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Platelet-Rich Plasma for Frozen Shoulder INR 0 INR 0
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Platelet-Rich Plasma for Frozen Shoulder

Frozen shoulder is a glenohumeral joint disorder that movement because of adhesion and the existence of fibrosis in the shoulder capsule. Platelet-rich plasma can produce collagen and growth factors, which increases stem cells and consequently enhances the healing. To date, there is no evidence regarding the effectiveness of platelet-rich plasma in frozen shoulder. A 45-year-old man with shoulder adhesive capsulitis volunteered for this treatment. He underwent two consecutive platelet-rich plasma injections at the seventh and eighth month after initiation of symptoms. We measured pain, function, ROM by the visual analogue scale (VAS), scores from the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and goniometer; respectively. After first injection, the patient reported 60% improvement regarding diurnal shoulder pain, and no night pain. Also, two-fold improvement for ROM and more than 70% improvement for function were reported. This study suggests the use of platelet-rich plasma in frozen shoulder to be tested in randomized trials. Keywords: Disability, Frozen shoulder, Pain, Platelet-rich plasma, Range of motion Introduction Frozen shoulder (FS) is a common disease that causes significant morbidity (1). The term frozen shoulder was first described in 1934 by Codman (2). Frozen shoulder affects the glenohumeral (GH) joint and limits active and passive movement because of adhesion and fibrosis in the GH capsule, which decreases joint space (3). Frozen shoulder is thought to have an incidence of 3-5% in the general population (4). The prevalence of FS in diabetic patients has been reported between 10-20% (5). No difference was found regarding the level of pain and disability of FS patients with or without diabetes (6). Although this disorder has a benign period and physicians think that this kind of disease improves after two or three years, in some cases disease symptoms and signs are permanent for patients. To the best of our knowledge, up to 40% of patients have permanent symptoms after three years (7, 8). Accurate diagnosis is of particular importance because the treatment approaches for these separate entities (subgroups) are different. Recent studies showed that magnetic resonance imaging (MRI) might provide reliable imaging indicators of FS. MRI is a satisfactory method for coracohumeral ligament (CHL) depiction so that a thickened CHL is highly suggestive of FS (9). Non-surgical treatment has been demonstrated to be beneficial for a great majority of patients with FS. The first treatment option for the recovery of these patients is rehabilitation. Passive mobilization and capsular stretching are two of the most commonly used techniques (1). Furthermore, corticosteroid injections might be the reason for long-term clinical problems such as increased probability of rupture, post-injection pain, subcutaneous atrophy and skin depigmentation (10). Platelet-rich plasma (PRP) is an autogenous concentration of human platelets in a small volume of plasma. Platelet-rich plasma development via centrifugation has been greatly simplified so that it can be used in office settings as well as operating rooms (11). The use of PRP has increased, given its safety as well as the availability of new devices for outpatient preparation and delivery (12). Platelet-rich plasma can produce collagen and growth factors and might increase stem cells, which consequently enhances the healing process by delivering high concentrations of alpha-granules containing biologically active moieties (such as vascular endothelial growth factor and transforming growth factor-β) to the areas of soft tissue damage (13). As this method has good results in the repair of tendons, muscles and ligaments and even fractures; and because there is no evidence of complications related to PRP injections and since we are not aware of the efficacy of the PRP injection on FS, we used PRP on a patient with FS.

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Slipped (Prolapsed) Disc Treatment INR 0 INR 0
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Slipped (Prolapsed) Disc Treatment

A 'slipped' (prolapsed) disc often causes severe lower back pain. The disc often presses on a nerve root which can cause pain and other symptoms in a leg. In most cases, the symptoms ease off gradually over several weeks. The usual advice is to do normal activities as much as possible. Painkillers may help. Physical treatments such as spinal manipulation may also help. Surgery may be an option if The spine is made up of many bones called vertebrae. These are roughly circular and between each vertebra is a disc. The discs are made of strong rubber-like tissue which allows the spine to be fairly flexible. A disc has a stronger fibrous outer part and a softer jelly-like middle part called the nucleus pulposus. The spinal cord, which contains the nerves that come from the brain, is protected by the spine. Nerves from the spinal cord come out from between the vertebrae to relay messages to and from various parts of the body. Strong ligaments attach to the vertebrae. These give extra support and strength to the spine. Various muscles also surround, and are attached to, various parts of the spine. (The muscles and ligaments are not shown in the diagram below, for clarity.) Note: this leaflet is about a 'slipped' (prolapsed) disc in the lower back (the lumbar spine). There is a separate leaflet about disc problems in the neck, called Cervical Spondylosis.

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Vertebroplasty Procedure INR 0 INR 0
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Vertebroplasty Procedure

The goals of the vertebroplasty surgical procedure are to stabilize the spinal fracture and to stop the pain caused by the fracture. Vertebroplasty is considered a minimally invasive surgical procedure because the procedure is done through a small puncture in the patient's skin (as opposed to an open incision). A typical vertebroplasty procedure, described below, usually takes about 1 hour to complete. The patient is treated with local anesthesia and light sedation, usually in an x-ray suite or operating room on an outpatient basis. A biopsy needle is guided into the fractured vertebra under X-ray guidance through a small puncture in the patient's skin. (Figure 2) Specially formulated acrylic bone cement is injected under pressure directly into the fractured vertebra, filling the spaces within the bone - with the goal of creating a type of internal cast (a cast within the vertebra) to stabilize the vertebral bone. (Figure 3) The needle is removed and the cement hardens quickly (about 10 minutes), congealing the fragments of the fractured vertebra and stabilizing the bone. (Figure 4) The small skin puncture is covered with a bandage. Shortly after the cement has hardened, the patient is free to leave the medical facility and can go home the same day. Patients are usually advised not to drive themselves home the day of the procedure, and may need to spend the night at a hotel in the area if they have to travel a long distance. If the patient needs further observation after the procedure, is particularly frail, or will not have assistance at home, a short stay in the hospital may be recommended. Recovery from Vertebroplasty Vertebroplasty Video Vertebroplasty Video For the first 24 hours after vertebroplasty, bedrest is usually recommended. Activities may be increased gradually and most regular medications can be resumed. There may be some soreness for a few days at the puncture site which may be relieved with an ice pack. Many patients undergoing percutaneous vertebroplasty experience 90 percent or better reduction in pain within 24-48 hours and increased ability to perform daily activities shortly thereafter.6,7,8 Recent research has demonstrated that percutaneous vertebroplasty can relieve pain from vertebral compression fractures for up to nearly three years following the procedure.8,9 Vertebroplasty Providers Specialists who perform percutaneous vertebroplasty include interventional neuroradiologists, radiologists, pain management physicians, neurosurgeons, and orthopedic spine surgeons. Credentialing requirements for percutaneous vertebroplasty include training in fluoroscopically guided needle placement. In addition, a physician must be educated on acrylic bone cement preparation, cement delivery system set up and the safe delivery of cement into the vertebral body. Vertebroplasty training must include patient selection criteria and patient care protocols. Potential Risks and Complications of Vertebroplasty

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Lumbar & Cervical Radiofrequency Ablation/Lesioning INR 0 INR 0
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Lumbar & Cervical Radiofrequency Ablation/Lesioning

What is Radiofrequency? Lumbar & cervical radiofrequency ablation procedure.Radiofrequency waves are electromagnetic waves which travel at the speed of light, or 186,000 miles per second (300,000 km/s). Radiofrequency Energy is a type of heat energy that is created by a special generator at very high or super high frequencies. With the use of this specialized generator, heat energy is created and delivered with precision to target nerves that carry pain impulses. The resulting “lesion”involves a spherical area of tissue destruction at the tip of the RF needle that can include pain-carrying nerves. Why is this procedure done? Radiofrequency ablation/lesioning is a procedure used to provide longer term pain relief than that provided by simple injections or nerve blocks. Many patients who are being considered for this procedure have already undergone simple injection techniques like Epidural Steroid Injection, Facet Joint Injection, Sympathetic Nerve Blocks, or other nerve blocks with pain relief that is less prolonged than desired. By selectively destroying nerves that carry pain impulses, the painful structure can be effectively denervated and the pain reduced or eliminated for anywhere from a few months to up to 12 months. How is this procedure done? Once a structure has been determined to be a pain generator, its nerve supply is targeted for interruption. A small insulated needle or RF cannula is positioned next to these nerves with fluoroscopic guidance (live video X-Ray). Your doctor knows where to place the RF cannula because he is an expert in anatomy. The shaft of this cannula except for the last 5 to 10 mm is covered with a protective insulation so that the electric current only passes into the surrounding tissues from the very tip of the cannula. When the cannula appears to be in good position, the doctor may perform a test and release a small amount of electric current through the needle tip at two different frequencies. This test helps to confirm that the cannula tip is in close proximity to the target nerve and that it is not near any other nerve. After a successful test confirms good cannula tip position, a local anesthetic is injected to numb the area. The RF generator is then used to heat the cannula tip for up to 90 seconds, and thus the target nerve is destroyed. What types of conditions will respond to Radiofrequency Lesioning?Radiofrequency treatments for chronic pain. There are a multitude of chronic pain conditions that respond well to this treatment. Chronic spinal pain, including spinal arthritis (spondylosis), post-traumatic pain (whiplash), pain after spine surgery, and other spinal pain conditions are those most commonly treated with RFL. Other conditions that are known to respond well to RFL include some neuropathic pain conditions like Complex Regional Pain Syndrome (CRPS or RSD), peripheral nerve entrapment syndromes, and other assorted chronic pain conditions. A patient’s candidacy for RFL is usually determined by the performance of a Diagnostic Nerve Block. This procedure will help to confirm whether a patient’s pain improves just for the duration of the local anesthetic (or not). Patients who have little to no pain relief after a diagnostic nerve block are not candidates for a neurodestructive procedure like RF Lesioning. Does the procedure hurt? This procedure is no more painful than any other injection procedure that is performed in interventional pain management. Patients are often given mild intravenous sedation during the procedure, but sedation is not absolutely required. Deep sedation is not a safe alternative and is therefore not offered for my RF procedures. It is quite common for neck or back pain to increase for a few days or longer after the RFL procedure before it starts to improve. What should I do to prepare for my procedure? On the day of your injection, you should not have anything to eat or drink for at least eight (8) hours before your scheduled procedure. If you are scheduled to receive sedation during the procedure, you must have someone available to drive you home. If you usually take medication for high blood pressure or any kind of heart condition, it is very important that you take this medication at the usual time with a sip of water before your procedure. If you are taking any type of medication that can thin the blood and cause excessive bleeding, you should discuss with your doctors whether to discontinue this medication prior to the procedure. These anticoagulant meds are usually prescribed to protect a patient against stroke, heart attack, or other vascular occlusion event. Therefore the decision to discontinue one of these medications is not made by the pain management physician but rather by the primary care or specialty physician (cardiologist) who prescribes and manages that medication. Examples of medications that could promote surgical bleeding include Coumadin, Plavix, Aggrenox, Pletal, Ticlid, and Lovenox. What should I do after my procedure? Discharge suggestions following procedures, Dallas Texas. Following discharge home, you should plan on simple rest and relaxation. If you have pain at the needle puncture sites, application of an ice pack to this area should be helpful. If you receive intravenous sedation, you should not drive a car until the next day. Patients are generally advised to go home and not return to work after this type of procedure. Some patients do return to work the next day. Could there be side effects or complications? Dr. Khatri will discuss these issues with you, and you will be asked to carefully read and sign a consent form before any procedure is performed. Can this procedure be repeated if my pain returns? It is possible for the treated nerve(s) to regenerate, which could lead to recurrent pain. However, RF Lesioning is repeatable for nerve regeneration if it worked the first time around.

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Prolotherapy (PRP & Regenerative Therapy) INR 0 INR 0
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Prolotherapy (PRP & Regenerative Therapy)

Over a last few years,PRP is one of the treatment modalities which is getting worldwide recognition.This is a boon for the patients who are suffering from knee joint pain but want to avoid the knee joint replacement surgery. Prolotherpy is a treatment that stimulates that diseased body part to heal or repair the painful area. In this, proliferant substance inject into the injured tissue. The benefit of the prolotherpy is that it stimulates the fibroblast to produce collagen and also stimulates and releases the growth factor in that particular area of injection which promotes the cartilage repair and ligament & tendon repair. This therapy includes Ozone and Dextrose & Platelates Rich Plasma(PRP).PRP is prepared by patient's own blood and seperates the growth factor and Platelates from blood and reinject in the required area. Main advantage of this PRP and Prolotherpy is that there is no serious side effects.Routinely 2 to 3 times therapy is necessary for each patient where the interval between two therapies is around 4-6weeks. Advantages: 1.Almost no side effects 2.Very effective in chronic pain or injuries 3.Natural way of healing 4.Cost effective therapy than stem cell therapy and Sahaj therapy. Where it works effectively: 1. In degenerative diseases like Osteoarthritis knee /ankle/shoulder/elbow ,low back pain, neck pain and sacroiliac joint pain, etc. 2.In ligament or tendon injuries eg.. Heal pain, tennis elbow, golfer's elbow, plantar fascitis, ankle sprain(acute and chronic ) 3.In muscle sprains eg. Supraspinatus tendinitis(shoulder impigment syndrome), bursitis, rotator cuff tear and retrocalcaneal bursitis. 4. In all type of sports'injuries. For more inquries and consultancy, please feel free to contact Dr. Ravi Khatri Pain Physician Mobile - 91-9414245172 Email - ravikhatri7200@gmail.com At DARD The Ortho & Cancer Pain Management Centre Jaipur (Rajasthan)

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Neck Pain Treatment INR 0 INR 0
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Neck Pain Treatment

Neck pain is the 2nd most common pain after Low Back Pain. The frequency of Neck Pain is increased due to bad postures or job profile eg computer work or over the head works. Neck pain is most common in Adult population between 21 to 55 years of age. It is 15% in male and 25% in female. Causes: Other then Trauma, Tumor and Infection are the various causes of Neck Pain. A. Cervical Spine Facet Joint Arthropathy Internal Disc Disruption Prolapsed Disc (Slipped) Cervical Radiculapathy Fracture Interspinous Ligament Sprian B. Myofascial Pain Syndrome(MFS) Trapezius MFS (most common) Sternocleidomastoid MFS Occipitalis MFS C. Spondyloarthropathies Degenerative Rheumatoid Ankylosing Treatment Acute Neck Pain : It has a favorable outcome. Almost 40% of patients get full recovery but in 30% a mild symptome persists. Infact analysis shows that "wait nd see" policy is best art for the treamtent of Acute Neck Pain. Pharmatherapy: Analgesic and muscle relaxant or opioid are best in treatment in initial therapy. Non Pharma Therapy: Staying active helps in speeding the recovery as compared to use cervical collar and rest. Strengthening and stretching exercise promote an increased range of motion and elasticity in neck muscle. Chronic Neck Pain: (Pain more than 3 months) Chronic neck pain merely respond to conservative treatment. So invasive treatment like Percutaneous Interventions are recommended. 1. Medial branch block for facet joint pain. 2. Cervical Epidural Steroid For Cervical Radicular pain. 3.Intervention for Myofascial Pain. Trigger points and taut band are treated by local anaesthetic injections or steroid injection. Dry needling or intramuscular stimulation is used for chronic case of muscle spasm and stiffness of neck muscle. 4.Advance treatment : Radiofrequency Denervation of facet joints Vertebroplasty Spinal cord stimulation Some Myths : 1. MRI is not advisable in all the cases of neck pain because it is not diagnostic in all cases. 2. Normal MRI of Neck doesn't mean that pain is not real. 3. Complete rest doesn't give any extra benefit in neck pain. 4. Use of cervical collar is not helpful,infact, it is harmful for neck muscle. 5.Cervical Traction is not helpful,infact, it is harmful for neck pain.

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Cancer Pain Treatment INR 0 INR 0
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Cancer Pain Treatment

Cancer Pain Management Cancer Pain " I am afraid not of Cancer but Pain" This phrase is frequently heard with cancer pain. Pain is one of the most common and depressing symptoms in Cancer. Cancer Pain is multifactorial and multidirectional in nature. It effects the relationship with the physical, psychological,spiritual and social functioning of the patient so cancer pain includes all these terms and it is called Total Pain. Main aim of treatment of Cancer Pain : Socially and Economically productive life Patient compliance to treamtent Aim for pain score of less than 4/10. Drawbacks are: Cancer Pain is one of the most diverse type of pain Pain intensity poorly correlate with stage of Cancer Treatment of pain is under two methods : 1. Pharmacotherapy The disadvantages are: Irregular followup by patient Strict Opioid regulation by law Cost Side effects 2. Interventional Pain Management The advantages are: Effectively breaks the pain cycle Treats the peripheral and central sentisization Decreases the side effects Single visit treamtent Longer duration of pain relief Inexpensive (cost effective) Repeated visits are not required Prolonged hospital stay is not required Patient can stay at home pain free

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BACK PAIN TREATMENT INR 0 INR 0
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BACK PAIN TREATMENT

Low back pain is most common and neck pain is the 2nd most common pain in the spine pain. 1. LBP is a pain between Lowest Back to Buttocks.Sometimes ,it is associated with radiation of pain in lower limb. 2. LBP is acute when it is less than 6weeks, Subacute when it is between 6-12weeks and chronic when it is more than 12weeks. 3. LBP arises from many parts from back like : Slipped Disc, facet joints, SI joints, muscular pain, interspinious ligament pain or lumber canal stenosis pain. 4. In the present scenario, LBP treatment is very much an art of the Doctor because the vital part of it is the Diagnosis from where the pain is generating. Treatment of LBP : 1.Conservative: Medicine, Physiotherapy, Exercise and physical therapy (most important of all) 2. Interventional: * Facet joint pain - Radiofrequency ablation or Cortison Therapy. * SI Joint - Radiofrequency ablation or Cortison Therapy. * Disc Pain - Epidural or Rami Communicating block. *Slipped Disc- Percutaneous Dissectomy, Percutaneous Neucleotomy by Ozone or Endoscopic Dissectomy. This is better and advance therapy in present, because no need of stay in hospital for long and also it is a bloodless procedure. *Muscular Pain - Physiotherapy and dry needling in Cortison and Lazer Therapy. Latest Facts about LBP: # Poor correlation between LBP and MRI findings.Most common is 50% MRI shows Slipped Disc but patient have no pain whereas 50%MRI don't show Slipped Disc but patient have Disc Pain. # Spondylsis is not a cause of LBP but it is a radiological finding,it is not clinical. The most common cause of LBP in elders is Facet Arthropathy and SI Joint Pain whereas in young it is Internal Disc Disruption. # Prolonged Bed Rest and Restriction from any work in LBP is not indicated nowadays. # L/S belt and brace are no more recommended. # Surgery is not always indicated in Slipped Disc with LBP. Need of surgery is only indicated if slipped disc is present with defficit or tumor or infection. At present, minimaly, invasive Percutaneous Procedure like Lumber Transforminal, Lumber Interlaminal, Caudal Cartison Injection like promising and effective in Treatment of Low Back Pain. 3. Surgical

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