Chronic pain is more prevalent in the head and neck region than other parts of the body. Almost one-third of patients attending a facial pain clinic have history of undergoing some dental procedures often without success. Literature review reveals that atypical odontalgia, atypical facial pain or if teeth have been extracted phantom tooth pain are used to describe a common pain syndrome. At present, chronic pain disorders are diagnosed mainly on the basis of clinical signs and symptoms, since the mechanism underlying the pathophysiology is not well understood. Many diagnostic criteria for atypical facial pain has been proposed without much benefit however, it remains a diagnosis of exclusion after ruling out all other pathologies of the head and neck. Clinically, phantom tooth pain is similar in many essential characteristics to deafferentation pain syndrome. In the absence of controlled clinical trials specifically directed to phantom tooth pain, treatment should be guided by standards used for other neuropathic pain disorders.

Orofacial pain (OFP), a highly debilitating and prevalent pain condition, is a major concern of national public health. OFP can arise from different regions and etiologies. This intractable pain condition, arising from oral structures innervated by trigeminal nerves, represent a challenge to the clinician as the pain has multiple sources of origin and range of etiologies, thus making the diagnosis very challenging. Odontalgia, temporomandibular disorders (TMD), trigeminal neuropathy and migraines are some common disorders for which patients seek treatment. Owing to its diverse classification and etiologies, proper identification of the condition and subsequent treatment approaches has become a necessity. A multidisciplinary treatment approach comprising patient education, pharmacological, non-pharmacological means and psychosocial interventions can be considered essential for this enfeebling condition.

Headache is a very common problem in pregnancy. Evaluation of a complaint of headache requires categorizing it as primary or secondary. Migrainous headaches are known to be influenced by fluctuation of estrogen levels with high levels improving it and low levels deteriorating the symptoms. Tension-type Headaches (TTHs) are the most common and usually less severe types of headache with female to male ratio 3:1. Women known to have primary headache before conception who present with a headache that is different from their usual headache, or women not known to have primary headache before conception who present with new-onset of headache during pregnancy need neurologic assessments for potential secondary cause for their headache. In addition to proper history and physical examination, both non-contrast computed tomography (CT) and Magnetic Resonance Imaging (MRI) are considered safe to be performed in pregnant women when indicated. Treatment of abortive and prophylactic therapy should include non-pharmacologic tools, judicious use of drugs which are safe for mother and fetus.

Headache is a widespread clinical problem; the prevalence is high in all age groups, from which children and teenagers are not spared. It has been reported that, as many as 75% of school-age children may experience headache infrequently, among them 10% have recurrent headaches. ^[1],[2] The vast majority of headaches are primary and classified as migraine, tension-type headache (TTH), cluster headache, and other trigeminal autonomic cephalgias. The type of primary headaches could usually be diagnosed by a thorough and careful history taking, and physical examination. Once the diagnosis of migraine is established and appropriate reassurance provided, a balanced and individually tailored treatment plan can be instituted. The goal of treatment includes abortive or acute pain treatment, preventive long-term treatment, and biobehavioral therapy. Knowledge of precise impact of primary headaches on child's quality of life helps to design a proper comprehensive treatment plan.

Background: Neuropathic pain is a pain initiated or caused by a primary lesion or dysfunction of the nervous system. Material and Methods: In this study, we evaluated the effect of alcoholic extract of roots and rhizomes of Rubia cordifolia on the development and expression of neuropathic pain induced by paclitaxel in sciatic nerve ligated rats. A peripheral mononeuropathy was produced in adult Wistar rats by placing loosely constrictive ligatures around the common sciatic nerve. The postoperative behavior of these rats indicated that hyperalgesia, allodynia, and spontaneous pain were produced. Treatment with paclitaxel (2 mg/kg i.p. on 7 ^th , 10 ^th , and 21 ^st day) produced long-lasting (2-3 weeks) heat hyperalgesia and cold allodynia in rats. Conclusion: Co-administration of R. cordifolia extract for 21 days significantly decreased pain indicating its usefulness in neuropathic pain.

Introduction: Low back pain is one of the most common causes of chronic pain syndrome. Epidural steroids are being used for relieving mechanical causes of back pain, accompanied by signs of nerve root irritation with good results. Transforaminal epidural block at a particular level is a convenient route for steroid injection. Methods: The study was carried out on patients attending our pain clinic complaining of low back pain with radiculopathy where conservative therapy failed. Patients were divided into three groups (20 in each, allocated by random number table), 1 ^st one having collapsed vertebra, 2 ^nd one having disc protrusion following degenerative changes, 3 ^rd one having Grade I spondylolisthesis in lumbosacral region. Each of them received transforaminal epidural block at one level (L1/L2) with a dose of 40 mg of depot methyl prednisolone, diluted with 1 ml of 0.25% isobaric bupivacaine (to make a volume of 2 ml for each level on both sides). Initial pain response (at 1 h) was assessed by visual analogue scale (VAS). Long-term pain and disability were assessed (at 1 ^st , 3 ^rd and 6 ^th months) by using VAS score and oswestry disability index (ODI) score. Results: Significant improvement in VAS and ODI score were observed in cases of collapsed vertebra and disc protrusion due to degenerative changes but in the cases of Grade I spondylolisthesis no such improvement was observed. Conclusion: Transforaminal epidural block causes significant relief of symptoms where compression of nerve roots at a particular level causing radiculopathy as in collapsed vertebra or disc protrusion, but not in spondylolisthesis.

Context: Knee osteoarthritis (OA) is an important cause of pain and functional limitation in older people. Several short-term studies state that walking and resistance exercise reduce pain and disability and improve physical fitness in people with knee OA. Aims: To compare the effect of walking and resistance exercise on pain and function in older adults with knee OA. Materials and Methods: A quasi-experimental study was conducted at the physiotherapy department of General Hospital. Twenty one males and females in the age range of 60-75 years, diagnosed with knee OA by the orthopedic department according to the American College of Rheumatology criteria were randomly allocated into three groups. Conventional physiotherapy treatment remained common for all the groups. Group A subjects additionally walked at a self-paced speed. Group B subjects received resistance exercise for hip and knee muscles. Group C subjects received conventional physiotherapy treatment alone. Intervention was given 5 days/week for 2 weeks. Pain intensity at rest and during activity was assessed using visual analog scale (VAS) and physical function was assessed by Western Ontario McMasters Arthritic Index (WOMAC). The level of significance was set at 5%. Results: There was a significant difference in VAS at rest within group A and group B. The difference in VAS during activity and WOMAC scores was significant within each group. Mean difference in VAS during activity revealed a significant difference between group B and group A and between group B and group C. The mean difference in WOMAC scores was significant between group A and group C. Mean difference in VAS at rest showed no difference between the groups. Conclusion: Resistance exercises are more effective in reducing pain during activity and walking is more effective in improving physical function in older adults with knee OA.

Introduction: Patients with rheumatic symptoms are frequently misdiagnosed and mismanaged in rural areas. The present study was conducted to assess the level of accuracy in management of musculoskeletal (MSK) symptoms in rural patients. Materials and Methods: The study was conducted over 1-year period involving the patients with rheumatologic symptoms such as MSK pain, swelling and stiffness of joints, and managed outside previously before attending to us for these symptoms. Patients were interviewed regarding their past investigations, diagnosis offered, and management schedules. Level of misdiagnosis and mistreatment was evaluated. Results: One hundred and twenty-five patients (50%) were treated by quacks. Large number of patients also went to homeopathic (12%) and ayurvedic (4%) practitioners. Medical graduates treated 24% cases. Few patients went to postgraduate physicians (4%) or rheumatologists (0.8%). Misdiagnosis and mistreatment were common mainly with quacks and alternative medicine practitioners. Overall only 28.8% cases were diagnosed correctly. Investigations were suggested inappropriately such as antistreptolysin O titer, rheumatoid factor, and uric acid when these were not required. Medicines such as benzathine penicillin, steroid, etc., were prescribed inappropriately. Physiotherapy and rehabilitation were neglected. Conclusion: Gap in quality of rheumatology care is prevalent at rural areas. Awareness program and basic rheumatology training to rural health professionals are of high priority.

Context: Swinging "repetitive and rhythmic" movements are helpful because these provide a continuous stimulus. These methods are reported to be effective upon decreasing baby's pains or cry. Aim: The purpose of this study was to determine the factors of the two different methods (rhythmic rocking of infants in the arm and rhythmic rocking infants on a blanket) on crying duration and colic as well as the factors affecting duration of crying with colic. Materials and Methods: A pre-test post-test quasi experimental model was used. Subjects included 72 infants (1-3 months) who had colic and their mothers. The infants were healthy and were delivered after full-term gestation. Results: It has been determined that as the duration of application increased (at the end of the second week), the crying duration of babies who were in each of the two groups decreased. Conclusion: It has been found that swinging ( rhythmic rocking) the infants on a blanket and in arm, decreased the colic and crying duration of infants.

Peripheral neuropathy is a group of disorders in which the peripheral nervous system gets damaged due to conditions such as diabetes, shingles, vitamin deficiency, acquired immune deficiency syndrome (AIDS), spinal cord disorder, poisoning by heavy metals, alchohol, etc. Patients with peripheral neuropathy usually present with symptoms such as numbness, tingling, paresthesia, and weakness of the involved limb. Here, we have discussed a case of a 34-year-old male who had tingling and numbness of the right leg and right foot. However, initially, he was treated as a case of lumbar radiculopathy but was finally managed with tablets oxcarbazepine and Pregabalin in due course of time to which he responded well.

Use of Smart phone application in medical field is a novel concept and has been documented since long. Physicians, patients and their family has been found to be involved with these applications and they use emails, short message service (sms), and multimedia message service (mms) as a mode of communication with each other. This telephonic conversation helps in sharing information about the status of pain and other symptoms, initiation and continuing medical or surgical treatment, and post procedure follow up. It also helps the patient in cutting off the waiting time for consultation. At our centre, we are regularly using whatsApp application for making plans for patients with chronic pain.