Pain Management

“Pain Relief is basic Human Right”

Pain management is sub-speciality of Anaesthesiology that caters to improving the quality of life of patients that suffer from chronic pain. It is devoted to diagnosis and treating chronic pain by employing minimally invasive techniques with less reliance on heavy medication. Pain Management Centre at MITR hospital offers supportive, compassionate and patient-centred environment. It is led by Dr. Shantanu Mallick who is the pioneer of Pain therapy in Navi Mumbai. He got his FIPP degree from World Institute of Pain, Texas, USA which is one of the highest milestones in the field of pain management.

Common disorders in Pain Management

  • Sciatic pain: Pain that originates in spine and runs to the back of the leg which occurs due to a herniated disk or a bony sour growth.
  • Cervical spondylosis: It is a degenerative age related condition caused due to wear and tear of the cartilages and bones in the neck giving rise to pain in the neck.
  • Frozen Shoulder: It is characterised by stiffness in the shoulder which leads to decreased mobility at the shoulder joint due to immense pain associated with it.
  • Migraine
  • Pancreatitis:  Pancreatitis is inflammation of the pancreas which results in abdominal pain.
  • Fibromyalgia or Myofascial pain Syndrome: Fibromyalgia and myofascial pain syndrome may co-exist but are two different things. Fibromyalgia is generalised pain in the muscles with tender points but no trigger points while Myofascial pain syndrome constitutes of trigger points which when pressed not only cause a localised pain in the muscle but also causes the pain to be radiated else-where.
  • Coccydynia: Pain in the coccyx pain or tail bone due to injury, fracture or dislocation.
  • Osteoarthritis
  • Whiplash Injury
  • Trigeminal Neuralgia: Pain that is associated with the fifth nerve of the brain called the trigeminal nerve. The pain is found in the area of distribution of the trigeminal nerve i.e. the face. It is considered to be one of the most painful conditions in medicine.
  • Herpetic neuralgia: Herpes virus hides in the nerves and when it is re-activated it leads to active herpes infection. The nerve pain that arises due to the damage done from infection of herpes virus is called as herpetic neuralgia.
  • Post Thoracotomy Pain
  • Diabetic neuropathy
  • Cancer pain,
  • Pain in AIDS
  • Complex Regional Pain Syndromes
  • Painful Medical Diseases

Common Symptoms in Pain Management

  • Pain in the back region.
  • Pain in the Neck.
  • Frequent unbearable headaches.
  • Pain that radiates to hand or leg.
  • Overall Body Pain.
  • Pain arising due to damage done to nerves.
  • Cancer patients suffering from pain.

Common Interventions in Pain Management

  • Lumber Epidural Steroid Injection
  • Facet Joint Block
  • Cervical Epidural Steroid Injection
  • Intradiscal Ozone therapy
  • Disc Dekompressor Therapy
  • Radio-Frequency Ablation Therapy
  • Lumber Sympathetic Block
  • Stellate Ganglion Block
  • Coeliac Plexus Block
  • Splanchnic Nerve Block
  • Superior Hypogastric Plexus Block
  • Gasserian Ganglion Block for Trigeminal Neuralgia
  • Spinal Cord Stimulator
  • Intrathecal Drug Delivery System

Representative cases

• Frozen shoulder:

http://www.youtube.com/watch?v=ssLZp_HbaQ8&feature=relmfu

·Poonam, 47yrs/female suffering from chronic shoulder pain for 6 months which was not manageable even after regular physiotherapy and medications. She was given Suprascapular Nerve block in one of the oldest hospitals in Vashi and she got total relief in 3 days.

·Sarabai, 68yrs/female, suffering from chronic shoulder pain for 7 months. Orthopedicians told them there is a full thickness tear of Supraspinatus muscle tear, which one of the major muscles of the shoulder which helps in movement but she has no history of trauma in shoulder. She was advised for surgery. To avoid surgery they consulted me and I felt she doesn’t need surgery as there is no history of trauma. I gave continuous suprascapular nerve block which immediately reduced her pain and she was able to do all movements of the shoulder.

·V A N Sharma, 48yrs, male suffering from chronic shoulder pain for more than a year working in multination company, which is affecting his job regularly. He has been given continuous suprascapular nerve block with regular physiotherapy and his shoulder became normal in 7 days.

·N S Kamble, 54yrs/ obese diabetic female suffering from frozen shoulder for more than a year untreated or not responding to physiotherapy due to severe pain during exercises. She was given Continuous Cervical Epidural Analgesia which given her tremendous pain relief and she could manage to do all the exercises within 3-4days. Now she is absolutely comfortable doing regular exercises.

Cervical spondylosis / Cervical Radicular pain

·Dr Rita, 62yrs/ female, a paediatrician and retired medical administrator of a corporate hospital of Delhi was suffering from severe neck pain radiating to left hand for 10 days. She was not responding to physiotherapy, medical management where as her MRI report was not showing much abnormality by which Neurosurgeon / Orthopedicians were reluctant to go for surgery. I have given her Continuous Cervical Epidural analgesia with local anaesthetics and steroids in Fortis Hospital, Vashi which gave her excellent relief. Now she is quite comfortable doing all her day-to-day activities.

·Neetu, 36yrs/female suffering from cervical radicular pain radiating to right hand with right chronic shoulder pain. She was given cervical epidural analgesia for 3 days. Her both problems were solved.

·NarendraKaur, 45yrs/female suffering from continuous cervical radicular pain on left side where MRI was showing disc bulge and nerve root compression at C5-6 and C6-7 level. She was given cervical epidural steroid injection which gave her excellent relief and no need to do surgery.

 Vertebral Fracture pain

·M R Ramsundar,52yrs/male suffering from chronic back pain restricted to mid portion of the back which is not radiating to legs. He had a history for sudden jerk during driving on a big bumper on the way going to Goa 4 yrs back. His x-ray was showing old compression fracture at the first Lumber vertebra. His pain was basically for Facet joint pain from that vertebra which give pain during bending, standing or turning in bed. It is really tough to treat these cases as we can’t replace the vertebra. We can only stop the pain sensation which is coming from facet joint. For this I have given facet joint block by Radio-frequency ablation. He is very much comfortable for last 8 months.

 Sciatica / Low back pain

·Vijaylakshmi, 45yrs/female suffering with low back pain radiating to right leg and MRI lumbar spine shows disc bulge at L4-5, L5-S1 with L5 nerve root compression. She was given Transforaminal Epidural Steroid injection at L4-5 and L5-S1 level which gave her excellent relief and no surgery required.

·Ratna 40yrs/female was suffering with low back axial pain for 10yrs, pain increases with standing and reduces with lying down, MRI show disc bulge at L5-S1 and S1 nerve root compression, facetal arthropathy. She was given Ozone Discolysis at L5-S1 with Bilateral Transforaminal Epidural Steroid inj at L5-S1 with Si nerve root block and facet joint block. She is now doing her all day-to-day activities without complains.

·Pinki , 43yrs/female suffering from low back pain radiating to right leg, MRI shows disc bulge at L4-5, L5-S1 with nerve root compression, with facetal arthropathy by which she was unable to maintain her teaching job. She was given Ozone Discolysis at L4-5, L5-S1 with facet joint block. Now she is maintaining her school as well as family happily.

·Sohanlal, 62yrs /male suffering with Myasthenia Gravis, a dreadful musculo-skeletal problem and known case of diabetes, hypertension having severe low back pain not radiating to legs. He was totally bedridden for 4 months even after extensive treatment in Bombay Hospital he is not getting any improvement in low back pain which restrict him turning in bed or pain during bending. After once diagnostic facet joint block he got tremendous relief and then it is continued by Radio-frequency ablation therapy. He is improving much from earlier condition.

Tail bone pain / perineal pain

·63yrs/female was suffering from peri-anal pain for 4 years. She became panic to sit straight and she always lies down or sits in one side. She had a history of surgery in anal canal 4 yrs back and pain started from then only. Recently Orthopedicians as well as Surgeons have seen no abnormality as such which necessitated a second surgery. No medical treatment was supporting her. She was given Ganglion Impar Block which gave her almost 90% pain relief for last 3 months and now she is comfortable sitting properly.

·Kalpana 38yrs/female, suffering from tail bone pain for two years. She had a history of fall on back and x-ray sacrum was showing there is an anatomical change in coccyx which gives her pain during sitting. This condition is tough to manage by surgery or by medicines. Only Ganglion Impar block can helped her almost for an year. Till today she is comfortable.

 Cancer pain

·Ratnavati, 55yrs/female suffering from CA rectum met to liver lung but not bones, LBP, generalized body pain, perianal pain. She was not tolerating morphine. She was given Superior Hypogastric plexus block and Ganglion Impar block by absolute alcohol. Now she is now much comfortable and peacefully lives for her life.

·Fakir, 63yrs/male suffering from pain in upper abdomen, H/o CA lower part of esophagus and stomach, back pain also, Bone metastasis. He is not tolerating morphine at all. He was given Splanchnic Nerve Block by absolute alcohol. He is happy with the quality of life.

 Vascular disease pain

·Rupali,21yrs/female was suffering with severe foot pain and her foot was getting gangrenous in short period due to total blockage of a major artery (arteria-dorsalis-pedis) due to unknown cause. She was getting so much pain that she was trying to commit suicide. Almost suffering after 10days she was brought to me and pain was initially relieved by Continuous Epidural Analgesia and Lumber Sympathetic Block. All medical treatments as well as angioplasty of foot also didn’t give any support rather than deterioration. She was only given multiple sitting of Lumber Sympathetic Block which totally cured her foot saved from amputation.

·Indira, 55yrs/female suffering from gangrenous changes in right middle finger due to vascular insufficiency (? Raynaud’s phenomenon). She was given repetitive Stellate ganglion block by local anesthetics and steroid. Her resting pain tremendously reduced and gangrenous changes couldn’t increase which saved the rest of the fingers and hand amputating the limited dead part of one finger.

Post surgical pain from Hernioplasty/Hysterectomy

·Raju, 25yrs/male suffering from post-hernia surgery pain on right lower part of abdomen where the surgery has been done one year back, severe pain on the surgical incision site (allodynia) with touch also, pain is also radiating to the right groin. He is scared to marry which may affect his sexual life. He was given continuous Lumber Plexus Block for 5days with neuropathic medicines which gave him more than 80% relief.

·Reena, 38yrs/female suffering with pain on abdomen on the operative site after hysterectomy, pain on right leg radiating in nature, low back pain, operating was done 8 months back. Surgeons, Orthopedicians, Neurologist didn’t find any major abnormality to treat. Diagnostic laparoscopy surgery was performed to see any problem in abdomen after hysterectomy. Sometime it was thought that she needs counselling. But she was given Lumber sympathetic block and local infiltration with local anaesthetic and Steroid and abdominal exercises. This is one kind of Complex Regional Pain Syndrome or Reflex Sympathetic Dystrophy. She is now quiet comfortable.

Post Thoracotomy pain or Post Heart Surgery pain

·Subhash, 58yrs/male suffering with pain after CABG on the right side of the chest and surgical areas for one year. He was given Thoracic Epidural / Thoracic Paravertebral Block with local infiltration with local anesthetic and steroid by which he is now very much comfortable. These are all due to nerve entrapment or neuritis from surgical injury.

 Pain from Rib fractures

·Dr Neera (Radiologist), 40yrs/female, suffering from severe pain due to right-sided multiple # ribs (T2 to T8) after she fell down in bathroom. She was getting too much difficulty in breathing and lying down. She was in sitting position for 2 days with minimal movements. Regular pain killers were not effective. She was given Continuous Thoracic Epidural for 7 days. With thoracic epidural analgesia she was sleeping as well as walking around the ICU comfortably.

 Trigeminal Neuralgia Pain

·Rekha Panthe, 58yrs/female, suffering from unilateral facial pain for many years. Trigeminal neuralgia pain is characterized by sharp shooting pain in one side of the face comes suddenly with some activity of mouth or face like chewing, sheaving or rubbing and pain stay for few minutes only and disappears for many days. In this was frequency of pain increases. This is due to some nerve pathology of Trigeminal nerve which supplying the face on both side. Most commonly effective medicine is Carbamazepine. If medical treatment fails then Trigeminal nerve Block by Radio-frequency Ablation is the most effective. Sometimes Neuro-surgery also helps. She was given Trigeminal nerve Block by Radio-frequency Ablation technique by which she is almost free from pain for last one year with minimal numbness on face which is manageable as there is no pain.

·Shivaji, 58yrs/male suffering from Trigeminal neuralgia ophthalmic division (V1) for 30 yrs. He was ultimately given Trigeminal nerve Block by Radio-frequency Ablation. He got more than 70% relief. You can see the video in you tube on this link http://www.youtube.com/watch?v=7IaoTkgt96M

 Complex Regional Pain Syndrome

·Narendra, 51/Male suffering from pain on right heel, history of fall in 1980 from an electric post and now he is having burning pain and pain with touch (allodynia) which giving him trouble during walk. Sometimes swelling also appears in ankle. This is a classical case of Complex Regional Pain Syndrome. He was given diagnostic Lumber Sympathetic Block which gave him more than 90% pain relief till today.

About Dr Shantanu Mallick

He is a Consultant in Pain Management at MITR Hospital and runs the Pain clinic at MITR.

·Dr Shantanu is a renowned anesthesiologist and has been practicing in Anesthesia since 2000. Dr Shantanu is an expert in obstetric Analgesia (painless Delivery) and runs an antenatal clinic. His special interest in Pain Management led him to devote majority of his time into Pain Management culminating into a Post Graduate Diploma in Pain Management, Apollo, Hyderabad under Dr Murlidhar Joshi in 2006(Aug-Nov) and finally FIPP degree (Fellow of Interventional Pain Practice) Exam in Hungary in Sept 2011.

·Dr Shantanu has also done Comprehensive Interventional Pain Management Course (CIPM-III, IV) from ISSP Mumbai Branch in March’2010 and 2011. He is the pioneer in Interventional Pain Therapy in Navi Mumbai and joined Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai as In-charge of Pain Clinic in Jan 2012.

·Dr Shantanu has a keen interest in academics as is evident by numerous presentations and guest lectures at various society meetings and CME’s such as Poster presentation in ISSPCON 2006 on “High risk breast surgery under TPVB, Ahmedabad; presentation in ISSPCON 2007 on “Basic Principles of Peripheral Nerve Stimulation” in PGI, Chandigarh; Paper presentation in FNCOA 2008 on “Special tips for giving Spinal/Epidural in Obese patients in lateral position” in Udaipur; Guest lecture in ISACON 2008 on “How to develop Labor Analgesia practice in urban areas” in Visakhapattanam; Paper presentation on breast surgery under TPVB (podium presentation) and Carotid Endarterectomy under cervical epidural (poster presentation) in ISACON 2010 in Lucknow.

  • He also chaired a scientific session in ISACON 2010 for a panel discussion on PDPH in Lucknow.
  • Dr Shantanu was the founder member of ISA (Indian Society of Anesthesiologist) Navi Mumbai City Branch.

Detailed CV 

  • Name: Dr Shantanu Mallick
  • Qualification: MBBS (Kol), DA (Mum), FIPP (USA),
  • Designation: Consultant Anesthesiologist & Pain Physician
  • Hobby: Singing, Photography

Experience

• Anesthesia Practicing since 2000
• Obstetric Analgesia (painless Delivery) practicing since 2002
• Running own antenatal clinic since 2002
• Started ISA (Indian Society of Anesthesiologist) Navi Mumbai City Branch in Dec’2003
• Poster presentation in ISSPCON 2006 on “High risk breast surgery under TPVB” in Ahmadabad
• Post Graduate Diploma in Pain Management, Apollo, Hyderabad under Dr Murlidhar Joshi in    2006(Aug –Nov)
• Pioneer in Interventional Pain Therapy in Navi Mumbai
• Paper presentation in ISSPCON 2007 on “Basic Principles of Peripheral Nerve Stimulation” in  SGPGI, Chandigarh
• Paper presentation in FNCOA 2008 on “Special tips for giving Spinal/Epidural in Obese patients in  lateral position” in Udaipur
• Guest lecture in ISACON 2008 on “How to develop Labor Analgesia practice in urban areas” in  Visakhapattanam.
• Comprehensive Interventional Pain Management Course (CIPM-III) from ISSP Mumbai Branch in  March’2010
• Comprehensive Interventional Pain Management Course (CIPM-IV) from ISSP Mumbai Branch in March’2011
• Started Pain Clinic in May’2010 in MGM Hospitals & Fortis Hospital in Navi Mumbai
• Paper presentation on breast surgery under TPVB (podium presentation) and Carotid  Endarterectomy under cervical epidural (poster presentation) in ISACON 2010 in Lucknow
• Chairing the session in ISACON 2010 for a panel discussion on PDPH in Lucknow
• Cleared FIPP (Fellow of Interventional Pain Practice) Exam in Hungary in Sept 2011
• Joined in Dr. D. Y. Patil Medical College and Hospital, Navi Mumbai as In-charge of Pain Clinic in Jan 2012.



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