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Current concepts in


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This is brief presentation about current concepts in pain management.
For further details contact Dr Harshe at

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Current concepts in

  1. 1. Dr Rajeev Harshe MDConsultant pain managementApollo Hospitals, Ahmadabad.(Hon. Pain consultant to H.E. Governor of Gujarat)
  2. 2. Why pain management ?Current practices in IndiaHow best can be done ?Acute pain management-brief overviewChronic pain management-brief overview.
  3. 3.  Human issue Recovery issue Hypersensitivity issue Legal aspect NABH/JCI issue Economic issue (faster turnover)
  4. 4.  I/M shots periodically I/V shots periodically Rectal suppositories I/V infusions ( 5% centers) Random use of patches
  5. 5.  Possibility of Inadequate analgesia Lack of dedicated person to look after pain relief Patients even if suffer.. feel it is a part ofexperience.
  6. 6.  Multimodal analgesia Infusion better Bolus for breakthrough pain more gratifying Topical and regional analgesia better used Pain Team including pain nurse. Consider status of liver/kidney/brain
  7. 7.  Portable infusion pump ( Elastomeric) PCA PCEA Diclofenac/ketorolac/buprenorphine patches Lollypops / Lozenzes Nasal sprays
  8. 8.  NSAIDS Opioids: Morphine,Fentanyl,buprenorphine,Tramadol Other: Paracetamol IV 1 gm qds Dexmedetomidine Clonidine/ketamine/neostigmine
  9. 9.  Tapentadol (dual action) Methadone (prolonged single shot preop.) Oxycodone Opioid antagonists Gabapentine in acute pain ( neuropathy) Opiorphine ( prevents degradation ofendogenous Opioids) ibudilast
  10. 10.  Diagnostic cum therapeutic nerve blocks- (somatic and sympathetic) Radiofrequency ablation of sensory nerves Epidural/ intrathecal infusions byimplantable pumps Peripheral plexus infusions by portablepumps Percutaneous epiduroscopy and adhesiolysis Spinal stimulation by implanted stimulators Various disc procedures for IDDs
  11. 11.  Pain due to spondylitis Pain due to propalsed disc Listhesis induced pain Vertebral pain Myofascial pain Neuralgias –trigeminal / post herpetic Malignancy pain Pain of vascular origin Persistent pain after spine surgery
  12. 12.  Platelet rich plasma injections. Stem cell treatment Nasal sprays for any kind of pain
  13. 13. Can we have Aroma Therapy used foranalgesia?
  14. 14. Dr Rajeev Harshe MDConsultant pain managementApollo Hospitals, Ahmadabad.(Hon. Pain consultant to H.E. Governor of Gujarat)