffering from pain, make them productive human being for the society and increase their self esteem so that they can live life as normal individuals.
Unfortunately awareness about pain management among medical professionals is very limited. In contrast to USA and other developed countries Indian medical community is not aware of interventional pain management techniques which can be helpful for many patients suffering from intractable chronic pain.
In the absence of proper education among health care professionals and lack of awareness in the public mind in India, there is misuse of painkillers resulting in high incidence of complications like gastritis, GIT bleeding, kidney failure, and bone marrow depression.
The Indian health care scene has a curious mix of paradoxes. Advances in cardiovascular surgery or high-tech investigative facilities in India are on par with any advanced country, at least in some cities. Though skills, advanced equipments are available, still pain relief is not available to majority of its population. At least a million people in India suffer unrelieved cancer pain. The number of people suffering other chronic pain conditions is anyone’s guess. Paradoxically, India stands high chance to become the health destination for pain management for the world, by using interventional pain therapies and very effective traditional therapies unique to India.
Pain treatment is tailor-made & no single treatment fits all.
Under treatment of pain is a major public health concern. It is a silent epidemic. It is cruel to deny people in pain access to effective pain treatment. People should not be suffering needlessly.

“Control pain before pain controls you.”
Percutaneous minimum invasive interventional pain management Fluoroscopic/Ultrasound/Nerve stimulator/CT guided techniques :-

It has both diagnostic & therapeutic relevance (As there are significant false positive & negative imaging studies not correlating to symptoms). Better results are obtained if treatment is started early.

 LESI-lumbar epidural steroid injections::
o interlamminar or transforaminal or caudal approach
 SNRB- selective nerve root block
 Epidural adenolysis or percutaneous decompressive neuroplasty
 Trigger point injection
 Botox paraspinal muscle injection
 Facet joint or pericapsular injection
 Facet RF thermal neurolysis
 SI joint injection or denervation
 Diagnostic provocative discography
 Intradiscal procedures:– IDET-intradiscal electrothermal therapy
o Coblation nucleoplasty
o Laser percutaneous discectomy
o Chemonucleolysis- chymopapain & ozone
o Dekompressor disc debulking
 Vertebroplasty & kyphoplasty
 Intrathecal pump neuraxial implants
 Augmentation or neuromodulation spinal cord stimulation lead implants
 Lumbar/cervicothoracic sympathetic blocks / neurolysis
 Stellate /splanchnic/ celiac plexus/ hypogastric/ impar neurolysis
 Paravertebral / psoas compartment blocks
 Intrathecal/ Epidural neurolysis
 Cranial nerves blocks / neuroablations
 Trigeminal gangliolysis
 Pituitary chemoadenolysis
 Botox chemodenervation
 Laser lessioning / radiofrequency (RF) neuroablations
“Pain is real & treatable — There is no merit in suffering!”

CONTACT:-
DR. NEERAJ JAIN M.D., FIMSA, FIPP (USA)
SENIOR CONSULTANT SPINE & PAIN SPECIALIST
SPINE & PAIN CLINIC, RU-23 PITAMPURA, NEW DELHI-110088
INCHARGE PAIN CLINIC SHRI BALAJI ACTION MEDICAL INSTITUTE & ACTION CANCER HOSPITAL &
MAX HOSPITAL, PITAMPURA.
98100 33800 (M), 27341685 (C)
Email – managepain@yahoo.com