Diclofenac and aceclofenac are nonsteroidal antiinflammatory drugs (NSAIDs). Diclofenac is advocated for the treatment of painful and inflammatory rheumatic and certain nonrheumatic conditions such as rheumatoid arthritis, osteoarthritis, ankylosing spondylitis, tendinitis, and bursitis, and in other inflammatory or painful conditions such as strains and sprains, dysmenorrhea, back pain, sciatica, and postoperative pain. Aceclofenac provides symptomatic relief in a variety of painful conditions such as joint inflammation, and reduces pain intensity and the duration of morning stiffness in the patients with rheumatoid arthritis, improves spinal mobility in the patients with ankylosing spondylitis. Gastrointestinal (GI) problems are the most frequent effects, which are caused by diclofenac and include dyspepsia and abdominal pain. Aceclofenac also has similar adverse effect but they are mild compared to diclofenac. We have reviewed 9 prospective studies that compared efficacy and safety of diclofenac with those of aceclofenac, 5 studies on osteoarthritis patients, 1 study on rheumatoid arthritis patients, 1 study on overall musculoskeletal disorders, 1 study on lower back pain, and 1 study on postextraction dental pain. Western Ontario and McMaster (WOMAC) universities scores, visual analogue scale (VAS), the Ritchie index, Lequesne OA severity index (OSI) were used in assessing the pain intensity and measuring the efficacy of the drug that proved beneficial in assessing the pain intensity and measuring the efficacy of both the drugs. All the studies came to the conclusion that aceclofenac is a better choice of drug in managing pain in case of all the above conditions with better efficacy and tolerability, patients experienced more number of adverse events (AEs) with diclofenac when compared with aceclofenac.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

History taking in patient suffering from pain is dealt like an art by emphasizing the multimodal experience of pain which is ignored in modern sophisticated investigations era. For clinical diagnosis, we need proper history, targeted clinical examination and support by investigation with or without diagnostic intervention. Ignoring history part in clinical assessment can lead to wrong diagnosis and unnecessary experience and expenses for patient. History part of patient evaluation can be divided into present pain as chief complaint, ruling out red flags or warning signals, past history, personnel history including sleep and bladder and bowel history, treatment history and family history. Present pain history can be divided into quantity assessment, quality assessment, mode of onset and location, duration and chronicity, provocative and relieving factors, special characters, timing of pain, relation to posture and associated features. Quantity and quality of pain can be assessed by different tools with different sensitivity and specificity. These tools give idea about the multimodal experience of pain which cannot be assessed by any physical examination and investigation. This helps us in diagnosing and planning for multimodal approach of pain management. We can conclude that proper history with adequate tools which is supported by physical examination and investigation with or without diagnostic intervention helps in diagnosing exact nature of pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Patients who are diagnosed clinically as Coccygodynia often do not get satisfactory relief. The clinical diagnosis is based on various hypotheses that have been proposed to explain the pain of coccydynia - including coccygeal spicules, pain from the pericoccygeal soft tissues, pelvic floor muscle spasm, referred pain from lumbar pathology, arachnoiditis of the lower sacral nerve roots, local posttraumatic lesions, somatization, etc. The diagnosis is difficult and the pathophysiology is poorly understood. Till recently, use of dynamic X-rays and MRI imaging was not considered to diagnose this condition. The author would like to report three patients who presented to the pain clinic with refractory coccygeal pain and underwent dynamic coccyx X-rays and MRI as part of their evaluation. All these patients had positive findings on MRI. These patients were treated satisfactorily as a result of the added diagnostic value of MRI.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Post herpetic neuralgia (PHN) is a chronic neuropathic pain in the region of the herpes zoster (HZ) rash, persisting after the cutaneous lesions have healed. Despite numerous treatment advances, many patients remain refractory to the current therapies and continue to have pain, physical and psychological distress. In this review, we will discuss the current strategies for prevention and management of this disease, as also the insight into the future probabilities.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Pain assessment remains a challenge to medical professionals and received much attention over the past decade. Effective management of pain remains an important indicator of the quality of care provided to patients. Pain scales are useful for clinically assessing how intensely patients are feeling pain and for monitoring the effectiveness of treatments at different points in time. A number of questionnaires have been developed to assess chronic pain. They are mainly used as research tools to assess the effect of a treatment in a clinical trial but may be used in specialist pain clinics. This review comprises the basic information of pain intensity scales and questionnaires. Various pain assessment tools are summarized. Pain assessment and management protocols are also highlighted.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Osteoarthritis (OA) is the most common form of arthritis characterized by progressive destruction of joint cartilage tissue, pain and inflammation, stiffness, and impaired physical activity. It is the most prevalent and leading cause of pain and disability across the globe. During the pain and inflammatory process, 5-lipoxygenase (5-LOX) pathway is also involved, which generates leukotrienes (LTs), namely LTB4 and cysteinyl LTs. Osteoblasts also synthesize LTs, which stimulate and enhance the production of interleukin 1, tumor necrosis factor α, and various other cytokines that are potent inflammatory mediators. LT formation leads to cartilage degradation and compensates chondrocyte-mediated cartilage repair mechanism. Current therapies include nonsteroidal anti-inflammatory drugs, analgesics, and disease-modifying agents, but do not affect 5-LOX pathway. Boswellia serrata extract–derived boswellic acids are specific, non-redox inhibitors of 5-LOX, and 3-O-acetyl-11-keto-β-boswellic acid (AKBA) possesses the most potent 5-LOX inhibitory activity. B. serrata extracts have shown significant efficacy and safety in the treatment of various inflammatory disorders such as OA, rheumatoid arthritis, asthma, and inflammatory bowel diseases. Aflapin^® is a novel synergistic composition containing B. serrata extract selectively enriched with 20% AKBA and B. serrata nonvolatile oil. Aflapin^® is a patented, selective, and most potent 5-LOX inhibitor, which significantly reduces joint pain, inflammation, stiffness, and improves physical function compared to placebo and other B. serrata extract. Aflapin^® also significantly reduces matrix metalloproteinase levels, enhances chondrocytes proliferation, and increases glycosaminoglycans levels, thereby providing cartilage protection in arthritis. Numerous in vitro studies, preclinical studies, and clinical studies suggest the potential of Aflapin^® as a useful therapeutic intervention for the management of arthritis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

In the current scenario of Corona-19 pandemic, absolute awareness among all health – care workers is necessary. History taking and analyzing the symptoms obviously remains the cornerstone for the detection of COVID-19. However,physician must suspect COVID-19 in patients presenting with the chief complaint of gastrointestinal symptoms such as abdominal pain,diarrhea, and vomiting with or without respiratory complaints. This case series conveys an important message about changing our approach in the initial assessment and management of patients with acute abdominal pain or acute on chronic abdominal pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

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.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

To draw attention to an uncommon complication that could arise from routinely performed procedure in pain practice like cervical epidural steroid injection. We report a case of 47-year-old female whose neuropathic pain was increased after cervical epidural steroid injection. Cervical epidural injection with methylprednisolone and lignocaine produced transient paresthesia during injection followed by a dull ache with pronounced allodynia in fingers. Next day, the patient reported severe pain in left forearm and hand with burning and sensitivity to light touch and swelling of the dorsum of the hand. On examination, there was marked allodynia, warmth, erythema, and swelling of the left hand. Sensory examination showed decreased sensation to pinprick. Patient was prescribed a tapering dose of oral steroids, pregabalin, and analgesic-muscle relaxant combination. Symptoms gradually resolved on weekly follow-ups for 4 weeks and no further intervention was needed. Increased neuropathic pain after cervical epidural steroid injection may result from either a direct nerve root irritation caused by the steroid solution or nerve root injury. Direct nerve root irritation by steroid injection is most probable cause in midline approach.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Preemptive analgesia, initiated before the surgical procedure to prevent pain in the early postoperative period has the potential to be more effective than a similar analgesic treatment initiated after surgery. This article aims to review all the recent published evidences that assess the efficacy of this enigmatic concept. Materials and Methods: We reviewed original research articles, case-reports, meta-analyses, randomized control trials (RCTs), and reviews based on pain physiology for preemptive analgesia from Medline, Medscape, and PubMed from 1993 to 2013. A broad free-text search in English was undertaken with major keywords "Preemptive analgesia," "postoperative pain," "preoperative," and "preincisional". Results: Review of publications showed that intravenous (IV) nonsteroidal anti-inflammatory drugs (NSAIDs) are quite effective when used alone, as well as with low dose iv ketamine, preemptively to provide adequate postoperative analgesia. However, ketamine has a doubtful role as a standalone agent. Preemptive administration of LA at the incision site reduces postoperative pain, but achieves an analgesic effect similar to that of postincisional anesthetic infiltration as does intraperitoneal administration. Preemptive epidural analgesia has proved its efficacy in controlling perioperative immune function and pain in comparison to parenteral opioids. Gamma-amino butyric acid (GABA) analogues like gabapentin and pregabalin have great potential as preemptive analgesic with the added advantage of its anxiolytic effect. Conclusion: Multimodal approaches that address multiple sites along the pain pathway is necessary to treat pain adequately. However, we need to find an answer to the question of how to obtain the maximal clinical benefits with the use of preemptive analgesia.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Background: The level of quality of life (QOL) and disability among women with low back pain is an important health issue at global level. Objective: To find out the prevalence of low back pain and to assess the relationship of low back pain with disability and QOL among women. Materials and Methods: A community-based cross-sectional study was conducted among 250 women in age group of 30-65 years residing in field practice area of a Tertiary Care Medical Institution, Puducherry. Severity of the pain was assessed using Numerical Pain Scale. Modified Oswestry Low Back Pain Disability Questionnaire was used to measure the disability level and WHO-BREF scale to assess the QOL among women with low back pain. Results: Overall, the prevalence of low back pain was found to be 42%. The majority of women (60.9%) with low back pain experienced moderate disability. Almost 72% of women with low back pain perceived their QOL as good and overall mean QOL score was 88.41 (standard deviation = 12.9). The low back pain was influenced by the demographic variables that include age, marital status, illiteracy, total family income, type of delivery, number of children and household chores, menopausal status, and chronic illness (P < 0.05). Disability was influenced by age, education, and occupation, whereas QOL was influenced by education of the women with low back pain (P < 0.05). Conclusions: Prevalence of low back pain among women was comparatively more than other studies in India. Although moderate disability was more among those with low back pain, overall QOL was good.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

One of the most severe pains experienced by a woman is that of childbirth. Providing analgesia for labor has always been a challenge more so because of the myths and controversies surrounding labor. It is imperative to understand the pain transmission during various stages of labor in order to select a proper technique for providing labor analgesia. The adverse effects of labor pain are numerous and affect both the mother as well as the fetus. Currently lumbar epidural is considered to be the gold standard technique for labor analgesia. Local anaesthetics like bupivacaine and ropivacaine are commonly used and adjuvants like clonidine, fentanyl and neostigmine have been extensively studied. However, despite being so popular, epidural analgesia is not without complications, with hypotension being the most common. Other complications include accidental dural puncture, infection, intravascular placement, high block and epidural hematoma. Other neuraxial techniques include continuous caudal analgesia, and combined spinal epidural analgesia. The numerous studies investigating the various aspects of this method have also served to dispel various myths surrounding epidural analgesia like increased incidence of cesarean section and instrumental delivery, prolongation of labor and future back pain. The future of labor analgesia lies in the incorporation of ultrasound in identifying the epidural space helping in proper catheter placement. The keywords "labor epidural" in the PUBMED revealed a total of 5018 articles with 574 review articles and 969 clinical trials. The relevant articles along with their references were extensively studied.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Globally, the burden of pain and consequent disability on healthcare and economy is significant. Given the pain prevalence, inconsistent, and inadequate specialist health care services in India, the burden is likely to be magnified. Analgesic medication is the mainstay treatment for most types of pain; however, its side effects and financial costs for prolonged periods of time have resulted in the search for safer, inexpensive treatment options. Transcutaneous Electrical Nerve Stimulation TENS is a non-invasive, self-administered and inexpensive analgesic technique used worldwide to manage pain. Evidence suggests that TENS is effective in relieving acute and chronic pain and can be used as a stand-alone treatment for mild to moderate pain or as an adjunct for moderate to severe pain. The purpose of this study is to overview the principles, techniques, and clinical research evidence when TENS is used to manage pain with reference to health care and research studies conducted in India. A summary of evidence was formed based on Cochrane reviews, systematic reviews and meta-analyses on TENS with respect to pain management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Sacroiliac joint (SIJ) pain is one of the common but underdiagnosed source of mechanical low back pain. The incidence is estimated to be in the range of 15%–30% in patients with nonradicular low back pain. The signs and symptoms of SIJ pain mimic pain arising from other causes of low back pain. There is no single symptom or physical examination finding that can firmly diagnose SIJ as a source of patient's pain. There is good evidence suggesting that a combination of three or more positive provocative tests strongly suggests SIJ dysfunction. Intra-articular injection with local anesthetic is considered the gold standard for diagnosis of SIJ pain. Many treatment modalities are available for SIJ pain, ranging from conservative management to surgical interventions. This review article covers all the aspects of SIJ pain, with treatment section mainly covering evidence-based interventional procedures.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Quadratus lumborum is one of the common sources of pain and that can be missed or ignored easily. Quadratus lumborum pain syndrome is a myofascial pain syndrome. The pain is due to spasm and stiffness of the muscle. Many a times, weak back muscles are compensated by quadratus lumborum leading to painful spasm. It is diffi cult to differentiate between quadratus lumborum and iliopsoas pain syndrome. Diagnostic quadratus lumborum injection helps differentiate between these two. In this report, we reported a case of quadratus lumborum pain syndrome as a primary diagnosis and iliopsoas pain syndrome as a secondary diagnosis. The diagnosis was confi rmed by fl uoroscopically guided quadratus lumborum injection.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Pain in the knee joint can be from a variety of reasons. It can be either from the joint itself, it can be myofascial or it can be neuropathy, radicular pain. The myofascial component can be in different forms, namely, collateral ligament pain, bursitis, tendinitis, and so on. This responds well to local injections of steroids. Pain from the joint can be because of osteoarthritis (OA), rheumatoid arthritis or any other variety of arthritis. Among these osteoarthritis is the most common and naturally occurring pain. There are several modalities used for managing pain in the knee joint. They include medicines and physiotherapy, intra-articular steroid injection, intra-articular Hyalgan, Synvisc injection, prolotherapy, genicular nerve block, ablation, intra-articular pulsed radio frequency (PRF) ablation, acupuncture, injection of platelet-rich plasma in the joint, total knee replacement, high tibial osteotomy, arthroscopy and lavage, and so on. All these modalities have their pros and cons. Literature and experience state that the pain relief provided may last for a few months with these modalities except in surgical interventions in advanced OA. The saphenous nerve is termination of femoral nerve and it is essentially sensory nerve. It supplies the medial compartment and some part of the anterior compartment of the knee joint. This nerve has been blocked near the knee joint by way of infiltration by surgeons and anesthetists, for relief of pain after knee surgery, with varying pain relief of postoperative pain. When we block the saphenous in the mid thigh in the sartorial canal, the fluid tends to block the medial branch of the anterior femoral cutaneous nerve also. It is hypothesized that this may give complete medial and anterior knee pain relief and as most of the knee OA patients have medial and anterior knee pain, this may prove useful. Use of ultrasonography helps to locate the nerve better, ensuring perfection. An effort has been made to block this nerve in the sartorial canal with steroid and LA under ultrasonography (USG) guidance and observe the results. Patients have received very good pain relief (95 - 100%) for a substantially long time (up to four years).

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

The effective management of pancreatic cancer pain continues to be a major challenge for patients and clinicians. Up to 80% of patients with advanced pancreatic cancer present with the symptoms of severe pain. One of the most important goals in their management is achieving the highest quality of life throughout the course of disease with effective palliation of pain. Majority of the current data supports the use Neurolytic celiac plexus block (NCPB) and has been shown to be more effective in reducing pain compared with standard pharmacotherapy. NCPBs have led to decreased opioid requirements and related side effects, thus preventing deterioration in quality of life. In this article, we discuss the treatment of pancreatic cancer pain and the advances in techniques of performing NCPB. We also analyzed the incidence of complications and the quality of pain relief with the use of NCPB. NCPB is effective, has a low incidence of complications, and should be used more often in patients with pancreatic cancer pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Neuropathic pain (NeP) constitutes a major pain-related disorder, which is often underdiagnosed and undertreated. Adverse physical, psychological, and economic consequences associated with NeP lead to poor quality of life. Burden of NeP in developing countries like India is colossal. Various international guidelines provide effective approaches to diagnose and manage NeP. However, differences in the genetic makeup of Indian population can result in subtle differences in clinical response, considering their low body weight, drug metabolism ability, and pain perception. Similarly, treatment-related adverse effects may also vary. Practice of Indian physicians may also differ for choice of drugs based on their availability and affordability. In the absence of country-specific guidelines, this document could serve as a guiding tool for health-care providers, ensuring uniformity in the treatment of NeP. Thus, applicability of all recommendations from any of these guidelines in Indian setting demands careful evaluation. Clinical experience of Indian physicians suggests that there are lot many challenges (e.g., busy outpatient departments, nonavailability of screening questionnaires in regional languages, and availability and affordability of medications) faced by them when managing NeP. In addition, in India, there are no country-specific guidelines that would help them to address these challenges. The objective for this consensus was to develop an expert opinion guideline to harmonize the management of NeP in India. The expert panel consisted of experts from various specialties such as pain medicine, anesthesiology, diabetology, neurology, and orthopedics. The panel critically reviewed the existing literature evidence and guideline recommendations to provide India-specific consensus on the management of NeP. The final consensus document was reviewed and approved by all the experts. This expert opinion consensus will help health-care professionals as a guiding tool for effective management of NeP in India. Use of Douleur Neuropathique 4 (DN4) questionnaire for NeP screening should be routine in day-to-day clinical practice. For effective utilization of DN4 questionnaire, it should be converted to regional language. If DN4 questionnaire screening fails to identify NeP, it should not be disregarded and should not replace the sound clinical judgment from the treating physician. Diagnostic tests may be considered as a supplement to clinical judgment. Cost-effective treatment should be the initial choice. Dosing should be individualized based on efficacy and tolerability. Tricyclic antidepressants (TCAs), gabapentinoids, and serotonin-norepinephrine reuptake inhibitors (SNRIs) can be considered among initial choices. Tramadol can be considered as a second-line add-on treatment for NeP if there is partial response to the first-line agent either alone or in combination. Fixed-dose combination (FDC) of gabapentinoids such as pregabalin (75 mg) with TCA such as nortriptyline (10 mg) is synergistic and improves treatment adherence. Among other treatments, Vitamin B12 (methylcobalamin) can be used either alone or in combination for the management of NeP. Use of Vitamin D and steroids should be limited to specific NeP in individual cases. Referral to pain specialists can be considered if two drugs fail to provide relief in NeP.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Clinical trial of 100 patients of chronic low back ache was conducted in the Department of Physical Medicine and Rehabilitation (PMR) at Sher-i-Kashmir Institute of Medical Sciences Soura a Tertiary care hospital for period of two year from January 2010 to January 2012 to find out effect of Microwave diathermy (MWD). All patients were treated with Microwave diathermy along with conventional treatment. The results were compared and student's 't' test was applied to see the level of significance. A significant improvement after treatment (P=0.000) was found. The present study suggests that short wave diathermy is effective for the treatment of patients with chronic low back pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Diagnosis of acute gout remains a diagnostic challenge if associated with trauma, and may easily be mistaken as cellulitis or septic arthritis. Gout is an inflammatory arthritis that is triggered by the deposition of sodium urate crystals within the joints and soft tissues, and is frequently associated with hyperuricemia. Hyperuricemia may arise in a wide range of clinical situations that cause overproduction or under-excretion of uric acid, or a combination of both. As uric acid is the ultimate breakdown product of purine nucleotide degradation in humans, any increase in purine production due to accelerated cell turnover may precipitate an acute attack of gout. Gout may be precipitated by conditions such a trauma, surgery, diuretic therapy, or ethanol intake. All predisposed individuals such as those with hypreuricemia, hypothyroid etc. with trauma and bone fractures should be observed for precipitation of acute gouty arthritis. Bone healing after a fracture may also lead to acute gout. Healing of a fractured bone, through multiple mechanisms, can precipitate acute gout, particularly in the presence of certain predisposing factors such as hypothyroidism, pre-existing hyperuricemia or tissue hypoxia. Acute inflammation and pain, if resistant to non-steroidal anti-inflammatory drugs, may necessitate treatment with colchicine.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Cervicogenic angina is paroxysmal precordialgia usually due to lower cervical vertebral involvement. But upper cervical vertebral segmental anomaly causing cervicogenic angina is rare. Herein, we report a case of cervicogenic angina due to fused 3 ^rd and 4 ^th cervical vertebra in a 37-year female, which was initially misdiagnosed as angina and treated likewise. But, persistence of symptoms led to evaluation of her cervical spine and subsequent diagnosis. Cervical traction, physiotherapy and posture training relieved her of her symptoms with no recurrence till 6 months of follow-up. Fused C3-C4 can be a cause of precordialgia and physicians should be aware of it.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Plantar fasciitis, though a common condition seen by pain specialists, occasionally presents diagnostic dilemmas and very often the management of this condition suffers from lack of awareness of the varied treatment modalities and progressive escalation of treatment options. For this purpose, we searched through all articles with key words of plantar fasciitis or heel pain in the last ten years for which full text was available and compiled a narrative review to guide clinical decision making. An appreciation of pathomechanics of involved structures, possible differential diagnoses and a review of all treatment modalities presented in this article may perhaps help in simplifying matters. Treatment options consist of non-invasive physical therapy modalities, footwear modification, exercise program and newer modalities like shock-wave therapy, minimally invasive treatments like steroid or platelet-rich plasma injections and surgery in recalcitrant cases. Resorting to combining treatment modalities, step-wise escalation of treatment depending on duration of the condition and using our suggested step-ladder approach maybe an appropriate way of treating this condition.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Failed back surgery syndrome (FBSS) is a condition of persistent pain following spine surgery as a result of epidural adhesions, nerve root entrapment/inflammation. Transforaminal epidural steroid (TFES), interlaminar/caudal epidural (CE) with local anesthetic, saline, steroid and hyaluronidase are established therapeutic options over re-surgery. We report a 55 years old male patient with FBSS since 10 years. Following informed consent, under fluoroscopy guidance TFES given at L4/5, L5/S1 foramina with 1.5 ml 0.25% bupivacaine + triamcinolone 20 mg. Besides, CE injection of 10 ml 0.25% bupivacaine with 50 mcg fentanyl given using 18 gauge Tuohy's needle. Fifteen minutes later 20 ml of 0.9% cold (2^°C) normal saline with hyaluronidase (on day 1) was injected forcefully through epidural catheter, repeated on 2 ^nd and 3 ^rd day with triamcenolone 20 mg. 90% pain relief persisted till 8 months with improved quality of life. TFES with successive CE saline can be a good therapeutic option for long term relief in FBSS.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The most common cause of orofacial pain is the Temporomandibular Joint Disorder (TMD), a collective term used to describe a group of medical disorders causing temporomandibular joint (TMJ) pain and dysfunction. As the causes of TMD are varied and run the gamut from mechanical issues, such as disc degeneration and dislocation or erosion of the fibrocartilaginous surfaces of the condyle, fossa, and articular eminence, the treatment approaches for the chronic TMJ case are also quite varied. As surgery is considered a last resort for TMD, it is common for sufferers to seek out alternatives and one of the alternative treatments is 'Prolotherapy,' which is also known as Regenerative Injection Therapy. This article provides an overview of this new alternative therapy.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]

Pain is an emotional experience almost experienced by almost every one of us. Since the pain can neither be seen nor measured, it poses a challenge to the patient as well as the clinician in understanding its complicated nature and the best way of managing it. There is no simple method of pain evaluation due to its subjective nature. However, comprehensive approaches for its evaluation exists, of which most common pain scale used are visual analog scale, Mc-Gills questionnaire, brief pain inventory (BPI) to name a few. We have tried to highlight the various advantages of the BPI scale over the other pain scales and to emphasize an improved instrument, which can be used as a promising modality for the assessment of orofacial pain.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub] [CITATIONS]