Dr (Maj) Pankaj N Surange MBBS, MD (Anesthesiology), FIPP (Hungary) Interventional Pain and Spine SpecialistSecretary, World Institute of Pain, India Chapter www.ipscindia.com
Interventional Pain management Interventional Pain management Interventions are Minimally Invasive, Non Surgical and Target Specific procedures to Diagnose and to treat Various painful conditions It fills the gap between pharmacologic management of pain & more invasive operative procedure
Important facts about pain management as the Speciality Recognised as a 34th speciality in USA: American society of Interventional pain physician In USA, The Department of Health and Human Services Centers for Medicare and Medicaid Services issued a memo March 4, 2005, including Interventional Pain Management specialists on the list of clinical specialties to be included in carrier advisory committees. Pain as fifth vital sign Pain relief a human right – WHO (world health organization) "Pain relief should be a human right, whether people are suffering from cancer, HIV/AIDS or any other painful condition,“
Intenational Association for study of Pain- 1973 World Institute of Pain-1993 Fellowship -2001
Management : Disc Herniation Percutaneous Ozonucleolysis + Transforaminal L5 and S1 Needle is inserted into the centre Under fluoroscopic Guidance of the Disc and ozone is Injected. Correct level of the prolapsed . Pain relief starts usually within disc is identified one week and ozone takes 3-4 weeks for its complete effect
Management : Disc Herniation Percutaneous disc decompression Minimally invasive procedure using small needle and probe to remove disc material of prolapsed disc ,releasing pressure on nerves and relieving pain in most of the patients of prolapsed/ bulging / slipped disc
Management : Case 1 Percutaneous Disc Decompression Rotating tip removes small portion of disc material. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable. Insertion site covered with bandage. Recovery is fast as unlike surgical decompression no bone or muscle is cut. 2-3 days of bed rest and may return to normal activity within one week.
Facet Arthropathy secondaryMRI to Disc degeneration • Disc bears 80% of weight • Facet joints bears 20 % of weight A change in the intervertebral disc produces Change in the whole motion segment
Facet Arthropathy• Low back pain- unilateral or bilateral• Tenderness over facet joints• Pain is deep, dull aching, difficult to localize• Referred to the buttocks, groin, hip, or posterior and lateral thigh.• Pain is more prominent in the morning and with inactivity• May aggravate on extension after forward flexion
Management- Facet Arthropathy Inflammatory Type Degenerative type
Case 3• 56 yrs /Female• Severe radicular pain in Rt Leg• H/o frequent back pains• Sensory loss in L5 Distribution and EHL- 4/5.• Known case of Rheumatoid Arthritis, Ucontrolled DM, CAD, Interstitial Lung disease.
Case -7• 38 yrs male• Low back pain radiating to both legs more on right side.• He had history of disc prolapse of L4-5 & L5-S1 and has undergone surgery 2 times before (laminectomy, discectomy & excision of scar).• Pain is increasing day by day.• Repeated investigations & visit to 16 consultants for last 4 years has taken away all faith from any form of medical treatment.• MRI-Epidural Fibrosis
Failed Back Syndrome (FBSS)• Epidural Adhenolysis