Current Issue Volume 4, Number 2 , May-August 2018

EDITORIAL
Mayank Chansouria, Peeyush Shivhare

Role of USG in Musculoskeletal pain and its Future perspective

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:51-52]



Over past two decades, musculoskeletal ultrasonography (MSK USG) has established itself as a versatile and precise imaging modality in the fields of radiology, sports medicine,rheumatology and pain medicine. It has become increasingly popular and, without doubt, has become an imaging modality of great value in the diagnosis of MSK disorders. In fact, it has gained its rightful place in literature, along with magnetic resonance imaging (MRI).

How to cite this article: Chansouria M, Shivhare P. Role of USG In Musculoskeletal pain and its Future perspective. J Recent Adv Pain 2018;4(2):51-52.

Source of support: Nil

Conflict of interest: None


ORIGINAL ARTICLE
Meena Singh, Mamta Mahobia, Rajesh Mishra, Vaibhv Maheshwari

Lumber Plexus Block for Postoperative Analgesia: Effect of Adding Low Dose Dexmedetomidine to Ropivacaine

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:53-56]



Introduction: Our aim is to assess the effect of adding 0.5μg/ kg dexmedetomidine to 0.33% ropivacaine in lumbar plexus block (LPB) on postoperative analgesia and opioid consumption. This dose and concentration has not been used in LPB in previous studies.

Materials and methods: This study enrolled 60 patients scheduled for hip surgery to receive either 32 mL of study drug which consisted of 30mL of ropivacaine 0.33% and 2 mL of Normal saline [Group RN (n = 30)] or 30 mL solution, in which dexmedetomidine 0.5 μg/kg was diluted in normal saline to reach a total volume of 2 mL and added to 30 mL of ropivacaine 0.33% Group RD (n = 30) before induction of general anesthesia. Postoperative analgesia was assessed with visual analog scale (VAS) scoring at 0,2,4,8,12,18,24 hours and patient satisfaction score(PSS) at 24 hour. Hemodynamic parameters were monitored perioperatively. Mann-Whitney U-test was applied for VAS and sedation scores. Unpaired t-test was applied for age, weight, duration of surgery and duration of post operative analgesia.

Results: Sixty patients were analyzed. There was significant reduction in pain scores in Group RD compared to RN upto 8 hours postoperatively. Duration of analgesia was significantly increased in Group RD, 502 ± 102 as compared to Group RN, 250 ± 116. Total analgesic requirement in form of opioid was also reduced by dexmedetomidine in first 24-hour. There was no difference in hemodynamic parameters and sedation scores throughout the study among both groups with nil complication.

Conclusion: Low dose dexmedetomidine as an adjuvant to ropivacaine prolongs the time for first analgesic requirement and reduces the total postoperative opioid consumption without major side effects.

Clinical significance: Limiting the dose of dexmedetomidine 0.5 μg/kg and ropivacaine concentration to 0.33% in combination, not only prolong duration of analgesia but also avoid undesirable side effects.

Keywords: Dexmedetomidine, Lumbar plexus block, Postoperative analgesia

How to cite this article: Singh M, Mahobia M, Mishra R, Maheshwari V. Lumber Plexus Block for Postoperative Analgesia: Effect of Adding Low Dose Dexmedetomidine to Ropivacaine. J Recent Adv Pain 2018;4(2):53-56.

Source of support: Nil

Conflict of interest: None


REVIEW ARTICLE
Bhavita Panjwani, Gautam Das, Leno Ninan Jacob, Abhisesh Shrestha

Platelet-rich Plasma in Plantar Fasciitis: A Review

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:57-59]



Aim: The aim of this review is to help decide outcome of patients in whom platelet-rich plasma (PRP) has been used and whether it can be used as an effective treatment in plantar fasciitis.

Introduction: Plantar fasciitis is a very common complaint for which patients see a pain physician. Plantar fasciitis is self-limiting and up to 90% patients recover by conservative treatment. Previously all treatments focused on decreasing inflammation, e.g., use of non-steroidal anti-inflammataory drugs (NSAIDs) and corticosteroid injections. Newer modalities of treatment target decreasing degeneration caused by the disease process. These treatments initiate an inflammatory reaction which restarts the healing process.2 These include PRP injections, extra corporeal shock wave therapy (ESWT), etc.

Review results: We screened 18 full text studies based on our searches, Out of these 1 was a meta-analysis of randomised control trials (RCTs), 3 were RCTs and remaining were level 3 cohort studies. These included studies done from 2011 till date. Our review inferred that PRP therapy decreases pain and helps in improving quality of life in patients with recalcitrant plantar fasciitis.7

Conclusion: Use of PRP in Chronic Plantar fasciitis is effective. It improves long term outcomes, decreasing chances of recurrences.

Keywords: Plantar fasciitis, PRP, Chronic

How to cite this article: Panjwani B, Das G, Jacob LN, Shrestha A. Platelet-rich in Plantar Fasciitis: A Review. J Recent Adv Pain 2018;4(2):57-59.

Source of support: Nil

Conflict of interest: None


PRACTITIONER'S SECTION
Ronnie Kaddu, Gautam Das, Karthik K

Piriformis Injection in Pain Management

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:60-63]



Introduction: Piriformis syndrome is an uncommon cause of unilateral lower limb pain that is as a result of sciatic nerve compression by the piriformis muscle. Symptoms associated with this syndrome often make it difficult to distinguish it from several other conditions that lead to buttock, thigh or leg pain. Despite a number of clinical signs suggestive of a piriformismyofascial disorder, not all patients present with the typical clinical features. This probably explains why it is frequently left undiagnosed. The piriformis injection should be considered when symptoms persist after attempts have been made with conservative methods. It is simple and fast and does not require a lot of needle manipulation. The technique for needle placement uses fluoroscopic guidance to inject the piriformis muscle with local anesthetic and can be used for both diagnostic and therapeutic purposes.

Keywords: Leg pain, Piriformis injection, Piriformis syndrome

How to cite this article: Kaddu R, Das G, Karthik K. Piriformis Injection in Pain Management. J Recent Adv Pain 2018;4(2):60-63.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Anuja Bhargava, Charu Singh, Mohd. Shakeel, Zeba Siddiqi, Sachin Khanduri, Ekta Agarwal, Rohit Gupta

Rhinolith–A Rare Cause of Sunct Syndrome: A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:64-65]



Short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) is a rare cause of unilateral headaches affecting predominantly males in usually the fifth decade. The pain is usually moderate to severe in intensity affecting the ocular and the periocular area. The mean duration of paroxysms is 1 minute, with a range of 5 to 250 seconds. A 25-year-old male complained of progressive unilateral left nasal obstruction for 8 months along with ipsilateral daytime headache predominantly in the periocular and temporal region, conjunctival injection, tearing and minimal eyelid edema. The patient was admitted and kept under observation for the reported symptoms. Nasal endoscopy and probing revealed a greenish/ dirty grey and gritty mass filling posterior part of the left nasal cavity at the time of a headache, there was right sided ipsilateral congestion in the conjunctiva, lacrimation minimal and periorbital edema neurological examination of the patient was normal. The patient was posted for endoscopic rhinolith removal followed by infundibulotomy and maxillary sinusotomy. At 3 week follow-up, the patient was relieved of all symptoms and required no medication. The patient was asymptomatic at 6 week and 6 months follow up. Thus a diagnosis of secondary SUNCT cause rhinolith was confirmed which resolved with rhinolith removal.

Key words: Headache, Rhinolith, Sunct syndrome

How to cite this article: Bhargava A, Singh C, Shakeel M, Siddiqi Z, Khanduri S, Agarwal E, Gupta R. Rhinolith—A Rare Cause of Sunct Syndrome: A Case Report. J Recent Adv Pain 2018; 4(2):64-65.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Pratibha Matche, Kavya H, CL Gurudutt

Pain Management with IV and Oral Ketamine in a Child with Acute on Chronic Pancreatitis: Old Wine in New Bottle–A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:66-68]



A 13-year-old male child, a known case of chronic pancreatitis with acute exacerbation, presented with severe abdominal pain. The pain was dull aching type associated with burning sensation present all over the abdomen with VAS score-9/10. He was treated with paracetamol, Non-steroidal anti-inflammatory drugs, and opioids. Despite this multimodal analgesia, he had inadequate pain relief. Since the child exhibited both nociceptive and neuropathic elements, ketamine was considered as the analgesic of choice. He was successfully treated with subanesthetic low dose intravenous (IV) ketamine infusion followed by oral ketamine therapy for 15 days till he underwent proposed surgery. We have been unable to find any previous reports of oral ketamine use for this condition.

Keywords: Acute pain, Chronic pancreatitis, Ketamine, Neuropathic pain, Oral administration, Pediatric pain

How to cite this article: Matche P, Kavya H, Gurudutt CL. Pain Management with IV and Oral Ketamine in a Child with Acute on Chronic Pancreatitis : Old Wine in New Bottle-A Case Report. J Recent Adv Pain 2018;4(2):66-68.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Amit A Sequeira, Gautam Das, Karan Patel

A Rare Case of Diffuse Idiopathic Skeletal Hyperostosis with Stable Burst Fracture of D12 Vertebra Presenting with Low Back Pain: A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:69-74]



Diffuse idiopathic skeletal hyperostosis (DISH) is a relatively poorly studied disease in the Indian population. The characteristic radiologic findings of this disorder are the presence of “flowing ossification“ especially along the anterolateral borders of the vertebral bodies. Trivial trauma, especially involving hyperextension of the spine, can lead to vertebral fractures, sometimes with serious neurological deficits. We present a case of DISH involving fracture of D12 and L1 vertebrae, following a minor fall at home, which was managed conservatively due to multiple risk factors for surgery. The patient presented to our pain clinic with signs and symptoms suggestive of the lower lumbar facet and bilateral sacroiliac joint arthropathy, without any features of D12, L1 fracture or any neurological deficits. We postulate that the lower lumbar and SI pathology could be a sequel of the orthotic support used in the conservative management of DISH in this patient or a natural progression of the disease.

Keyword: Burst fracture, DISH, Flowing ossification

How to cite this article: Sequeira AA, Das G, Patel K. A Rare Case of Diffuse Idiopathic Skeletal Hyperostosis with Stable Burst Fracture of D12 Vertebra presenting with Low Back Pain: A Case Report. J Recent Adv Pain 2018;4(2):69-74.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Karan M Patel, Gautam Das, Amit A Sequeira, Praneet Singh

Imagining findings can be misleading; clinical correlation is must: A Rare case of Spinal Cord A-V Malformation Masquerading Radiculopathy

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:75-78]



Spinal dural arteriovenous fistulas (SDAVF), is a clinical condition that can pose a challenge to the clinicians both in the diagnosis as well as treatment. This rare disorder can present with certain nonspecific symptoms and signs, including gait abnormality or lower-limb sensory or motor weakness. Symptoms may progress gradually or in some cases decline over a period. It can be treated surgically or through an endovascular approach involving disconnection of the fistula to make a prompt diagnosis, detailed history and proper neurological examination along with correlated imagine findings is the right way. We encountered a patient having long-standing bilateral lower limb weakness and sensory disturbances for which he was operated twice at different levels, with partial improvement. By a combination of detailed neurological examination and appropriate diagnostic imaging, we concluded that an arteriovenous (AV) malformation at the mid-thoracic spinal cord level was the causative factor for the same which is proposed below.

Keywords: Clinical examination, Fistula, Spinal cord AV malformation.

How to cite this article: Patel KM, Das G, Sequeira AA. Singh P. Imagining findings can be misleading, clinical correlation is must: A rare case of Spinal Cord A-V Malformation Masquerading Radiculopathy. J Recent Adv Pain 2018;4(2):75-78.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Praneet Singh, Gautam Das, Palak Chavda, Abhisesh Shrestha

A Case Report on Lumbar Synovial Cyst: An Uncommon Presentation

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:79-81]



Lumbar synovial cyst, though rare, can mimic many other conditions including lumbar radiculopathy or neurogenic claudication and therefore should be included in the differential diagnosis for radiculopathy, especially in elderly patients. Here we discuss our experience with a postoperative case of transpedicular screw fixation presenting with typical features radiculopathy and claudication symptoms caused by a lumbar synovial cyst, its diagnosis and successful management of the neurological symptoms.

Keywords: Nerve root compression, Spine surgery, Synovial cyst

How to cite this article: Singh P, Das G, Chavda P, Shrestha A. A Case Report on Lumbar Synovial Cyst: An Uncommon Presentation. J Recent Adv Pain 2018;4(2):79-81.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Rajeev Harshe

Prolonged Coccydynia with Discogenic Low Back Pain Relieved by Hypodermic Needling– A Novel, Economical, Safe and Effective Technique.

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:82-83]



Pain at tailbone-coccydynia is a nagging pain. The patient finds it difficult to sit straight and give pressure on the coccyx. This is generally seen after trauma on the coccyx. This does disturb the quality of life. Similarly, discogenic low back pain is very common.
Local injection at coccyx in the form of cortisone, caudal epidural with or without ganglion impar block is a commonly used method to treat this pain. There are many instances when these treatments also do not relieve pain.
Herewith, I am presenting a case where a patient with refractory coccydynia with discogenic low back was given the treatment of hypodermic needling and patient-reported significant pain relief.
This technique is based on the concept of stimulating A beta fibers present in the subcutaneous region and attempting to release endorphins into the segmental dorsal horn. Simple hypodermic needles number 26 gauge half inch length is used to be put in the subcutaneous area of respective sclerotomes.

Keywords: Acupuncture, Coccydynia, Coccyx pain, Low back pain, Needling, Pain at tail bone

How to cite this article: Harshe R. Prolonged Coccydynia with Discogenic Low Back Pain Relieved by Hypodermic Needling - A Novel, Economical, Safe and Effective Technique. J Recent Adv Pain 2018;4(2):82-83.

Source of support: Nil

Conflict of interest: None


CASE REPORT
Praneet Singh, Gautam Das, Ronnie P Kaddu

Radiofrequency Lesioning of Rami Communicans for Discogenic Back Pain: Is Failure Inevitable? A Case Report

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:84-86]



Internal disc disruption is the most common cause of low back pain amongst the younger adults. It is characterized by diffuse axial back pain with or without non-dermatomal leg pain limited up to knee usually. Presence of hyper-intense zone in magnetic resonance imaging (MRI), provocative discography and rami communicans block is the current diagnostic modalities. Radiofrequency ablation of the rami communicans is one of the therapeutic options in cases which are resistant to other treatment modalities. However, many a time it has been found that in spite of significant pain relief achieved with diagnostic rami communicans block with local anesthetics, conventional radio frequency procedures may give unsuccessful outcomes. We hereby discuss a similar case scenario with possible explanations based on literature.

Keywords: Discogenic back pain, Rami communicans block, innervation of disc, Sinuvertebral nerve

How to cite this article: Singh P, Das G, Kaddu RP. Radiofrequency lesioning of Rami Communicans for Discogenic Back Pain: Is Failure Inevitable? A Case Report. J Recent Adv Pain 2018;4(2):84-86.

Source of support: Nil

Conflict of interest: None


LETTER TO EDITOR
Sachin Upadhyay, Pushpraj Patel

Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker

[Year:2018] [Month:May-August] [Volumn:4 ] [Number:2] [Pages:36] [Pages No:87]



We read with great interest the recently published case report1 entitled “Bipolar Radiofrequency Ablation of Genicular Nerves in Patients with Pacemaker”. Radiofrequency ablation of genicular nerves seems to be a safe and effective for chronic knee osteoarthritis (OA) patients with a favorable response to diagnostic block. Although we applaud the work, we wish to draw the attention of the author to certain critical points which need to be clarified.


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