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Prolotherpy (PRP or 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)
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 :     1.Socially and Economically productive life 2.Patient compliance to treamtent  3.Aim for pain score of less than 4/10.  Drawbacks are: 1. Cancer Pain is one of the most diverse type of pain 2. Pain intensity poorly correlate with stage of Cancer  Treatment of pain is under two methods :  1. Pharmacotherapy  The disadvantages are:  1.Irregular followup by patient  2.Strict Opioid regulation by law  3.Cost   4.Side effects  2.Interventional Pain Management  The advantages are:  1.Effectively breaks the pain cycle 2. Treats the peripheral and central sentisization  3.Decreases the side effects 4. Single visit treamtent 5. Longer duration of pain relief 6. Inexpensive (cost effective) 7.Repeated visits are not required 8.Prolonged hospital stay is not required   9.Patient can stay at home pain free  For consultancy and further details, please call or write us: Dr. Ravi khatri Pain Physician  M: +91-9414245172 Email: ravikhatri7200@gmail.com You may also visit our facebook page. 
Endoscopic discectomy A young patient, M/28 ; had a severe radiating pain in right lower limb while walking. He used to feel discomfort while walking for even short distance/s like 100 mtr.or so. He used to feel excruciating pain in lower limb . His VAS score was 9 and SLR was 30°in right side . During proper examination of SPINE and in MRI findings, we diagonsed the problem of L4_5 Disc prolapse with Lateral CANAL Stenosis of right side. We did his ENDOSCOPIC DISCECTOMY ( Sutureless Spine Surgery) of rt.L4_5 level . The patient got immediate relief on the operation table only. Just after the surgery, on OT Table only; the patient SLR turned 90°. He himself moved out from the OT after the surgery done. The main advantage of this surgery is that no need of applying General Anesthesia to the patient/s , infact, patient himself can detail us, during the surgery ; about his clinical condition. Secondly, no need of cuting down any muscle or bone. The patient can get the discharge on the same day from the hospital. Significantly , no need of undergoing strict bed rest after the surgery. The patients suffering from Low Back Pain or Spine Pain or related issues can visit or contact us for consultancy and treatment. We, Dard the Ortho and Cancer Pain Management Centre, under the umbrella of Royal Orthopaedic Hospital and Sports'Injury Centre, Jaipur.
TRIGEMINAL NEURALGIA Trigeminal neuralgia is one of the most intense pains a person can experience. Trigeminal neuralgia is a nerve disorder of the face. It causes abrupt, searing facial pain, especially in the lower face and jaw and around the nose, ears, eyes, or lips. Also known as tic douloureaux, it is thought to be one of the most painful human conditions. Neuralgia refers to severe pain along the course of a nerve, due to nerve irritation or damage. Trigeminal neuralgia affects the trigeminal nerve, one of the most wide-reaching nerves in the head. What is trigeminal neuralgia?SymptomsCausesDiagnosisTreatmentPrevention Fast facts on trigeminal neuralgia Trigeminal neuralgia is an extremely painful condition that affects the facial, or trigeminal, nerve.The pain will usually be severe and occur on one side of the face.Trigeminal neuralgia is often caused by blood vessels applying pressure to the root of the trigeminal nerve.It is treated with anticonvulsant medication or a range of surgeries. What is trigeminal neuralgia? Trigeminal neuralgia is a type of non-nociceptive pain. Pain can be nociceptive and non-nociceptive. Nociceptive pain happens when an external stimulus triggers specific pain receptors in the nervous system, for example, the pain caused by a burn.Non-nociceptive pain results from damage or irritation to the nerves or a fault in the nervous system. The nerves themselves are sending pain messages to the brain. Neuralgia is a type of non-nociceptive pain, and trigeminal neuralgia is non-nociceptive pain caused by the trigeminal or 5th cranial nerve in the face. People with neuralgia describe it as a short-lived but intense burning or stabbing pain. It may feel as if the pain is shooting along the course of the affected nerve. Although the pain is brief, trigeminal neuralgia is a chronic condition, which gets worse in time. Bouts of pain can last a few minutes, usually on one side of the face. Trigeminal neuralgia is twice as common in women than men, and it is more likely after the age of 50 years. Symptoms One or more of the following symptoms may occur: intermittent twinges of mild pain lasting from a few seconds to several minutessevere episodes of searing, shooting, jabbing pain that feel like electric shockssudden attacks of pain triggered by stimuli that are usually not painful, such as by touching the face, chewing, speaking, or brushing the teethspasms of pain which last from a couple of seconds to a couple of minutesepisodes of cluster attacks, which may last much longer, but between them, there may be no painpain wherever the trigeminal nerve and its branches may reach, including the forehead, eyes, lips, gums, teeth, jaw, and cheekpain in one side of the face, or, less frequently, both sidespain that is focused in one spot or spreads in a wider patternattacks of pain that occur more regularly and intensely over timetingling or numbness in the face before pain develops Attacks of pain may occur hundreds of times each day in severe cases. Some patients may have no symptoms for months or years between attacks. Some patients will have specific points on their face that trigger pain when if touched. Area of pain The area of pain will be based on the three branches of the trigeminal nerve: Ophthalmic: Affects the forehead, nose, and eyesMaxillary: Affects the lower eyelid, side of nose, cheek, gum, lip, and upper teethMandibular: Affects the jaw, lower teeth, gum, and lower lip Trigeminal neuralgia sometimes affects more than one branch at a time. Atypical trigeminal neuralgia Atypical trigeminal neuralgia is a variation on typical trigeminal neuralgia. Pain may be described as burning, aching, or cramping, rather than sharp or stabbing. It may occur on one side of the face, often in the region of the trigeminal nerve, and can extend into the upper neck or the back of the scalp. The pain can fluctuate in intensity from a mild ache to a crushing or burning sensation. The atypical presentation of trigeminal neuralgia is harder to diagnose. Causes The main cause of trigeminal neuralgia is blood vessels pressing on the root of the trigeminal nerve. This makes the nerve transmit pain signals that are experienced as stabbing pains. Pressure on this nerve may also be caused by a tumor or multiple sclerosis (MS). Other causes may include: Multiple sclerosis: This is due to demyelinization of the nerve. Trigeminal neuralgia typically appears in the advanced stages of multiple sclerosis.A tumor presses against the trigeminal nerve: This is a rare cause.Physical damage to the nerve: This could be the result of injury, a dental or surgical procedure, or infection.Family history: The formation of blood vessels is inherited. Demyelination: Causes, symptoms, and treatments Demyelinization of a nerve can lead to severe pain, but what is it and what causes it? Click here to learn more. READ NOW Sometimes the cause remains unknown. Diagnosis If an individual's symptoms indicate trigeminal neuralgia, a doctor will examine their face to determine the affected areas. A magnetic resonance imaging (MRI) scan may help eliminate other conditions with similar symptoms, such as tooth decay, a tumor, or sinusitis. However, an MRI is unlikely to show the exact cause of nerve irritation. Treatment The main treatments for trigeminal neuralgia involve prescribed medications and surgery. Medications Medications are available to treat trigeminal neuralgia, but these may become less effective over time. There is also a risk of undesirable side effects. In these cases, surgery may be the best option. Anticonvulsants Painkillers, such as paracetamol, will not relieve the pain of trigeminal neuralgia. Doctors, therefore, prescribe anticonvulsant medication. These are normally used to prevent seizures, but they can also reduce or block the pain signals sent to the brain. They do this by calming the nerve impulses. The most common anticonvulsants for trigeminal neuralgia are: carbamazepine (Tegretol, Carbatrol, Epitol)phenytoin (Dilantin)gabapentin (Neurontin)topiramate (Topamax)valproic acid (Depakene, Depakote)lamotrigine (Lamictal) Sometimes the anticonvulsant loses its effectiveness over time. If this happens, the doctor might increase the dosage or switch to another anticonvulsant. Side effects of anticonvulsants include: dizzinessconfusiondrowsinessvision problemsnauseasuicidal thoughts Make sure that you are not allergic to these medications, and consult with your doctor about any allergies. Antispasticity agents Baclofen is a muscle-relaxing agent. It can be prescribed alone or combined with anticonvulsants. Adverse effects include nausea, drowsiness, and confusion. Alcohol injection This numbs the affected areas of the face and provides temporary pain relief. The doctor injects alcohol into the painful part of the face. The patient may require either further injections or a more permanent solution later on. Surgery Surgery for trigeminal neuralgia aims to: stop a vein or artery from pressing against the trigeminal nervedamage the trigeminal nerve so that the uncontrolled pain signals stop Damaging the nerve may lead to temporary or permanent facial numbness. Surgery can provide relief, but symptoms may return months or years later. There are a number of surgical options for trigeminal neuralgia. Microvascular decompression Microvascular decompression (MVD) involves relocating or removing the blood vessel that is pressing on the root of the trigeminal nerve. MVD can be effective at eliminating or reducing pain, but sometimes the pain returns. There is also a small risk of some hearing loss, facial weakness, facial numbness, and double vision. The procedure carries a very small risk of stroke and fatality. Percutaneous glycerol rhizotomy Most people experience significant pain relief with PGR, but pain may recur later. Many patients experience facial tingling or numbness. Percutaneous balloon compression of the trigeminal nerve The procedure is effective, but the pain may return. Most patients experience some facial numbness and over half experience temporary or permanent weakness of the muscles used for chewing. Percutaneous stereotactic radiofrequency thermal rhizotomy This procedure uses electrical currents to destroy specifically selected nerve fibers linked to pain. An electrode is attached to the nerve root under sedation. The patient is woken from sedation to identify whether they can feel the electrical pulses and put back under while the electrodes heat up and destroy the nerve. Most patients undergoing PSRTR will experience some facial numbness afterward. Partial sensory rhizotomy The doctor makes a small hole in the skull and severs the nerve. As the base of the nerve is severed, the patient will have permanent facial numbness. Sometimes the doctor rubs the nerve instead of severing it. Gamma-knife radiosurgery A high dose of radiation is aimed at the root of the trigeminal nerve, gradually resulting in nerve damage and pain reduction. The patient will experience slowly improving pain relief over several weeks. Initial benefits may take several weeks to appear. GKR is effective for most patients. However, some may experience a recurrence of pain later on. Prevention There are no guidelines for preventing the development of trigeminal neuralgia. However, the following steps may help prevent attacks once diagnosed: eating soft foodsavoiding foods that are too cold or hotwashing your face with lukewarm waterusing cotton pads when washing your faceif tooth brushing triggers an attack, rinsing your mouth with lukewarm water after eatingas far as possible, avoiding known triggers Trigeminal neuralgia can be debilitating, but managing the symptoms can drastically improve the quality of life.
Tennis Elbow(Lateral Epicondylitis) is common in players & person who done regular twisting movement of forearm. It is a over use syndrome of extensor of forearm musle. There is inflammationof origin of extensor. main TREATMENT of this Tennis elbow is rest, ice and analgesic. Physiotherapy is second option. Prolotherapy (PRP)is latest & evidence based best treatment. In this repeated 2 to 3 PRP therapy session given with 4 week interval.PRP Therapy is far far better than Steroid inj.B/C this therapy has no side effect.
Pain in Cancer is most distressing symptom. Patient is mainly afraid by pain in Cancer not by itself Cancer. Routinely Medical Treatment is sufficient for pain Management. But in Latest Recommendation Interventional Pain Management is best for Pain Managment in Cancer.Main benefit of this we can bypass the side effect of Medicine & get immediate relief and we can improve patient life.
ENDOSCOPIC DISCECTOMY is Sutureless Spine Surgery for SLIPPED DISC, Annular Tear , Prolapse Disc. Main benefits of this Procedure is that no need of General Anaesthesia, no Blood loss and not required long admission for Hospital.
CANCER PAIN is worst symptom in Cancer patients. Many patients were mainly afraid to pain in Cancer. Recent advance in medical says that PAIN is as early as possible manage in Cancer patients. In this medical Managment and interventional PAIN MANAGEMENT are two basic things.we suggest interventional pain management on priority because it increases the quality and social life if patients.
Astonishing Result of Radio Frequency Ablation in Spine Pain A patient, M/64, had a complain of low back pain with radiating pain in lower limb from a long time, say around 2 to 3 yrs. Elevated back pain at the time of backward banding and sleeping was his real concern. Elevation of Radiating pain at the time of walking was also troubling him. MRI of l/s spine shows Diffused Slipped Disc at level of L4_5. At every centre/hospital (wherever he approached) , he was provided with treatment of slipped disc ; as MRI shows disc bulge in L4_5. Consequently, he couldn't get proper benefit . Auspiciously, after everything he consulted us at our Centre. During proper examination of his back, we found that he was mainly suffering from FACET SYNDROME of L4_5 and L5_S1 level. Firstly, we confirmed our diagnosis by diagnostic block of facet syndrome. And, thereafter treated it by RADIO FREQUENCY ABLATION of Facet Joints. Now patient is completely pain free from his back pain and radiculopathy in lower limb. In such type of patients, esp. with low back pain which radiating to lower limb is not always due to slipped disc. A prudent examination of Spine is vital for diagnose; Not just on the basis of MRI findings. MRI is only beneficial in our diagnosis it's not confirmatory .
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