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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.
ENDOSCOPIC DISCECTOMY   (Sutureless & Blood less Pin hole technique for Slipped Disc) ENDOSCOPIC DISSECTOMY and Microdiscectomy If you suffer from Low Back Pain or Sciatica that has failed to respond to conservative treatment, this revolutionary treatment may be an option for you. What is a DISSECTOMY? A Discectomy is a cutting-edge, minimally invasive procedure proven to reduce pain caused by Disc herniations (Sciatica) that are unresponsive to conservative, non-surgical therapy. Also called Microlumbar discectomy (MLD), this is a truly advanced procedure whereby a physician can remove the herniated or protruding portion of an intervertebral disc that is compressing the spinal cord and affecting the nerve root – essentially shrinking an injured or bulging disc, taking pressure off of a painful nerve and reducing pain. A Discectomy is a safe and effective procedure that has been performed on over 100, 000 patients around the world.  Compared to conventional spine surgery, there is less post-operative pain, faster recovery and a quicker return to the activities you love. INDICATIONS: A Discectomy is a minimally invasive procedure indicated for pain that has failed to respond to conservative treatments and therapy (i.e. medication, physical therapy, epidural injections, radiofrequency ablation, etc). Including: 1.Low Back Pain 2.Buttock Pain 3.Sciatica 4.Lumbar Radiculopathy (low back pain that radiates into the leg(s) 5.Discogenic Pain What Are The BENEFITS? This revolutionary procedure has been proven to reduce pain and restore function in patients with Low Back Pain and Sciatica. Because this is a minimally invasive procedure there are a number of BENEFITS : 1.Smaller incisions 2.Smaller, more cosmetically pleasing scars 3.Less pain 4.Decreased postoperative narcotics 5.Reduced operative time 6.Less soft tissue damage, due to reduced muscle retraction 7.Reduced blood loss 8.Less painful surgical incisions that heal faster 9.Faster recovery 10.Less postoperative pain 11.Many times can be performed as an outpatient 12.Quicker return to work and activities More Details How Does It Work? A discectomy is an outpatient procedure that is typically performed in one of three ways: (A)Percutaneous Discectomy – A small percutaneous (through the skin via a needle-puncture) probe is inserted into the disc and a small amount of the center of the disc is removed. (B)Microdiscectomy – A small incision is made in the skin and a special retractor is used to allow your physician to visualize the disc. Once the disc is visible, small instruments are used to shrink the disc under direct visualization. (C)ENDOSCOPIC DISCECTOMY  – A small incision in the skin is made (approximately 1 inch) and then a port is inserted and advanced down onto the disc. Then an endoscope is inserted through the port. This allows your physician to see the disc and surrounding tissue on a large monitor using the camera to transmit images of the disc. Then the procedure is performed by passing instruments through the endoscope to accomplish the same goal as a pair of hands. The light illuminates the area of the procedure and the camera provides surgeons with an inside view, enabling surgical access to the affected area of the spine. When Will I Feel Better? The positive effects of the procedure varies from person to person.  Some patients report pain relief immediately.  As the procedure takes place in 2 parts (the removal of the excess disc material then the cauterization of the damaged disc lining) the healing/pain relief is felt in 2 phases.   There will be some initial pain relief that will take place within the first week after the procedure as a result of the removal of excess disc material causing the disc to bulge or herniate. With the extra material is gone, the pressure on the spine will be relieved somewhat. The second phase of relief is due to the cauterization of the disc lining – this can take up to 6 weeks to fully take effect. Is a Discectomy Right for Me? If traditional treatments and therapies have not provided you relief, a discectomy may be an option. It’s LESS AGGRESSIVE and LESS EXPENSIVE than major surgery. The procedure is minimally invasive by nature and the RECOVERY TIME is drastically SHORTER.   If you are suffering from Chronic Back Pain or Sciatica due to a Disc herniation, contact to Dr.Ravi khatri Pain Physician DARD The Ortho & Cancer Pain managment centre Jaipur Rajasthan today and schedule an appointment . to see if you are a candidate for one of these state of the art treatments. DARD The Ortho & Cancer Pain Managment centre is dedicated to patient care and pain relief. We strive to help patients avoid major surgery, and we are deeply committed to excellence in personal healthcare.
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. 
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)
History of a patient dated June 2017: A patient, F/65yrs;sikar resident suffering from Failure Back Surgery Syndrome (FBSS).10 years back, she was operated for Laminectomy and Dissectomy at Lumber Spine. From last 1.5years, her complaint was pain at Parasurgical area with Muscularplain and Severe Pain and Numbness in both the lower limbs after walk , even for a short distance . Pain used to be relieved only after or if taken rest.she visited numerous of doctors in Jaipur but in vain.Finally she approached us at DARD the Ortho and Cancer Pain Management Centre Jaipur for the same where she was treated with the help of PROLOZONE Therapy and other medicines of pain management. Her VAS Score Pre procedure :8 (severe pain) Post procedure (after 15days):2(mild pain) The patient is fully satisfied and happy with the result.Similarly , many such patients are approaching us taking consultancy and treatments. You or any sufferer u know can visit at our hospital or call us on the mentioned numbers. Pain Physician in Jaipur Dr. Ravi Khatri +91-9414245172
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
H/O patient dated June 2017 : A patient, M/77years , had a complaint of Numbness in his feet from last 7years; including severe low back pain and b/l thigh pain.He was adviced for Spine Surgery at L5-S1 level but he dint go for it. Now, from last 2 years, the severity of the pain got in higher side. While his morning walks, he had to take rest and massage the thighs in every 100-200 mts.MRI reports shows Slipped Disc at L4-5 level and Slipped Disc at L5-S1 level with Facet Joints Arthropathy with Lumber Canal Stenosis. He visited and consulted us at DARD- The Ortho and Cancer Pain Management Centre Jaipur where got his treatment ( Interventional Pain Management). His VAS Score: Before:8. / After :3 Mr.Gupta is completely satisfied and very happy with our medical amenities, treatment and care.His audio review is being uploaded here. We ensure that we will be providing Best Medical Services and Facilities. Please call or visit us for queries, consultancy and treatment. The Pain Physician in Jaipur Dr. Ravi Khatri +91-9414245172 Email - ravikhatri7200@gmail.com Mantra: Be positive towards life.
A patient history dated 7 June 2017 6 month back , some Patient, F/35; had an injury in her calf muscles .Since then, she was suffering from continous severe pain . With the time, it was becoming more severe. No medicines were effecting her properly. She was even unable to sleep at night or take rest in any position. Meanwhile, she consulted many doctors but couldnt get any proper treatment. Thereafter, she visited and consulted us at DARD the Ortho and Cancer Pain Management Centre Jaipur. Here, she is provided with some Intervention and Medicine of Pain Management .She herself found drastic improvement nd Relief and got discharge on the same day.She is advised with physiotherapy and medicines. Her VAS Score : Before : 9 After : 2 She is completely satisfied with the treatment and results. You, if needed, can visit or call us. please take prior appointment to avoid inconvenience. Pain Physician in Jaipur Dr. Ravi Khatri M :+91-9414245172 Email: ravikhatri7200@gmail.com Mantra of Happy Life : Stay Healthy and Fit.
On 17 April 2017, we organised a free camp in Udhyog Bhawan Jaipur, covering Orthopaedics, Sports'Injury and Pain Managment. Approx 250 patients of Low Back Pain, Spine Pain, Sports 'injury, Frozen Shoulder, Neck Pain, Osteoarthritis knee, Cancer Pain, etc visited our camp from various departments like RIICO, PWD, Mines and Geology, RFC, and many more.Free Consultancy, Check ups and physiotherapy been provided to them but it could'nt be a success without thier kind support. We are thankful to all.
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