Pain Management

When it comes to cancer, a vast majority of patients (70% - 90%) suffer from pain during their course of the disease and treatment. Cancer pain is multifactorial, so it is important to recognize the pain early so that it can be managed with the help of an expert physician along with the management of the disease.

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Headache is a common problem and majority of common headaches can be managed by commonly used painkillers. Some with more frequent episodes require prophylactic agents to reduce the frequency of attacks. However in some cases, despite all measures the headaches can be difficult to manage. Pain clinic can offer interventions which can help not only in establishing better pain control and improving quality of life but also in confirming the diagnosis (in some cases).Pain clinic offers multi-disciplinary approach to address concomitant magnifiers/ triggers such as anxiety, depression, altered sleep cycle, medication overuse, life style and poor posture. The term Cervicogenic Headaches is commonly used for headaches originating from cervical spine pathology or surrounding soft tissues. These types of headaches are mostly accompanied by neck pain, stiffness and are commonly undertreated. Extra cranial sources of headaches such as nerves, joints and muscles can also be easily missed. Examples include neck facet or Atlantoaxial joint pathology, headaches secondary to third occipital nerve, supraorbital neuralgia, occipital neuralgia,sternocleidomastoid and trapezius muscle strain and spasms. Some of the interventions available via the pain clinic include: Facet joint injections & Radiofrequency - Headaches originating from facet joints are more commonly observed in the elderly and after whiplash injury (flexion/extension injuries). Third Occipital Nerve Block & Radiofrequency- this nerve or the joint it supplies can be a source of headaches localised to the back of head on one side. The pain can sometimes spread towards the top of the head. An injection of the nerve and radiofrequency treatment can help to confirm diagnosis and provide long lasting relief. Occipital Nerve Block & Radiofrequency-Greater occipital nerve block is most frequent peripheral nerve block used in management of cervicogenic headache. These nerves are located on the back of head and pain originating from these presents as shooting or stabbing pain with altered sensation in the distribution of the nerve. Local anaesthetic block can help in confirming the diagnosis and radiofrequency treatment can help provide long pasting pain relief. Sphenopalatine Ganglion Block - Sphenopalatine ganglion is located behind the nose and serves as a relay centre for messages before being transmitted to brain. It is closely linked to one of the main nerves involved in headaches, facial pain (trigeminal nerve). A block of this ganglion is used in conditions such as cluster headaches, migraine and atypical facial pain. Botox for Migraine- Botox when injected into muscles partially blocks the nerve impulses and reduces the muscle contractions. In chronic migraine this can help in reducing the frequency of headaches with effects lasting for 8 to 12 weeks. Other commonly used injections include Trigger Point Injection and Nerve Blocks. These interventions are used in combination with physiotherapy, psychology, medications and Complimentary therapies (acupuncture, TENS, meditation, Ayurveda and wellness).

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Joints form the connections between the bones in our body. They provide support and help in movement. Joint pain refers to discomfort, aches, and soreness in any of the body’s joints. Any damage to joints from disease or injury can interfere with movement and cause pain. One of the most common causes of joint pain is arthritis. The two primary forms of arthritis are: Osteoarthritis: age-related arthritis Inflammatory arthritis: usually associated with autoimmune diseases Other causes may include (but are not limited to): Osteoporosis: In addition to causing loss of bone mass and strength, osteoporosis weakens the bones and makes them susceptible to unexpected and sudden fractures. Trauma to the joint or to the structures around the joints Gouty arthritis: Due to increased uric acid Tendinitis: Inflammation of tendons around joints Bursitis: Inflammation of coverings around joints Musculoskeletal pains may be associated with joint pain due to the aforementioned conditions. It may also be due to nutritional causes, including deficiency of certain vitamins and minerals in the body.

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Low back pain in simple terms is pain at the lower end of spine in the area between lower margins of ribs and the lower gluteal folds. Sciatica is a term used for pain radiating down from the lower spine to the legs. Most common cause of sciatica is irritation or compression of the nerves as they exit the spine on their way to the lower limbs. It may be accompanied by numbness, tingling and weakness in the distribution of the involved nerve.

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Neck Pain is pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic. Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety and depression, stress can play a role in magnifying the perceived pain. Pain from the upper part of the neck can radiate to the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and the scapula. It is not uncommon for patients to have reduced neck movement along with localized areas of muscle tenderness commonly known as trigger points. Neck pain may be a result of: Local pathology Whiplash (flexion-extension) injuries or trauma Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc. Be a result of referred pain from neighboring areas such as shoulder joint

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Neuropathic pain is a chronic condition which is the result of damage or disease affecting the nerves. The pain may be associated with abnormal sensations (called dysesthesia pain) from normally non-painful stimuli (Allodynia). It may have continuous and/or episodic (paroxysmal) components.

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Fibromyalgia is one of the common causes of long term widespread body pain. This may be accompanied by other symptoms such as Fatigue Non refreshing sleep Memory issues Impaired concentration Mood disturbances Increased sensitivity Numbness and tingling in hands and feet Certain conditions such as irritable bowel syndrome, temporomandibular joint disorder, restless legs and tension headaches are seen more commonly in association with fibromyalgia.

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