"Pain management"

Management of acute pain in directly related to the disease but chronic pain is a real diagnostic and therapeutic challenge to modern medicine. It is a complex interaction with the tissue injury , nervous system and psychological factors, leading to a non resolving chronic condition.

Existing diagnostic modalities commonly used (e.g. - X-Ray, CT-Scan, MRI) are mostly focuses on visualization of the structure of the affected organ. In chronic pain there may be a complete absence of such structural changes leading to diagnostic failure.

Medicines commonly prescribed for pain are often ineffective for chronic pain. The mechanism that leads to chronic persistent pain are complex and not always related to the prostaglandin mediated peripheral mechanism. So the common pain killers are ineffective and requires other pain medications that can act on central mechanisms as well.

Invention of diagnostic interventions is one of the landmarks in management of pain. The concept is very simple , where no defect can be identified or the identified structural defect is not matching with the symptoms a simple diagnostic block can be performed to find out the exact source of pain , commonly known as pain generator. e.g. - In case of chronic back pain the joints behind the vertebral bodies called the facet joints are common source of pain but in most of the patients it can not be identified on X- Rays or MRIs. In such cases if injection of a very small amount of local anesthetic agent inside the joints/or nerve supplying the joint relieves the pain , it can be confirmed as the source of pain. But performing such blocks requires detailed knowledge of anatomy, special training for performing such blocks.