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
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
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
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
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………!