Interventional pain and spine centre.

1. ........Bight new hope for people who’ve been living with pain.
Volume 1, November 2010
Ta k e B a c k
YO UR LI F E
If You or someone you know is suffering from:
Back Pain • Slipped Disc • Discogenic Pain • Degenerated Disc
Sciatica Pain • Cancer Pain • Shingles Pain • Rheumatic Pain
Joint Pain • Frozen Shoulder • Neuropathic Pain • Neuralgias
Complex Regional Pain Syndrome • Failed Back Surgery Syndrome
Contact Us
Bhagat Chandra Hospital Mob. 09871985514 Mayom Hospital
Mahavir Enclave Email: pankajnsurange@yahoo.co.in D block, South city-1
Near Palam Flyover Main market
Dwarka, New Delhi www.ipscindia.com Gurgaon
Also Available for Consultation at:
Artemis Health Institute Columbia Asia Hospital Arcus Superspeciality Medicentre
Sec 51 , Gurgaon F-block, Palam Vihar, Gurgaon Sec 4 Market, Dwarka
Saturday: 6 to 8 PM Saturday: 10 to 12 AM Mon-Wed-Fri : 6 to 8 pm
Quality – Caring – Compassion

2. Interventional Pain & Spine Centre
Consultant In- Charge
Interventional Pain and Spine Centre
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 Surange
MBBS, MD, FIPP (World Institute of Pain, Hungary)
Interventional Pain and Spine Specialist
Quality – Caring – Compassion

3. 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 The goals of interventional pain
of the severity of the pain. Commonly, the management are to relieve, reduce, or
first steps of treatment are rest, application manage pain and improve a patient’s
of cold or heat and intake of OTC (over overall quality of life through minimally
the counter) medication. The next step invasive techniques specifically designed
in the treatment of pain is a combination to diagnose and treat painful conditions.
of physical therapy and prescribed pain Interventional pain management also
medication. It is important to note that strives to help patients return to their
sometimes, interventional pain management everyday activities quickly and without
needs to be started prior to Physical heavy reliance on medications.
Therapy in order to stop acute pain (i.e.
acute radiculopathy) and allow the patient to We are now able to make a real difference
comply with necessary exercise. If prescribed in the lives of our patients, their families
pain medication and physical therapy don’t and their physicians. We provide a
work, the next step is usually interventional valuable service to society by helping
pain management, unless the patient has to return disabled patients to a more
acute loss of function or acute neurological functional and productive state. We work
deficit (in which case surgery is needed). together with the patients’ physician to
If interventional pain management doesn’t promote the best possible outcome
alleviate the pain, surgery might be required.
However, even after surgery interventional We provide world-class treatment
pain management has a very important role in integrating innovative interventions and
the treatment of patients, especially when all complimentary therapies to relieve your
other options are exhausted (eg. “failed back pain and improve the quality of your
surgery” syndrome). life.”
Note
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.
Quality – Caring – Compassion

4. Interventional Pain & Spine Centre
Representation at National and International Level
Awarded
Fellow Interventional Pain Practice (FIPP)
By World Institute of Pain, Budapest, Hungary.
Invited Speaker and Faculty
International congress on Interventional Pain management
Conducted by
Iran University of Medical Sciences
Quality – Caring – Compassion

5. Conducted CME and Live demonstration of Pain procedures
At Birla Group of Hospital, Satna.
Invited Speaker and Faculty
National Pain conference- Jabalpur Medical College.
Appointed
Faculty, Moderator
and Editor
Daradia: Pain Institute, Kolkata
Quality – Caring – Compassion

6. Interventional Pain & Spine Centre
Spine Interventions
Percutaneous Discectomy/ Disc Decompression/ Ozone Discectomy
Minimally invasive procedure Rotating probe is inserted
using small needle and through needle into the disc
probe to remove disc
material of prolapsed disc, under X-Ray/ Fluoroscopic
releasing pressure on nerves guidance
and relieving pain in most of
the patients of prolapsed/
bulging / slipped disc.
Rotating tip removes small Insertion site covered with
portion of disc material. bandage.
Because only enough of the Recovery is fast as unlike
surgical decompression no
disc is removed to reduce bone or muscle is cut.
pressure inside the disc, the 2-3 days of bed rest and may
spine remains stable return to normal activity
within one week.
Intra Discal Electrotherapy/ Radiofrequency
Minimally invasive procedure Electrothermal catheter
to relieve pain caused by disc or Radiofrequency needle
degeneration or Annular tear is inserted under X-Ray/
or small disc herniation. 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.
Facet joint block / Radiofrequency Denervation
This minimally invasive A small needle is inserted
procedure reduces or under fluoroscopic guidance
eliminate the pain of damaged
facet joint by either reducing either directly into the joint
the joint inflammation or by to inject anti-inflammatory
disrupting the nerves that medications or positioned at
carry pain signals from the nerve supplying the joint.
joint.
To confirm the diagnosis Radiofreqency needle is
of Facet Arthropathy, local inserted through cannula.
anesthetic may be injected After confirming the
to temporarily block the position, heat is applied to
nerves. This may be required the electrode to cauterize
at multiple levels. the nerve.
Quality – Caring – Compassion

7. 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
Kyphoplasty
This minimally invasive A small cannula is inserted
intervention treats spine into the fractured vertebral
fractures caused by
Osteoporosis or Vertebral body and inflatable balloon
secondaries. is placed
It gives instant pain relief and
helps straighten the spine.
Cavity is created by inflating Cavity is then filled with
the device bone cement.
This stabilizes the vertebral
body and provides rapid
mobility and pain relief
Intrathecal pump implantation
Intrathecal pumps are Very minute catheter is
programmed to deliver small
amount of medicine directly to inserted into intrathecal
the space surrounding the spinal space through small needle.
cord.
This prevents pain signals from This catheter is cannulated
being perceived by the brain. to temporary pump –Trial
Effective in treating Cancer pain,
severe back pain, Neuropathic period.
pain and spasticity.
Medication is injected Once the safety and efficacy
through catheter for few is established temporary
days of trial period to
determine if the system catheter is removed and
helps the patient. If pain permanent catheter is
decreases during trial implanted.
period permanent pump is
implanted.
Permanent pump is Amount of medication
implanted and catheter is dispensed by the pump
connected to Pump. is programmed with the
external unit.
Quality – Caring – Compassion

8. Interventional Pain & Spine Centre
Spinal cord stimulation
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 On trial implantation , small
inserted through small pulses are delivered to
electrodes that stimulate
needle into space the nerves, blocking pain
surrounding the spinal cord signals.
called Epidural space The patient gives feedback
to help determine where to
place the electrodesto best
block the patients Pain.
If the patient determines that Through a small incision
the amount of Pain relief is Implantable pulse generator
acceptable, system may be in positioned under the
permanently implanted. skin.
The lead is then connected The electrical impulses
to Battery. 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.
Transforaminal Epidural Injections
This minimally invasive Under X-Ray/ fluoroscopic
intervention is performed to
relieve Back pain and radiating guidance , appropriate nerve
pain to Arms or Leg. root is localized.
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 Anti inflammatory medication
confirm the position of is injected into the space,
needle in Epidural space. bathing the painful nerve
root.
Quality – Caring – Compassion