PROPOSED APPROACH TO PAIN MANAGEMENT
STEP 1: Evaluation for a pain generator, Nociceptive (organic) or neuropathic.
STEP 2: Analgesic opioid, antidepressant, anticonvulsant muscle relaxant medications.
STEP 3: One of the Following;
Interventional Procedures: Fluoroscopy control is used for precision with every process. Nonionic radio opaque dye injection ensures optimal deposition of drugs.
Diagnostic Blocks: Of nerves, plexuses, epidural, spinal, sympathetic ganglia Discography for annular tears in non prolapsed intervertebral discs.
Therapeutic Blocks: Nerve blocks with LA, steroid, clonidine Botox etc. Denervation with radiofrequency is preferable to neurolytic agents (phenol, alcohol) that can give rise to neurophatic pain.
Definitive Blocks:
- Spinal cord stimulation
- Intrathecal pump implantation
- Spinal Endoscopy, RACZ Procedure.
- IDET (Intradiscal Electro Thermal Annuloplasty)
- Nucleoplasty
All these procedures are no doubt expensive but are feasible in India.
STEP 4: Psychological evaluation and coping strategies where necessary.
STEP 5: Physiotherapy - An integral part of pain management before and after blocks as most of the pain from locomotor system is worsened by inactivity.
Yoga: Asanas systematically exercise muscles in a gentle, guarded and graded manner. It raises self awareness (conscious proprioception) for an objective assessment of self pain, helps in depression by motivation. Pranayama can be used like a bio-feedback technique and auto suggestion for recruiting cerebral facilitation and inhibition of pain pathways.
Acupuncture: Its an accepted modality of treatment for many types of pain by WHO (World Health Organisation). Particularly effective for migraine, neuralgias and neuropathies etc. It has great potential in difficult conditions like RSD, smoking addiction etc.
With this armamentarium we hope to make effective pain relief a reality for patients with the belief that "Man can but propose, for God to dispose."
|
