# data[].attributes.body
Pain affects more people than heart disease, diabetes, and cancer combined International Association for the Study of Pain (IASP)

If you do not believe this statement then let me remind you of some common scenes from your daily life. You may have stopped noticing these believing that nothing can be done or accepted them as a part of aging. BUT IS THAT SO?

…remember the grandma who grunts in pain every time she tries to get up

…. the husband who complains of a backache every morning, taking his time to overcome the stiffness before he can start his day

….aunt who finds it difficult to get out of the car because of pain

….your colleague who has to randomly take time off work because of severe headaches

…your work colleague who keeps pressing his neck complaining of neck pain

….your friend who gave up badminton because of shoulder pain

….diabetic uncle who cannot sleep as he feels his feet are on fire

….your close friend who underwent breast surgery a few years back and still complains of pain

Do these sound familiar… and I have not even talked about the numerous patients with sciatica, tennis elbow, heel pain, abdominal pain, cancer pain, pelvic pain, testicular pain, chest-wall pain, post-traumatic pain, nerve injury pain, etc. The list is endless. The financial burden of these problems on individuals, families, society, and government is enormous.

Yes, these are all examples of chronic pain

Yes, these are challenging to treat because pain is a very personal experience and one therapy does not work for all.

BUT YES…. there are options that can improve your quality of life significantly.

After all, quality of life is important for everyone. For someone, it may all be about being able to play a few rounds of golf and for someone to attend an important meeting at work without being distracted by pain. Your goals are your goals and they are important.

Chronic pain is a frequent condition affecting an estimated 20% of people worldwide. Globally 1 in 10 adults is diagnosed with chronic pain each year. Despite this, not many are aware of the available pain management options. The general perception is that pain management is for cancer pain. Even for the majority of well-informed people, it stops at a few nerve blocks for relieving pain in cancer or trigeminal neuralgia.

In India, there is huge variability in the services offered by the existing pain clinics. Lack of recognized comprehensive training curriculum in pain medicine with government-approved minimal training standards may be one of the contributing factors. The focus of most specialists is on interventions rather than holistic management. This is contrary to most western countries where Pain Medicine is a separate specialty with a well-defined curriculum and minimum standards that must be fulfilled for one to proclaim himself as a pain specialist. The focus there is on long term solutions using multidisciplinary approach and teamwork. Nevertheless, the awareness for chronic pain options is increasing with an important role being played by the media. I hope that the benefits do not get restricted to a privileged few and all fellow brothers and sisters are able to benefit.

# data[].attributes.attachment_link.readable_text
If you do not believe this statement then let me remind you of some common scenes from your daily life. You may have stopped noticing these believing that nothing can be done or accepted them as a part of aging. BUT IS THAT SO?

...remember the grandma who grunts in pain every time she tries to get up

.... the husband who complains of a backache every morning, taking his time to overcome the stiffness before he can start his day

....aunt who finds it difficult to get out of the car because of pain

....your colleague who has to randomly take time off work because of severe headaches

...your work colleague who keeps pressing his neck complaining of neck pain

....your friend who gave up badminton because of shoulder pain

....diabetic uncle who cannot sleep as he feels his feet are on fire

....your close friend who underwent breast surgery a few years back and still complains of pain

#lifewithoutpain#justadream#

Do these sound familiar... and I have not even talked about the numerous patients with sciatica, tennis elbow, heel pain, abdominal pain, cancer pain, pelvic pain, testicular pain, chest-wall pain, post-traumatic pain, nerve injury pain etc. The list is endless. The financial burden of these problems on individuals, families, society, and government is enormous.
Yes, these are all examples of chronic pain
Yes, these are challenging to treat because pain is a very personal experience and one therapy does not work for all.

BUT YES.... there are options that can improve your quality of life significantly. After all, quality of life is important for everyone. For someone, it may all be about being able to play a few rounds of golf and for someone to attend an important meeting at work without being distracted by pain. Your goals are your goals and they are important.

Chronic pain is a frequent condition affecting an estimated 20% of people worldwide. Globally 1 in 10 adults is diagnosed with chronic pain each year. Despite this, not many are aware of the available pain management options. The general perception is that pain management is for cancer pain. Even for the majority of well-informed people it stops at a few nerve blocks for relieving pain in cancer or trigeminal neuralgia.

In India, there is a huge variability in the services offered by the existing pain clinics. Lack of recognized comprehensive training curriculum in pain medicine with government approved minimal training standards may be one of the contributing factors. The focus of most specialists is on interventions rather than holistic management. This is contrary to most western countries where Pain Medicine is a separate specialty with well-defined curriculum and minimal standards that must be fulfilled for one to proclaim himself as a pain specialist. The focus there is on long term solutions using multi disciplinary approach and teamwork. Nevertheless, the awareness for chronic pain options is increasing with an important role being played by the media. I hope that the benefits do not get restricted to a privileged few and all fellow brothers and sisters are able to benefit.

# data[].attributes.attachment_link.description
If you do not believe this statement then let me remind you of some common scenes from your daily life. You may have stopped noticing these believing that nothing can be done or accepted them as a part of aging. BUT IS THAT SO?

# data[].attributes.headline
Neck Pain Treatment in Delhi by Pain Management

# data[].attributes.subject
Neck Pain Treatment in Delhi by Pain Management

# data[].attributes.body
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 findAcupuncture 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 Pain, Neck Pain Management In Delhi

# data[].attributes.attachment_link.readable_text
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 findAcupuncture 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.

# data[].attributes.attachment_link.title
Neck Pain Treatment in Delhi | Best Neck Pain Specialist in Delhi

# data[].attributes.attachment_link.description
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.

# data[].attributes.headline
Epidural Steroid Injections can provide quick relief if pain originating from the spine

# data[].attributes.subject
Epidural Steroid Injections can provide quick relief if pain originating from the spine

# data[].attributes.body
Epidural injections are a pain management option for patients with leg or arm pain originating from the spine. This is also known as Radicular pain or Radiculopathy. The pain usually radiates away from the irritated nerves. For Example – the pain could be originating from lower spine and may be felt far away in the legs. Pain specialists offer non-surgical options like this one for pain relief. As the techniques used are minimally invasive, and do not involve surgical incision or prolonged recovery, the risks involved are less.

One of the causes nerve pain is the narrowing (stenosis) of the space for these nerves in the spine or narrowing of the space from which these nerves exit the spine. This may be secondary to a slip disc or rupturing of the discs.

Depending on the problem different techniques /routes may be utilised to perform epidural injection. Nerve root block /transforaminal epidural, caudal epidural, interlaminar epidural are all epidural injections. Different names are used to indicate the technique used and route of entry. The route or the technique used can have an impact on where the maximum amount of drug is deposited.

How the epidural Injection works

Generally a combination of local anaesthetics and steroid are uses in these injections. The resulting pain relief can last for a few months although some people can experience long lasting relief from these injections. Corticosteroids serve dual purpose as an analgesic as well as have anti-inflammatory property. So, they help to control both pain and inflammation.

Immediately after the injection the injection site can feel sore although this is not troublesome for most people. This is mainly because of the mechanical process of inserting needle or at time also due to irritation resulting from the injected medication. But you need not worry about this as it will fade away soon and the pain relief would become apparent as the steroids start to work.

Benefits of Epidural Steroid Injection

There are numerous benefits of epidural pain injection over oral corticosteroids:

Epidural injection delivers the medication close to the problem as a result more drug reaches the site of action compared to when it is taken orally.

Side effects of the epidural injection are less compared to oral corticosteroids.

The duration for which the effect of epidural steroid injection is generally longer. This period can be effectively utilized by the patient to engage in physiotherapy and strengthen the supporting muscles.

Epidural steroidal injections help in providing quick pain relief in case of severe pain

Epidural injection works very well in case of pain originating from lower back (thoracic spine), neck (cervical spine) and mid back (thoracic spine). You should take expert advice from experienced pain specialists in Delhi as they can give you advice regarding the most appropriate therapy for you. Generally epidural injections are more beneficial in cases where the pain travels (radiates) towards arms or legs. Discuss this option with your specialist to find out if this is the right treatment for you.

# data[].attributes.attachment_link.title
Pain Specialist In Delhi for Spine Pain treatment

# data[].attributes.attachment_link.description
Epidural injections are a pain management option for patients with leg or arm pain originating from the spine. This is also known as Radicular pain or Radiculopathy. The pain usually radiates away from the irritated nerves. For Example - the pain could be originating from lower spine and may be felt far away in the legs.

# data[].attributes.headline
Radiofrequency Treatment for Chronic back pain and Neck Pain Treatment In Delhi

# data[].attributes.subject
Radiofrequency Treatment for Chronic back pain and Neck Pain Treatment In Delhi

# data[].attributes.body
Radiofrequency ablation is a commonly used procedure for the management of chronic low back pain and neck pain. It is used for managing pain secondary to arthritis of the joints in the spine and offers a safe, effective nonsurgical, minimally invasive option for patients suffering from longstanding back and neck pain. This procedure is also used for sacroiliac joint pain as in patients with ankylosing spondylitis.

Advantages of this procedure include

No requirement for hospital stay or prolonged rehabilitation

Normal activities can generally be resumed soon after the procedure with little recovery time

Less pain can lead to improved functionality and reduced medication requirements

Lasting pain relief for and a low complication rate

Chronic back and neck pain

Spine is made up of a number of vertebrae which are stacked one above the other. These vertebrae are cushioned anteriorly by the disc and join with each other posteriorly at joints called the facet joints. There are two facet joints at each level. Wear and tear, degeneration of these joints can lead to back or neck pain. This condition is called facet joint arthritis or facet arthropathy. Pain originating from facet joint arthritis is generally described as a dull ache accompanied by stiffness. It is not uncommon for the pain in lower back to radiate along the back of thighs up to the knee joint. Similarly pain from lower neck (cervical) joints can radiate to in between the shoulder blades or the shoulder joint and that from upper neck joints can cause headaches.

Pain sensations form the facet joints are transmitted to brain via nerves called the medial branches. These nerves are the target in the radiofrequency treatment

Radiofrequency ablation involves placing special needles, using x-ray guidance, close to the nerves carrying pain sensation from the affected facet joints. Using specialised equipment a small area of these nerves is heated using the electric current produced by radio waves. This reduces the pain signals being transmitted by the nerves to the brain resulting in pain relief. This is a day care procedure performed under local anaesthesia and can provide long lasting pain relief.

Dr. Manocha has been formally trained in performing this procedure in the U.K. and U.S. The technique he uses is the same as advocated by International Spine Society giving you the best chances of having a successful outcome.

# data[].attributes.headline
Modalities of Chronic Pain Treatment In Delhi

# data[].attributes.subject
Modalities of Chronic Pain Treatment In Delhi

# data[].attributes.body
Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.

Chronic or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes which remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.

Impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspect of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends, etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.

The management varies depending on the actual pathology, severity, comorbidities, patient preferences, available resources/ expertise, and many other factors. At your first consultation with me, you can expect a detailed assessment including history, examination, and review of investigations. This is aimed at identifying the underlying reason for pain so that an appropriate personalized management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:

Medical management

I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in right doses for the required duration are unlikely to be effective.

Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which help to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.

Interventional procedures

In certain situations I suggest procedures such as

Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain

Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm diagnosis

Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.

Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi speciality team approach based on biopsychosocial model of pain you have best chances of managing your pain.

Role of Physiotherapy

There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than physiotherapy. They play an important role in

Patient education regarding their condition, do’s and don’ts specific to their condition,

Setting realistic goals-dividing exercises into smaller achievable steps

Help patients understand and implement pacing of activities

Promoting compliance, increasing confidence and making you self reliant

Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation

Role of Psychology

Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by

Teaching coping and self-help strategies

Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain

Cognitive Behavioural Therapy (CBT)

# data[].attributes.attachment_link.readable_text
Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

Acute pain is the pain that is present after an injury until healing occurs. Pain in this situation is a protective response bringing our attention to the affected area and helping us protect, rest the affected tissue providing an opportunity for healing. As the tissue heals, the pain gradually abates.

or persisting pain is pain that persists even after the usual time required for healing. It is important to understand that chronic pain does not always signify on-going damage. Nerves have a memory (plasticity in medical terms) whereby they develop changes which remain even after the original inciting problem is corrected. A simple example to explain this is persisting leg pain even after amputation of the affected part. There are numerous mechanisms to explain this and your doctor can help you understand these better.

Impact of chronic pain is not limited to the involved person but also affects their loved ones and family members. The longer it persists the more chances that it will have an impact on multiple aspect of your life including your ability to work, sleeping pattern, mood, social life, relationship with family and friends, etc. Hence it is important to take corrective measures to reverse or control the condition as soon as possible.

The management varies depending on the actual pathology, severity, comorbidities, patient preferences, available resources/ expertise, and many other factors. At your first consultation with me, you can expect a detailed assessment including history, examination, and review of investigations. This is aimed at identifying the underlying reason for pain so that an appropriate personalized management plan can be made. Some more tests may be requested as necessary. Close liaison with specialists in other fields such as neurology and surgery is maintained to formulate the best plan tailored to your condition and requirements. Some of the common pain treatment modalities include:

Medical management

I normally review your current medications and any existing medical problems prior to suggesting new medications or changes to current medications. Therefore it is a good idea to carry a detailed list of your medications and make of list of the ones you may have tried previously. Doses of medications tried previously are equally important as some medications if not used in right doses for the required duration are unlikely to be effective.

Different types of pain may need treatment with different medications, for example pain of inflammatory origin maybe be effectively managed with anti-inflammatory medication and pain due to irritation of nerve may need medication which help to desensitize the nerves. Hence the importance of identifying the likely pain generators prior to prescribing medications.

Interventional procedures

In certain situations I suggest procedures such as

Injections/ radiofrequency procedures that help to reduce the pain signals being transmitted by the nerves to your brain

Injections directly into a joint space/ around the area of problem such as a tendon or bursa which can help reduce the inflammation more effectively than medications taken orally. These procedures along with being therapeutic may also help the consultant confirm diagnosis

Regenerative medicine has opened new avenues where cells from your body are used to promote healing and reduce pain. Awareness of options such as Platelet-Rich Plasma (PRP) and stem cells is increasing and new research in this area is improving our understanding day by day.

Some interventional procedures can be done in the outpatient setting, whereas others will require a day case admission. This depends on the procedure being performed and your general health, other medical problems. We aim to reduce your pain as much as possible by offering you most appropriate interventions keeping your goals and preferences in mind and with an integrated multi speciality team approach based on biopsychosocial model of pain you have best chances of managing your pain.

Role of Physiotherapy

There are few common elements in management of most chronic pain situations like weakness accompanied by disuse of affected part for long time will require gradual mobilization and strengthening. A good chronic pain physiotherapist offers more than physiotherapy. They play an important role in

Patient education regarding their condition, do's and don'ts specific to their condition,

Setting realistic goals-dividing exercises into smaller achievable steps

Help patients understand and implement pacing of activities

Promoting compliance, increasing confidence and making you self reliant

Challenging your unhelpful thoughts, mitigating any false believes and minimising catastrophisation

Role of Psychology

Chronic pain can generate significant distress, anxiety and depression and all these, in turn, can magnify perceived pain. This is a normal human reaction which is often more visible to friends and family. Addressing these factors can help in reducing perceived pain and in improving quality of life. Psychologists can help you by challenging maladaptive beliefs, attitudes and emotions. They can help by

Teaching coping and self-help strategies

Relaxation techniques- these can be a useful tool especially in dealing with sleep disturbances and periods of increased pain

Cognitive Behavioural Therapy (CBT)

# data[].attributes.attachment_link.title
Treatment Modalities In Chronic Pain Treatment In Delhi - AWebCity

# data[].attributes.attachment_link.description
Pain, no matter how trivial, is an unwelcome guest. It can be associated with undue suffering and disability which everyone would like to avoid. It is helpful to understand the types of pain one may experience. Pain can be categorized as acute or chronic pain.

# data[].attributes.headline
How To Communicate about Joint Pain To Your Joint Pain Specialists in Delhi

# data[].attributes.subject
How To Communicate about Joint Pain To Your Joint Pain Specialists in Delhi

# data[].attributes.body
Joint pain can be a source of prolonged discomfort which 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 which 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 centre 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

Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology

Treatments offered 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 which 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 possible point 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, shouting or stabbing pain? Is it present all the time?

Aggravating or reliving 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 the 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.

# data[].attributes.attachment_link.readable_text
Joint pain can be a source of prolonged discomfort which 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 which 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 centre 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

Involvement of multiple joint in the body may require different assessment/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology

Treatments offered 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 which 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 possible point 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, shouting or stabbing pain? Is it present all the time?

Aggravating or reliving 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 the 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.

# data[].attributes.attachment_link.description
Joint pain can be a source of prolonged discomfort which 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 which can provide quick relief.

# data[].attributes.headline
Cervicogenic Headache Treatment In Delhi by best Pain Management Centre In Delhi

# data[].attributes.subject
Cervicogenic Headache Treatment In Delhi by best Pain Management Centre In Delhi

# data[].attributes.body
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 behavioral 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

# data[].attributes.attachment_link.readable_text
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 behavioral 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

# data[].attributes.attachment_link.title
Cervicogenic Headache Treatment In Delhi

# data[].attributes.attachment_link.description
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.

# data[].attributes.headline
Managing Chronic Back Pain Treatment In Delhi by Pain Management in Delhi

# data[].attributes.subject
Managing Chronic Back Pain Treatment In Delhi by Pain Management in Delhi

# data[].attributes.body
We have all endured finite episodes of severe pain whether that is a fractured bone or severe migraine or throes of labour pains. While we may be fortunate enough to remember them as distant memories, those with constant pain are often denied this luxury of forgetfulness. Their lives often encompassed around managing pain. Leaving aside the distress/agony it causes, it can cause other harmful effects on most body systems whether it is your mental/ emotional well being or your heart or your quality of life. Hence it is import to control it sooner rather than later.

Pain, although distressing, has the benefit of bringing medical problems to our attention. It usually abates as healing occurs. Chronic pain is pain that persists beyond the period of healing. Traditionally pain is thought to represent ongoing damage in body. This is now considered incorrect especially in context of longstanding/ chronic pain.

The newer understanding of chronic pain

In the past patients who usually complained of long standing pain, were often dismissed by healthcare professionals and most patients accepted pain as a part of ageing. In many cases it was not easy to figure out the underlying cause of pain, as chronic pain was not well understood. Over the years, with the amount of research that has gone into the study of chronic pain, doctors now understand more about different facets of pain management – physiological, psychological, pharmacological, interventional etc. There is enhanced understanding of mechanisms which can cause amplification of perceived pain symptoms. These advances and technological developments have enabled pain specialists to offer more to their patients. This stands true for back pain as well. While a significant number of people in a population suffer from back pain, fortunately for most this will resolve with time. However a small proportion does go on to develop chronic pain. The severity can vary from mild discomfort to debilitating illness interfering with activities of daily living and limiting functionality. Pain management specialists use a combination of modalities and specialties known as multimodal multidisciplinary approach to effectively manage the back pain.

What do you understand by pain management?

The complexities of pain and the fact that surgery or pills cannot resolve all pain has been long recognised. Understanding and treating chronic pain is challenging as we all experience and process pain differently. Hence one therapy does not work for all. This has lead to the development of Pain Medicine as a separate speciality. In this speciality the doctors are trained specially to deal chronic pain conditions and develop a better understanding of pain, underlying mechanisms and ways of reducing its impact on life.  A good pain physician focuses on holistic management of patient rather than just treating the disease.

Pain medicine is branch of medicine concerned with evaluation, treatment, and rehabilitation of persons in pain.  It utilises a Multi –disciplinary approach with specialists from different fields working together help in managing your pain, restore functioning and improving quality of life. The team mostly comprises of Pain Specialists, Specialist Nurses, Physiotherapists, Occupational therapists, Acupuncturists, Psychologists and Dieticians.

Role of pain management for chronic back pain

When it comes to chronic back pain, there are a variety of ways in which pain clinic can help.  Most pain clinic interventions have the advantage of being low risk, minimally invasive, non-surgical options without any need for prolonged hospitalisation. The treatment plan is individualised and may include a combination of the following

Patient Education

Medication Management

Physiotherapy and rehabilitation

Psychology input including relaxation therapy, coping and self-management skills, cognitive behavioral therapy

Complementary and alternative therapies including Acupuncture, TENS, acupressure, meditation

Dietary advice

Interventions such as injections. These can be especially useful for people where the source of pain is not known despite extensive investigations. Diagnostic injections can help in reliably identifying sources of pain when investigations have been inconclusive. Some of the treatment options are not commonly available elsewhere and these include

X-ray/ ultrasound  guided injections like nerve blocks, epidurals, facet joint injections

CT guided interventions in areas which require precision for accuracy and minimising risks

Advanced techniques such as Radiofrequency treatment which can provide prolonged pain relief for common conditions arthritis of the joints in the spine

Research and technological developments have opened new avenues in pain management such as

Newer technologies – cooled radiofrequency and spinal cord stimulators

Regenerative medicine options including stem cells and platelet rich plasma(PRP)

Asa vast majority of patients with back pain do not require surgery, a combination of above mentioned modalities can help in effective pain relief.  Pain clinic is also an option for patients who have had inadequate results from previous surgery or those who are not keen on surgery or not fit to have surgery.

Tags >>Back treatment Pain In Delhi, pain management centre in delhi, Best Back Pain Doctor in Delhi

# data[].attributes.attachment_link.readable_text
We have all endured finite episodes of severe pain whether that is a fractured bone or severe migraine or throes of labour pains. While we may be fortunate enough to remember them as distant memories, those with constant pain are often denied this luxury of forgetfulness. Their lives often encompassed around managing pain. Leaving aside the distress/agony it causes, it can cause other harmful effects on most body systems whether it is your mental/ emotional well being or your heart or your quality of life. Hence it is import to control it sooner rather than later.

Pain, although distressing, has the benefit of bringing medical problems to our attention. It usually abates as healing occurs. Chronic pain is pain that persists beyond the period of healing. Traditionally pain is thought to represent ongoing damage in body. This is now considered incorrect especially in context of longstanding/ chronic pain. To simplify- CHRONIC PAIN DOES NOT ALWAYS SIGNIFY ONGOING DAMAGE.

The newer understanding of chronic pain

In the past patients who usually complained of long standing pain, were often dismissed by healthcare professionals and most patients accepted pain as a part of ageing. In many cases it was not easy to figure out the underlying cause of pain, as chronic pain was not well understood. Over the years, with the amount of research that has gone into the study of chronic pain, doctors now understand more about different facets of pain management - physiological, psychological, pharmacological, interventional etc. There is enhanced understanding of mechanisms which can cause amplification of perceived pain symptoms. These advances and technological developments have enabled pain specialists to offer more to their patients. This stands true for back pain as well. While a significant number of people in a population suffer from back pain, fortunately for most this will resolve with time. However a small proportion does go on to develop chronic pain. The severity can vary from mild discomfort to debilitating illness interfering with activities of daily living and limiting functionality. Pain management specialists use a combination of modalities and specialties known as multimodal multidisciplinary approach to effectively manage the back pain.

What do you understand by pain management?

The complexities of pain and the fact that surgery or pills cannot resolve all pain has been long recognised. Understanding and treating chronic pain is challenging as we all experience and process pain differently. Hence one therapy does not work for all. This has lead to the development of Pain Medicine as a separate speciality. In this speciality the doctors are trained specially to deal chronic pain conditions and develop a better understanding of pain, underlying mechanisms and ways of reducing its impact on life. A good pain physician focuses on holistic management of patient rather than just treating the disease.

Pain medicine is branch of medicine concerned with evaluation, treatment, and rehabilitation of persons in pain. It utilises a Multi -disciplinary approach with specialists from different fields working together help in managing your pain, restore functioning and improving quality of life. The team mostly comprises of Pain Specialists, Specialist Nurses, Physiotherapists, Occupational therapists, Acupuncturists, Psychologists and Dieticians.

Role of pain management for chronic back pain

When it comes to chronic back pain, there are a variety of ways in which pain clinic can help. Most pain clinic interventions have the advantage of being low risk, minimally invasive, non-surgical options without any need for prolonged hospitalisation. The treatment plan is individualised and may include a combination of the following

Patient Education

Medication Management

Physiotherapy and rehabilitation

Psychology input including relaxation therapy, coping and self-management skills, cognitive behavioral therapy

Complementary and alternative therapies including Acupuncture, TENS, acupressure, meditation

Dietary advice

Interventions such as injections. These can be especially useful for people where the source of pain is not known despite extensive investigations. Diagnostic injections can help in reliably identifying sources of pain when investigations have been inconclusive. Some of the treatment options are not commonly available elsewhere and these include

X-ray/ ultrasound guided injections like nerve blocks, epidurals, facet joint injections

CT guided interventions in areas which require precision for accuracy and minimising risks

Advanced techniques such as Radiofrequency treatment which can provide prolonged pain relief for common conditions arthritis of the joints in the spine

Research and technological developments have opened new avenues in pain management such as

Newer technologies - cooled radiofrequency and spinal cord stimulators

Regenerative medicine options including stem cells and platelet rich plasma(PRP)

Asa vast majority of patients with back pain do not require surgery, a combination of above mentioned modalities can help in effective pain relief. Pain clinic is also an option for patients who have had inadequate results from previous surgery or those who are not keen on surgery or not fit to have surgery.
Consult Best Pain Specialist In Delhi, Dr. Amod Manocha.

# data[].attributes.attachment_link.description
We have all endured finite episodes of severe pain whether that is a fractured bone or severe migraine or throes of labour pains. While we may be fortunate enough to remember them as distant memories, those with constant pain are often denied this luxury of forgetfulness. Their lives often encompassed around managing pain.

# data[].attributes.headline
Shoulder Pain Treatment In Delhi by Best Pain Specialist In Delhi

# data[].attributes.subject
Shoulder Pain Treatment In Delhi by Best Pain Specialist In Delhi

# data[].attributes.body
What is frozen shoulder?

Frozen shoulder is a condition in which there is a significant loss of motion of shoulder joint accompanied by pain and stiffness. The movement involving reaching straight up and rotation of joint such as while reaching behind the back may be affected first although with time all movements may get affected. Pain may be deep-seated, poorly localized and constant or only at night when lying on the affected side.

To understand the condition better it is helpful to know about the basic anatomy of shoulder joint. The shoulder joint is formed by three bones — the arm bone (humerus), shoulder blade (scapula), and the collar bone (clavicle). The rounded head of the arm bone (humerus) is relatively large compared to the socket of the shoulder blade and this size discrepancy allows for the large range of motion of the shoulder. The shoulder joint is surrounded by a strong joint capsule and further supported by a group of muscles called the rotator cuff.

In the frozen shoulder, the capsule surrounding the shoulder joint becomes thickened and tight thereby limiting the movements of the joint. The joint may lose some of its lubricating fluid reducing the space for the arm bone to move. Movement of the shoulder causes pain, hence one tries to avoid this which leads to further contraction of the capsule. As the condition advances scarring or adhesions may develop between the capsule and the head of the arm bone further limiting the movement. With time there may be the relative weakening of the muscles with loss of muscle mass (atrophy).

What causes a frozen shoulder?

The cause behind the condition is not well understood. This condition is estimated to affect 2–3 % of individuals although this may be an overestimation as previously many more conditions were labeled as frozen shoulder — with it becoming more like a waste bin diagnosis. The actual incidence maybe around 0.75%.

It is seen more commonly in

Women as compared to men

People over the age of 40 years, most commonly between the age of 40–60 years

Diabetics have approximately five times more chances of developing this condition compared to non — diabetics. (10–20 percent of individuals with diabetes may develop frozen shoulder and about 30% of people with a frozen shoulder also have diabetes).

Periods of shoulder immobilization like after a fracture or stroke (more like an underuse injury)

Patients with an overactive or underactive thyroid

Parkinson’s disease

How is a frozen shoulder diagnosed?

Frozen shoulder is diagnosed clinically, however, investigations are required to rule out other conditions that may present similar symptoms.

To diagnose frozen shoulder, your doctor will:

The doctor will evaluate the range of shoulder movement. In frozen shoulder, both the active movements (when you move your shoulder/ arm) and passive movements (when the doctor moves your shoulder /arm) are reduced. The examination may reveal tenderness in the front of the shoulder at a specific spot called the coracoid process.

The doctor may carry out other special tests to rule out other conditions which may present with similar symptoms

He may conduct an examination of your neck as neck problem manifests with shoulder pain frequently

Can a frozen shoulder recover on its own?

A significant number of cases improve with simple exercises and pain control, however, it can take a long time too and sometimes as long as 3 years. The limitation of daily activities can have a significant impact on the quality of life. It is often self-limited, however, some patients never regain full function of their shoulders.

Typically the condition is described to pass through three stages

Freezing stage

This is the initial stage where the pain and restriction of movement develops. Initially, the pain may be only on movement or at night when lying on the affected side. Slowly, it can increase in severity, affecting the shoulder joint diffusely and often spreading towards the upper arm. This stage can last from 6 to 9 months.

Frozen stage

In this stage, the pain may become better although the restriction of movement persists and may become worse. This stage can last 4–12 months.

Thawing stage

During this phase, the movements start to return slowly and it can last 6 months to 2 years.

What is the treatment for frozen shoulder?

The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder’s normal range of motion. Timely interventions can help control pain and restore function sooner. A pain clinic can play a significant role by prescribing medications, using timely interventions such as injections and providing supervised physiotherapy. This Multidisciplinary approach has the best chances of improving outcomes and reducing disability.

Treatment options are explained below and it is important to understand that they are to be used in tandem and not seen as alternatives to each other.

MEDICATIONS– anti-inflammatory drugs can help reduce the pain and inflammation, although these should not be used without advice from your doctor. Your pain specialist may consider other stronger medications depending on your pain severity and other medical comorbidities.

INTERVENTIONS– This may include a shoulder joint steroid injection or hydrodistension of the shoulder joint. These injections can help reduce pain and improve the range of movement, reducing disability.

Shoulder joint steroid injections- Steroid injections injected directly into the joint are preferred over the oral steroid as they are associated with fewer side effects. Some studies have found that oral steroids are as much as 5 times more likely to give you the typical steroid side effects when compared to the one with off joint injections. Also, the lack of long-term benefits make oral steroids a less attractive option in this condition. Some studies comparing physiotherapy with steroid injections have found no significant difference in pain relief or shoulder function whereas others have found improved shoulder function with steroid injections.

Hydrodistension of the joint involves injecting sterile water or local anesthetic into the shoulder joint with the intention of stretching the joint capsule to improve range of motion. There is evidence supporting the use of a combination of hydrosilation and corticosteroid injection, as it may expedite recovery of pain-free range of motion compared to corticosteroid injection alone.

Both of these procedures can be performed in OPD settings under ultrasound guidance. Ultrasound helps to improve accuracy, maximizing the chances of getting benefits from injections.

Physical therapy. This forms an essential component of frozen shoulder treatment and requires the regular active participation of the affected individual. The aim of physical therapy is to maintain, improve range of motion and help in strengthening of the joint, Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone.

Surgery. This is rarely necessary to treat frozen shoulder. It is considered when there is a minimal improvement after 6 to 12 weeks of nonsurgical treatment. Options include manipulation under anesthesia and arthroscopic capsule release. Shoulder manipulation involves forcefully moving the shoulder under general anesthesia to loosen up your shoulder tissue and disrupt the adhesions. This needs to be supported by physiotherapy after the procedure. Arthroscopic capsular release is considered in some cases when other treatments have failed to provide relief.

# data[].attributes.attachment_link.readable_text
What is frozen shoulder?

Frozen shoulder is a condition in which there is significant loss of motion of shoulder joint accompanied by pain and stiffness. The movement involving reaching straight up and rotation of joint such as while reaching behind the backmay be affected first although with time all movements may get affected. Pain may be deep seated, poorly localised and constant or only at night when lying on the affected side.

To understand the condition better it is helpful to know about the basic anatomy of shoulder joint. The shoulder joint is formed by three bones - the arm bone (humerus), shoulder blade (scapula), and the collar bone (clavicle). Therounded head of the arm bone (humerus) is relatively large compared to the socket of the shoulder blade and this size discrepancy allows for thelarge range of motion of the shoulder. The shoulder joint is surrounded by the strong joint capsule and further supported by a group of muscles called the rotator cuff.

In frozen shoulder the capsule surrounding the shoulder joint becomes thickened and tight thereby limiting the movements of the joint. The joint may loose some of its lubricating fluid reducing the space for the arm bone ot move. Movement of shoulder causes pain, hence one tries to avoid this which leads to further contraction of the capsule. As the condition advances scarring or adhesions may develop between the capsule and the head of arm bone further limitating the movement. With time there may be relative weakening of the muscles with loss of muscle mass (atrophy).

What causes frozen shoulder?

The cause behind the condition is not well understood.This condition is estimated to affect 2-3 % of individuals although this may be an overestimation as previously many more conditions were labelled as frozen shoulder - with it becoming more like a waste bin diagnosis. The actual incidence may be around 0.75%.
It is seen more commonly in

Women as compared to men

People over the age of 40 years, most commonly between the age of 40-60 years

Diabetics have approximatley five times more chances of developing this condition compared to non - diabetics. (10 - 20 percent of individuals with diabetes may develop frozen shoulderand about 30% of people with a frozen shoulder also have diabetes).

Periods of shoulder immobilization like after a fracture or stroke (more like an under use injury)

Patients with overactive or underactive thyroid

Parkinson's disease

How is frozen shoulder diagnosed?

Frozen shoulder is diagnosed clinically, however investigations are required to rule out other conditions which may present similar symptoms.
To diagnose frozen shoulder, your doctor will:

Take detailed history of your condition and look for any predisposing factors

Conduct a physical examination of your shoulders, arms and neck:

The doctor will evaluate the range of shoulder movement. In frozen shoulder both the active movements (when you move your shoulder/ arm) and passive movements (when the doctor moves your shoulder /arm) are reduced.Examination may reveal tenderness in the front of shoulder at a specific spot called the coracoid process.

The doctor may carry out other special tests to rule out other conditions which may present with similar symptoms

He may conduct examination of your neck as neck problem manifests with shoulder pain frequently

Investigations- X-rays of the shoulder may be requested to rule out arthritis, MRI scan and ultrasound may be requested to rule out other problems such as a rotator cuff tear. Ultrasound scan can show thickening of coracohumeral ligament or the capsule

Blood tests may be requested to check for diabetes / thyroid problems

Can a frozen shoulder recover on its own?

A significant number of cases improve with simple exercises and pain control, however, it can take a long time too and sometimes as long as 3 years. The limitaion of daily activities can have significant impact on the quality of life. It is often self-limited, however, some patients never regain full function of their shoulder.
Typically the condition is described to pass through three stages
Freezing stage

This is the initial stage where the pain and restriction of movement develops. Intitially pain may be only on movement or at night when lying on the affected side. Slowly, it can increase in severity, affecting the shoulder joint diffusely and often spreading towards the upper arm. This stage can last from 6 to 9 months.

Frozen stage

In this stage the pain may become better although the restriction of movement persists and may become worse. This stage can last 4-12 months.

Thawing stage

During this phase, the movements start to return slowly and it can last 6 months to 2 years.

What is the treatment for frozen shoulder?

The treatment for a frozen shoulder is focused on relieving pain and restoring the shoulder's normal range of motion. Timely interventions can help control pain and restore function sooner. A pain clinic can play a significant role by prescribing medications, using timely interventions such as injections and providing supervised physiotherapy. This Multi discliplinary approach has the best chances of improving outcomes and reducing disability.

Treatment options are explained below and it is important to understand that they are to be used in tandem and not seen as alternatives to each other.

MEDICATIONS- anti-inflammatory drugs can help reduce the pain and inflammation, although these should not be used without the advice from your doctor. Your pain specialist may consider other stronger medications depending on your pain severity and other medical comorbidities.

INTERVENTIONS- This may include a shoulder joint steroid injection or hydrodistension of the shoulder joint. These injections can help reduce pain and improve range of movement, reducing disability.

Shoulder joint steroid injections- Steroid injections injected directly into the joint are preferred over the oral steroid as they are associated with fewer side effects. Some studies have found that oral steroids are as much as 5 times more likely to give you the typical steroid side effects when compared to the one with off joint injections. Also the lack of long-term benefits makes oral steroids a less attractive option in this condition. Some studies comparing physiotherapy with steroid injections have found no significant difference in pain relief or shoulder function whereas others have found improved shoulder function with steroid injections.

Hydrodistension of the joint involves injecting sterile water or local anaesthetic into the shoulder joint with the intention of stretching the joint capsule to improve range of motion. There is evidence supporting the use of a combination of hydrodilatation and corticosteroid injection, as it may expedite recovery of pain free range of motion compared to corticosteroid injection alone.

Both these procedures can be performed in OPD settings under ultrasound guidance. Ultrasound helps to improve accuracy, maximising the changes of getting benefit from injections.

Physical therapy. This forms an essential component of frozen shoulder treatment and requires regular active participaton of the affected individual. The aim of physical therapy is to maintain, improve range of motion and help in strengthening of the joint, Physiotherapy and corticosteroid injections combined may provide greater improvement than physiotherapy alone.

Surgery. This is rarely necessary to treat frozen shoulder. It is considered when there is minimal improvement after 6 to 12 weeks of nonsurgical treatment. Options include manipulation under anaesthesia and arthroscopic capsule release. Shoulder manipulation involves forcefully moving the shoulder under general anesthesia to loosen up your shoulder tissue and disrupt the adhesions. This needs to be supported by physiotherapy after the procedure. Arthroscopic capsular release is considered in some cases when other treatments have failed to provide relief.

# data[].attributes.attachment_link.title
Frozen shoulder non surgical treatment in delhi | Dr. Amod Manocha

# data[].attributes.attachment_link.description
Frozen shoulder is a condition in which there is significant loss of motion of shoulder joint accompanied by pain and stiffness. The movement involving reaching straight up and rotation of joint such as while reaching behind the backmay be affected first although with time all movements may get affected.

# data[].attributes.headline
Why do you continue to experience pain after knee replacement?

# data[].attributes.subject
Why do you continue to experience pain after knee replacement?

# data[].attributes.body
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

Cooled Radiofrequency is an alternative treatment. Details about this treatment can be found in the Knee pain section of the website and in old blogs.

What causes continued pain following surgery?

The causes of knee pain following replacement surgery can be located inside the joint (intra articular causes) or outside the joint (extra articular causes).

The intra articular causes include:

Knee joint instability

Loosening of the implant

Infection of the bone or the joint space

Problems related to the kneecap (patella)

Osteolysis (loss of bone)

Issues related to size or type of implant

It is important to rule out the extra articular causes when a patient complains of persistent knee joint pain following surgery, because they can have serious consequences if they are missed.

The extra articular causes include:

Localized knee problems such as tendinitis and bursitis

Pain radiating from the nearby joints/body parts such as spine, hip and ankles

People who have ongoing psychological illnesses will also tend to experience longer postoperative pain

Nerve injuries/ problems

The focus of a recent research in Oxford, UK has been weather the knee replacement should be done earlier and not as a last resort. The authors suspected that long term persisting knee pain can lead to changes in the nervous system (nerves, spinal cord and brain) which can be responsible for persisting pain even if the original cause is corrected.

Diagnosing the problem:

You doctor will go through multiple steps in order to evaluate the pain you are experiencing. This process includes, taking a detailed history of the pain, such as when what type of pain you are experiencing and when you experience it the most. Then your doctor will go on to examine the knee, which will help him/her to further narrow down on probable causes & identify problems such as stiffness, swelling, and issues with alignment of the joint.

You will be asked to undergo investigations such as, X-ray, MRI, blood tests including inflammatory markers such as CRP and ESR etc.

How to manage this condition?

Depending on the cause of your pain, you doctor may suggest a variety of treatment plans. On some occasions pain relief medication may help to control the pain, and even get rid of it completely. Physiotherapy is another option which has proven to be effective in managing pain following knee replacement surgery. Nerve blocks are sometimes offered if nerves are suspected to be the pain generator. Cooled Radiofrequency of the nerve supplying the knee can help in reducing or resolving your pain issues. Sometimes repeat surgery such as revision knee replacement is required If.

# data[].attributes.attachment_link.readable_text
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

Cooled Radiofrequency is an alternative treatment. Details about this treatment can be found in the Knee pain section of the website and in old blogs.

What causes continued pain following surgery?

The causes of knee pain following replacement surgery can be located inside the joint (intra articular causes) or outside the joint (extra articular causes).
The intra articular causes include:

Knee joint instability

Loosening of the implant

Infection of the bone or the joint space

Problems related to the kneecap (patella)

Osteolysis (loss of bone)

Issues related to size or type of implant

It is important to rule out the extra articular causes when a patient complains of persistent knee joint pain following surgery, because they can have serious consequences if they are missed.
The extra articular causes include:

Localized knee problems such as tendinitis and bursitis

Pain radiating from the nearby joints/body parts such as spine, hip and ankles

People who have ongoing psychological illnesses will also tend to experience longer postoperative pain

Nerve injuries/ problems

The focus of a recent research in Oxford, UK has been weather the knee replacement should be done earlier and not as a last resort. The authors suspected that long term persisting knee pain can lead to changes in the nervous system (nerves, spinal cord and brain) which can be responsible for persisting pain even if the original cause is corrected.

Diagnosing the problem:

You doctor will go through multiple steps in order to evaluate the pain you are experiencing. This process includes, taking a detailed history of the pain, such as when what type of pain you are experiencing and when you experience it the most. Then your doctor will go on to examine the knee, which will help him/her to further narrow down on probable causes & identify problems such as stiffness, swelling, and issues with alignment of the joint.

You will be asked to undergo investigations such as, X-ray, MRI, blood tests including inflammatory markers such as CRP and ESR etc.

How to manage this condition?

Depending on the cause of your pain, you doctor may suggest a variety of treatment plans. On some occasions pain relief medication may help to control the pain, and even get rid of it completely. Physiotherapy is another option which has proven to be effective in managing pain following knee replacement surgery. Nerve blocks are sometimes offered if nerves are suspected to be the pain generator. Cooled Radiofrequency of the nerve supplying the knee can help in reducing or resolving your pain issues. Sometimes repeat surgery such as revision knee replacement is required If.

# data[].attributes.attachment_link.title
Cooled Radiofrequency For Knee Pain treatment In Delhi

# data[].attributes.attachment_link.description
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.

# data[].attributes.headline
All you need to know about Sciatica From Best Back Pain Doctor In Delhi

# data[].attributes.subject
All you need to know about Sciatica From Best Back Pain Doctor In Delhi

# data[].attributes.body
1. What is sciatica?

Sciatica is term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to disc bulge in the low back pain. This is most commonly seen in middle-aged adults and men are more susceptible. The term sciatica originated from the sciatic nerve, which is the single largest nerve in our body. This nerve is responsible for a significant proportion of leg sensation and movement. Sciatica represents pain in the area supplied by the sciatic nerve.

Radicular pain/ radiculopathy are medical terms which doctors use when describing this condition. There are numerous reasons for having leg pain and every leg pain is not sciatica. Commonly people misinterpret sciatica as a disease and need to be explained that it is a symptom of the underlying problem.

2. What are symptoms of sciatica?

The severity and symptoms many vary considerably. In severe cases the affected individual may find it difficult to walk or even stand up straight.

Some of the commonly observed symptoms include

Sharp, burning, stinging, shooting, electric shock or cramps like pain in one or both legs often as far down as the foot. Movement, coughing and sneezing can intensify the pain

Tingling, pins and needles and/or numbness in leg or foot

Muscle weakness with difficulty in weight bearing or walking.

Buttock/low back pain and stiffness.

3. What causes sciatica?

Disc herniation: Spine is formed of many bones called vertebrae arranged one above the other. In between these vertebrae are discs, which are like cushions or shock absorbers. The discs are made up of an outer tough substance and an inner soft jelly like substance. Herniation of the disc can occur if there is splitting or crack in the outer layers allowing the inner jelly like substance to protrude through the crack. This can cause inflammation and compression of the nerve roots in the vertebral column. Slipped disc is a commonly used term for this condition. There is an increased susceptibility to disc herniation as we age because the soft, jelly like substance dries out and shrinks with time, making the disc more fragile.

Spinal stenosis: Stenosis means narrowing. The narrowing can be of the central canal of the spine or the passageways/ tunnels from which the nerves exit the spine. Besides disc problems, arthritis of the spinal joints or thickening of ligaments can also cause/ contribute to the narrowing.

Spondylolisthesis: In this condition there is a problem with the alignment of vertebrae, where one vertebra is more forward or backwards, which can narrow the spaces for nerves and produce sciatica as a result.

Piriformis syndrome: In this condition piriformis muscle in the pelvis is responsible for pressure on sciatic nerve.

Trauma/ fractures

Spinal tumors and infections are rare causes of sciatica

4. Can it resolve on its own?

Fortunately most cases of sciatica resolve within a period of weeks to months with conservative treatment. Specialist input and treatment can help. Painkillers, heat or cold pack, altered activity levels and physical therapy may be suggested depending on your condition. An injection of steroids into the epidural space within the spine can provide short-term pain relief in sciatica. Persistent pain can lead to changes in the nerves (referred to as plasticity). This can be a source of persistent pain even if the original inciting event is resolved … hence the importance of managing these sooner than later.

Having seen numerous cases over the years, I would say that it is not easy to predict the course. It can resolve but to what extend depends on numerous factors- some are modifiable and others are not. The recovery period varies from individual to individual.

5. What are the warning signs I need to be watch for?

Some symptoms point towards a serious problem and require urgent medical attention. Ignoring these could lead to permanent nerve damage. Some of these include

Loss of urinary control/ inability to pass urine

Loss of control over stools

Numbness around the bottom

Worsening leg weakness / loss of control

6. What can I do to reduce my risk of having sciatica?

Though it’s not possible to completely eliminate the risk of sciatica, however adopting a healthy life style can help in reducing the risk. This includes

Giving up smoking

Regular exercises

Right posture and work ergonomics

Healthy diet and maintaining weight in the normal range

Using proper manual handling techniques while lifting to avoid back injury

Stress Management

7. What investigations are generally considered for sciatica?

Your doctor may request for investigations such as magnetic resonance imaging (MRI) scan and blood tests. Sometimes computerized tomography (CT) scans may also be required. X-rays are not as helpful and they can provide only limited information.

Bulging discs on an MRI scan are not an uncommon finding. It is important not to get fixated on the MRI findings. A bulging disc is not permanent and can reverse. The investigation results should be interpreted in combination with patient history, examination findings to assess their significance.A number of patients with severe MRI findings may be asymptomatic and vice versa.

8. What are the other treatment options?

Sciatica is different from common ailments we all suffer and hence taking professional help is recommended. Your doctor can help to confirm that you have sciatica and help identify the cause. A range of different options- non surgical (such as injections- nerve root blocks, epidurals, piriformis injection etc) or surgical may be considered. There is no one solution for sciatica pain and the options are numerous – some with good evidence and others with not so robust evidence.

Generally a multimodal multidisciplinary approach is preferred as this helps in addressing not only the pain but also the impact of pain on one’s life. I ensure that the patient understands the nature or problem and the do’s and don’ts. Time spent in explaining the conditions and the expected course goes a long way in fostering realistic expectations. I generally use a combination of the modalities mentioned below to enhance the chances of quicker recovery.

Pain relief:
Pain reduction achieved by medicines help to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms and individual factors such as co morbidities and allergies. Some of the commonly prescribed pain killers include

Non steroidal anti-inflammatory drugs (NSAIDs)
This includes drugs such as DIclofenac, Naproxen, Aceclofenac, Ibuprofen etc. NSAIDs are prescribed to reduce the pain and inflammation during periods of acute sciatica although the evidence supporting their use is not very robust. The risk benefit ratio needs to be evaluated while prescribing any drugs.

Neuropathic pain killers
This group includes antidepressants and anticonvulsants both of which are well known painkillers for nerve pain. It generally takes a few weeks for the full effects of these drugs to become apparent. Effects such as reduced anxiety and sedation can be used beneficially by tailored selection to suit individual patients. Their use is supported by the NICE guidelines, UK.

Opioids
Weak opioids such as tramadol are often prescribed during pain flare up episodes. It is a good practice to be aware of the side effects of a medicine prior to using it.

Muscle relaxants
These are used for short duration to relieve any muscle spasm contributing to the back pain.

Spinal Injections:

The use of epidural steroids/ Nerve root blocks has been shown to have beneficial improvements in leg pain and disability scores in short term. Steroids help by their anti-inflammatory and analgesic (pain relieving) effect. Epidural steroids are preferred to oral steroids as they are given close to site of actual problem and have less adverse effects.

Physiotherapy:

Physiotherapy is an essential component of sciatica treatment. Your physiotherapist can help with posture advice, do’s and don’ts relevant to your condition, understanding the concept of pacing of activities, setting practical goals, teaching strengthening exercises for core, leg muscles and manual handling techniques.

Surgery:

If a combination of above fails to provide adequate relief then surgical options such as discectomy (operation to remove bulging part of the disc or separated disc fragments) and microdiscectomy can be considered for sciatica resulting from disc bulge. Surgical options will vary depending on the cause of sciatica and sometimes may be the first choice, depending on the actual pathology and its severity.

# data[].attributes.attachment_link.readable_text
1. What is sciatica?

Sciatica is term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to disc bulge in the low back. This is most commonly seen in middle-aged adults and men are more susceptible. The term sciatica originated from the sciatic nerve, which is the single largest nerve in our body. This nerve is responsible for a significant proportion of leg sensation and movement. Sciatica represents pain in the area supplied by the sciatic nerve.

Radicular pain/ radiculopathy are medical terms which doctors use when describing this condition. There are numerous reasons for having leg pain and every leg pain is not sciatica. Commonly people misinterpret sciatica as a disease and need to be explained that it is a symptom of the underlying problem.

2. What are symptoms of sciatica?

The severity and symptoms many vary considerably. In severe cases the affected individual may find it difficult to walk or even stand up straight.

Some of the commonly observed symptoms include

Sharp, burning, stinging, shooting, electric shock or cramps like pain in one or both legs often as far down as the foot. Movement, coughing and sneezing can intensify the pain

Tingling, pins and needles and/or numbness in leg or foot

Muscle weakness with difficulty in weight bearing or walking.

Buttock/low back pain and stiffness.

3. What causes sciatica?

Disc herniation: Spine is formed of many bones called vertebrae arranged one above the other. In between these vertebrae are discs, which are like cushions or shock absorbers. The discs are made up of an outer tough substance and an inner soft jelly like substance. Herniation of the disc can occur if there is splitting or crack in the outer layers allowing the inner jelly like substance to protrude through the crack. This can cause inflammation and compression of the nerve roots in the vertebral column. Slipped disc is a commonly used term for this condition. There is an increased susceptibility to disc herniation as we age because the soft, jelly like substance dries out and shrinks with time, making the disc more fragile.

Spinal stenosis: Stenosis means narrowing. The narrowing can be of the central canal of the spine or the passageways/ tunnels from which the nerves exit the spine. Besides disc problems, arthritis of the spinal joints or thickening of ligaments can also cause/ contribute to the narrowing.

Spondylolisthesis: In this condition there is a problem with the alignment of vertebrae, where one vertebra is more forward or backwards, which can narrow the spaces for nerves and produce sciatica as a result.

Piriformis syndrome: In this condition piriformis muscle in the pelvis is responsible for pressure on sciatic nerve.

Trauma/ fractures

Spinal tumors and infections are rare causes of sciatica

4. Can it resolve on its own?

Fortunately most cases of sciatica resolve within a period of weeks to months with conservative treatment. Specialist input and treatment can help. Painkillers, heat or cold pack, altered activity levels and physical therapy may be suggested depending on your condition. An injection of steroids into the epidural space within the spine can provide short-term pain relief in sciatica. Persistent pain can lead to changes in the nerves (referred to as plasticity). This can be a source of persistent pain even if the original inciting event is resolved ... hence the importance of managing these sooner than later.

Having seen numerous cases over the years, I would say that it is not easy to predict the course. It can resolve but to what extend depends on numerous factors- some are modifiable and others are not. The recovery period varies from individual to individual.

5. What are the warning signs I need to be watch for?

Some symptoms point towards a serious problem and require urgent medical attention. Ignoring these could lead to permanent nerve damage. Some of these include

Loss of urinary control/ inability to pass urine

Loss of control over stools

Numbness around the bottom

Worsening leg weakness / loss of control

6. What can I do to reduce my risk of having sciatica?

Though it's not possible to completely eliminate the risk of sciatica, however adopting a healthy life style can help in reducing the risk. This includes

Giving up smoking

Regular exercises

Right posture and work ergonomics

Healthy diet and maintaining weight in the normal range

Using proper manual handling techniques while lifting to avoid back injury

Stress Management

7. What investigations are generally considered for sciatica?

Your doctor may request for investigations such as magnetic resonance imaging (MRI) scan and blood tests. Sometimes computerized tomography (CT) scans may also be required. X-rays are not as helpful and they can provide only limited information.

Bulging discs on an MRI scan are not an uncommon finding. It is important not to get fixated on the MRI findings. A bulging disc is not permanent and can reverse. The investigation results should be interpreted in combination with patient history, examination findings to assess their significance.A number of patients with severe MRI findings may be asymptomatic and vice versa.

8. What are the other treatment options?

Sciatica is different from common ailments we all suffer and hence taking professional help is recommended. Your doctor can help to confirm that you have sciatica and help identify the cause. A range of different options- non surgical (such as injections- nerve root blocks, epidurals, piriformis injection etc) or surgical may be considered. There is no one solution for sciatica pain and the options are numerous - some with good evidence and others with not so robust evidence.

Generally a multimodal multidisciplinary approach is preferred as this helps in addressing not only the pain but also the impact of pain on one's life. I ensure that the patient understands the nature or problem and the do's and don'ts. Time spent in explaining the conditions and the expected course goes a long way in fostering realistic expectations. I generally use a combination of the modalities mentioned below to enhance the chances of quicker recovery.

Pain relief:
Pain reduction achieved by medicines help to maintain activity and improves physiotherapy compliance. The medications used depend on the type and severity of pain, duration of symptoms and individual factors such as co morbidities and allergies. Some of the commonly prescribed pain killers include

Non steroidal anti-inflammatory drugs (NSAIDs)
This includes drugs such as DIclofenac, Naproxen, Aceclofenac, Ibuprofen etc. NSAIDs are prescribed to reduce the pain and inflammation during periods of acute sciatica although the evidence supporting their use is not very robust. The risk benefit ratio needs to be evaluated while prescribing any drugs.

Neuropathic pain killers
This group includes antidepressants and anticonvulsants both of which are well known painkillers for nerve pain. It generally takes a few weeks for the full effects of these drugs to become apparent. Effects such as reduced anxiety and sedation can be used beneficially by tailored selection to suit individual patients. Their use is supported by the NICE guidelines, UK.

Opioids
Weak opioids such as tramadol are often prescribed during pain flare up episodes. It is a good practice to be aware of the side effects of a medicine prior to using it.

Muscle relaxants
These are used for short duration to relieve any muscle spasm contributing to the back pain.

Spinal Injections:

The use of epidural steroids/ Nerve root blocks has been shown to have beneficial improvements in leg pain and disability scores in short term. Steroids help by their anti-inflammatory and analgesic (pain relieving) effect. Epidural steroids are preferred to oral steroids as they are given close to site of actual problem and have less adverse effects.

Physiotherapy:

Physiotherapy is an essential component of sciatica treatment. Your physiotherapist can help with posture advice, do's and don'ts relevant to your condition, understanding the concept of pacing of activities, setting practical goals, teaching strengthening exercises for core, leg muscles and manual handling techniques.

Surgery:

If a combination of above fails to provide adequate relief then surgical options such as discectomy (operation to remove bulging part of the disc or separated disc fragments) and microdiscectomy can be considered for sciatica resulting from disc bulge. Surgical options will vary depending on the cause of sciatica and sometimes may be the first choice, depending on the actual pathology and its severity.

# data[].attributes.attachment_link.description
Sciatica is term used to describe pain that travels (radiates) down the leg from the lower back or buttock. It is a type of nerve pain and a number of cases are caused by pressure on the nerves due to disc bulge in the low back.

# data[].attributes.headline
Headaches are a common health issue that affects people of all ages world over

# data[].attributes.subject
Headaches are a common health issue that affects people of all ages world over

# data[].attributes.body
Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headaches and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches . Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

General lifestyle modifications

Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.

Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen preexisting headaches.

Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.

Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible.

Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.

Quit smoking

Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques.

These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications:

Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation.

Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches

Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine.

NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods:

When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

Nerve blocks

Injections of the cervical spine

Radiofrequency treatment

Botulinum toxin injections

Complementary & Alternative therapies

These include:

Acupuncture – which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief

Massage therapy – this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.

Meditation and relaxation therapy

Herbs and nutrients – Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring.

It is best to seek medical advice before you starting with any of the above methods.

# data[].attributes.attachment_link.readable_text
Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headaches and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches . Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

General lifestyle modifications

Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.

Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen preexisting headaches.

Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.

Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible.

Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.

Quit smoking

Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques.

These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications:

Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation.

Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches

Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine.

NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods:

When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

Complementary & Alternative therapies
These include:

Acupuncture - which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief

Massage therapy - this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.

Meditation and relaxation therapy

Herbs and nutrients - Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring.

It is best to seek medical advice before you starting with any of the above methods.

# data[].attributes.attachment_link.title
Migraine & Headache Specialist & Doctors In Delhi

# data[].attributes.attachment_link.description
Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc.

# data[].attributes.headline
Carpal Tunnel Syndrome (CTS) Treatment In Delhi , India

# data[].attributes.subject
Carpal Tunnel Syndrome (CTS) Treatment In Delhi , India

# data[].attributes.body
What is carpal tunnel syndrome?

Carpal tunnel syndrome or ‘median nerve compression’ is a painful condition that develops as a result of excess pressure on a nerve (median nerve) as it travels into the wrist through the narrow passageway.

Median nerve of arm carries sensation from thumb, index finger, middle finger and a part of the ring finger to the brain and controls the movement of some important hand muscle.  This nerve arises from the brachial plexus which is formed by the joining of many nerve roots exiting the spine in the neck region.  Median nerve runs down the forearm and passes through a narrow tunnel like passageway (carpal tunnel) on the palm side of the wrist. Your pain specialist can further explain the anatomical details to help you understand the condition better.

What causes carpal tunnel syndrome?

CTS may affect one or both hands. Those, who are involved in jobs requiring repetitive movement of the wrist such as construction workers, manufacturers etc. are more likely to be diagnosed with CTS. Women are three times more likely to have CTS and the prevalence, severity increases with age. Some studies have observed a peak incidence between the age of 45 and 59 years and a second peak between 75 and 84 years. In most cases it is difficult to pinpoint the cause as to why this condition develops although many predisposing factors have been identified and these include:

Fluid retention from pregnancy especially in 3rd trimester

Diabetes

Thyroid dysfunction

Obesity

Autoimmune disorders such as rheumatoid arthritis

Fractures or trauma to the wrist

Repeated over extension of the wrist or movement such as typing, working on computers for more than 20 hours/ week

Hereditary factors and conditions such as polyneuropathy (where multiple nerves are affected)

What are the symptoms of carpal tunnel syndrome?

In the early stage the symptoms may be intermittent and only at night.  As the condition advances these may become constant with development of wasting and weakness of hand muscles. The common symptoms include

Numbness, burning, tingling, shock like sensation, pain in the ring, middle, index fingers and the thumb.

Affected individuals often have disturbed sleep with urge to shake out their hand to obtain relief from symptoms.

Provocation of symptoms by sustained hand or arm positions especially those involving arm elevation and wrist flexion as while holding a phone.  Provocation may also be more noticeable after repetitive actions of the hand or wrist.

Clumsiness and weakness of hand with difficulty performing simple tasks like buttoning clothes & opening jars.

Losing grip over things/ difficulty to hold objects firmly in hand due to weakness.

Burning sensation/ pain may involve forearm, upper arm.

How is carpal tunnel syndrome diagnosed?

Your doctor will take a careful history and perform examination of your hand, arm, shoulders and neck. The sensation and movements of the hand may also be evaluated. The doctor may also hold, bend your wrist in a flexed position to check if this increases/ brings on your symptoms as this position further narrows the space for the nerve temporarily.

He/she may request for investigations such as electrodiagnostic studies (nerve conduction studies and electromyography) and ultrasound. Electrodiagnostic studies can help determine severity and prognosis. Plain X-ray may be useful if bone or joint disease/ structural abnormalities are suspected. Magnetic Resonance Imaging is useful in picking up rare pathological causes of CTS such as ganglion or bony deformity and these can have bearing on the surgical plan.

How is carpal tunnel syndrome treated?

Management of CTS depends on the severity of symptoms. In mild to moderate cases your doctor may recommend the conservative approach which should result in improvement in a few weeks time. This includes

Non-surgical methods

Splinting or bracing – Wearing a splint or brace will keep you from moving or bending the wrist while you rest. One study has shown that using a neutral wrist splint is twice as likely to give symptom relief compared to a splint in extension position. This modality, in combination with other treatment modalities, can be especially useful in pregnancy. However not everyone is able to get accustomed to the splint.

Physical therapy – There is some evidence that physical therapy techniques are effective CTS treatments. Multiple sessions from specialist physiotherapists and treatment modalities include carpal bone mobilization, therapeutic ultrasound and nerve glide exercises.

Oral medications – Oral steroids have shown to improve symptoms for limited time but are less effective than local injections with more side effects. Anti-inflammatory medications (NSAIDS) and diuretics have questionable benefits. Similarly  research studies show that vitamin B-6 supplementation has a negligible therapeutic effect.

Ultrasound-guided local injections

This involves injecting local anaesthetics and a small dose of steroid close to the problem site under ultrasound guidance. Ultrasound helps to ensure accuracy and minimises the risk of complications. One study has estimated the risk of serious complication with these injections as less than 0.1%.  There is evidence suggesting that the local injection is effective for more than one month in patients with mild to moderate carpal tunnel syndrome and delays the need for surgery at one year. Some studies have demonstrated improvement lasting 10 weeks to more than one year. This option can help manage the symptoms, avoiding the need for surgery. Certain cases may require a repeat injection for more effective symptom control. Wrist injections may help to relieve inflammation of the affected nerves and the fibrous sheath and fasten the healing process.

Surgical management

This option is suitable for patients with severe carpal tunnel syndrome or when symptoms have not improved after four to six months of conservative therapy. It is an effective option and can provide a lasting relief in 70 to 90 % of cases. The procedure involves release of pressure by placing a cut on the fibrous sheath, which will provide more space for the median nerve to pass through.

# data[].attributes.body
Treatments:
- Back Pain and Sciatica treatment in Delhi
- Neck and Arm Pain treatment in Delhi
- Thoracic spine and Chest wall treatment Pain in Delhi
- Coccyx Pain treatment in Delhi
- Joint and Musculoskeletal Pain treatment in Delhi
- Neuropathic Pain treatment in Delhi
- Abdominal and Pelvic Pain treatment in Delhi
- Headaches in Delhi treatment in Delhi
- Post Herpetic Neuralgia treatment in Delhi
- Complex Regional Pain Syndrome treatment in Delhi
- Chronic Post Surgical Pain treatment in Delhi
- Cancer Pain treatment in Delhi
- Fibromyalgia/ Widespread Pain treatment in Delhi

# data[].attributes.attachment_link.title
Pain Specialist In Delhi, Pain Management In Delhi - Dr. Amod Manocha

# data[].attributes.attachment_link.description
Dr. Amod Manocha is a leading Pain Management Specialist In Delhi. He helps patients with all kinds of chronic pain conditions including back pain, neck pain, Neuropathic Pain, Coccyx Pain, Diabetic Pain, Pelvic Pain, joint pain and nerve pain.