Quality – Caring – Compassion

Ta ke B a c k

YOUR LIFE

........Bight new hope for people who’ve been living with pain.

Back Pain • Slipped Disc • Discogenic Pain • Degenerated DiscSciatica Pain • Cancer Pain • Shingles Pain • Rheumatic PainJoint Pain • Frozen Shoulder • Neuropathic Pain • NeuralgiasComplex Regional Pain Syndrome • Failed Back Surgery Syndrome

www.ipscindia.com

Mob. 09871985514Email: pankajnsurange@yahoo.co.in

Bhagat Chandra HospitalMahavir EnclaveNear Palam FlyoverDwarka, New Delhi

Mayom HospitalD block, South city-1Main marketGurgaon

If You or someone you know is suffering from:

Contact Us

Artemis Health InstituteSec 51 , GurgaonSaturday: 6 to 8 PM

Columbia Asia HospitalF-block, Palam Vihar, GurgaonSaturday: 10 to 12 AM

Arcus Superspeciality MedicentreSec 4 Market, DwarkaMon-Wed-Fri : 6 to 8 pm

Also Available for Consultation at:

Volume 1, November 2010

Welcome to the first edition of “IPSC INDIA”-quarterly newsletter designed to keep you informed on the latest developments in the field of Interventional pain management.

I am pleased to present the first newsletter on Completion of one year of Pain centre at Bhagat Hospitals. We have successfully performed various pain interventions including Advanced Interventions like Percutaneous discectomy, Vertebroplasty, Decompressive Neuroplasty, ozonucleolysis and Ozone Discectomy with a success rate of more than 80 %.

In the circulation of these articles and case reports, we hope to provide the latest clinical information on many diverse pain conditions.

I am also pleased to Announce the opening of New Branch at Mayom Hospital, south city , Gurgaon.

The contents of this newsletter have come from our achievement in last one year and also in this issue we will be covering Spine Interventional Procedures.

We welcome questions and answers between readers and also welcome contributions and suggestions as to how we may improve on this Newsletter.

Dr. (Maj) Pankaj N SurangeMBBS, MD, FIPP (World Institute of Pain, Hungary)Interventional Pain and Spine Specialist

Quality – Caring – Compassion

Consultant In- ChargeInterventional Pain and Spine Centre

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Interventional Pain Management:New Knowledge, More Choices

The Specialty of “Pain Management” has progressed Significantly in the last 20 years through a better understanding of anatomy and physiology and through advances in pharmacology and technology.

Interventional pain management is a “discipline of medicine devoted to the diagnosis and treatment of pain related disorders by minimally invasive and Target Specific Procedures”

Pain treatment begins with an assessment of the severity of the pain. Commonly, the first steps of treatment are rest, application of cold or heat and intake of OTC (over the counter) medication. The next step in the treatment of pain is a combination of physical therapy and prescribed pain medication. It is important to note that sometimes, interventional pain management needs to be started prior to Physical Therapy in order to stop acute pain (i.e. acute radiculopathy) and allow the patient to comply with necessary exercise. If prescribed pain medication and physical therapy don’t work, the next step is usually interventional pain management, unless the patient has acute loss of function or acute neurological deficit (in which case surgery is needed). If interventional pain management doesn’t alleviate the pain, surgery might be required. However, even after surgery interventional pain management has a very important role in the treatment of patients, especially when all other options are exhausted (eg. “failed back surgery” syndrome).

The goals of interventional pain management are to relieve, reduce, or manage pain and improve a patient’s overall quality of life through minimally invasive techniques specifically designed to diagnose and treat painful conditions. Interventional pain management also strives to help patients return to their everyday activities quickly and without heavy reliance on medications.

We are now able to make a real difference in the lives of our patients, their families and their physicians. We provide a valuable service to society by helping to return disabled patients to a more functional and productive state. We work together with the patients’ physician to promote the best possible outcome

We provide world-class treatment integrating innovative interventions and complimentary therapies to relieve your pain and improve the quality of your life.”

Quality – Caring – Compassion

Most of the Interventional Pain Procedures are done in Local Anesthesia under Fluoroscopy Guidance in Procedure room as Day care (3 to 4 Hours stay).

Usually One to Two Procedures at an interval of 2-4 weeks are required but in Resistant cases additional procedure may be required.Trial procedures are required in Advanced Interventions before placing costly Implants.

Note

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Representation at National and International Level

Quality – Caring – CompassionQuality – Caring – Compassion

AwardedFellow Interventional Pain Practice (FIPP)

By World Institute of Pain, Budapest, Hungary.

Invited Speaker and FacultyInternational congress on Interventional Pain management

Conducted byIran University of Medical Sciences

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Quality – Caring – CompassionQuality – Caring – Compassion

Conducted CME and Live demonstration of Pain procedures At Birla Group of Hospital, Satna.

Invited Speaker and FacultyNational Pain conference- Jabalpur Medical College.

AppointedFaculty, Moderator

and EditorDaradia: Pain Institute, Kolkata

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Spine InterventionsPercutaneous Discectomy/ Disc Decompression/ Ozone Discectomy

Intra Discal Electrotherapy/ Radiofrequency

Facet joint block / Radiofrequency Denervation

Minimally invasive procedure using small needle and probe to remove disc material of prolapsed disc, releasing pressure on nerves and relieving pain in most of the patients of prolapsed/ bulging / slipped disc.

Rotating probe is inserted through needle into the disc under X-Ray/ Fluoroscopic guidance

Rotating tip removes small portion of disc material. Because only enough of the disc is removed to reduce pressure inside the disc, the spine remains stable

Insertion site covered with bandage.Recovery is fast as unlike surgical decompression no bone or muscle is cut.2-3 days of bed rest and may return to normal activity within one week.

Minimally invasive procedure to relieve pain caused by disc degeneration or Annular tear or small disc herniation.

Electrothermal catheter or Radiofrequency needle is inserted under X-Ray/ Fluoroscopic guidance and maneuvered to locate the diseased portion of the disc.

The temperature of the needle or catheter is increased, raising the temperature of damaged disc wall. The heat shrinks and repairs the tear in the disc wall. It also burns the nerve endings causing pain.

This minimally invasive procedure reduces or eliminate the pain of damaged facet joint by either reducing the joint inflammation or by disrupting the nerves that carry pain signals from the joint.

A small needle is inserted under fluoroscopic guidance either directly into the joint to inject anti-inflammatory medications or positioned at nerve supplying the joint.

Radiofreqency needle is inserted through cannula. After confirming the position, heat is applied to the electrode to cauterize the nerve.

To confirm the diagnosis of Facet Arthropathy, local anesthetic may be injected to temporarily block the nerves. This may be required at multiple levels.

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Quality – Caring – Compassion

Kyphoplasty

Intrathecal pump implantation

Pain may increase after the procedure for 3-5 days and may get full relief within 2-4 weeks. Pain relief with RF nerve disruption lasts longer than facet joint injections

Cavity is created by inflating the device

Cavity is then filled with bone cement.This stabilizes the vertebral body and provides rapid mobility and pain relief

Intrathecal pumps are programmed to deliver small amount of medicine directly to the space surrounding the spinal cord.This prevents pain signals from being perceived by the brain.Effective in treating Cancer pain, severe back pain, Neuropathic pain and spasticity.

Very minute catheter is inserted into intrathecal space through small needle.This catheter is cannulated to temporary pump –Trial period.

Medication is injected through catheter for few days of trial period to determine if the system helps the patient. If pain decreases during trial period permanent pump is implanted.

Once the safety and efficacy is established temporary catheter is removed and permanent catheter is implanted.

This minimally invasive intervention treats spine fractures caused by Osteoporosis or Vertebral secondaries.It gives instant pain relief and helps straighten the spine.

A small cannula is inserted into the fractured vertebral body and inflatable balloon is placed

Permanent pump is implanted and catheter is connected to Pump.

Amount of medication dispensed by the pump is programmed with the external unit.

Quality – Caring – Compassion

This minimally invasive intervention is performed to relieve Back pain and radiating pain to Arms or Leg.The anti-inflammatory medications reduces the swelling and inflammation caused by spinal conditions such as Disc prolapse, slipped disc, Disc herniation, Spinal stenosis

Contrast is injected to confirm the position of needle in Epidural space.

Under X-Ray/ fluoroscopic guidance , appropriate nerve root is localized.

Anti inflammatory medication is injected into the space, bathing the painful nerve root.

This revolutionary treatment works by blocking pain perception from traveling up through the spinal cord to Brain.It involves smaller electrodes that are placed near spinal cord in Epidural space.Spinal cord stimulator delivers low level impulses that interfere with the perception of pain especially chronic nerve pains.Indications: Complex regional pain syndromes, Failed Back Surgery syndrome, Degenerative disc disease, Peripheral neuropathies etc.

Insulated electrodes are inserted through small needle into space surrounding the spinal cord called Epidural space

On trial implantation , small pulses are delivered to electrodes that stimulate the nerves, blocking pain signals.The patient gives feedback to help determine where to place the electrodesto best block the patients Pain.

If the patient determines that the amount of Pain relief is acceptable, system may be permanently implanted.

Through a small incision Implantable pulse generator in positioned under the skin.

The lead is then connected to Battery.

The electrical impulses are programmed with an external control unit.Patient themselves can use the external control unit to turn the system On and Off and can also adjust the stimulation power.

Spinal cord stimulation

Transforaminal Epidural Injections

I n t e r v e n t i o n a l P a i n & S p i n e C e n t r e

Quality – Caring – Compassion