Mayank Chansoria

Scope of Pain Clinics in India

One of the revolutionary disciplines emerging in the field of medicine in India in recent times is Pain Medicine, though developed countries like the United States have put a special impetus on its practice and recognized it as a separate specialty since the last century. This shows the lack of awareness of this specialty in our country not only among patients but also among the medical fraternity. This huge lag in the awareness of pain management facilities calls for special endeavors involving dedicated awareness programs via educational handouts, social media, TV, press release, and public exhibitions. Separate continuing medical education programs and conferences should be promoted among the medical community specially dedicated for the cause. A major part of pain management lies in palliation of the incurable conditions like cancer, which is emerging as a major cause of morbidity in the present scenario of increased life expectancy due to advanced medical facilities. Medical science has found ways to cure cancer or at least prolong its course, but the patients who go through the cycles of treatment only know the pain they have to go through to put up with their situation. The unbearable pain, however, makes life worse. And little do the patients know that there is an escapade from the situation in pain medicine. Even doctors, when encounter such situations, leave the patients with prescriptions of mild analgesics like paracetamol, not realizing that they are in fact making their patients life worse with the ignorance of their enormous pain. Pain clinic is an answer to the problem, providing palliative care to patients with such incurable conditions. Palliative medicine in itself Editorial

Bacterial colonization of epidural catheters used for short-term postoperative analgesia: a microbiological examination and risk factor analysis -

Background: Epidural catheter-related infections are very rare, but if occurs, the complications are debilitating and life-threatening. The route by which the infection spreads is still under debate with the prime suspected route being direct spread with migration along the epidural catheter. Objective: To critically analyze the incidence of epidural catheter-related infections, correlate the proposed risk factors leading to infection, and come up with a time frame at which the catheter should be ideally removed. Material and Methods: A prospective observational study was done to study the incidence of epidural catheter-related infections and to find the bacteriological profile associated with epidural catheter-related infections. Ninety patients of ASA I and II aged between 18 and 65 years scheduled for elective surgeries requiring epidural catheter for intraoperative and postoperative analgesia were randomly allocated into three groups. Groups I, II, and III consisted of 30 patients each, and the epidural catheters were removed aseptically after 24, 48, and 72 h, respectively, and the catheter tips were sent for microbial culture examination. Result: There was no incidence of epidural infections during the whole study. The incidence of bacterial colonization over epidural catheter tip in our study was 7.1% with “coagulase-negative Staphylococcus epidermidis” as the most common organism. Among the various risk factors studied, we found significant correlation only to that of the duration of catheter in situ with that of the positive catheter tip cultures, with 85.7% of the positive cultures from group III. Conclusion: It is not advisable to allow the epidural catheters to be in situ for more than 72 h to avoid the chances of epidural catheter-related infections.

A preliminary study of a novel technique of suprascapular nerve block in treating chronic shoulder pain

Objective: The objective was to evaluate efficacy of a novel landmark-based technique of suprascapular nerve block (SSNB) in the treatment of shoulder pain and disability. Study Design: Prospective, observational study. Materials and Methods: Forty patients with chronic shoulder pain were treated with a new technique of SSNB. Visual analog scale for pain (VAS) and shoulder pain disability index (SPADI) were assessed before giving the block and at both the follow-up visits at the end of 1 st and 4 th week. Pain relief was also assessed on Likert scale in both the follow-up visits. Results: The baseline VAS of 8.45 ± 0.87 was significantly improved to 2.80 ± 0.70 and 5.02 ± 1.02 after 1 st and 4 th week of SSNB, respectively (P = 0.000). Similarly, the baseline total SPADI was of 71.15 ± 4.96, was significantly improved to 55.22 ± 1.32 and 57.61 ± 3.50 after 1 st and 4 th week of follow-up, respectively (P = 0.000). The mean Likert scale score after 1 week was 3.68 ± 0.656 and after 4 weeks was 4.00 ± 0.679. Conclusion: This new technique of SSNB is safe, effective, and well-tolerated in treating chronic shoulder pain and disability.

Randomized blinded comparative analysis of autologous mononuclear medullary fraction and viscosupplementation in grade 0 and grade 1 radiographic scale of knee osteoarthritis

Introduction: Bone marrow aspirate concentrate (BMAC) has been demonstrated to induce unfathomable healing activity in various forms of arthritis. On the other hand, viscosupplementation is widely used as one of the modalities to palliate the symptoms of knee osteoarthritis (OA). To the best of our knowledge, no research involving a comparison of the two interventions has been done. We evaluated and critically analyzed the comparative efficacy of an intra-articular injection of BMAC or sodium hyaluronate injection (Halonix; Cadila) in terms of pain relief or functional improvement using validated scoring instruments. Materials and Methods: Fifty patients of either sex, aged more than 18 years with grade 0 and grade 1 primary knee OA were randomized to receive intra-articular injection of either the mononuclear marrow concentrate or Halonix, and they were followed for 6 months. The patients treated received single injection either of mononuclear marrow concentrate or Halonix during the course of study. An independent, blinded evaluator assessed the patient with the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and the visual analog pain scale. Results: Both the cohorts treated with mononuclear marrow concentrate and with Halonix showed improvements from the baseline parameters at the end of 1-month follow-up. Group treated with BMAC showed significant difference (p<0.05) with respect to WOMAC, or visual analog scale results at the end of 6 months of follow-up. Men demonstrated significant improvement (p<0.05) in both the groups. Conclusion: Statistical significant differences were detected between patients treated with intra-articular injections of monocular marrow concentrate and those treated with the Halonix with respect to pain relief or function at 6 months of follow-up. Clinical Relevance: Direct delivery of bone marrow mononuclear concentrate to radiographic symptomatic grade 0 and grade 1 knee OA has the clinical potential to improve functional activity/ functional aspect of knee OA, providing a cost-effective approach for grade 0 and grade 1 knee OA.