Back Pain

One of the most common health problems with 50-80% of adults experiencing it anytime leading to loss of quality of life. Most common cause is mechanical strain to the back which resolves with conservative measures in 90% of them. Other than sciatica, there are many pain sensitive structures in the spine like facet joints, muscles, ligaments & bones. Patients unresponsive to medications can undergo minimally invasive procedures like epidural injections, facet joint radiofrequency ablation, peripheral muscle plane blocks, sacroiliac joint injections, epidurolysis added with physiotherapy gives considerable relief to patients before considering for surgery. Persistent post spine surgery pain can also be treated by minimally invasive procedures depending on the cause. Resistant cases with radiculopathy can be treated with spinal cord stimulation.

Neck Pain

Commonly referred to as cervical spondylosis, neck pain is most commonly due to improper posture during working conditions over a prolonged period of time. The other causes being disc compressing over the nerves. Neck pain due to disc prolapse can be treated with epidural injections and facet joint pains with radiofrequency ablation. Shoulder pain can also radiate and present as neck pain. Proper posturing and physiotherapy is also important.

Shoulder Pain - Frozen Shoulder

One of the common joint issues particularly in diabetics is shoulder pain, commonly called frozen or periarthritis shoulder. Shoulder is a very mobile joint but in diabetics the ligaments become stiff and the joint movements become painful. Physiotherapy being the mainstay of treatment, is disabled due to pain. Ultrasound guided dynamic shoulder examination helps to pinpoint the problem in the joint with simultaneous intervention. Intra-articular injections, regenerative therapy for tendinopathy and muscle tears, radiofrequency ablation for the joint help to decrease pain, increase the range of movement and thus facilitate physiotherapy to normalize the joint.

Knee Pain

Most common joint involved in geriatric age group is knee joint. Osteoarthritis knee being the most common condition caused due to age related degenerative changes. Weight reduction, quadriceps strengthening exercises help in the initial stages. Early osteoarthritis can be treated with regenerative therapy and viscoelastic supplements added with physiotherapy. Patients not willing for surgery, high risk for surgery or have post knee replacement pain can be treated with radiofrequency ablation.

Ligament injuries are the next common cause of knee pain mostly seen in young individuals following trauma. Complete tears need surgery while partial tears are amendable to regenerative therapy and physiotherapy.

Cancer Pain

Pain in cancer patients can be due to the disease itself or the treatment undergone. About 90% of patients with cancer experience pain and nearly in 60-80% of cases it is of moderate to severe intensity. Treatment of pain particularly in cancer patients is multidimensional including psychological, functional and emotional components. Narcotic medications remain the mainstay. Nerve blocks including sympathetic blocks provide symptomatic relief. Refractory cases can be treated with intrathecal morphine pumps.

Facial Pain – Trigeminal Neuralgia

Trigeminal neuralgia is sudden episodic shooting type of pain in one or more of the territories of face supplied by trigeminal nerve. Most common cause is neurovascular conflict which is amendable to surgery. Patients not willing for surgery or are high risk for surgery and in patients where there is no neurovascular conflict radiofrequency ablation of the nerve is a safer alternative. It is a percutaneous and a day care procedure done under local anaesthesia or mild sedation.

Musculoskeletal Pain / Sports Injuries

Epicondylitis (tennis elbow & golfer’s elbow) is pain and tenderness in the elbow. Ultrasound guided steroid or regenerative therapy gives promising results in patients unresponsive to medical management and physiotherapy.

Plantar fasciitis is pain in the foot particularly in the heel part, most commonly seen in diabetics. Regenerative therapy has good results in patients unresponsive to medications.

Postherpetic Neuralgia

Post herpetic neuralgia is pain in the dermatomal area of herpes zoster, mostly self-limiting and cured with neuroopathic medications. Patients unresponsive to medications can be treated with nerve blocks, epidural injections, dorsal root ganglion block and radiofrequency ablation for prolonged relief.

Myofascial Pain Syndromes

Fibromyalgia is a myofascial pain syndrome where patient experiences pain and tenderness all over the body. Medical management and cognitive behavioural therapy are the mainstay of treatment. Patients unresponsive to these treatments can be treated with dry needling, muscle plane and nerve blocks.

Palliative Care

Palliative care or end of life care helps to provide comfortable and pain free life in patients with end stage diseases like metastatic cancer, heart failure, respiratory failure and disabled geriatric patient. It is a multifaceted approach taking care of patient’s medical condition, psychological, emotional and even nutritional support with physiotherapy and rehabilitation.

Neuropathic Pain

Neuropathic pain is caused by nervous system dysfunction. Commonly seen being

• Diabetic neuropathy
• Postherpetic neuralgia
• Meralgia paresthetica
• Trigeminal neuralgia
• Phantom limb pain
• Complex regional pain syndrome

All the above conditions can be treated with percutaneous interventions when unresponsive to medical management. These blocks are followed by radiofrequency ablation for prolonged pain relief.

Chronic Abdominal And Pelvic Pain

Neuropathic pain can manifest as chronic abdominal pain, commonly seen being ilioinguinal and iliohypogastric nerve neuralgias.

Chronic pelvic pain is seen most commonly in females, causes being recurrent urinary tract infections, endometriosis, pudendal nerve entrapment.

These conditions can be treated with simple nerve blocks.