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.

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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).

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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.

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Until recently, perioperative pain management in neurosurgical patients has been inconsistently recognized and inadequately treated. An increased awareness of pain management in general along with advances in the understanding of pain modulation and pathophysiology, has led to improved practice and perioperative care of patients following craniotomy. Otherwise, severe postoperative pain impairs the quality of recovery and causes emotional distress with the possibility of inducing chronic pain and lasting functional deficits. The greatest challenge in managing neurosurgical patients is the need to assess the neurological function while providing superior analgesia with minimal side effects. To achieve this goal, a multimodal approach to analgesia, using various drugs and techniques, is advocated. There still remains a need, however, to conduct further randomized, controlled trials, to determine the best combination of drugs or techniques for treating perioperative pain in this patient population. Improved awareness, assessment, and treatment of pain result in better care and overall patient outcome.

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Background: Two different doses of intrathecal clonidine with hyperbaric bupivacaine fentanyl combination is compared in women undergoing abdominal hysterectomy to get best beneficial effects with minimal incidence of side effects/complications. Methods: 90 patients undergoing abdominal hysterectomy under spinal anesthesia, were randomized to 3 groups, BFC0: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl, BFC30: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 30μgm clonidine and BFC60: received 3 ml hyperbaric bupivacaine 0.5% + 25μg fentanyl + 60μgm clonidine. Time to reach peak sensory levels, sensory and motor regression times, intraoperative pain score and time for first analgesic requirement, hemodynamic changes, fluid and vasopressor requirement were recorded. Results: Addition of clonidine has not increased the rapidity of spread of sensory block to T4. Duration of motor block and time to regression to L1 is significantly less in BFC0, (167.78±25.09min and 213.59±22.99min respectively) compared to BFC30 (248.33±26.07 min and 297.33±25.96 min respectively) and BFC60 (260.18 ± 47.64min and 306.43±44.76min respectively). In patients of BFC0 intraoperative vas score (1.3±1.2) was significantly higher and demanded analgesics earlier (241.3 ± 27.76 min) compared to others. Fall in BP was observed in a dose dependent manner. Conclusions: Adding small doses of clonidine to bupivacaine-fentanyl combination improves the quality of perioperative analgesia in a dose dependent manner. However, 60μg clonidine shows significant hemodynamic changes. Hence, 30μg of intrathecal clonidine added to bupivacaine (15mg) fentanyl (25μg) combination is the preferred choice.

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This case report aims to introduce the use of intra-articular phenol in the management of chronic pain due to severe hip osteoarthritis in a patient with multiple comorbidities, in whom operative management was not an option. Phenol has been used in pain medicine since 1936, as a neurolytic agent. It has been used intrathecally, epidurally, in paravertebral somatic blocks, peripheral nerve blocks, and sympathetic blocks. It has been used for joints in the lower spine, but has not yet been described as an intra-articular agent for pain management of major weight-bearing joints.

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Intrathecal injection of drugs for anesthesia, regional analgesia, and chronic pain management are common practice now. Local anesthetic, adjuvants, and opioids are in common use. Human error in the Operation Theater and the Intensive Care Unit setup is also known and reported, due to stress and overwork. A case of unintentional atropine injection intrathecally, which was closely observed for any untoward effects, is reported here.

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The stellate ganglion block is a common procedure performed for management of the Complex Regional Pain Syndrome (CRPS) of the upper limb. Somatic anesthesia of the ipsilateral brachial plexus is a known complication of the stellate ganglion block. We report a case of CRPS of the left upper limb developing somatic blockade of the contralateral brachial plexus following a stellate ganglion block. This case report emphasizes the importance of vigilant monitoring during every procedure, as unusual complications can occur.

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