User talk:Dr. Amod Manocha

Suffering from chronic pain?
Here’s how the Pain Management Specialist can make a difference… Pain is a common reason for medical consultation. Over the years, studies evaluating the Global Burden of Diseases have found chronic pain conditions amongst the leading causes of disability worldwide. The impact of chronic pain can vary, ranging from an occasional distraction or discomfort to constant severe debilitation. Some examples of common chronic pain conditions include back and neck pain, sciatica, diabetic neuropathy, headache, frozen shoulder, persisting post surgical pain, cancer pain, abdominal pain, pelvic pain and fibromyalgia. Pain in a significant proportion of these conditions is amplified by stressful and sedentary life style with obesity, lack of regular exercise, smoking, poor workplace ergonomics contributing to the increasing incidence and severity.

Chronic or longstanding pain does not always signify ongoing damage. Conditions such as arthritic knee or back pain are often accepted as part of aging process, stopping people from exploring treatment options. It can, however, cause significant distress and compromise the quality of life. With the correct help, you can control your pain better and make your life easier. A pain specialist can help to diagnose the cause of your pain and work towards relieving/ reducing it and minimise the impact on your daily routine. This is how the approach of pain management specialists is different:

Knowledge and experience When you receive specialist training in a subject and deal with specific conditions on a daily basis (chronic pain in this case) your experience/ learning is bound to reflect your treatments and outcomes. The education and the training received helps in successfully diagnosing and treating pain issues. In India the opportunities for specializing in Pain Medicine are limited with no nationally ascribed curriculum. In the western countries pain medicine is reorganized as a separate specialty with numerous training and super specialization opportunities. Pain clinics form an integral part of most reasonable sized, good hospitals. Pain specialists generally undertake a detailed assessment of every aspect of pain and try to address problems comprehensively.

I have spent a year doing pain research and another year in pursuing advanced training in the field of pain medicine in London, UK. This is addition to the basic and intermediate training in pain medicine during my 7 years of initial anaesthesia training in London, UK. Subsequently I have worked as a Chronic Pain Consultant in UK.

Treating the cause of the pain and not just the symptoms Pain specialists try to explore why a problem may have occurred as this is important to prevent reoccurrences. Once the underlying problem has been resolved, the pain may automatically ease off giving you lasting relief. This is better approach than just taking medications for temporary relief. Understandably this may not be possible in all cases but this should not become a deterrent to trying.

Treating the body as a whole Pain management specialists are trained to visualize body as a whole and use a multidisciplinary approach while addressing chronic pain. They don’t concentrate on just controlling the pain, as they understand that pain can affect multiple facets of life from mental health to relationships to jobs to social life etc. Each person is unique and experiences/ processes pain differently and hence the need for individually tailored therapies. They use a combination of modalities including physiotherapy, medications, injections/ interventional therapies, psychological therapies, Complementary and alternative therapies including Acupuncture, TENS, acupressure, and meditation along with patient education to achieve the best possible results.

Headaches are a common health issue that affects people of all ages world over
Headaches are a common problem that affects people of all ages worldwide. There can be many reasons why people can develop headaches and these poor neck position while working or sleeping, stress, overwork, medical conditions such as degenerative disease of the spine, trauma, sinus problems, strokes, infections etc. Headaches which keep recurring are called recurrent headache and those that tend to persist for a long period of time are called chronic headaches.

Headaches can hinder day to day activities and severely affect the quality of life especially in individuals who experience frequent severe headaches or long lasting / constant headaches. Recurrent headaches can be quite difficult to handle since they tend to develop suddenly, not giving you an opportunity to prepare for it and plan your day. There a variety of measures that you can take in order to reduce the impact and frequency of these headaches. Some of these are quite simple, but most people doubt the effectiveness and hence are hesitant to implement. These can work synergistically with the other management options suggested by your pain specialist. These include

 General lifestyle modifications Regulating your sleep cycle: Having a regular sleep cycle goes a long way in helping to reduce these headaches. Good sleep environment plays an important role and includes a darkened bedroom, a quiet place where you are comfortable and it helps to unwind. Some find a relaxing hot bath helpful in unwinding prior to heading off to bed. It is advised to avoid watching TV, using laptops or mobiles before you go to bed.

Hydration: Keep yourself well hydrated, because dehydration is a known trigger of headaches, and can worsen preexisting headaches.

Regular meals: Have you meals on time. This another important factor that plays a role in the development of headaches. Low blood sugar/ hypoglycemia can trigger headaches. If you are in the habit of skipping meals or eating late and heavy meals, then you should consider changing this.

Avoiding triggers: Other trigger/ precipitating factors may vary from individual to individual. From particular foods to the brightness of TV screens to loud noises, certain smells etc there are numerous factors. You are the best person to identify these and avoid them as much as possible. Tea and coffee: Minimize your intake of coffee and tea, because they are known to precipitate headaches. Avoid taking them late in the evenings and just before going to bed.

Quit smoking

Stress management and relaxation: Learn how to manage your stress in a productive manner and practice relaxation techniques. These general measures, when used in combination with advice from your pain specialist can help you control your headaches better. Some of the common medical interventions used in management of headaches include:

Medications: Medications for headache can be used to terminate the headache at the time you are experiencing it or can be taken as a preventive measure to reduce your chances of developing a headache. Preventive medications are usually taken when people experience frequent or continuous headaches, and they should be taken as prescribed by your doctor. Too much of any medication can also end up being the cause of your headache as well, and is given the name Medication Overuse Headache. The different medicines used for recurrent headaches are:

Antidepressants: These medications, besides the pain relieving effects can also have other beneficial effects like reducing anxiety and sleep disturbances. The drug selected will depend on your individual situation. Beta blockers: Beta blockers, commonly used in management of high blood pressure and heart problems. They are helpful in the management of migraine related headaches

Anti-seizure medicines: Several anti-seizure medicines help in the prevention different types of recurrent/ chronic headaches including migraine. NSAIDs: Nonsteroidal anti-inflammatory drugs are commonly used over the counter medications for mild to moderate pain, and they are effective in various different types of headaches. On frequent usage they can have harmful side effects such as gastritis and peptic ulcer disease; therefore they must be used with caution and under medical supervision.

Other interventional methods: When simple measures such as lifestyle modifications and oral medications are not successful in resolving the headaches, then it may be worth considering other interventional methods. The intervention used will depend on the diagnosis. The common interventions include:

Nerve blocks Injections of the cervical spine Radiofrequency treatment Botulinum toxin injections Complementary & Alternative therapies These include:  Acupuncture – which involves the insertion of thin needles at definitive points in your body, with the intention of providing pain relief Massage therapy – this can help to reduce the stress and tension. It helps to relax the tightened muscles and thereby provides relief.

Meditation and relaxation therapy Herbs and nutrients – Several organic herbs help in preventing migraine headaches and reduce the intensity of headaches. In deficiency states vitamin and mineral supplements can be taken to reduce headaches and prevent them from reoccurring. It is best to seek medical advice before you starting with any of the above methods.