Cervicogenic Headache Treatment In Delhi - Removemypain

What is Cervicogenic Headache?

Cervicogenic headache in simple terms means headache originating from the neck. Even though the pain you experience is in the head or part of the face, the actual problem in lies in the neck. The possible pain generators in the neck include the joints, discs, surrounding tissues such as the neck muscles, coverings of the spinal cord, and blood vessels.

Headaches afflict people of all ages. The impact is variable from mild discomfort to severe incapacitation, depending on the severity and the frequency of headaches. Often the causative factors are numerous and difficult to pinpoint. Cervicogenic headaches represent one such condition that is easily overlooked and under diagnosed, due to limited awareness about the condition. This is a treatable cause of headaches with possibility of good relief if the diagnosis is correct.

Signs & Symptoms of Cervicogenic Headache:

Some of the pointers towards cervicogenic headache include:

• Increase in headache with neck movements such as nodding or rotation of neck
• Increase pain with pressure on certain sensitive points in the neck
• Stiffness and reduced range of neck movements
• Pain is generally one sided and does not change sides. Sometimes both sides are involved
• Generally described as a pressure sensation at the back, side or front of head or in the area around the eye. It may be episodic with varying duration or present constantly. During severe episodes nausea and vomiting and other features similar to migraine can be present making the diagnosis more challenging.

The headaches often start after trauma/ injuries such as whiplash. Conditions such as occipital neuralgia (a problem associated with the nerves at the back of head) are closely linked to cervicogenic headaches.

Causes of Cervicogenic Headache:

A number of neck conditions have been attributed to cause cervicogenic headaches including:

• Degenerative changes in the joints of the cervical spine such as osteoarthritis
• Discs of the cervical spine
• Whiplash injury to the cervical spine or other sports injuries
• Spasms of the neck muscles
• Bad posture of the neck for long periods of time, such as when working or sleeping

Diagnosing Cervicogenic Headaches:

Diagnosing a cervicogenic headache can be tricky, as a number of headaches can present with similar features. Your doctor will obtain a detailed history often taking you back to when it had first started. You will be asked in detail about your pain symptoms, stress levels, work, eating and sleep habits, medication usage etc. This is usually followed up by examination. Diagnostic investigations such as X-ray, MRI, CT scans cannot conform the diagnosis but do provide support to the diagnosis. An injection is often used for confirmation of the diagnosis.

Cervicogenic Headache Management Options:

There are a variety of treatment methods for helping with cervicogenic headaches. These include:

• Lifestyle changes such as regulation of sleep cycle, workplace ergonomics
• Medication may include mild or potent pain killers
• Interventions such as joint, nerve or muscle injections. These generally involve injection of local anaesthetics with or without steroids. Sometimes Botulinum toxin injections are used for muscles
• Radiofrequency treatment can help relieve/ reduce these headaches for a prolonged duration

Management Options continued:

• Physical therapy can help to stretch and relax the muscles in and around your neck. They can help deal with the muscular trigger points
• Psychology input may involve biofeedback, relaxation therapy and cognitive behavioural therapy
• Complimentary and alternative medicine including meditation, yoga, TENS, acupressure and acupuncture
• Surgery – this may be used in cases with severe joint changes or nerve compression causing severe headache remains unrelieved by other modalities, but this is rare

Tag = Pain Management in Delhi, Pain Treatment in South Delhi, Best pain specialist in Delhi, Pain Specialist in Delhi, Cervicogenic Headache Treatment In Delhi

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Chronic Post Surgical Pain (CPSP) - Removemypain

Chronic post-surgical pain (CPSP) is pain localized to the surgical site or a referred area persisting 3 months after surgery. To diagnose CPSP pain should have been absent before surgery or should have different characteristics from preoperative pain. Other possible causes of the pain such as infection, recurrence of the original problem, etc need to be excluded.

CPSP is a common complication of surgery and rates up to 80 % in adults have been reported in some studies. CPSP is also reported in children although the incidence is less than in adults. It can have significant consequences for the individual and the World Health Organisation plans to include this as a separate diagnosis in the upcoming version of the International Classification of Diseases, ICD-11. Type of surgery influences not only the risk of development but also the severity of CPSP. Some surgeries are more prone to develop CPSP such as amputations, thoracotomy, and mastectomy. It is observed after commonly performed operations such as hernia repair, cesarean sections, knee replacement, etc. Risk factors for developing CPSP include having pain before surgery, the severity of acute pain immediately after surgery, multiple surgeries younger age, and site of surgery. Genetic and psychological factors are also thought to play a role. A significant proportion of the cases are attributed to nerve damage.

Management of CPSP required a multi-modal approach focussing on

• Patient and family education
• Optimization of medications
• Interventional approaches such as injections and neuromodulation.
• Physiotherapy
• Psychological interventions such as cognitive behavioral therapy

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Neck Pain Treatment in Delhi | Best Neck Pain Specialist in Delhi

Majority of us would experience neck pain at some point in our life. Neck Pain can disrupt daily routine activities. Muscle spasm, pain can make it difficult to turn head and activities such as driving become difficult. It is not uncommon for the neck pain to radiate to shoulders or lead to persistent headaches. Neck pain is more commonly observed in middle ages and may have a mechanical or postural basis. Most uncomplicated neck pain is associated with poor posture, anxiety and depression, neck strain, injuries. Fortunately majority of cases are not due to serious causes. If you are experiencing unresolving or severe pain, you should seek medical opinion from neck and shoulder pain treatment specialists in Delhi so that timely diagnosis can be done and corrective action can be taken.

Some common causes include –

• Muscle sprain, spasm/ increased tension
• Poor posture and work ergonomics
• Incorrect positioning of the neck while sleeping
• Aging: Degenerative disc disease and spinal osteoarthritis become more common as we age
• Injuries/ Whiplash: Whiplash neck involves sudden jolting of neck forwards and backwards and is commonly observed in vehicular accidents. This can cause excessive stretching of neck muscles, ligaments or other injuries which can be associated with neck pain.

Neck pain can be a part of more widespread medical issues such as in fibromyalgia, arthritis, ankylosing spondylitis, infections, cancer etc. You can approach Pain Management Specialists in Delhi for diagnosing your problem and suggesting suitable solutions

It is advisable to seek early medical attention if you experience any of the following

• Persisting symptoms or severe pain not responding to usual care or medications
• Pain starting after fall, injury
• New onset numbness, weakness or tingling in arms
• Gait or balance problems
• Loss or urine or stool control
• Signs of infection/ meningitis
• Pain worse at night time/interfering with your sleep

Some of the pain management techniques for neck pain include:

Lifestyle changes: Incorrect/ ignored posture while working on laptops mobiles etc can put excessive cervical spine strain leading to pain. Certain professions can be more prone to develop neck pain. Simple posture awareness and improvement, taking regular breaks can go a long way in reducing symptoms.

Medications: Anti-inflammatory drugs such as ibuprofen or naproxen and pain relievers like acetaminophen may initially be prescribed by your doctor. Sometimes medications like muscle relaxants or stronger painkillers may also be suggested by your doctor.

Physical Therapy: Regular exercise, good posture, stretching can help to reduce/ prevent to prevent unwanted stress and tension to your neck muscles. Heat or cold application may be used during the initial phases of injury to facilitate your recovery and physical exercise. Depending on the severity, time since injury and your recovery the specialist may recommend limiting normal physical activity or slow range-of-motion exercises or strengthening exercises.

There is research evidence supporting the use of specific strengthening exercises as part of a routine practice for chronic neck pain, cervicogenic headache and radiculopathy.

Ergonomics & Posture
Simple posture changes and better workplace ergonomics can help in preventing/reducing neck pain. Measures include adjustment of furniture height and computer position such that

• Eyes point directly at the top third of the screen
• Forearm is parallel to floor
• Feet should be flat on the floor with thighs parallel with the floor

While sitting in office chair it’s a good practice to have back aligned against the back of the office chair and avoid slouching. Avoid sitting in one place for too long. Taking regular breaks to walk around and stretch is a good practice.

Relaxation techniques: relationship between stress and increase pain is well known and easily appreciated by most patients. Measures to deal with stress and anxiety help in more effective pain management.

Massage Therapy: The evidence supporting the use of massage therapy is limited although some people do find it useful in the short term. Massage can help in relaxing, loosening of muscles but it is important to remember that wrongly done massage can lead to harm.

Acupuncture: Certain people find Acupuncture helpful in neck pain management. When performed correctly it is a low risk procedure. The traditional acupuncture is based on the theory of restoring the energy balance in body and removing any blockages to the flow of energy.

Injections/ other interventions such as Radiofrequency ablation: These would depend on the cause of neck pain and actual pathology. They have been explained in more detail in the neck & arm pain section under treatments, on my website- removemypain.com

Ignoring persisting symptoms can aggravate the situation leading to chronic pain with reduced functionality. So, if your pain persists and does not respond to usual lifestyle changes and painkillers then seek medical opinion on time.

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Shoulder Pain Treatment In Delhi, Frozen shoulder treatment in delhi - Removemypain

Shoulder pain may be an isolated problem localised to the shoulder or be a part of widespread pain as in rheumatoid arthritis. A combination of history, examination and diagnostic investigations is utilised to identify the pathology and guide further management. Diagnostic ultrasound scan is an effective bedside tool as it can reliably identify common shoulder pathologies and reduce the requirement of additional investigations. I routinely perform ultrasound scans at the time of initial assessment. This reduces the requirement of additional investigations and if required a guided injection can be performed at the same time.

Some of the common reasons for shoulder pain include

• Inflammation, injury, or weakening/tear of muscles and tendons around the shoulder joint (rotator cuff)
• Damage to bones, cartilage of shoulder joints as in the arthritis of glenohumeral, acromioclavicular joint
• Bursitis (Bursa allow for smooth sliding of tendons or muscles over the joint or frictional areas)
• Frozen shoulder or Adhesive capsulitis
• Spasm/injury of neck and shoulder muscles
• Referred pain from surrounding areas like neck for example in nerve entrapment or neck joint arthritis

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Cancer Pain Treatment In Delhi and Gurgaon - Dr. Amod Manocha

Pain in cancer may arise due to many reasons and is often the presenting complaint leading to the diagnosis of cancer. It may be

• Related to cancer itself or its spread to other body parts
• A late presentation due to side effect of treatments such as chemotherapy, radiotherapy and surgery
• A result of extra stress placed on other body parts for example shoulder pain due to using of a stick for walking
• A totally unrelated coincidental problem such as arthritis

Pain can be of differentiated into background pain (which is always present in the background and is managed with regular medications) and breakthrough pain (pain that breaks through your regular pain relief). Breakthrough pain may occur unprovoked or may be triggered by external or internal factors. In cancer patients, different types of pain may coexist. It is not just limited to pain arising from inflammation and tissue damage for example cancer of the pancreas spreading to neighboring organs and nerves leading to visceral and neuropathic pain respectively and a distant spread to bones producing bone pain. Different types of pain present differently for example

• Neuropathic/ Nerve pain is generally described as burning, shooting, electric shock-like, or stabbing pain with associated tingling or numbness. It may be a consequence of cancer itself or a result of treatments such as chemotherapy (chemotherapy-induced peripheral neuropathy- CIPN).
• Visceral Pain originates from the viscera (organs in the body cavity) and is generally described as deep aching, squeezing, and cramping sensation
• Bone pain presents as an aching, throbbing sensation. Some cancers have a preference to spread to bones

Pain Management

Pain relief needs to be tailored to the cause, severity, and duration of pain. In most cases, a reasonable control can be achieved by using a combination of methods. Multimodal, Multidisciplinary approach provides the opportunity to maximize pain relief and provide support not only for the physical needs but also for the emotional, spiritual, and social needs.  

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Trigger Finger / Thumb : Symptoms, Causes, and Treatment In Delhi, India

 

What is trigger finger/thumb?

If your finger gets stuck in a bent position or snaps when bent and straightened, then the trigger finger can be the likely cause. The name trigger finger comes from the similarity with a gun trigger being pulled or released. This is a common cause of hand pain and is seen in roughly 2- 3 percent of the general population. The thumb or ring finger of women in the fifth or sixth decade of life is most commonly affected. The condition can however involve multiple fingers and both hands.

What are the causes of trigger finger/thumb?

Tendons are rope-like structures that attach the muscles to the bones. These are surrounded by a covering (sheath) and are held attached firmly to the bones by anchors called pulleys. A disparity in the size of the tendons and the sheath or the anchors results in the disruption of the smooth gliding mechanism and the resulting snapping or locking sensation is addressed as a trigger finger.

The exact cause of this condition is not known, but its development may be related to activities requiring repeated gripping (like rock climbing) or physical activity involving extensive use of the hand as in repetitive screw driving. Certain professions such as farmers, industrial workers, musicians may experience this problem more often. Injuries to the pulley and tendon problems are seen in this condition.

This condition is seen more commonly in association with

• Diabetes – up to 10% of diabetics may be affected
• Rheumatoid arthritis
• Carpal Tunnel Syndrome or after surgery for this problem
• Hypothyroidism
• Renal disease or dialysis
• Mothers thumb or De Quervain’s disease

What are the symptoms of trigger finger/thumb?

The common symptoms include

• Stiffness and swelling especially in the morning
• Palpable painful nodule at the base of the finger
• Clicking during movement of the finger
• Intermittent finger locking during bending often requiring extra effort to straighten the finger
• In severe cases, the affected finger may become locked in a bent position

How is trigger finger/thumb diagnosed?

The diagnosis of the trigger finger is based on medical history and clinical examination. The key finding is locking of the finger when it is bend, with snapping when it is straightened. Ultrasound is an inexpensive and easily available modality used to assess the severity and measure the thickness of the affected sheath. A guided injection for relief can be performed at the same time for relief. Ultrasound offers the advantage of being able to compare to the other side and perform a dynamic assessment (assess the problem as the finger is being moved).

What are the treatment options for trigger finger/thumb?

Most cases are treated conservatively with rest, activity modification, splinting, anti-inflammatory medications, physical therapy and local injections. Early treatment of trigger thumb has been associated with better outcomes. Splints can limit motion and reduce aggravating activities. These are usually worn for 6-10 weeks although are less effective in individuals with severe triggering or longstanding symptoms.

Steroid injection

A small amount of steroid with local anesthetic is used for injection under ultrasound guidance. Unguided injections without ultrasound may risk injury to surrounding structures such as nerves and blood vessels. Dr. Manocha routinely performs these injections under ultrasound guidance in his OPD as guided injections are more accurate. Injections are low-cost alternatives to surgery with fewer complications and a quick return to work.

The injection can reduce inflammation and resolve pain, triggering in up to 75% of cases. Some individuals may require more than one injection. If a series of two injections do not resolve the problem, then the surgical option can be considered. Surgery is successful in vast majority who fail to improve with the above measures. Options include open, endoscopic or percutaneous release.

Tags >> symptoms of trigger finger, treatment of trigger finger, Trigger Finger, trigger thumb, Pain Management in Delhi, Pain Management in South Delhi

Pain At The Side Of Hip (Trochanteric Bursitis Or GTPS) - Removemypain

 

What is the commonest cause of pain on the side of the hip ?

Greeter trochanteric pain syndrome (GTPS) or trochanteric bursitis is a common reason for pain at the side of hip especially in females between the age of 40-60 years. It affects approximately 1.8 per 1000 patients annually and is a result of degenerative changes affecting the tendons of the buttock muscles and bursa.

The side of the hip has a large bony bump called the greater trochanter. A thick band of tissue (called iliotibial band or ITB) and number of tendon pass over this bony bump. Also present in this region are numerous bursae which are fluid filled sacs to prevent friction between these structures as we move our leg. There could be as many as 20 bursae in this region of which 3 are consistently present in most individuals. GTPS diagnosis includes a range of conditions with similar symptoms such as tears or degenerative change of the of gluteal muscles and inflammation of the bursae in this region.

What causes this condition and who all are at risk?

The likely cause of GTPS is repetitive friction and microtrauma between the bony bump on the outer side of hip (greater trochanter) and the band of tissue (ITB), muscles passing over it. Abnormal hip biomechanics are believed to contribute to this condition.

There are several factors that increase one’s chances ofdeveloping this condition. These include

• Age between the age of 40–60 years. It may also occur in extremely active younger patients who do regular exercises
• Gender – 4 times more common in women
• Being overweight
• Leg length discrepancies
• Fall/ injury
• Repetitive activity, mechanical overload, training errors or high-intensity training
• Sedentary lifestyle
• Gait changes& incorrect posture
• Post hip replacement surgery
• Other conditions such as rheumatoid arthritis&gout
• Hip arthritis or low back pain is seen in approximately two thirds of individuals with GTPS

What are the symptoms of trochanteric bursitis/ GTPS?

Common symptoms include

• Aching or burning pain on the side of the hip with increased pain on pressing the area. Pain can radiate towards the outer thigh up to the knee or buttock
• Pain is worse when lying on the affected site
• Pain worse with high impact physical activities, cycling, walking, climbing stairs, getting up from a low chair or getting out of a car
• As the problem progresses, it can produce a limp when walking
• Eventually, the pain may become constant and may also be present at rest

The condition can be differentiated from hip arthritis as the ability to put shoes and socks is not affectedcontrary to hip arthritis where such tasks become difficult to perform.

How is this condition diagnosed?

GTPS can be diagnosedclinically on the basis of symptoms and examination findings. Local tenderness is a common finding. Difficulty in standing on one leg (on the affected side) is commonly observed. Pain on trying to rotate the hip outwards against resistance is also a common finding.

Other tests such asultrasound scan or MRImay also be requested forfurther evaluation.

• Ultrasound scans – these may demonstrate thickening ,calcification or tears of the tendons, fluid-filled and thickened bursa
• MRI is very effective to recognize partial and full thickness tears, calcification and muscle atrophy . It may demonstrate oedema which is one of the earliest signs of tendon problems. 

What are the pain relief options in GTPS?

Over 90% of cases of GTPS resolve with conservative measures. Main goals of treatment include managing load, reducing compressive forces across greater trochanter and strengthening gluteal muscles. Non-surgical treatment options for this condition include

• Relative rest& activity modification – This is especially useful in younger patients as in this age group GTPS is mostly because of overuse. Activities that worsen symptoms such as sleeping on the affected side should be avoided. Using a pillow between legs when sleeping in helpful
• During initial stages ice compression(wrapped in a towel) for 10-15 minutes several times a day can help
• Supportive devices such as crutches or a cane in opposite hand can help
• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Physical therapy including stretching and strengthening exercises, shock wave therapy (SWT) is sometimes used in the treatment
• Losing weight can help in those who are overweight

INJECTIONS

• Ultrasound guided local corticosteroid injection is commonly used in the management of this condition.  This can be easily performed as an OPD procedure and can provide permeant or lasting relief. These injections should be viewed as an opportunity to engage with an effective rehabilitation/ physical therapy programme. Some individuals may require a repeat injection.
• Regenerative therapy such as PRP may be considered in specific circumstances especially prior to consideration of surgical intervention, although studies supporting their use are limited.
• Surgery in considered in specific situations where the above measures fail to provide relief. Options include simple longitudinal release or lengthening of the overlying band of tissue(ITB), excision of bursa, open or arthroscopic gluteus medius tendon repair and reattachment.

Tag = GTPS, Pain At The Side Of Hip, pain specialist, Trochanteric Bursitis, Pain Clinic in Gurgaon, Pain Management in Delhi, Pain management centre in Delhi, Pain Specialist in Delhi

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Cervical Pain Treatment in India - Removemypain

Cervical radiculopathy or pinched nerve in the neck is a common problem. Irritation or compression of the nerves coming out of the spine can cause severe pain travelling (radiating) to the shoulders and arms. The arm pain is often more severe although the root of the problem lies in the neck. This pain can be associated with tingling, numbness, weakness in the arm and hand.

To understand a bit more about these pains it is essential to have an understanding of the anatomy of the neck. The neck or the cervical region consists of seven bones (vertebrae) stacked one above the other. There are labelled as C1-C7, where C stands for cervical and 1-7 are the numbers to identify the level being referring to. These vertebrae are separated from one another by discs which are like cushions allowing the spine to move freely.

Each vertebra encloses a hollow space which lines up with the space of the vertebrae above and below, running along the entire length of the spine. This hollow space is called the spinal canal and houses the spinal cord which is a thick bundle of nerves connected to the brain. Between every two vertebrae there are openings on the sides called the foramina. A pair of spinal nerves (one on each side) exit through these foramina and supply a specific part of the body for example the nerves coming out of the neck would go to the arm and hands. When these nerves are irritated, either inside the spine or as they come out of the spine, it leads to the pain being felt in the area supplied by the nerve and this explains when we get arm pain whereas the actual problem lies in the neck.

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