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   Table of Contents - Current issue
December 2022
Volume 36 | Issue 4 (Supplement)
Page Nos. 1-50

Online since Friday, December 30, 2022

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Redefining pain interventions: Call it right! p. 1
Samarjit Dey, Prateek Arora
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Radiofrequency ablation in chronic pain syndromes: An evidence- and consensus-based indian society for the study of pain guidelines, 2022 p. 2
Gautam Das, Pankaj Surange, Anurag Agarwal, Kailash Kothari, Samarjit Dey, Karthic Babu Natarajan, Palak Mehta, Gaurav Sharma, Uttam Siddhaye, Neeraj Jain, VK Mohan
Chronic pain is a frequent, intricate, and adverse condition that has a considerable influence on individuals and society at large. In India, its prevalence is around 20%. Although a spectrum of conservative treatment modalities is available, a significant proportion of patients with chronic pain syndromes remain refractory and require surgical intervention. In these groups of patients, radiofrequency ablation (RFA) techniques are safe minimally invasive treatments and provide significant and durable pain relief. Thus, we aimed to formulate the Indian Society for the Study of Pain (ISSP) guidelines for the management of chronic pain syndromes with various RFA techniques. An in-depth literature review by experts in Pain Medicine practising in India, was used to produce 16 statements across 4 common chronic pain syndromes, including knee pain, headache and facial pain, lumbar facet joint pain, and sacroiliac joint pain. The quality of evidence was assessed with the Third US Preventive Service Task Force guidance document and the strength of the recommendation was determined by the Delphi consensus process. The level of evidence for most of the statements was I. Moreover, for most statements, the level of agreement between the experts was good (≥80% of the experts). The ISSP guidelines for the management of chronic pain syndromes are developed by experts in pain medicine. For most of the statements, the highest level of evidence was available and inter-expert agreement was good. However, further high-quality research is required to formulate more inclusive guidelines in this evolving pain medicine speciality.
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Minimally invasive pain and spine interventions for low backache p. 24
Pravesh Kanthed, Nitika Vyas, Prateek Arora, Samarjit Dey
Various pain generators can lead to low backpain. It includes conditions affecting the muscles, lumbar spine, joints, traversing and exiting nerve roots etc. The IASP named 2021 the year as the Global Year About Back Pain, highlighting its importance. Multiple modalities exist for the treatment of conditions causing low-back pain, including non-pharmacological therapies, drugs, percutaneous minimally invasive techniques and surgeries. This review aims at providing a cursory view of the common ailments causing low backache and its corresponding minimally invasive techniques.
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Percutaneous treatment of trigeminal neuralgia: A narrative review p. 31
Anurag Agarwal, Shivani Rastogi, Neha Singh, Manish Kumar Singh, Yasum Litin, Sunny Bhasin
Background: Minimally invasive and percutaneous treatments are effective treatment options for idiopathic trigeminal neuralgia (TN).Objectives: Multiple approaches have been described for the treatment of TN. This narrative review has been done to evaluate the current literature on different percutaneous treatment options for TN and to determine whether anyone treatment is better. Methods: The literature through a search of PubMed and Google Scholar was done and the review of the citations of relevant literature, and the authors knowledge of the literature and activity in the field. The literature was reviewed to find the preferred technique of preferred percutaneous treatment by different investigators and the difference in the outcome and/or complications and side effects. Results: Multiple techniques of such as percutaneous retrogasserian glycerol rhizolysis (PRGR), radiofrequency thermal coagulation (RFTC), and percutaneous balloon compression (PBC) for idiopathic TN have been used by different researchers. Effective pain relief and improved quality of life have been reported to be achieved by all the approaches. RFTC has been the most extensively used method, but PBC has been found to be more suitable for corneal preservation in cases of ophthalmic (V1) division pain. The most common imaging method used by large number of researchers is fluoroscope, though few authors have recommended computed tomography scan guidance for placement of cannula in foramen ovale and Meckle's cave, especially in cases with difficult anatomy. Limitations: This review has focused only on percutaneous techniques used by pain physicians. Other techniques such as radiosurgery and gamma knife used by radiologists and neurologists are not included. Conclusions: minimally invasive and percutaneous treatments such as PRGR, RFTC, and PBC are effective methods for the treatment of idiopathic TN. Selection of approach is largely dependent on the pain physician's choice, experience, and equipment available and can be used interchangeably; although for V1 neuralgia, PBC has superiority due to the preservation of corneal reflex.
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Percutaneous vertebroplasty in metastatic vertebral fracture: A retrospective cross-sectional study p. 40
Shivani Rastogi, Anurag Agarwal, Yasum Litin, Neha Singh, Hitesh Patel
Introduction: Metastatic vertebral fractures (VF) commonly cause severe disabling pain in cancer patients. VFs are common among elderly patients and account for approximately 1.5 million per year in the general population. Objective: Bone metastasis, which is a second major cause of pathologic fracture, may lead to severe intolerable pain, life-threatening hypercalcemia, spinal cord compression, and immobility. The purpose of this study was to evaluate pain relief and improvement in quality of life (QOL) in patients with metastatic VF undergoing percutaneous vertebroplasty (PVP). Methods: Ten cancer patients having metastatic VF underwent PVP from July 2018 to August 2020. All demographic data, procedures, improvement in pain, and analgesic requirements of patients were taken from a computer data system and telephonic follow-up. Results: Majority of patients were suffering from carcinoma lung followed by carcinoma pancreas. The mean ± standard deviation of Visual Analog Scale preoperatively was 8.8 ± 1.35, reduced to 2.14 ± 2.11 at 6 months postoperatively, suggesting significant pain reduction. Eight patients had reduction in analgesic requirements and two did not require any analgesics postoperatively. During the entire follow-up, there was no delayed complication. Conclusion: PVP is an effective, safe, and minimally invasive procedure for treating painful metastatic vertebral compression fracture refractory to conservative treatments. It provides a marked reduction of pain, maintains mechanical stability of the vertebrae, and improves QOL.
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Botulinum toxin application in erector spinae blockade for the management of myofascial syndrome in patients with fibromyalgia: A case series p. 46
German W Rangel J, Karina A Ortega A, Ximena J Cediel C
Botulinum toxin (BoNT) is a type of bacterial exotoxin that has been included in medical practice for multiple purposes, one of which is pain management. Some of the proposed mechanisms state that BoNT can reduce neurogenic inflammation by blocking the discharge of neuropeptides, including substance P and calcitonin gene-related peptides. Here, we present three patients with myofascial syndrome and fibromyalgia whose main symptom was pain in the dorsal region, wherein BoNT administered in the erector spinae bilaterally provided prolonged pain relief.
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Fluoroscopic landmarks related to gasserian ganglion intervention p. 50
Ravi Shankar Sharma, Ajit Kumar, Gaurav Purohit, Sonal Goyal
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