Sacroiliac Joint Pain Treatment In Delhi - Removemypain

 

What are sacroiliac joints (SIJ) and where are they located?

The sacroiliac joint is large, strong joints between lower end of the spine and the pelvis. There are two sacroiliac joints, one on each side. These joints play an important role in transmitting the upper body weight to the hips and legs and hence undergo a significant amount of stress in day to day life. They function as shock absorbers and are reinforced by multiple strong ligaments. Sacroiliac joints are supplied by a number of nerves which when irritated can hurt.

What causes sacroiliac joint pain?

Sacroiliac joints do not allow much movement as both too much and too little movement can become a source of pain. Some of the causes of SIJ pain include

• Trauma/ injuries involving the joints or the surrounding ligaments such as following a fall on the buttock or a road traffic accident.
• Mechanical stress due to various reasons such as previous spinal fusion surgery or leg length discrepancy leading to altered weight bearing. As per some studies 75% of patients with previous fusion surgery can develop SIJ degeneration after 5 years.
• Inflammation. Sacroiliitis is a term used inflammation of the sacroiliac joint. Ankylosing spondylitis is a type of inflammatory arthritis which can affect the SIJ and the spine. This is seen more commonly in young men. In severe cases it can cause fusion of the sacroiliac and spinal joints leading to pain with reduced range of motion.
• Normal wear and tear (degenerative changes.) These are more common with advancing age.
• Infections and tumors are fortunately not as common as the other causes of sacroiliac pain.

What are the symptoms of sacroiliac joint pain?

As many as fifteen to twenty percent of all lower back pain cases can be attributed to the issues related to the sacroiliac joint. SIJ pain can mimic pain arising from hip or spine and affects all ages.

Patients with sacroiliac joint pain generally present with buttock or lower back pain and stiffness. Pain is deep aching in character although may be sharp/ stabbing in character. It can involve one or both sides and spread towards the groin, hip, thigh and leg. Activities such as getting up from sitting position, getting in and out of car, climbing stairs, walking and sitting may become painful. Young adults suffering from ankylosing spondylitis generally present with pain and stiffness, worse in the morning and improving with exercises.

Tag = Joint Pain Treatment in Delhi, Pain Management in Delhi, Pain Specialist in Delhi, Joint Pain Specialists in Delhi

For More Information https://www.removemypain.com

Read Our More blog https://ello.co/kneepaintreatmentindia/post/q6mhihjjqy-jmh22apbs-g

Follow us https://pin.it/3hp2nM6

Struggling With Pain After Breast Cancer Surgery? Learn More About Post Mastectomy Pain

Breast cancer is a common cancer among women worldwide. A variety of problems can occur during treatment, and persisting pain after surgery is one such issue. It can affect 20% to 50% of women after mastectomy (operation involving removal of breast) and is defined as pain in the chest, armpit, upper arm, and shoulder persisting for more than 3 months post-surgery. Treating this pain is important as persisting pain besides causing suffering, can negatively impact on mood, sleep, activities of daily living, social interactions, and overall quality of life. Reduced working ability and financial implications are obvious consequences as shown in one study where 54% of individuals reported reducing their workload to part-time as a direct result of pain. As survivorship is increasing, enabled by the technological advancements in medicine, the focus needs to be equally on quality of life and reducing suffering. Phantom breast sensation (where one feels that the removed breast is still present) has an even higher incidence (60-80% of patients). The actual problem and pain may be underreported due to reasons such as worries about cancer reoccurrence, barriers in discussing personal issues, fear of being misconstrued, etc.

Another subgroup of patients undergoing mastectomy are those who want to reduce their risk of developing breast cancer such as those with gene mutations (e.g., BRCA1, BRCA2) and strong family history. Advances in surgical treatment like breast-conserving approaches have enabled patients to really consider this option.

Who are at risk of developing persisting pain?

Some factors associated with increased risk of persisting pain include:

Type of surgery: Nerve preservation approaches are associated with a reduced incidence of sensory deficits (53 % vs. 84 %) but may not be possible in all cases.

Different breast cancer surgery options include

• Radical mastectomy – involves removing the breast, skin, fat, chest muscles (pectoralis major and minor), and all the lymph nodes of the affected side.
• Modified radical mastectomy spares the chest (pectoral) muscles when compared to the surgery mentioned previously.
• Lumpectomy with axillary node dissection involves removal of the tumor with a surrounding margin of normal tissue and the axillary (armpit) lymph nodes.
• Breast-conserving surgery (lumpectomy) also known as breast preservation, conservative breast surgery, wide local excision, partial mastectomy is generally used in early breast cancer  and involves removal of the tumour and a margin of normal tissue.
• Lumpectomy with sentinel lymph node biopsy involves removal and examination of the first axillary node (sentinel node) receiving drainage from the breast. The node is identified by injection of a special dye/ radiolabeled substance prior to the operation. If this node is free of disease, axillary dissection is not required.

Axillary nodes dissection leads to increased chances of lymphedema (arm swelling due to inadequate drainage) and poses risks to one of the nerves (intercostobrachial nerve) which is responsible for the sensation of the inner aspect of the upper arm. Both of these factors can become a source of persisting pain. The wide variation in the size, location, and branching patterns of the nerve makes it more vulnerable to injury. Damage may occur as a result of stretching during surgery or direct nerve injury, presenting with numbness and pain in the area supplied by the nerve. As per one study women with axillary node dissection are 3.1 times more likely to experience moderate-to-severe pain at rest.

Other nerves in the area are also at risk of injury and can become a source of persisting pain. These include 

• The medial cutaneous nerve of the arm (provides sensation to the lower medial skin of the upper arm (damaged during a section of the tributaries of the axillary vein)
• Medial and lateral pectoral nerves (control the chest wall or pectoral muscles)
• Long thoracic nerve (controls the serratus anterior muscle present along the side of chest wall close to armpit)
• Thoracodorsal nerve (controls the latissimus dorsi muscle)

Other treatments like radiation therapy administered in conjunction with surgery increase risk of persisting pain. This may be due to increased tissue fibrosis, neural entrapment, and impaired shoulder movement. Moreover, radiotherapy also increases the risk for lymphedema which is another reason for persisting pain. The later-stage disease also is likely to require more aggressive treatment (i.e., chemotherapy) and may be associated with higher rates of pain. Regardless these are necessary treatments and when indicated should be pursued. 

Pre-existing pain prior to surgery is one of the most consistent factors related to the increased risk of persisting pain after surgery. Even those patients with unrelated pain conditions such as headaches or low back pain are more likely to develop chronic pain after surgery. 

Severe pain after the operation requiring high doses of painkillers increases the likelihood of persisting pain.

Age: In several studies, younger age was seen to be associated with a greater likelihood of persistent pain. Although the exact reason is not known, some postulated factors include the presence of more aggressive cancers requiring more aggressive treatment, higher preoperative anxiety, and the need for adjuvant chemotherapy in this group.

Psychosocial distress can be both a risk factor for and a consequence of chronic pain. Preoperative anxiety has been found to be related with immediate postoperative pain levels. Numerous studies have found correlations between persisting pain after surgery and depression, stress, and psychological vulnerability. 

Tag = Cancer Pain Treatment in Gurgaon, Cancer Pain Treatment in Delhi, Pain specialist in Gurgaon, Pain specialist in Delhi, Pain Management in Delhi

For More Information https://www.removemypain.com

Read More Blog https://www.removemypain.com/blog

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

For More Information https://www.removemypain.com

Read our more blogs https://www.removemypain.com/blog

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.

Tags >> neck and shoulder pain treatment specialists in Delhi, Neck Pain, Neck Pain Management In Delhi, Pain Management Specialist in Delhi, Pain Specialist In Delhi

For More Information https://www.removemypain.com

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

For More Information https://www.removemypain.com

Read More Blog https://kneepaintreatmentinindia.tumblr.com/post/661660884129775616/cervical-pain-treatment-in-india-removemypain

Why do you experience chronic knee pain? - Removemypain

 

Why do you experience chronic knee pain?

Chronic knee pain troubles a significant number of people worldwide. It is a common problem amongst the aging population, and can indeed be very painful and debilitating, sometime even confining individuals to the bed. The most common cause of knee pain in elderly is osteoarthritis (OA), a condition where the cartilages of the knee joint have worn out due to wear and tear. This results in friction between the bones of the joint during movement which results in pain. The impact is more in overweight and obese because of the extra load on the knees. The risk of knee OA in overweight women is nearly 4 times and in overweight men is 5 times greater. It is not just the mechanical factors which promote OA in obesity but also the co-existence of disordered glucose and lipid metabolism and the highly metabolic and inflammatory environments have a significant role.

What can be done for chronic knee pain?

Initial management involves lifestyle modification, supplements, simple pain killers and physiotherapy. It is estimated that an extra Kg of weight exerts a force of nearly three to six times across the knee while walking. Thus, weight loss is an important modifiable factor in the treatment of knee OA which the affected individual can drive. Various studies have demonstrated that weight loss improves both pain and function in obese subjects with knee OA.

Local injections are considered depending on the severity of problem and other factors such as age, functional status etc. When the pain and discomfort is severe your doctor may offer you the option of undergoing a knee replacement surgery. This involves removal of the worn out part of joint, shaping the ends of the bone and placing a metal implant. This reconstruction of the knee joint allows for smooth, pain free movement for most individuals. However some, even following the rehabilitation process, continue to experience pain.

For those who are

• Not keen on the replacement surgery or
• Not fit to have one or
• Continue to have pain after knee replacement surgery

For More Information Click Here Knee Pain Treatment in India

Tag = Knee Pain Treatment in India, Pain Specialist in Delhi, Pain management centre in Delhi, Pain Management in South Delhi

Medical Care https://medicalcaree.wordpress.com/dr-amod-manocha-pain-specialist-in-delhi-india

Read Our More Blog on Tumblr https://kneepaintreatmentinindia.tumblr.com

See our Video on Youtube https://www.youtube.com/channel/UCo5DUW5DLKvCO-M1xEwXH5w

See our Photo on Plurk https://www.plurk.com/CervicalPainTreatmentinIndia

 Social Bookmarking https://www.folkd.com/user/BackPainTreatmentinIndia

Knee Pain Treatment in India - Removemypain

How Common Is Persisting Pain After Knee Replacement And Why Is It Important ?

Pain is the most important indication for joint replacement surgery and although surgery is successful in a vast majority of patients, some continue to have persisting pain. As per research evidence, approximately 9% after hip and 20% after knee replacement have an unfavourable pain outcome. 20% implies 1 in 5 patients, a significant number. Despite the high prevalence, the condition remains under acknowledged and can be rightly addressed as a silent epidemic.

Persistent pain not only has an adverse impact on the quality of life but often leaves patients confused or blaming themselves for the pain or the decision to go ahead with surgery. It can have an impact on mobility, general health, mood, sleep and lead to functional limitation with social isolation. When no obvious cause is found, the problem may be downplayed leading to the dissatisfaction, frustration, anger, tension or breakdown of the doctor–patient relationship, promoting doctor shopping. Somewhat ironically, persisting pain can sometimes be a consequence of surgery that was performed to alleviate pain.

Risk Factors for Persisting Pain after Knee Replacement

Persisting pain may have more than one reason, with a wide range of factors influencing the outcomes. It is important to know about these as some of them are modifiable. 

Some of the known risk factors include

• Poor mental Health including major depression, anxiety
• Catastrophization (Constant worrying and exaggerated negative orientation towards pain experience)
• Presence of other chronic pain conditions
• Surgical factors include infection, instability, implant loosening or failure, alignment problems with the implant (misalignment), soft-tissue impingement, nerve injury and extensor mechanism problems (patellar malt racking and non-resurfaced patella) 
• Severe preoperative pain. Some studies have linked poorly controlled pain after the operation to increased chance of developing chronic pain whereas other studies have found insufficient evidence. 
• High number of comorbidities (other medical problems). Pre-existing heart disease has been found to be an independent risk factor for pain at 5 years after knee replacement. The peripheral edema (swelling), sedentary lifestyle/ reduced engagement with physical therapy may contribute to increased pain levels. 
• Young age and female gender 

Pain Assessment

Most patients with persisting pain after the replacement surgery would return to the operating surgeon for a reassessment. Sometimes a second opinion from another surgeon is sought. Careful assessment in required to identify the problem and this involves detailed history, clinical examination (including the spine, hip and knee), psychological exploration, review of preoperative images & operative records, new investigations (serological, radiological and microbiological), assessing response to treatments and joint aspiration/ diagnostic injections if indicated. Sometimes despite extensive evaluation and best attempts using all modern technology at our disposal, the cause of pain cannot be identified. In such cases a trial of conservative therapy including pain relieving medications and physical therapy is often suggested. 

Management Of Persisting Knee Pain After Knee Replacement Surgery

Treatment of chronic pain after knee replacement is challenging. It requires a multidisciplinary team approach with input from orthopaedic surgeon, pain physician, physiotherapist, psychologist and many others. The aim is generally improvement in function and quality of life. Once the cause of persisting pain is known the treatment can be directed accordingly. 

Anatomically the cause of pain may be located 

• Extra articular (outside the knee joint at a distant site such as spine)
• Peri articular (around the joint) such as tendinitis (ten on problem), bursitis (inflammation of bursa) 
• Intra articular (inside the joint) such as joint instability, loosening of implant, issues related to size/type of implant, infection, osteolysis (loss of bone), kneecap problems 

How Can A Pain Physician Help ?

A pain specialist plays an important role in management of persistent pain and this includes

• Identifying the type /source of pain. This is especially relevant when issues with implant have been excluded and surgery is not required/not possible. Diagnostic joint injections can help differentiate whether the pain is coming from inside the joint or from an external source. If required, some joint fluid can be aspirated (removed) at the same time to evaluate for infection. Similar injections can be used to identify pain sources around the joint by trigger point injections, nerve blocks etc.
• Regulating pain medications. This is an essential component of overall management, best performed by professionals who are aware of all options and their limitations. Pain physicians are more familiar with use of stronger pain killers and some options such as capsaicin & Lidocaine patches as they use it more often. Sometimes small changes in medications can make a huge difference in the pain levels.
• Treating nerve pain. Nerve pain after knee replacement often goes unrecognized and may be responsible for persisting pain in approximately 6%-13% of patients. Typically, it presents with electrical shock like or burning sensation, numbness or altered sensitivity, although it can also present as an aching sensation associated with stiffness. Sometimes thickening of the nerve (neuromas) can be a source of persistent pain. 

Infrapatellar branch of the saphenous nerve. This is a small nerve running from the inner to the outer side of the knee below the kneecap. An injury to this nerve or a neuroma can be a common cause of persistent knee pain. Pain physicians can treat this successfully in an overwhelming majority of patients with nerve blocks, radiofrequency or cryoablation procedures. 

• Nerve blocks are offered if nerves are suspected to be the pain generator. A simple OPD performed procedure can often help identify the pain source and provide prolonged relief. 
• Pulsed Radiofrequency can be performed as a day case in an attempt to prolong the pain relief, in case the effect of the nerve block is short lasting. This is similar to nerve block but uses special needles and a radiofrequency machine to interfere with the pain signals being transmitted to the brain. 
• Cryoablation. This specialised technique involves application of cold to cause temporary disruption of the nerves ability to transmit pain signals without causing permanent nerve damage. 

• Other specialist interventions used to provide pain relief include

• Radiofrequency Ablation of Genicular nerves. Knee joint is supplied by many nerves and these are collectively addressed as genicular nerves. This procedure involves an initial diagnostic test whereby a small amount of local anaesthetic is injected close to these nerves. If this produces effective pain relief then one proceeds with the radiofrequency ablation. In radiofrequency ablation special types of radio waves are used to create a heat lesion around the nerves interrupting the transmission of pain signals to the brain. These nerves are approached with help of needles placed under x-ray and ultrasound guidance with no requirement for any surgical incisions. This is a safe, non-surgical procedure performed as a day case under local anaesthesia.
• Cooled Radiofrequency Ablation. Cooled Radiofrequency treatment is a minimally invasive treatment performed on a day care basis under local anaesthesia. The treatment aims to deactivate the nerves responsible for transmitting pain signals from the painful knee. It involves placing needles close to these nerves under x-ray or ultrasound guidance followed by heating of nerves to reduce the pain signals being transmitted. It differs from conventional Radiofrequency (described earlier) as it has water circulating through the device and can create a larger treatment area increasing the chances of success. Normal activities can generally be resumed soon after the procedure. 

• Spinal Injections – All nerves supplying the knee joint originate from the spine and interventions targeted on these (such as pulsed radio frequency of dorsal root ganglion) can help reduce the pain.
• Identifying your needs and directing you to other experienced professionals (such as physiotherapists, occupational therapists, psychologists) as required. 

Tag = Knee Pain Treatment in India, Knee Pain Treatment in Delhi, Pain Specialist in Delhi