Pain Clinic at Tata Motors Hospital; Past Present and Future –A report
Dr Ashok Jadon, MD DNB MNAMS
Aesculap fellowship of...
adjunct or complimentary to interventional techniques and are essential to provide
comprehensive approach to patients suff...
for disc prolapse (Percutaneous Discectomy) was started. Two Percutaneous
Discectomies were done this year with excellent ...
provide intraoperative anaesthesia and rectal or perineal pain due to malignancy or
other causes are already used on many ...
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Pain clinic at tata motors hospital

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Pain clinic at tata motors hospital

  1. 1. Pain Clinic at Tata Motors Hospital; Past Present and Future –A report Dr Ashok Jadon, MD DNB MNAMS Aesculap fellowship of interventional pain management Chief Consultant & HOD Department of Anaesthesia Tata Motors Hospital, Jamshedpur Pain clinic or pain relief service at Tata Motors Hospital was available since beginning of the hospital under the auspices of Anaesthesia department. However, initially, very few patients were treated and basic techniques like acupuncture and TENS (Trans cutaneous nerve stimulation) were used. Epidural steroid injections to treat acute or chronic spinal pain were started in 2005 and 16 patients were treated during yr 2005 & 2006. Work of pain clinic has grown-up exponentially after yr 2007. Keeping up- breasted approach to acquire current knowledge in management of pain, newer techniques were introduced and Interventional pain management techniques which were only available in few selected centers in India became main stay of management. However, practice of basic techniques like trigger point injections, TENS, muscle and joint manipulation, counseling and advice for exercise along with appropriate medications continued as before. These techniques work as
  2. 2. adjunct or complimentary to interventional techniques and are essential to provide comprehensive approach to patients suffering from pain. Since yr.2008 onwards, every year, 75 to 100 new patients are treated with approximately 100 to 200 interventional procedures. Chronology of Landmarks in the progress of pain clinic: Year 2008: Fluoroscopy was introduced for interventional pain procedures. Facet intra articular injections and piriformis injections were started. First, caudal adhesinolysis was done with indigenous technique by using tunneled epidural catheter and continuous infusion of saline in a case of failed back surgery. Epidural blood patch was introduced to treat post spinal headache. During this year thirty five patients were treated and total 40 interventional procedures were done. Year 2009: This year was a breakthrough year for pain clinic. As water soluble contrast was available, more advanced procedures were included like stellate ganglion block (to treat CRPS of upper limbs), Transforaminal injections and Sacro iliac joint injection. On September 15, first cervical epidural injection was given under fluoroscopic contrast control to treat cervical root pain. Few interesting and resistant cases like headache after aneurismal clipping and scrotal pain were treated successfully. Medial branch blocks for facet arthropathy and intercostal block for intercostal neuralgias were introduced. A new gadget an Ozone generator was procured and Intradiscal ozone for treatment of Discogenic pain due to prolapsed intervertebral disc or IDD (internal disc disruption) was introduced. This year 100 patients were treated and more than 200 procedures were done and 5 new procedures were introduced. Year 2010: With continuous efforts and study progress, two breakthrough events happened this year. Firstly Radio-frequency generator was procured which is back bone for any advanced pain clinic and secondly a new minimally invasive surgery
  3. 3. for disc prolapse (Percutaneous Discectomy) was started. Two Percutaneous Discectomies were done this year with excellent results. Radio-frequency procedures for medial branches, discs, and stellate ganglion were introduced. This year 80 patients were treated and 110 procedures were done. Year 2011: With better understanding of radiofrequency techniques a new procedure DRG (dorsal root ganglion) pulsed radiofrequency treatment was introduced for neuropathic back pain. This year was devoted to improve technical competence for procedures like trans-foraminal injections cervical epidurals and epidural adhesinolysis. One Percutaneous Discectomy was done. Cervical epidurals numbers were increased. Many successful stellate ganglion blocks were given and a study on the results was published in indexed journal. We also got nerve stimulator which helped us to locate nerves and preformed stimulator guided procedures for piriformis, lumbar plexus, sciatic, femoral and brachial plexus blocks. Two studies on lumbar plexus block were published in indexed journals. This year 90 new cases were treated and 125 procedures were performed. Year 2012: This whole year many new techniques were introduced. Lumbar sympathetic block for CRPS of lower limbs, grey ramus block for # vertebra pain, cervical transforaminal (very advanced procedure requires extremely high precision) were introduced. Few techniques were modified to get better results and to ease the difficulty of performer like lateral or Para-central approach to inter- laminar epidural, oblique view approach to cervical epidural and Kambin’s approach to lumbar transforaminal injections. Radiofrequency for stellate ganglion was introduced. This year 95 new cases were treated and 130 procedures done. Year 2013: Only 4 months have passed this year and, as usual keeping good track record, five new techniques are already introduced and used successfully. Ganglion Impar block for rectal pain due to prostate malignancy, nerve stimulator guided and fluoroscopic guided supra-scapular nerve block to manage frozen shoulder pain and nerve stimulator guided and fluoroscopic guided Pudendal nerve block to
  4. 4. provide intraoperative anaesthesia and rectal or perineal pain due to malignancy or other causes are already used on many patients successfully. Success Vs. Failures: In the world of pain physicians, the criteria for successful pain management is “50% or more reduction in symptoms up to reasonable duration i.e. more than 6wks”. To this definition our results are comparable and our customer satisfaction is very high. In the beginning we also had failures and technical difficulties to target the pathology, however; with persistence and training we could overcome those hurdles. We had three complications (diagnosed on time and no further consequences) out of >500 procedure (0.6%) during these years. Future; way forward: Pain management is advancing leaps and bounds and newer technology is being introduced every day. Over the time, as our resources would permit, we would like to adopt those techniques for our patients also. As we already have infrastructure for radiofrequency, treatment for Trigeminal Neuralgia and Glossopharyngeal Neuralgia by radiofrequency is our next target. Later on, we can adopt more advanced techniques like implantable pumps and spinal cord stimulator for nociceptive and neuropathic pain at our pain clinic of Tata Motors Hospital. Future is very promising indeed………!

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