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........Bight new hope for people who’ve been living with pain.                                                           ...
Interventional           Pain      &    Spine        Centre                            Consultant In- Charge              ...
Interventional Pain Management:                             New Knowledge, More Choices                                   ...
Interventional    Pain   &   Spine   Centre   Representation at National and International Level                          ...
Conducted CME and Live demonstration of Pain procedures            At Birla Group of Hospital, Satna.                    I...
Interventional      Pain         &     Spine         Centre                     Spine Interventions    Percutaneous Discec...
Pain may increase after the procedure for 3-5 days and may get full relief within 2-4 weeks.                      Pain rel...
Interventional     Pain          &      Spine       Centre                             Spinal cord stimulation            ...
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Interventional pain and spine centre.

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  1. 1. ........Bight new hope for people who’ve been living with pain. Volume 1, November 2010 Ta k e B a c k YO UR LI F E If You or someone you know is suffering from: Back Pain • Slipped Disc • Discogenic Pain • Degenerated Disc Sciatica Pain • Cancer Pain • Shingles Pain • Rheumatic Pain Joint Pain • Frozen Shoulder • Neuropathic Pain • Neuralgias Complex Regional Pain Syndrome • Failed Back Surgery Syndrome Contact UsBhagat Chandra Hospital Mob. 09871985514 Mayom HospitalMahavir Enclave Email: D block, South city-1Near Palam Flyover Main marketDwarka, New Delhi Gurgaon Also Available for Consultation at: Artemis Health Institute Columbia Asia Hospital Arcus Superspeciality Medicentre Sec 51 , Gurgaon F-block, Palam Vihar, Gurgaon Sec 4 Market, Dwarka Saturday: 6 to 8 PM Saturday: 10 to 12 AM Mon-Wed-Fri : 6 to 8 pm Quality – Caring – Compassion
  2. 2. Interventional Pain & Spine Centre Consultant In- Charge Interventional Pain and Spine Centre Welcome to the first edition of “IPSC INDIA”-quarterly newsletter designed to keep you informed on the latest developments in the field of Interventional pain management. I am pleased to present the first newsletter on Completion of one year of Pain centre at Bhagat Hospitals. We have successfully performed various pain interventions including Advanced Interventions like Percutaneous discectomy, Vertebroplasty, Decompressive Neuroplasty, ozonucleolysis and Ozone Discectomy with a success rate of more than 80 %. In the circulation of these articles and case reports, we hope to provide the latest clinical information on many diverse pain conditions. I am also pleased to Announce the opening of New Branch at Mayom Hospital, south city , Gurgaon. The contents of this newsletter have come from our achievement in last one year and also in this issue we will be covering Spine Interventional Procedures. We welcome questions and answers between readers and also welcome contributions and suggestions as to how we may improve on this Newsletter. Dr. (Maj) Pankaj N Surange MBBS, MD, FIPP (World Institute of Pain, Hungary) Interventional Pain and Spine Specialist Quality – Caring – Compassion
  3. 3. Interventional Pain Management: New Knowledge, More Choices The Specialty of “Pain Management” has progressed Significantly in the last 20 years through a better understanding of anatomy and physiology and through advances in pharmacology and technology. Interventional pain management is a “discipline of medicine devoted to the diagnosis and treatment of pain related disorders by minimally invasive and Target Specific Procedures”Pain treatment begins with an assessment The goals of interventional painof the severity of the pain. Commonly, the management are to relieve, reduce, orfirst steps of treatment are rest, application manage pain and improve a patient’sof cold or heat and intake of OTC (over overall quality of life through minimallythe counter) medication. The next step invasive techniques specifically designedin the treatment of pain is a combination to diagnose and treat painful conditions.of physical therapy and prescribed pain Interventional pain management alsomedication. It is important to note that strives to help patients return to theirsometimes, interventional pain management everyday activities quickly and withoutneeds to be started prior to Physical heavy reliance on medications.Therapy in order to stop acute pain (i.e.acute radiculopathy) and allow the patient to We are now able to make a real differencecomply with necessary exercise. If prescribed in the lives of our patients, their familiespain medication and physical therapy don’t and their physicians. We provide awork, the next step is usually interventional valuable service to society by helpingpain management, unless the patient has to return disabled patients to a moreacute loss of function or acute neurological functional and productive state. We workdeficit (in which case surgery is needed). together with the patients’ physician toIf interventional pain management doesn’t promote the best possible outcomealleviate the pain, surgery might be required.However, even after surgery interventional We provide world-class treatmentpain management has a very important role in integrating innovative interventions andthe treatment of patients, especially when all complimentary therapies to relieve yourother options are exhausted (eg. “failed back pain and improve the quality of yoursurgery” syndrome). life.” Note Most of the Interventional Pain Procedures are done in Local Anesthesia under Fluoroscopy Guidance in Procedure room as Day care (3 to 4 Hours stay). Usually One to Two Procedures at an interval of 2-4 weeks are required but in Resistant cases additional procedure may be required. Trial procedures are required in Advanced Interventions before placing costly Implants. Quality – Caring – Compassion
  4. 4. Interventional Pain & Spine Centre Representation at National and International Level Awarded Fellow Interventional Pain Practice (FIPP) By World Institute of Pain, Budapest, Hungary. Invited Speaker and Faculty International congress on Interventional Pain management Conducted by Iran University of Medical Sciences Quality – Caring – Compassion
  5. 5. Conducted CME and Live demonstration of Pain procedures At Birla Group of Hospital, Satna. Invited Speaker and Faculty National Pain conference- Jabalpur Medical College. Appointed Faculty, Moderator and Editor Daradia: Pain Institute, KolkataQuality – Caring – Compassion
  6. 6. Interventional Pain & Spine Centre Spine Interventions Percutaneous Discectomy/ Disc Decompression/ Ozone Discectomy Minimally invasive procedure Rotating probe is inserted using small needle and through needle into the disc probe to remove disc material of prolapsed disc, under X-Ray/ Fluoroscopic releasing pressure on nerves guidance and relieving pain in most of the patients of prolapsed/ bulging / slipped disc. Rotating tip removes small Insertion site covered with portion of disc material. bandage. Because only enough of the Recovery is fast as unlike surgical decompression no disc is removed to reduce bone or muscle is cut. pressure inside the disc, the 2-3 days of bed rest and may spine remains stable return to normal activity within one week. Intra Discal Electrotherapy/ Radiofrequency Minimally invasive procedure Electrothermal catheter to relieve pain caused by disc or Radiofrequency needle degeneration or Annular tear is inserted under X-Ray/ or small disc herniation. Fluoroscopic guidance and maneuvered to locate the diseased portion of the disc. The temperature of the needle or catheter is increased, raising the temperature of damaged disc wall. The heat shrinks and repairs the tear in the disc wall. It also burns the nerve endings causing pain. Facet joint block / Radiofrequency Denervation This minimally invasive A small needle is inserted procedure reduces or under fluoroscopic guidance eliminate the pain of damaged facet joint by either reducing either directly into the joint the joint inflammation or by to inject anti-inflammatory disrupting the nerves that medications or positioned at carry pain signals from the nerve supplying the joint. joint. To confirm the diagnosis Radiofreqency needle is of Facet Arthropathy, local inserted through cannula. anesthetic may be injected After confirming the to temporarily block the position, heat is applied to nerves. This may be required the electrode to cauterize at multiple levels. the nerve. Quality – Caring – Compassion
  7. 7. Pain may increase after the procedure for 3-5 days and may get full relief within 2-4 weeks. Pain relief with RF nerve disruption lasts longer than facet joint injections Kyphoplasty This minimally invasive A small cannula is inserted intervention treats spine into the fractured vertebral fractures caused by Osteoporosis or Vertebral body and inflatable balloon secondaries. is placed It gives instant pain relief and helps straighten the spine. Cavity is created by inflating Cavity is then filled with the device bone cement. This stabilizes the vertebral body and provides rapid mobility and pain relief Intrathecal pump implantation Intrathecal pumps are Very minute catheter is programmed to deliver small amount of medicine directly to inserted into intrathecal the space surrounding the spinal space through small needle. cord. This prevents pain signals from This catheter is cannulated being perceived by the brain. to temporary pump –Trial Effective in treating Cancer pain, severe back pain, Neuropathic period. pain and spasticity. Medication is injected Once the safety and efficacy through catheter for few is established temporary days of trial period to determine if the system catheter is removed and helps the patient. If pain permanent catheter is decreases during trial implanted. period permanent pump is implanted. Permanent pump is Amount of medication implanted and catheter is dispensed by the pump connected to Pump. is programmed with the external unit.Quality – Caring – Compassion
  8. 8. Interventional Pain & Spine Centre Spinal cord stimulation This revolutionary treatment works by blocking pain perception from traveling up through the spinal cord to Brain. It involves smaller electrodes that are placed near spinal cord in Epidural space. Spinal cord stimulator delivers low level impulses that interfere with the perception of pain especially chronic nerve pains. Indications: Complex regional pain syndromes, Failed Back Surgery syndrome, Degenerative disc disease, Peripheral neuropathies etc. Insulated electrodes are On trial implantation , small inserted through small pulses are delivered to electrodes that stimulate needle into space the nerves, blocking pain surrounding the spinal cord signals. called Epidural space The patient gives feedback to help determine where to place the electrodesto best block the patients Pain. If the patient determines that Through a small incision the amount of Pain relief is Implantable pulse generator acceptable, system may be in positioned under the permanently implanted. skin. The lead is then connected The electrical impulses to Battery. are programmed with an external control unit. Patient themselves can use the external control unit to turn the system On and Off and can also adjust the stimulation power. Transforaminal Epidural Injections This minimally invasive Under X-Ray/ fluoroscopic intervention is performed to relieve Back pain and radiating guidance , appropriate nerve pain to Arms or Leg. root is localized. The anti-inflammatory medications reduces the swelling and inflammation caused by spinal conditions such as Disc prolapse, slipped disc, Disc herniation, Spinal stenosis Contrast is injected to Anti inflammatory medication confirm the position of is injected into the space, needle in Epidural space. bathing the painful nerve root. Quality – Caring – Compassion