Description
Same, Same but Different" patterns in pain refer to situations where patients report similar symptoms or sensations but have distinct underlying causes or mechanisms. This concept emphasizes the importance of thorough clinical evaluation, as seemingly identical pain experiences may require different diagnostic approaches and treatments.
Summary Listen
- Pain is a subjective experience influenced by various factors, including spirituality, mental strength, age, sex, race, and comorbidities. A "RAT" approach is essential: Recognize the presence of pain, Assess the type of pain (acute, chronic, nociceptive, neuropathic, cancer, non-cancer), and Treat accordingly. Acute pain differs significantly from chronic pain; the former is protective, while the latter is pathological and serves no protective function. Nociceptive pain arises from tissue damage, neuropathic pain from nerve damage, and central pain involves hypersensitivity without identifiable nerve or tissue damage.
- Back pain is a prevalent musculoskeletal disorder, often with a neuropathic component. Pain generators in the spine include interspinal ligaments, muscles, facet joints, and discs. Treatment involves medical management, physiotherapy, and Interventional pain management; surgery is the last resort. Transforaminal epidural steroid injections can be effective for disc-related pain, and intradiscal ozone can help heal damaged discs.
- Coxidia, or tailbone pain, can be managed with injections of local anesthetics and steroids, RF ablation of the coxal nerve plexus and ganglion impar. Osteoarthritis can be addressed with regenerative methods like PRP Therapy and Prolotherapy, which aim to heal the cartilage and provide pain relief and stability. Frozen shoulder can be treated with intraarticular or periarticular steroid injections.
- Cancer pain management involves interventions like mandibular nerve neurolysis, maxillary nerve neurolysis, paravertebral neurolysis, and sympathetic blocks to reduce opioid dosage. Complex regional pain syndrome (CRPS) can be managed with sympathetic blocks such as stellate ganglion block for upper limb and head/neck CRPS, and lumbar sympathetic block for lower limb CRPS. Trigeminal neuralgia is treated with radio frequency ablation of the gasserian ganglion or balloon compression.
- Peripheral vascular disease-related pain can be addressed with lumbar sympathectomy to open collateral blood circulation. Headache is another common problem, with migraine and tension-type headache being the most frequent. Chronic post-operative pain can be managed with epidural neuroplasty. CBD shows promise in managing chronic pain due to its potential in reducing constipation, inducing euphoria, and improving sleep quality.
Sample Certificate
About the Speakers
Dr. Anurag Aggarwal
Director and HOD - Emergency Medicine and Trauma, Fortis Hospital, Noida
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