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Contidions Treated

Sports Injuries

In an age of highly technological and competitive sports, these injuries are quite commonly encountered. Those who play sports regularly present less with these injuries, as opposed to the family man who plays some form of sport on an occasional weekend "I play cricket on a Sunday when I am free". This is because professional athletes know how to take care of themselves and also when to seek help. However they are highly motivated people who drive themselves to achieve perfection. In the process they do injure themselves.

Sports injuries can be prevented by good care prior to exercise in the form of stretches, conditioning and nutrition. More importantly stretching after the workout is more important but unfortunately neglected. These youngsters love the "high" of strenuous exercise but ignore the drudgery of stretching after.

This “High” has been demonstrated to be associated with the “feel good” chemicals in the brain that increase the functional activity in certain areas of brain. This fascinating work comes from functional MRI studies done in Germany. It has been shown that when these athletes have to stop their running or exercises because of an injury they literally feel sick. They have to be treated early so that they can resume getting their “High”. We have treated several patients who have had to give up their running, or martial arts practice or a similar activity because of an injury . We find these the most difficult patients to treat because these achievers are highly frustrated by their invalid state which has lasted years. However, patience, counseling medications and IMS or botox does get them out of the problem but this may take several months

Different therapeutic techniques, exercises and training can help treat many of these injuries.

For severe forms of sports injury that require other treatments , referrals can be made to appropriate specialists.

Ashirvad Pain clinic offers a number of treatment strategies that are used in combination to suit the needs of the patient. The ultimate aim of the treatment strategies is to reduce the pain significantly, which allows the patient to resume his or her role in society, and function to the best of the patient's ability.

Treatment strategies at Ashirvad have been enumerated below. These are meant for only for outlining the different procedures possible, and may not be construed as medical advice. For details regarding the treatments, please feel free to contact us.

INTERVENTIONAL PAIN MANAGEMENT

Interventions are commonly performed in the operation theatre in order to provide standard quality of care to the patient. These procedures are commonly performed in pain clinics throughout the world, and we perform many of these especially those on spinne ( for back pains ) with X ray guidance (Fluoroscopy guidance) in order to improve the accuracy and efficiency of these sophisticated procedures. However now we are replacing X -ray with ultrasound so as to avoid radiation risks for the patient as well as personnel

Nerve stimulator guidance: when nerve blocks are done we use a nerve stimulator ( Braun) to see whether we can elicit twitches in the area of pain and then only give the injection of local anaesthetic and steroid combination. Where continuous blocks are performed we use special stimulating catheters ( Arrow ). This is because though the needle lies near a nerve when we pass the catheter the catheter may wander away from the nerve . With a stimulating catheter we make sure that the catheter tip continues to be near the nerves . This we believe is one of the main reasons for our results in continuous catheter techniques. However the skill needed to use these techniques especially placement of stimulating catheters is quite unusual so the experts are rather hard to come by. At ashirvad these are specially trained .

Ultrasound guidance: We have a S- MSKmachine of sonosite which is specially designed for nerve and muscle imaging . We use this to locate the nerves and then place the needle near the nerve. Then we coneect the nerve stimulator to confirm that the nerve we wish to stimulate is indeed being stimulated. In any plexus there are several nerves and localizing the wrong one leadsto a less effective block. With the nerve stimulator we change the position of the needle tip till we get the stimulator of the correct nerve and then only pass the stimulating catheter. This leads to a very high level of accuracy that is needed for the correction of conditions like RSD ( reflex sympathetic dystrophy) or CRPS ( complex regional pain syndrome ).

All these procedures like localization with a ultrasound or C arm ( real time X-ray ) and then further confirmation with nerve stimulator and stimulating catheter may sound time consuming and exacting. They are. But this gives a level of accuracy essential for success. Since this is routine work for us at Ashirvad the time taken is between 20-40 minutes.

We prefer to perform trigeminal ganglion injections with CT guidance as this gives an accuracy of needle placement within 0.8mm of the target. All the trigeminal blocks we have done with CT have been so successful that we have not needed to do RF ablation of the ganglion.

In addition, a number of other interventions may be performed depending upon the need of the individual patient and the particular problem that the patient suffers from.

Deciding on treatment strategies requires a thorough interaction with the patient, and an understanding of disease pathology an understanding of the patient's requirements and needs. These treatment strategies are not used singly- they are part of the treatment package that the patient receives in order to treat and prevent all illness.

• Interventions in Backache
1. Transforaminal Epidural
2. Midline Intralaminar Epidural
3. Facet joint injection
4. Injection into the pars interarticularis for spondylolysis
5. Median branch block for testing the response of the pain to a block so as to predict the efficacy of RF (Radiofrequency ablation) in relieving the patient’s pain
6. Caudal epidural injection
7. Racz Adhesiolysis
8. Lumbar Sympathetic block
9. Discography, Intradiscal injections of ozone (in stringently selected patients)
10. Trigger injections

• Interventions in neck pain
1. Intralaminar midline epidural
2. Cervical facet injection
3. Median branch block
4. Intradiscal procedures
5. Trigger injections

• Interventions in Cancer
1. Sympathetic blocks like stellate ganglion block for head & neck pains, Lumbar sympathetic block for lower limb pains
2. Regional blocks like celiac plexus block for pain of abdominal cancer , hypogastricor ganglion impar block for pelvic cancer pain
3. Neurolytic procedures to kill the pain producing nerve
4. Radiofrequency ablation burn the pain producing nerve

• Interventions for joint pains
1. Intraarticular injections ( these are sparingly used)
2. Nerve blocks around the joints ( very useful for knee and shoulder pains )

These are some of the commonly performed procedures. For more detai, please lscontact us

INTRAMUSCULAR STIMULATION or DRY NEEDLING

A significant component of all pains is musculoskeletal, and these treatment modalities address

musculoskeletal and neuropathic pains effectively, and perform a wonderful primary role and/or accessory role in treating many pain conditions.

PHYSICAL THERAPY

Physical therapy at Ashirvad pain relief clinic is patient specific, and treatment protocols are designed for each patient after a thorough consultation and work up. In general, stretching exercises are preferred to achieve pain relief and later during the rehabilitation phase strengthening exercises are used. Treatment is provided under the same roof, and patients may attend follow up and physical therapy in the same area without having to make separate visits to different places. A lot of novel therapies are used at Ashirvad pain clinic, in order to achieve the best results for the patients.

BOTOX

Once we realized that muscles are the major generator of pain and that IMS achieved great success in these pains, use of BOTOX was but a short step away but here again our use of botox is different because it is guided by IMS results. So that we can use the minimum necessary dose into the muscles where it is needed most. This insight is only possible with extensive experience of IMS. Botox however is expensive MRP-16500 per vial and many pain conditions may need upto three vials. So we try to minimize the amount of Botox by using IMS to cover the areas that do not get Botox. Botox effect is expected to last (6) month but IMS prolongs this ad makes it permanent. Botox is very useful when patients can’t tolerate IMS or are from outside Bombay or India so that we have to achieve more in a short time. When pain is so severe that is a kinder to start with botox to bring down the pain level so that IMS can maintain the pain relief.

YOGA

The ancient practice of Yoga benefits all systems of the body. It addresses the spiritual, physical and mental aspects of one’s well being. Yoga is promoted as a way of life, and advice is given regarding incorporating these practices in day to day life in order to attain perfect health. SPefic asanas and mudras are taught for specific pains . when the patient needs it pranayamaand stress management are taught .

ACUPUNTURE

Acupuncture is a useful treatment modality that can be used to treat numerous conditions. It's role in Pain management is being explored worldwide, and we use it as a useful treatment technique to reduce stress, anxiety and treat certain patients and at certain times. It is particularly useful in migraine, atypical facial pains , trigeminal neuralgia etc. It is also very useful in treating certain non painful conditions like parkinsonism. Blindness frommacular degewnertation , Bell’s palsy ( facial paralysis) where the problem can be reversed with in a few days compared to the untreated patients who require months to years to return to normal.

MEDICATIONS

Medications can be a useful adjunct in different pain conditions. They act as a crutch to tide over painful crises, and many times they help in reducing the pains to bearable levels to allow the blocks and IMS to take effect. Once pain relief has been achieved, medications help in the pains that come on as the patient activities are increased for successful rehabilitation. Recent developments in pharmacology and drug delivery like the transdermal patches, intranasally delivered drugs, fentanyl lollipops etc have provided pain clinicians with important tools that reduce the side effects and help in improving the success of treatment strategies.

DIETARY ADVICE

In the last few years we have found that deficiency of vitamin B-12 plays a very significant role in pain production. Estimation of this and subsequent correction to beyond what is considerd “NORMAL” helps in pain relief.

Calcium, magnesium, and copper are major ions in the muscle metabolism advice regarding the adjustment of intake of these makes major difference to pain relief in patients. Effects of Tobacco chewing, intake of aspartame etc; on pain are clarified and emphasized.

Condition where we have achieved astounding success with our combination of nerve blocks with IMS and physical therapy.

1. Low Back Pain – from Discs, Facets, Mechaical back pain spondylitis. Operated back with no relief of pain.
2. Neck Pain – Frozen shoulder, Tennis elbow.
3. RSD – CRPS.
4. Post Stroke Pains.
5. Osteoarthritis of knee – where it is decided not to have surgery because surgeon thinks the problem is too early or for medical reasons.
6. Interstiatial cystitis, chronic prostatitis, chronic pelvic pains, Pain during intercourse.
7. Chronic Abdominal Pains.
8. Cancer Pains.
9. Herpes zoster and Post herpatic neuralgia.
10. Fracture ribs.
11. Pain Persisting after knee and back surgery or coming on after hernia surgery
12. Miscellaneous pains where patients had lost hopes

STRESS MANAGEMENT

with acupuncture and Yoga and Pranayama
Modern life is full of unpredictable stressors, and individual coping strategies help in reducing the effects of stress on the physical quality of life. Our stress busters’ help in reducing a significant mental component- the apprehension, anxiety and worries associated with chronic pains. The patient learns to help himself with these modalities. A good example is migraine where the patients are taught to do certain types of pranayama as well as apply press needles (of 1mm) to the stress points to abort the attack

EXPERT REFERRAL

Every patient affords a unique clinical challenge. Many times, patients need adequate counselling and referral to an expert from a different specialty in order to complete the treatment cycle and deliver the best quality of care to the patient. At Ashirvad, referrals are made with an understanding that the treatment should be directed to the patient, who receives best possible care in addition to pain management modalities