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Neck Pain Management

Majority of us would experience neck pain at some point in our life. Neck Pain can disrupt daily routine activities. Muscle spasm, pain can make it difficult to turn head and activities such as driving become difficult. It is not uncommon for the neck pain to radiate to shoulders or lead to persistent headaches. Neck pain is more commonly observed in middle ages and may have a mechanical or postural basis. Most uncomplicated neck pain is associated with poor posture, anxiety and depression, neck strain, injuries. Fortunately majority of cases are not due to serious causes. If you are experiencing unresolving or severe pain, you should seek medical opinion from neck and shoulder pain treatment specialists in Delhi so that timely diagnosis can be done and corrective action can be taken.

Some common causes include –

Muscle sprain, spasm/ increased tension

Poor posture and work ergonomics

Incorrect positioning of the neck while sleeping

Aging: Degenerative disc disease and spinal osteoarthritis become more common as we age

Injuries/ Whiplash: Whiplash neck involves sudden jolting of neck forwards and backwards and is commonly observed in vehicular accidents. This can cause excessive stretching of neck muscles, ligaments or other injuries which can be associated with neck pain.

Neck pain can be a part of more widespread medical issues such as in fibromyalgia, arthritis, ankylosing spondylitis, infections, cancer etc. You can approach Pain Management Specialists in Delhi for diagnosing your problem and suggesting suitable solutions

It is advisable to seek early medical attention if you experience any of the following

Persisting symptoms or severe pain not responding to usual care or medications

Pain starting after fall, injury

New onset numbness, weakness or tingling in arms

Gait or balance problems

Loss or urine or stool control

Signs of infection/ meningitis

Pain worse at night time/interfering with your sleep

Some of the pain management techniques for neck pain include:

Lifestyle changes: Incorrect/ ignored posture while working on laptops mobiles etc can put excessive cervical spine strain leading to pain. Certain professions can be more prone to develop neck pain. Simple posture awareness and improvement, taking regular breaks can go a long way in reducing symptoms.

Medications: Anti-inflammatory drugs such as ibuprofen or naproxen and pain relievers like acetaminophen may initially be prescribed by your doctor. Sometimes medications like muscle relaxants or stronger painkillers may also be suggested by your doctor.

Physical Therapy: Regular exercise, good posture, stretching can help to reduce/ prevent to prevent unwanted stress and tension to your neck muscles. Heat or cold application may be used during the initial phases of injury to facilitate your recovery and physical exercise. Depending on the severity, time since injury and your recovery the specialist may recommend limiting normal physical activity or slow range-of-motion exercises or strengthening exercises.

There is research evidence supporting the use of specific strengthening exercises as part of a routine practice for chronic neck pain, cervicogenic headache and radiculopathy.

Ergonomics & Posture Simple posture changes and better workplace ergonomics can help in preventing/reducing neck pain. Measures include adjustment of furniture height and computer position such that

Eyes point directly at the top third of the screen

Forearm is parallel to floor

Feet should be flat on the floor with thighs parallel with the floor

While sitting in office chair it’s a good practice to have back aligned against the back of the office chair and avoid slouching. Avoid sitting in one place for too long. Taking regular breaks to walk around and stretch is a good practice.

Relaxation techniques: relationship between stress and increase pain is well known and easily appreciated by most patients. Measures to deal with stress and anxiety help in more effective pain management.

Massage Therapy: The evidence supporting the use of massage therapy is limited although some people do find it useful in the short term. Massage can help in relaxing, loosening of muscles but it is important to remember that wrongly done massage can lead to harm.

Acupuncture: Certain people find Acupuncture helpful in neck pain management. When performed correctly it is a low risk procedure. The traditional acupuncture is based on the theory of restoring the energy balance in body and removing any blockages to the flow of energy.

Injections/ other interventions such as Radiofrequency ablation: These would depend on the cause of neck pain and actual pathology. They have been explained in more detail in the neck & arm pain section under treatments, on my website- removemypain.com

Ignoring persisting symptoms can aggravate the situation leading to chronic pain with reduced functionality. So, if your pain persists and does not respond to usual lifestyle changes and painkillers then seek medical opinion on time.

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Smoking And Back Pain – What Is The Link?

Everyone knows about the relationship between cigarettes and heart disease or lung cancer, but are you aware that Smoking Can Increase the Chances of Your Having Disc Problems By 4 Times. When I inform my patients about this they are very surprised. Cigarettes contain more than 7000 toxic chemicals and we know at least more than 250 of them are harmful to our body. Numerous studies have reported that smoking is associated with chronic pain, especially back and joint pains. Increased chronic pain is due to the ability of nicotine and other chemicals to:

Narrows blood vessels, reducing the blood flow to the muscles, bones and other body parts

Impact on brain circuitry

Impact on immunity and slow healing

Increased fatigue

Increase blood pressure

The incidence of chronic low back pain among smokers compared to non-smokers is higher, and smokers experience more severe pain. This is true irrespective of the sex and nature of work (manual laborers Vs white-collar). Some studies have reported former smokers having a higher prevalence of back pain than never smokers and other studies have reported that those who smoked more cigarettes per day had higher prevalence of back pain.

For those with back pain, it is important to know about the link between smoking and back pain as smoking is known to

Impact on Discs

One of the most important factors responsible for increased back pain is the impact of smoking on the discs. The disc is dependent on the surrounding tissues for its nutrition and when we smoke, the pores through which the nutrition goes, start getting blocked, negatively affecting the healing and regenerating capacity of the discs. Nicotine can alter the size of the blood vessels and the ability for the body to adapt, increasing the chances of damage. The flexibility of discs suffers and they can degenerate quickly, leading to early disc problems.

Impact on Bones

Your bones also become weak due to smoking because smoking increases osteoporosis.

Impact on Pain Sensitivity

Another factor due to which the pain can increase is pain sensitivity. When you smoke your pain sensitivity increases which means that the pain which was less troublesome before increases in severity.

Impact on Muscles

So when you smoke, your muscles become weak. Muscle mass, flexibility, and strength decreases and this can become a reason for the pain arising from the muscles

Impact on Tendons & Ligaments

The stability and the strength of ligaments and tendons reduces due to which the instability of the spine can increase.

Other Effects

Besides the above effects, smoking has many other adverse effects such as causing inflammation and impairing immune function affecting the healing capacity of the body.

TAGS- Back pain treatment in Delhi Best Pain Specialist in South Delhi Best Neck Pain Specialist in Delhi

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Why Does Cancer Cause Pain?

Sources of pain in cancer may not be easy to identify and often require detailed assessment with attention to detail. Identification of the source often holds the key to correct treatment and ability to provide relief. Pain in cancer may originate from

Cancer itself – When cancer grows it damages the tissues. It causes inflammation, unusual stretching, irritation and all this can lead to pain. Like if we talk about a pancreatic cancer, when it grows or stretches it can irritate the diaphragm (main breathing muscle) and that cause shoulder pain

Cancer spread – when cancer grows uncontrollably then it can spread to the nearby or distant body parts like the bone, liver, kidney, lymph nodes etc.

Associated problems like bloating, constipation, blockage of ducts, clotting problems, distention of liver or abdomen etc.

Cancer treatments like radiotherapy or chemotherapy are known to cause nerve pain (peripheral neuropathy. Surgery may also be associated with chronic persistent pain.

Extra stress on other body parts – Often to protect one part of our body, we put pressure on other parts for example using crutches to offload a leg may become the source of shoulder pain as the crutches place extra load on my shoulder

Other coincidental problems – it is not necessary that all pain that every cancer patient suffers is due to cancer. There could be other coincidental problems like in the general population such as arthritis. So it is important to identify not only the type of pain but also the source of pain, before we plan treatment.

Pain related to cancer may have different components such as background pain and breakthrough pain. These need to be taken into account while making treatment plans. Let’s take an example of pain due to pancreatic cancer. These patients may have a constant pain (background pain) and there may be increased pain that comes after eating (breakthrough pain). Breakthrough pain may happen due to provoked or unprovoked factors and when we make a treatment plan it is important to have a plan for breakthrough pain.

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5 Things You Should Know About Coccyx Pain

1. Introduction

The coccyx or the tailbone is the bottom most part of the spinal vertebral column which has many muscle and tendon attachments. It is one of the lesser known body parts but this bony beak shaped structure gains attention in cases of coccygeal pain or in common terms, coccydynia. It is imperative to consult the best pain specialist and many patients are now looking for pain treatments in Delhi due to availability of experienced doctors, high-end infrastructure and world class treatment available at quite a reasonable price.

2. What triggers Coccydynia?

Coccyx plays a role in stabilizing your body when you sit, or switch positions and is subjected to stress and strain especially when using lack of ergonomically designed furniture.

Coccydynia is particularly common in women due to a wider pelvic structure possibly predisposing tailbone to more stress. Coccyx injury in particular is the most common cause of coccyx pain and it may cause bruising, inflammation, dislocation or fracture of the tailbone.

Mentioned below are the various causes for coccyx injury:

Falling while being in a seated position, while on a chair, or from the stairs

Sports injuries

Injury during labour

Friction injury caused by cycling or rowing

Idiopathic causes

Bone spurs

Infections

Neoplasms

Obesity

Prolonged sitting

3. A brief overview of the symptoms and signs of Coccyx Pain:

Coccydynia causes intense, severe, sharp pain in the buttock area and can aggravate on changing positions from sitting to standing or leaning.

Coccydynia can present as pain and discomfort during sexual intercourse.

Sometimes it is accompanied by bruising.

Difficulty in bowel movements, accompanied by pain.

4. How is Coccyx Pain Diagnosed?

You need to consultant experienced pain specialist who can diagnose your tailbone pain. Proper diagnosis and identification of provocating factors helps tailor treatment to achieve best results

A proper history is taken first to rule out any instances of injury or trauma

Examination can help narrow down the possible pain generators

In cases of bone spurs and injury, X rays are taken.

MRI may be requested especially In case of cancer or fracture

Injections can further help confirm the source of pain

5. Management and Treatment

The key to successful management of coccydynia is consulting an experienced pain specialist. Coccydynia can be managed by a combination of lifestyle modifications, physical therapy and pharmacological measures. This includes

Avoiding further strain on the pain area by using cushions for support

Reducing weight if you are overweight

Physical therapy

Use of injections like –

Coccyx or Sacrococcygeal Joint Injections, and

Ganglion Impar block and Radiofrequency treatment.

Pain Specialists also suggest the following for relief from Coccydynia :

Preventing prolonged sitting position and avoiding hard surfaces while sitting

Ice fomentation during acute flare up episodes

Over the counter medications including NSAIDS like Naproxen, Acetaminophen, Ibuprofen

Consuming high fiber foods to counter constipation

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How To Communicate Regarding Your Joint Pain To Your Doctor

Joint pain can be a source of prolonged discomfort that one may have to endure in life. This can affect your daily activities and make you feel depressed. Joint pain specialists in Delhi NCR are daily visited by numerous patients complaining of severe pain and in search of treatments that can provide quick relief.

For you to get the most appropriate treatment, the way you explain your pain to the doctor is important. There are a plethora of options for joint pain treatment in Delhi NCR. But reaching out to the right-center with experienced and skillful professionals whom you can count upon is important.

Read below to understand the importance of accurately describing your joint pain concerns to your treating doctor:

Joint pain is subjective, without your explaining it may be very difficult for the doctor to know what your pain feels like and how severe it is

Joint pain can have numerous causes such as like age-related wear and tear, injury, trauma, infections, etc

The involvement of multiple joints in the body may require different assessments/investigations than just one isolated joint problem. Treatment options may also differ depending on the actual pathology

Treatments offered to depend on the severity of symptoms, their impact on your life, your age, activity levels, and your goals/expectations. There are many treatment alternatives –both non-surgical and surgical, depending on the assessment of the above factors

These are some important points that may help your doctor to understand and treat your pain better:

Explain where the pain is; how long you have had the pain and how it started. If the possible point to the exact place, is it in the knee, ankle, or shoulder pain?

The character of pain can help in narrowing down the possible causes. For example is it aching, burning, shooting, or stabbing pain? Is it present all the time?

Aggravating or relieving factors are equally important- Is it worse when you are walking or at night time when you are trying to sleep. is it when you sit, walk or stand?

It is important to tell the doctor how the pain affects your daily life. This information is essential as it enables the doctor to have a clear overview of what you are feeling. While describing the impact of pain do not forget about your sleep and mood.

In case the pain is short-term, your doctor may recommend home care like –

Applying ice or hot compression at the joint several times.

Avoiding activity that may cause pain.

Using a brace to protect the joint.

Various other options are used for Joint pain treatment in Delhi NCR like steroid or hyaluronic acid injections, nerve blocks, and radiofrequency treatment. They can all help to ease the suffering and improve your quality of living. Some options are specific to the joints involved. These are mostly combined with medications and physiotherapy to improve outcomes.

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Are You suffering from numbness, tingling or burning sensation after Chemotherapy?

Learn more about Chemotherapy Induced Peripheral Neuropathy (CIPN)

What is peripheral neuropathy?

Peripheral nerves carry sensations from the different parts of your body to the brain and control the movement of our arms and legs. The set of symptoms resulting from damage to these nerves is addressed as Peripheral neuropathy. Symptoms are usually symmetrical starting from toes and fingers, and progress towards the body. Common symptoms include

Tingling or pins and needles sensation in hands of feet

Numbness and reduced ability to feel hot and cold

Sharp, electric, burning pain

Sensitivity to touch, pressure or temperature

Balance issues and difficulty walking

Leg cramps

Weakness

Difficulty with fine activities such as writing, buttoning and unbuttoning

What is Chemotherapy Induced Peripheral Neuropathy (CIPN)?

Some of the chemotherapy drugs used to treat cancer can cause peripheral nerve damage. This is addressed as chemotherapy-induced peripheral neuropathy (CIPN).

The symptoms of CIPN include all peripheral neuropathy symptoms mentioned above, with the most common one being numbness and tingling starting in fingers and toes and progressing proximally as the condition progresses. This appears earlier and is generally more prominent than pain. CIPN can have an impact on ones sleep, mood, functionality and quality of life (QOL).

Symptoms can appear hours to days after chemotherapy and the condition can worsen with additional chemotherapy cycles. The progression usually levels off after stopping the chemotherapy except in the case of platinum-based drugs where the sensation may continue to deteriorate for several months.

Different patterns can be seen with different drugs like in Oxaliplatin (a chemotherapy drug) induced acute neuropathy, there is cold sensitivity, throat discomfort, discomfort swallowing cold liquids, and muscle cramps with more severe symptoms in upper limbs. The usually peaks 2 to 3 days after each dose and can increase in subsequent treatment cycles.

In Paclitaxel (another chemotherapy drug) induced acute neuropathy the pain occurs in truncal/hip distribution or lower extremities and tends to resolve more between doses. The symptoms peak approximately in 2 to 3 days after each dose and are not worsened in subsequent cycles.

What are my chances of getting CIPN?

CIPN affects approximately 30% and 40% of patients undergoing chemotherapy and the risk varies with factors such as

Drugs used – Some drugs are more likely to cause CIPN than others. A list of some of these is included at the end of this blog.

Duration of use

Dose used

Pre-existing neuropathy

Comorbidities such as diabetes, vitamin deficiencies

Age

Can CIPN be cured or is it permanent?

In most cases the CIPN symptoms go away with time. They can last for weeks, months, or even years after treatment. It does vary depending on the drugs, doses used and in some cases it can be permanent. Unfortunately, there is no clear cure or treatment that will repair nerve damage.

What should I do to deal with CIPN?

It is a good idea to report your symptoms to the team looking after you and they may consider altering the treatment plan to prevent your symptoms from worsening. This may involve dose delaying, reduction, stopping chemotherapy or substituting with other agents that do not cause CIPN. A pain specialist opinion should be taken if your symptoms are severe and require specialist input. A pain specialist may prescribe nerve types of painkillers which need to be taken regularly to help manage your symptoms.

Other measures which can help include

Avoiding things that make your symptoms worse, such as hot or cold temperature, or tight clothes or shoes

Regular exercises

Avoiding smoking and alcohol

Ensuring normal vitamin levels and blood sugars.

No medication or supplement has been shown to definitively prevent CIPN including N-acetylcysteine, calcium, magnesium vitamin B, vitamin E, omega-3 fatty acids, alpha lipoic acid and cannabinoids. It, however, makes sense to regulate other factors which are known to cause nerve injury such as alcohol intake and blood sugar levels.

When the sensation in hands and feet is affected one might be more prone to injury and sensible precautions are required like

If the neuropathy involves your hands, protect them while using sharp objects, if it affects the feet protect them by wearing shoes even when you are indoors.

Avoid extreme temperatures and keep your hands and feet covered, warm in cold weather

Protect yourself from heat injuries especially when using warm water for washing bathing

What are the other causes of peripheral neuropathy?

There can be many other causes of peripheral nerve damage- some related to cancer and some independent. Determining the underlying cause is important as it may have a bearing on the treatment.

Related to cancer and its treatments.

Surgery or radiotherapy

Tumors pressing on nerves

Other independent causes

Diabetes

Alcohol abuse

Shingles, infections involving the nerves

Low vitamin B levels

Spinal cord injuries

Poor circulation (peripheral vascular disease)

How do we manage CIPN?

The importance of discussing with the admitting team, if symptoms of CIPN develop during treatment, has already been discussed. This provides an opportunity to modify treatment and prevent further damage rather than dealing with an irreversible situation later.

IF CIPN develops, pain can often be helped with treatments but the numbness is usually resistant to treatment. Some of the modalities which can be used for treatment include

Medications used to treat nerve pain such as antiepileptics, antidepressants, topical gels, patches or creams of numbing medicine, strong painkillers such as opioids, steroids

Drug infusions or pain relieving medications which act on nerves

Physical therapy can help with balance, strength and safety.

Occupational therapy can help improve fine motor skills like buttoning shirts

Relaxation therapy, distraction, biofeedback

Some chemotherapy drugs which are likely to cause CIPN

Certain chemo drugs are more likely to cause CIPN. Some of the more common ones include:

Platinum drugs like cisplatin, carboplatin, and oxaliplatin

Taxanes including paclitaxel, docetaxel, and cabazitaxel

Plant alkaloids such as vinblastine, vincristine, and etoposide

Immunomodulating drugs like thalidomide, lenalidomide

Proteasome inhibitors such as bortezomib, carfilzomib, and ixazomib

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Pelvic Pain Treatment In Delhi - Removemypain

Coccyx or tailbone is the last bone at the end of the spine. Pain in the region of the tailbone is called coccydynia. Common causes include trauma, childbirth, and repeated strain on the coccyx. Patients may have increased mobility which triggers the inflammation. Other causes include fracture, infection, and tumor.

Most patients present with pain on sitting or getting up from a sitting position and localized tenderness around the coccyx. Pain during a bowel movement or sex daycare present. Diagnosis is made based on history and examination findings. Sometimes tests such as x-rays, CT scans, and MRIs are requested. Treatment involves avoiding further strain on the coccyx-using appropriate cushions, weight management, simple painkillers combined with physiotherapy, manipulation, and injections such as

Coccyx/ Sacrococcygeal Joint Injection – these are performed under x-ray or ultrasound guidance and involve injecting local anesthetics and a small dose of steroids in or around the sacrococcygeal joint. It is not uncommon for the ligaments around the coccyx to be the pain generator and these are often injected at the same time. The procedure is performed as a day case under local anesthesia.

Ganglion Impar block and Radiofrequency - ganglion impar is a collection of nerves located in front of the sacrum and coccyx. This procedure involves injecting a local anesthetic and steroids mixture under x-ray guidance close to ganglion impair. The needle position is verified by giving a dye (contrast) before injection. Radiofrequency treatment is performed if the benefits of injection are short-lasting.

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