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

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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

Tag = Chronic Post Surgical Pain, Pain Management in Delhi, Pain Treatment in South Delhi

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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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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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Freezing of Nerves : New Technology for Arthritis, Cancer & Nerve Pain Relief - Removemypain

The word cryoablation is formed of two words – “cryo “meaning cold and “ablation” meaning removal or destruction. In simple words cryoablation in pain management is freezing of the nerves to reduce pain. This technology has undergone significant advancement over the years and can be used for relief in a magnitude of pain conditions including

• Arthritis of the large joints such as the knee, hip and shoulder. This procedure is especially helpful in young patients with arthritis pain who want to avoid or postpone joint replacement surgery
• Arthritis of joints in the spine, sacroiliac joints
• Cancer pain
• Nerve pains such as postherpetic neuralgia, phantom limb pain, neuroma, thigh pain due to lateral femoral cutaneous nerves (meralgia paresthetica), pain after nerve injuries
• Post surgery pain such as Post hernia repair and Post thoracotomy (open chest surgery) pain
• Pain after rib fractures

The primary aim in cryoablation treatment is deactivation of the nerves transmitting the pain signals. This is achieved by freezing the nerves in a controlled fashion to temperatures as low as minus 80 degrees. The procedure is performed using a special probe called cryoprobe, which is guided to the correct location using ultrasound, x-rays and nerve stimulators. Cryoprobe is a hollow needle through which the super-cooled gas such as nitrous oxide or carbon dioxide is delivered once the probe is in the correct place. The extremely low temperatures achieved at the tip of the cryoprobe results in formation of an ice ball which can be visualised on an ultrasound scan. This freezes the nearby nerves thereby reducing pain. Once the procedure is finished, the cryoprobe is removed and the procedure site covered with a small bandage.

This technology is minimally invasive pain relieving alternative that does not require any cuts or incisions. It is a safe, day care procedure with the potential of providing quick and lasting pain relief. Less pain can translate into improved functional ability, reduced painkiller requirements and reduced disability. Besides, it can be easily repeated without any added side effects.

For more details about cryoablation and how it can help you, contact Dr Amod Manocha, Head – Pain Management Services, Max hospital, Saket, Delhi.

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