Cooled Radiofrequency Treatment In Delhi for Chronic Knee and Sacroiliac Joint Pain

Cooled Radiofrequency treatment has recently become available in New Delhi, India. It is an alternative for those suffering from chronic knee pain secondary to various reasons such as osteoarthritis, degenerative joint disease and persisting pain after knee replacement. It offers a safe, effective non surgical, minimally invasive alternative to knee replacement for patients who are either

• Not keen on surgery or
• Not fit for surgery due to other medical problems or
• Have persisting pain after knee replacement.

This procedure can also be used for sacroiliac joint pain as in patients with ankylosing spondylitis and for low back pain secondary to facet joint arthritis. It is a day care procedure performed under local anaesthesia with no requirement for hospital stay or prolonged rehabilitation. Normal activities can generally be resumed soon after the procedure with little or no recovery time. Less pain can lead to improved functionality and reduced medication requirements.

Knee joint is supplied by branches from many nerves and these are collectively addressed as genicular nerves. The initial diagnostic procedure involves local anaesthetic injections close to the nerves supplying the knee joint. If the diagnostic procedure produces good pain relief then it is beneficial to proceed with radiofrequency treatment from pain specialist. Radiofrequency treatment aims to reduce the pain signals being transmitted by the nerves to the brain. This is achieved by heating up a small area of the nerve using the electric current produced by radio waves. The procedure involves placing needles close to these nerves under x ray or ultrasound guidance followed by heating of nerves. Cooled differs from conventional Radiofrequency as it has water circulating through the device, needle tip and can create a larger treatment area increasing the chances of success. It can provide lasting pain relief for up to a period of 18- 24 months and has a low complication rate. I trained in this procedure in Germany a few years back and I use a combination of ultrasound and x rays to improve the chances of having a successful outcome.

Consult Best Pain Specialist In Delhi, Dr. Amod Manocha.

Tags >> Chronic Knee Pain, Cooled Radiofrequency Treatment, Cooled Radiofrequency Treatment In Delhi, Sacroiliac Joint Pain

Are You suffering from numbness, tingling or burning sensation after Chemotherapy?

 

What is peripheral neuropathy?

Peripheral nerves carry sensations from the different parts of your body to the brain and control the movement of our arms and legs. The set of symptoms resulting from damage to these nerves is addressed as Peripheral neuropathy. Symptoms are usually symmetrical starting from toes and fingers, and progress towards the body. Common symptoms include

• Tingling or pins and needles sensation in hands of feet
• Numbness and reduced ability to feel hot and cold
• Sharp, electric, burning pain
• Sensitivity to touch, pressure or temperature 
• Balance issues and difficulty walking
• Leg cramps 
• Weakness
• Difficulty with fine activities such as writing, buttoning and unbuttoning 

What is Chemotherapy Induced Peripheral Neuropathy (CIPN)?

Some of the chemotherapy drugs used to treat cancer can cause peripheral nerve damage. This is addressed as chemotherapy-induced peripheral neuropathy (CIPN).

The symptoms of CIPN include all peripheral neuropathy symptoms mentioned above, with the most common one being numbness and tingling starting in fingers and toes and progressing proximally as the condition progresses. This appears earlier and is generally more prominent than pain. CIPN can have an impact on ones sleep, mood, functionality and quality of life (QOL).

Symptoms can appear hours to days after chemotherapy and the condition can worsen with additional chemotherapy cycles. The progression usually levels off after stopping the chemotherapy except in the case of platinum-based drugs where the sensation may continue to deteriorate for several months.

Different patterns can be seen with different drugs like in Oxaliplatin (a chemotherapy drug) induced acute neuropathy, there is cold sensitivity, throat discomfort, discomfort swallowing cold liquids, and muscle cramps with more severe symptoms in upper limbs. The usually peaks 2 to 3 days after each dose and can increase in subsequent treatment cycles.

In Paclitaxel (another chemotherapy drug) induced acute neuropathy the pain occurs in truncal/hip distribution or lower extremities and tends to resolve more between doses. The symptoms peak approximately in 2 to 3 days after each dose and are not worsened in subsequent cycles.

What are my chances of getting CIPN?

CIPN affects approximately 30% and 40% of patients undergoing chemotherapy and the risk varies with factors such as

• Drugs used – Some drugs are more likely to cause CIPN than others. A list of some of these is included at the end of this blog.
• Duration of use
• Dose used
• Pre-existing neuropathy
• Comorbidities such as diabetes, vitamin deficiencies
• Age

Can CIPN be cured or is it permanent?

In most cases the CIPN symptoms go away with time. They can last for weeks, months, or even years after treatment. It does vary depending on the drugs, doses used and in some cases it can be permanent. Unfortunately, there is no clear cure or treatment that will repair nerve damage.

What should I do to deal with CIPN?

It is a good idea to report your symptoms to the team looking after you and they may consider altering the treatment plan to prevent your symptoms from worsening. This may involve dose delaying, reduction, stopping chemotherapy or substituting with other agents that do not cause CIPN. A pain specialist opinion should be taken if your symptoms are severe and require specialist input. A pain specialist may prescribe nerve types of painkillers which need to be taken regularly to help manage your symptoms.

Other measures which can help include

• Avoiding things that make your symptoms worse, such as hot or cold temperature, or tight clothes or shoes
• Regular exercises
• Avoiding smoking and alcohol
• Ensuring normal vitamin levels and blood sugars.

No medication or supplement has been shown to definitively prevent CIPN including N-acetylcysteine, calcium, magnesium vitamin B, vitamin E, omega-3 fatty acids, alpha lipoic acid and cannabinoids. It, however, makes sense to regulate other factors which are known to cause nerve injury such as alcohol intake and blood sugar levels.

When the sensation in hands and feet is affected one might be more prone to injury and sensible precautions are required like

• If the neuropathy involves your hands, protect them while using sharp objects, if it affects the feet protect them by wearing shoes even when you are indoors.
• Avoid extreme temperatures and keep your hands and feet covered, warm in cold weather
• Protect yourself from heat injuries especially when using warm water for washing bathing

What are the other causes of peripheral neuropathy?

There can be many other causes of peripheral nerve damage- some related to cancer and some independent. Determining the underlying cause is important as it may have a bearing on the treatment.

Related to cancer and its treatments.

• Surgery or radiotherapy
• Tumors pressing on nerves

Other independent causes

• Diabetes
• Alcohol abuse
• Shingles, infections involving the nerves
• Low vitamin B levels
• Spinal cord injuries
• Poor circulation (peripheral vascular disease)

How do we manage CIPN?

The importance of discussing with the admitting team, if symptoms of CIPN develop during treatment, has already been discussed. This provides an opportunity to modify treatment and prevent further damage rather than dealing with an irreversible situation later.

IF CIPN develops, pain can often be helped with treatments but the numbness is usually resistant to treatment. Some of the modalities which can be used for treatment include

• Medications used to treat nerve pain such as antiepileptics, antidepressants, topical gels, patches or creams of numbing medicine, strong painkillers such as opioids, steroids
• Drug infusions or pain relieving medications which act on nerves
• Physical therapy can help with balance, strength and safety.
• Occupational therapy can help improve fine motor skills like buttoning shirts
• Relaxation therapy, distraction, biofeedback

Some chemotherapy drugs which are likely to cause CIPN

Certain chemo drugs are more likely to cause CIPN. Some of the more common ones include:

• Platinum drugs like cisplatin, carboplatin, and oxaliplatin
• Taxanes including paclitaxel, docetaxel, and cabazitaxel
• Plant alkaloids such as vinblastine, vincristine, and etoposide
• Immunomodulating drugs like thalidomide, lenalidomide
• Proteasome inhibitors such as bortezomib, carfilzomib, and ixazomib

Tags >> Cancer Pain Treatment in Delhi, Cancer Pain Treatment in Gurgaon, Chemotherapy Induced Peripheral Neuropathy, Peripheral nerves, peripheral neuropathy

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Pelvic Pain Treatment In Delhi - Removemypain

Coccyx or tailbone is the last bone at the end of the spine. Pain in the region of the tailbone is called coccydynia. Common causes include trauma, childbirth, and repeated strain on the coccyx. Patients may have increased mobility which triggers the inflammation. Other causes include fracture, infection, and tumor.

Most patients present with pain on sitting or getting up from a sitting position and localized tenderness around the coccyx. Pain during a bowel movement or sex daycare present. Diagnosis is made based on history and examination findings. Sometimes tests such as x-rays, CT scans, and MRIs are requested. Treatment involves avoiding further strain on the coccyx-using appropriate cushions, weight management, simple painkillers combined with physiotherapy, manipulation, and injections such as

Coccyx/ Sacrococcygeal Joint Injection – these are performed under x-ray or ultrasound guidance and involve injecting local anesthetics and a small dose of steroids in or around the sacrococcygeal joint. It is not uncommon for the ligaments around the coccyx to be the pain generator and these are often injected at the same time. The procedure is performed as a day case under local anesthesia.

Ganglion Impar block and Radiofrequency - ganglion impar is a collection of nerves located in front of the sacrum and coccyx. This procedure involves injecting a local anesthetic and steroids mixture under x-ray guidance close to ganglion impair. The needle position is verified by giving a dye (contrast) before injection. Radiofrequency treatment is performed if the benefits of injection are short-lasting.

Tag = Pelvic Pain Treatment In Delhi, Pain Management in Delhi, Pain Clinic in Gurgaon

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How To Communicate Regarding Your Joint Pain To Your Doctor

Joint pain can be a source of prolonged discomfort that one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments that can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR. But reaching out to the right-center with experienced and skillful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

• Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is
• Joint pain can have numerous causes such as like age-related wear and tear, injury, trauma, infections, etc
• The involvement of multiple joints in the body may require different assessments/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology
• Treatments offered to depend on the severity of symptoms, their impact on your life, your age, activity levels, and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors
• These are some important points that may help your doctor to understand and treat your pain better:
• Explain where the pain is; how long you have had the pain and how it started. If the possible point to the exact place, is it in the knee, ankle, or shoulder pain?
• The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shooting, or stabbing pain? Is it present all the time?
• Aggravating or relieving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?
• It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

• Applying ice or hot compression at the joint several times.
• Avoiding activity that may cause pain.
• Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks, and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.

Tags >> Joint pain treatment in Delhi, joint pain treatment in Delhi NCR, Joint pain treatment in South Delhi

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Read More About Cancer Pain treatment in Delhi

Thoracic spine treatment in Delhi - Removemypain

This section covers pain anywhere between the shoulders to the bottom of the ribs. It can arise from

• Inside the thoracic cavity (inside chest)
• From the chest wall including the thoracic spine
• Be referred from the neighboring areas and structures such as the abdomen, cervical spine.

Chest wall pain can originate from any of the chest wall structures including bones, joints, muscles, cartilage, ligaments, tendons, nerves, skin, and soft tissue. It generally increases with arm movement and is accompanied by localized tenderness.

Some common conditions/situations leading to chest wall pain are

• Prolonged unaccustomed physical activity. This may cause muscle soreness which persist

• Trauma/fall with fracture of ribs or vertebrae. In presence of osteoporosis even trivial trauma can lead to fractures. The event may be difficult to remember especially when the onset of pain is delayed

• The spine can be a source of posterior chest pain. Pain may arise from joints including those between the vertebrae (facet joints), between the ribs and vertebrae (costovertebral joints, costotransverse joints), discs, spinal ligaments, muscles (paravertebral muscles), and the nerves. The pain can radiate towards the side of the chest and as far as the front of the chest and abdomen

• Other joints such as the one between the collar bone and sternum or the ones between the ribs and sternum can also be a source of chest wall pain. Inflammation of the cartilage connecting the ribs to the sternum is known as chostrochondritis Infections such as Shingles commonly affect the thoracic area (Post Herpetic Neuralgia)

• Rheumatological disorders such as rheumatoid arthritis, ankylosing spondylitis 

• Post surgical pain arising after surgeries such as heart, lung, breast surgery

• Nerve injury or damage as a result of surgery, trauma or otherwise 
Cancer which has spread to chest wall or bones

Tag = Thoracic spine treatment in Delhi, Pain Management in Delhi, Pain Specialist in Delhi, Chest wall pain treatment in Delhi

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Read blog on neck pain treatment in India 

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Is your pain not letting you sleep ? Here are some useful tips… ( Removemypain )

 

What is the relation between pain and sleep? Does, not being able to sleep make the pain feel worse, or is severe pain responsible for the inability to sleep?

The answer is both are true. Sleep is a natural analgesic (pain reliever) and a good night’s sleep can improve one’s ability to tolerate pain. For some chronic pain patients, the only respite is when they are sleeping, and losing this luxury can have adverse consequences.

The amount of sleep required by an individual varies depending upon many factors including age, but most adults require between 7 to9 hours a night, although it can range from 5 to 10 hours. Healthy sleep comes in waves during the night and every night we cycle 4-6 times, through different stages of sleep- light sleep, deep sleep, and REM (rapid eye movement) sleep. Usually, we wake up after the REM stage. If pain disturbs the sleep, we end up spending too much time in light sleep reducing the REM sleep and this may result in increased pain sensitivity.

Inadequate sleep also produces other related issues such as

• Fatigue or low energy levels
• Advert effect on the immune system and
• Hormonal balance especially the ones regulating out appetite
• Sleep is related to many other medical conditions such as obesity, Alzheimer’s disease, depression, diabetes, and cardiovascular disease

So, what can a chronic pain sufferer do to ensure that sleep does not become a problem?

This impact can be reduced by strict discipline and simple measures which are collectively addressed as Sleep hygiene. Simply stated these are behaviors that can promote good sleep. You can divide these into three broad headings

• Measures intended at REDUCING STIMULATION
• Promoting a COMFORTABLE SLEEPING ENVIRONMENT
• Forming a HEALTHY SLEEP ROUTINE

Reducing Stimulation

The underlying logic is simple brain needs to wind down and be in a calm state before one can go off to sleep so anything that stimulated the brain can be counterproductive.

Do not watch TV use tablets or mobile in bed. Besides stimulation, these can be counterproductive in other ways as well. When one used these gadgets in bed brain starts associating the bed with being awake which is not helpful. The bed is for sleeping and the brain should associate bed with sleep, like when we go to a religious place the environment and our thoughts are in a certain direction similarly the association of bed should be with sleep

Stop drinking caffeine, tea, sodas 6 hours before sleep time. It is equally important to avoid heavy, sugary, and fatty foods before bed. Alcohol should be avoided in the evening as although it may help one to fall asleep but often the sleep is disturbed a few hours into the night

Avoid substances that may interfere with sleep such as cigarettes, alcohol and even certain medications can have an adverse impact on sleep. Medications such as steroids can be stimulation and are best avoided close to sleep time. Alcohol should be avoided in the evening as although it may help one to fall asleep but often the sleep is disturbed a few hours into the night

Don’t stay in bed awake for more than 5-10 minutes. If your mind is racing and flooded with thoughts it is better to get out of bed and sit in a chair in the dark until you are sleepy, and then return to bed.

Comfortable Sleeping Environment

Having a quiet, comfortable, conducive environment can go a long way in promoting sleep. It is a good idea to reduce the light, noise and bedroom temperature.

• A little cooler is better than a little warmer temperature as it helps one to fall asleep.
• Darkness can increase the levels of the hormone melatonin that promotes sleep.
• Relaxing music or soothing sounds such as gentle waves can help one fall asleep.
• The environment includes having a comfortable bed and mattress. Extra pillows can help to get painful joints in a comfortable position.

Healthy Sleep Routine

Have a regular sleep routine and go to bed, wake up at the same time every day. Often people tend to wake up late or take naps in the middle of the day on their off days and this can be counterproductive. The amount of sleep one needs is fixed and when you lie in bed for the extra time you may experience difficulty falling asleep that night, leading to an accumulation of sleep deficit with difficulty waking up the next day. This is often the reason behind the low energy, fatigued Monday starts.

Have a pre-bedtime routine. This can help wind down and calm down the brain before bed. Half an hour spent before bedtime in meditation, deep breathing, or a warm shower can be quite helpful. When done regularly these pre-bedtime routines help the body, the brain prepare for sleep and expect it.

Regular exercises can be helpful, however, it is a good idea to avoid heavy exercises two to three hours before bedtime.

Tag = Chronic Pain, Pain and sleep, Pain Clinic in Gurgaon, Pain Management in Delhi

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Neck Pain Treatment Gurgaon - Removemypain

Neck Pain is a pain posteriorly anywhere between the skull base and thoracic spine. It is the largest cause of musculoskeletal disability after low back pain. Approximately two-thirds of the population will suffer from neck pain at some time in their life with high prevalence in middle ages. Fortunately for most people the acute pain resolves within days or weeks although in some it may reoccur or become chronic.

Neck pain may be a result of...

• Local pathology
• Whiplash (flexion-extension) injuries/ trauma
• Be a part of a more widespread systemic problem such as ankylosing spondylitis, rheumatoid arthritis, fibromyalgia etc.
• Be a result of referred pain from neighboring areas for example the shoulder joint

Neck pain usually has a multifactorial etiology -poor posture, neck strain/injuries, anxiety, depression and stress can play a role in magnifying the perceived pain. Quite often the diagnosis of simple or nonspecific neck pain is used implying postural and mechanical causes; this is contrary to other serious causes of neck pain such as fracture, tumour, infection etc.

Pain from upper neck can radiate towards the head leading to frequent headaches and that from the lower part of the neck can radiate to the shoulder, arm, chest wall and the scapula. Reduced neck movement along with localized areas of muscle tenderness known as trigger points are commonly observed along with pain.

Tag = Neck Pain Treatment in Gurgaon, Pain Clinic in Gurgaon, Pain specialist in Gurgaon, Pain Management in Delhi

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