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A natural remedy for pain

Olio di ricino è buono. In realtà è la migliore

Jatropha is a genus of approximately 175 succulent plants, shrubs and trees from the family Euphorbiaceae. The name is derived from the Greek words iatros, meaning “physician,” and trophe, meaning “nutrition,” hence the common name physic nut. It has an interesting history. Hydrogen cyanide which is present in the leaves and the extracts could be dangerous, and Ricin extracted from this genus is a potent biological weapon. Jatropha seed extract (Castor Oil) was used in intimidatory tactics by the Blackshirts under Mussolini, possibly as an alternative to bunga-bunga parties. Today, the Italian term olio di ricino, still carries strong political connotations. It is used to satirize patronizing politicians. They should be used with caution in common conversation. The love hate relationship Italy had with Turkey during the wars must have made many a Turk utter “amanakku,” the Siddha name for Jatropha!

In Siddha medicine the physiological components of human beings were classified as Vatha (air), Pitha (fire) and Kapha (earth and water). When the normal equilibrium of three humors is disturbed, disease is caused. The factors, which affect this equilibrium, are environment, climatic conditions, diet, physical activities, and stress. Alchemy known as Rasasastra was part of Siddha, and flourished between the 10 and 14th centuries. Varma, another branch of Siddha, deals with traumatology and accidental injuries. The drugs used in Siddha could be classified into three groups: herbal product, inorganic substances and animal products.

The leaves of Jatropha, as well as the castor oil extracted from its seeds were used to treat back pain, arthritis, abdominal pain and rheumatism for centuries in Siddha Medicine. In a recently published study, the researchers extracted the physiologically active components of the leaves of Jatropha curcas using methanol as solvent. The pain relieving effect at 200-400mg/kg was comparable to aspirin. More work on isolating and characterizing the active ingredient in the extract and in determining the precise mode of action, is now being done.

Jatropha oil is being promoted as an easily grown bio-fuel crop in hundreds of projects throughout India. The railway line between Mumbai and Delhi is planted with Jatropha and the train itself runs on 15-20% bio-diesel. Indian medicine in the past had looked to Jatropha for treating pain. The present, with sex selection and female foeticide, looks to Jatropha as an abortifacient. The future might look like one large Jatropha shrubbery (20 male flowers to each female flower).

Author: Dr.P.Vijayanand, Director, Axon Pain Center, Hyderabad, India.

Posted in Analgesic, Health, natural remedies for pain, Siddha medicine | Tagged , | Leave a comment

Shoulder Pain

Shoulder pains come and go.

The “self” is a much more tenuous and vacillating entity than we like to think. Severe, persistent pain like the one in your shoulder makes the self vacillate even more to the point to be off the hinges. Shoulder pain is common. Women, particularly the middle-aged and elderly, are affected more by it.

Overuse of the shoulder joint is the main culprit. Writing, cleaning, lifting heavy weights etc could damage the soft tissue structures (muscles, tendons, capsule, ligaments) in the joint. If you suffer with diabetes too, then the shoulder might feel worse. As repetitive movements cause pain, and our life is full of them, there are too many in India who know not much in the way of joie d’vivre. Not being able to do things you used to, and what you have lost, could turn explosive in mind, body, and soul. Our optimism and sense of purpose are liable to drain away, like water from a punctured container.

Causes of shoulder pain

A myriad of reasons may cause shoulder pain, common of which are Supraspinatus tendinitis, Rotator cuff injury, frozen shoulder, and Periarthritis of shoulder.

Supraspinatus Tendinitis as the name implies is a tendon inflammation. A tendon is a tough band of fibrous tissue that connects muscle to bone. This particular muscle helps lift your shoulder sideways, like when you are holding a bucket. Also known as ‘Impingement syndrome’ the pain occurs with initial movement of the shoulder, with tenderness over the outer border of the shoulder.

Rotator Cuff Injury happens when one or more of the 4 muscles of the rotator cuff which holds the shoulder stable during forward rotation are injured. The pain is in the front of the shoulder, at the beginning of the arm bone; movements would be limited, and tenderness would be present.

Periarthritis of Shoulder is inflammation of shoulder joint soft tissue structures like ligaments, articular cartilage. The pain occurs between 60-120 degree range of motion i.e. (out stretch), and pain free in remaining degree of movement. Tenderness could be present on the outer border of shoulder joint.

Frozen Shoulder is the tightening of the joint capsule of the shoulder joint which limits movements, and pain and tenderness could be present all over the joint.

Shoulder pain treatments

Most shoulder pains, like Ishant Sharma’s form, are of the garden variety. Give it sufficient time, and it will go away on its own. On occasions it might persist. The treatment in the initial stages of the pain is simple. Any physiotherapist worth his salt would recommend RICE. R-Rest, I-Icing, C- Compression and E- Elevation, the last two however, are not applicable with shoulder pain. Rest could be achieved with cuff and collar. It is advisable to wear it for 2-3 weeks to promote faster healing and recovery. Ice cube massage for 3-4 weeks reduces local inflammation. Anti-inflammatory medications can be useful too. Electrotherapy modalities like Ultrasound Therapy, Short Wave Diathermy, Interferential Therapy, TENS, Wax Therapy, and Infra Red Radiation Therapy are used externally and are effective pain relieving modalities.

Shoulder pain remedies should be tailored to suit the individual’s pain condition and capabilities. Much like Dhoni the Wandering Conjurer! Performing tricks with very few mishaps en route in terms of team selection (Piyush Chawla was the rabbit that died in the hat). Exercises include passive range of motion (with the help of therapist) to improve the joint movement. Once you gain a good range of movements active exercises are recommended i.e. you would be encouraged to perform the movements on your own. Strengthening Exercises improve the muscle power, and are done with or without gravity, and when better, against some resistance (weights). Joint stretching and manipulation are also offered at Axon to help reduce stiffness in the joint and its surrounding soft structures.

Certain sensible precautions would help avoid recurrence of pain. Regular shoulder exercises for 10 minutes a day for the rest of your life would almost certainly help avoid a visit to the doctor.  Avoid resting the head on the shoulder while sleeping and lifting heavy weights. If you are diabetic always check the sugar levels and maintain it in normal range.

Word of caution. If not careful, you will end up with pages and pages of exercises for shoulder pain. It might look like an electronic contraption received from a distant sadistic relative, which has more parts than a Formula 1 car and instructions written only in what you think might be Chinese. Fear not. What looks at first like a Byzantine array of do’s and don’ts is actually very simple. Always verify with the doctor what has been understood.

Authors: Pradeep Kumar, Consultant Physiotherapist & Dr.P.Vijayanand, Director, Axon Pain Center, Hyderabad.

Posted in shoulder pain, shoulder pain exercises, shoulder pain home exercises, shoulder pain treatments | Tagged , , , , , | Leave a comment

Kamal Hassan & Back Pain Exercises

Very Nabokovian

When it comes to well thought out intellectual speak, the vacuous world of Indian celebrities cannot hold a candle to Kamal Hassan. In this interview, as he approaches material that seems to be personal and important to him he swerves aside, going off in many different directions and leaving behind false leads. Very Nabokovian. “The most feared thing should be death but after a lot of rumination, I have settled to fear incessant pain.” he said. We agree with you sir, as long as you promise not to sing. It always sounds like a frog with emphysema.

Gabapentin: Pfizer in the dock

Some clinical trials are intended for drug marketing, and not advancing science, screamed a JAMA headline. Known as seeding trials, such trials which occur after a drug is approved, are primarily conducted to promote drugs and increase prescribing among physicians who partake in these studies rather than to advance scientific knowledge. The drug in question – Gabapentin; marketed as Neurontin in USA. In this case, a company called Parke-Davis, now part of Pfizer, reached out to more than 700 neurologists and convinced them to give this drug to their patients with epilepsy as part of research on its effectiveness and safety. But Parke-Davis didn’t tell doctors about the real purpose of the study, which was made clear in the company’s internal communication, the investigators say. The company also hid that purpose from review boards whose job is to make sure a study is ethical and doesn’t put patients at risk unnecessarily, the investigators add. It wasn’t a particularly good week for Pfizer, as there was another headline of a  “surreal, bizarre and horrific death,” with Neurontin in Huffington Post.

Institute of Medicine’s Report on Pain

Not only does chronic pain affect the quality of life of over 116 million Americans, there is a massive economic burden too, estimated to be between $560 and $635 billion each year for the country, researchers from the Committee on Advancing Pain Research, Care, and Education; IOM (Institute of Medicine) revealed in a report issued last week. The Scientific American observed “IOM’s new report describes chronic pain as a major public health challenge and one that requires aggressive action and a more comprehensive strategy.” The report calls for more of everything – more research, more training in pain for healthcare professionals and expanded insurance coverage of pain care, reported LA Times. Maia Szalavitz wrote about in great detail in The TIME. She has been an ardent advocate for pain patients, who have long been viewed with skepticism and suspicion, rather than understanding, presenting a barrier to care. Thank You.

Back Pain Exercises

Up to 80 percent of Americans experience back pain at some point in their lives, and each year 15 percent of all adults are treated for such problems as herniated discs, spinal stenosis or lumbar pain. The New York Times, not to be left out on reporting about pain, came up with a couple of timely articles on prevention of low back pain. Forget About Crunches. Here’s How to Protect Your Back – touched on home exercises; while Sit Up Straight. Your Back Thanks You – focused on ergonomics. Good stuff, both. Back pain home remedies have never been better explained.

Can you see pain?

A new exhibition at the Menier Gallery explores this very concept. Drawing on patients’ personal testimonies, medical texts and artist and patient notes, the exhibition seeks to give sufferers a voice, and explore whether images can help negotiate between different perspectives. MASK:MIRROR:MEMBRANE explores the invisible and complex nature of chronic pain. Some stunning pictures too.

Author: Dr.P.Vijayanand, Director, Axon Pain Center, Hyderabad, India




Posted in Analgesic, back pain exercises, back pain home remedies, back pain home remedy, Back pain India, Gabapentin, Health, Neckpain treatments | Tagged , , , , , , , , , , , , , , | Leave a comment

My Pain, my journey

He also doubles up as the neighborhood RMP

Our pain management programme Shambhala has been reaching out to people in pain for the past year. The programme led by a multi-disciplinary team of doctors, psychologists, physiotherapists, occupational therapists, yoga & art therapists has rehabilitated pain sufferers back into work and into the community. Our results presented as a poster at the Annual Scientific Meeting of the Indian Society for Study of Pain, was commended by the judges and made it to the final top 5. We share with you the letter we have received from one of the beneficiaries of Shambhala. Part funny, part poignant, fully street smart – this might be your journey too. Many thanks to the author for allowing us to publish his letter!

I have suffered with back and neck pain for a few years now. Whenever I used to get pain I just pop some pain killers. Just think pain and next moment I will find a pain killer. Because Bhag dhod Bhari Jindagi may rukna mana hai (in race of life we are not suppose to stop). And then if pain is not controlled, I visit the nearby medical store guy, who may or may not be qualified (mine is an intermediate pass). He will give a different medicine, which may or may not relieve my pain. I have felt clever and happy that I have saved money by not visiting a physician.

The pains were getting more frequent and worse, so I visited the most popular physician in my neighborhood with his magic experience of treating all problems. He gave 2-3 tablets or capsules plus antacid to relieve me from side effects of pain killers. That’s what we say good idea or if that doesn’t work then we will say get idea. As old saying goes Jahan chai wahan rai (Where there is tea there is an advice), I reached to my elders for home remedies. Life then took multiple U turns – Ayurveda, Homeopathy, Unani… but my pain still persisted.

When pain became unbearable, work life was affected, sleeping became a problem etc… I started looking for super specialty hospital. The super specialist proceeded to give a list of diagnostic tests. These tests may or may not give us a scientific answer to our pain. Outcome of my visit – physically fit and MRI says, I quote “degeneration and correlate clinically” and other tests were all normal. I gave big sigh of relief that I was fine; also it made me proud of visiting a big hospital, and making the effort. Unfortunately for me, the pain still persisted.

One of the super specialists recommended you, Axon. Not sure I have discussed my medical problems with the doctor over a cup of coffee before I came to you. I found caring and amiable medical professionals who not only helped with my pain relief but also restructured my thoughts and helped me relax. I came to know how the body and mind is one. I have no words now, just I can say pain-pain go away do not come another day because I want to play. Thanks.

The letter was received by Johnsey Thomas, our psychologist at Axon Pain Center, who leads Shambhala as an individualized programme taking into account the cultural sensitivities unique to India.


Posted in Analgesic, Back pain India, Cognitive behavioral therapy, Health, Health Psychology, Indian Society for Study of Pain, Medicine, Neck pain India, Neckpain, Neckpain treatments, Pain, Pain management, Pain treatments India, painkiller, Physical exercise, Physical therapy, Psychologist India, Psychology | Tagged , , , , , , , , , , , , , , , , , , , , | Leave a comment

Pain fellowship and training in India

Benares Hindu University

Roy Porter in The Greatest Benefit to Mankind, states that before anaesthetics, antiseptics and antibiotics, medicine could do little for the sick except perhaps reduce pain with narcotics. This was the norm even when the ancient Egyptians used a combination of pulverized crocodile dung with herbs and honey to make contraceptive pessaries.

Since independence, our population has trebled; the life-spans have doubled; not to mention the corruption and scams where the “values” would not fit in a logarithmic scale. Healthcare has improved despite the mayhem, though modern treatments are still unaffordable to a vast majority. As it stands, there aren’t sufficient doctors who are trained enough to manage pain in India. Only a systematic education and training of doctors would help our population in the long run. The Indian Society for Study of Pain (ISSP), with tireless enthusiasm, has been vanguardist at its efforts to train doctors. We catch up with Dr. Muralidhar Joshi to figure out the efforts of ISSP.

Dr. Muralidhar Joshi has authored the first ‘Text Book of Pain Management’ in India. He was instrumental in starting various teaching programmes like online pain course and fellowship in pain management in the country for the first time. Currently he is the national active member of Apex Academic Body of ISSP. He is also the general secretary of Andhra Pradesh chapter of ISSP and organizing secretary for the national conference of ISSP in February 2009. At present he is the Director of Kamineni Pain Management Centre at Hyderabad.

Changing attitudes and entrenched practices is never quick and easy. ISSP works in the hope of greasing that path. How far have we progressed in terms of training in pain medicine?

For quite some time, we had short courses of 2 to 6 weeks duration, developed by ISSP and Palliative Care Society of India to train the professionals. This was never enough. An apex academic body was formed in 2006 by ISSP to look into standardizing pain education and training in India. Based on its recommendation an ISSP Task Force was formed in 2009. The remit of the Task Force was to formulate guidelines and monitor the training programmes. It was obvious, that to make pain education more acceptable, the curriculum should be introduced at Undergraduate and Post graduate level of medical education. We have been in discussion with Medical Council of India (MCI) and Ministry of Health in an attempt to take this agenda forward.

When ISSP sat down to formulate guidelines, there must have been limitations on what it could and could not do. Could you take us through the thought process?

That’s right. We were well aware that, with ISSP not being a statutory body, we have no legal control over public or private organizations which intend to start an academic programme in pain medicine. Moreover, to have legal or employment value, the course should be university and MCI affiliated.  ISSP cannot endorse or certify any such training programme; it could only provide its seal of approval or provide guidelines to conduct training programmes in universities.

There are other barriers too, like

  • Limited number of trained teaching faculty
  • Accreditation from MCI, NBE or Universities
  • Lack of motivation from institutions
  • Stipend or honorarium for students
  • Inadequate volume of patients and resistance from other specialties

Yet, we have a set of guidelines. Why?

Well, status quo was simply unacceptable. Many reasons we could count

  • To popularize the specialty. If more training centers are recognized, more junior/senior doctors would be trained to manage pain effectively.
  • Impart some uniformity and standard in training.
  • The guidelines, furthermore, can be utilized by concerned institutions/pain centers to obtain university or MCI approved long term training programmes of six months/one year duration.

But still, ISSP endorsed programmes will be of additional skill category, without legal or employment value. That would be the responsibility of MCI.

Sociology students could do well watching Jhalak Dikhlaja, Bigg Boss or worse Karan Johar. Doctors? They will need a bit of structured training surely!

Structured training is the way forward. For undergraduates, we have proposed 5 lectures in the anaesthesia module during 3rd or 4th year. The lectures would be on

  • Physiology and psychology of pain, history & examination
  • Acute pain, postoperative pain, post traumatic pain
  • Development of chronic pain with examples of chronic pain syndromes
  • Cancer pain
  • Neuropathic pain

For postgraduates we have proposed 12 lectures

  • Overview of Pain Management.
  • Physiology & Pathophysiology of pain
  • Clinical history & Physical exam
  • Radiology & Electrodiagnostics
  • Acute Postoperative pain
  • Chronic pain syndromes
  • Cancer pain
  • Neuropathic pain
  • Interventional Pain Management
  • Establishing a Pain Clinic
  • Adjuncts to Pain Management
  • Advanced Pain Therapy

It is the age of specialisation, after all. Everyone has used science to get better at what they do. Bacteria and Virus included. Anything for the junior doctors?

There are short-term training programmes of 2-6 weeks duration endorsed by ISSP. There are also courses proposed to be introduced next academic year.

  • Two weeks training programme (basic course).
  • Two weeks training programme (advanced).
  • Six weeks comprehensive training programme (basic & advanced).
  • Six months training programme (diploma).
  • One year training programme (fellowship/PDCC {post doctoral certificate course})

A quick update on recent developments.

  • Status at MCI & Health Ministry: At initial discussion stage.
  • Status at National Board Examinations: There is already a Diploma in Pain Management
  • Status at University level: NTR Health University of Andhra Pradesh and Banaras Hindu University have started regular courses at University level. Recently SGPGI of Lucknow has started PDCC in Pain Management
  • Status at individual institution level: Kamineni Hospital at Hyderabad has a one year fellowship in Pain Management.
  • Many institutions in the country conduct short term courses of 2 weeks to 6 months.

Thank you, that was comprehensive.

In medicine, seeking to reduce and alleviate human suffering, increase and enhance the capacity for freedom and happiness and, when necessary, to accept death with dignity and courage, still seem ideals not wholly unworthy of respect. Efforts at palliation need to confront the influences that caused the pain to be insufferable as assiduously as they confront the pain itself, if not more so. However, doctors trained in alleviating pain and suffering are only a handful. The reason – pain education and training in India till a few years ago was Nil. Nihil. Nada. Nichts. Rien. Even in developed nations, pain medicine is considered a Cinderella specialty due to neglect. Developing training programmes to match the needs of the population, however, should be like Cinderella’s glass slipper. Perfect. Specific. Ultra-refined. We are still a long way from that elusive fit.

Disclaimer: No affront to sociology students. Some young doctors in India, not all, learn their medicine as well as mannerisms, watching E.R, Scrubs and House. So, beware of pill-popping juniors who walk with a limp or a Malinga look alike who thought of flattering George Clooney.

Not the small print: At Axon, we offer a one year fellowship in Pain Medicine with stipend. The intake is in January, with advertisements appearing in The Indian Journal of Anaesthesia well in advance. Aspiring young anaesthetists could contact us by email or phone.

Interviewed & authored by Dr.P.Vijayanand, Director, Axon Pain Center, Hyderabad.



Posted in Health, India, International Association for the Study of Pain, Interventional Pain Medicine, Pain, pain fellowship, training in pain | Tagged , , , , , , , , , , , , , , , , , | Leave a comment

Fibromyalgia – a new kid on the block


When it comes to fibromyalgia (FM), fairytale endings in which the baddie gets killed, the wedding is done, and they lived happily ever after – rarely happens. A recent research published in Pain, however, provides some hope to FM sufferers. Sodium oxybate is the drug in question. It improves pain, fatigue, function, and sleep in FM without actually curing it. The fact is there is no cure. Still, like the Royal wedding without Tony Blair, it is a cause for optimism.

γ-Hydroxybutyric acid (GHB), also known as 4-hydroxybutanoic acid and sodium oxybate (SXB) is a naturally occurring substance found in the central nervous system, wine, beef, small citrus fruits, and almost all animals in small amounts. GHB modulates activity of noradrenergic, serotonergic, dopaminergic, cholinergic, and glutamatergic neurons and promotes growth hormone secretion and the production of some neurosteroids. GHB has been used as a general anaesthetic, to treat conditions such as insomnia, clinical depression, narcolepsy, cataplexy, alcoholism, and to improve athletic performance.

The multi-centre study was a double-blind, placebo-controlled, parallel-group study examining the efficacy and safety of SXB in 548 FM patients. It demonstrated that SXB treatment results in clinically important therapeutic benefits for a constellation of symptoms experienced by patients with FM. At the evaluated doses, SXB significantly reduced pain and fatigue relative to placebo, and improved functionality, with effects observed as early as 1 week after treatment initiation and persisting throughout the study period (14 weeks). Improvements in sleep disturbance were observed with SXB.This study confirms and extends findings from 2 previous proof- of- concept trials showing efficacy and tolerability of SXB for the treatment of FM.

Couple of things of note. Firstly, this study was sponsored by Jazz Pharmaceuticals, the company which markets SXB. Not a bad thing, as long as it benefits the end user. Secondly, it has many street names, including “Liquid Ecstasy”, “G”, “Liquid X”, and “Liquid G”, as well as “Fantasy” and the reordered initialism GBH. This means regulations have to be in place in countries like India, where the state of affairs is less than desirable. So the perfect ending where an angry Salman Khan fires 2-extra bullets after the villain is dead, is not there. It, however, is an advance in the treatment of FM, where modern medicine have done better than asking to bury a potato to cure a wart, or starve a fever and feed a cold.

Posted in American College of Rheumatology, Analgesic, Cognitive behavioral therapy, fatigue, Fibromyalgia, Health, India, Pain, Psychology | Tagged , , , , , , , , , , , , , , , | Leave a comment

Managing your Neck pain

In the face of uncertainty, there is nothing wrong with hope.

When your neck seem to break down more often than peace talks in the Middle East; the whole mood about the house is about as uplifting as a grand piano dropped from a great height. No one suffers illness in a vacuum. No illness illustrates that aphorism better than neck pain. It is not the pain that drives you to seek medical care; it is the suffering consequent to the uncertainties that the pain precipitates in your mind. It is suffering that is your chief complaint. It is suffering that demands recognition and care.

Our spines were last normal and pristine when we were teenagers. If you have a pristine spine at age sixty, it is quite abnormal. Following numerous investigations like X-rays, nerve conduction studies and MRI scans, the doctors have labelled you as suffering from non-specific neck pain and put a giant pink bow on it. Ta-da! Or even worse said, “It’s all in your mind.” Today’s lifestyle of hectic schedules, where everyone and everything wants a piece of you, doesn’t help. The combined effect of looking for an answer and not able to find it along with fast-paced life results in one big negative – maladaptive postures.

These are the voluntary and involuntary postures you adopt to avoid pain, which sets into motion a series of physiological changes involving the muscle, nervous system and the brain, making pain a permanent albeit unwanted guest. Ignoring it doesn’t help. In fact, a lot of effort is needed from you as well as your care provider to keep things under control. This includes medicines, nerve blocks, exercises, change in lifestyle, ergonomic modifications etc., all done with enormous patience and even more determination.

So, what is it in your neck that hurts. The neck is a complicated machinery involving muscles, nerves, ligaments, bones, joints, cushioning disc and everything in between. So theoretically anything could. Pain may start from your neck and go up the head or radiate down the shoulder, arm, forearm, hand and at times upper back. The commonest cause of neck pain is simple muscle strain or tension. Lifting heavy weights, sleeping without good neck support, sleeping on the stomach, degenerated disc, nerve dysfunction, and osteoporosis are some other causes for your neck pain. On many occasions there might not be a cause at all. There could be something serious too, if the pain follows a severe blow or fall, or is due to infection or tumours.


  • If the symptoms are very severe and makes you immobile.
  • If there is numbness, tingling, or weakness in your arm or hand.
  • If there is history of a fall, blow or injury.
  • If you have swollen glands or a lump in the neck.
  • If the pain does not go away with the regular over the counter pain medications.
  • If the pain is associated with difficulty in swallowing or breathing.
  • If you lose control over passing urine or stool.


This may sound like “Bob’s your uncle,” but is a vital part of managing your pain of the simple muscle strain variety. What we propose should promote healing, avoid re-injury, help strengthen muscles and develop confidence.
1. Pain reduction techniques: For acute pain, apart from the drug therapy, bed rest is advised for initial 24 – 48 hours. The neck should be well supported during the rest period. Use of ice is recommended for first 72 hours for 3 times a day followed by heat therapy. For chronic pain or low grade pain, heat is a better option. Electrotherapy could help too.
2. Postures to facilitate relaxation: We take great pains to teach good postures. This along with proper support to the neck and knees with pillows eases the pain.
3. General neck support by the way of soft neck collar in day time provides rest to neck muscles.
4. Frequent change in position along with simple body and neck stretches helps to relax your muscles.
5.Relaxation techniques: deep breathing, specific muscle relaxation, and guided imagery are some of the techniques used at our place.
6. Postures to avoid: Circling your neck in attempt to “crack it out” and bending excessively forward is not what we recommend.
7. Regular exercise schedule: for this to be started the pain should be within tolerable limits. Gradually graded stretching exercises for neck should be introduced with the help of a therapist initially. Exercises should always be done within a comfortable pain-free zone and in no way should it aggravate the pain. For chronic neck pain sufferers, isotonic exercises could be started initially with gradually increasing levels of intensity.
8. Modification of work place: Certain modification are mandatory at work place, which may be your office or home. For example, if you sit at a desk all day, then your back should be supported. An ergonomically designed chair is even better. Adjust your computer monitor to eye level. Use a headset when on the telephone, especially if answering or using the phone is a main part of your job.
9. Awareness of body: how you move yourself to carry out a particular activity and your posture is very important. If this is good, then half your problem is solved.
10. Coping strategies: if you are unable to do some activity, then alternate ways can be made available in order to finish the task. For example, if you have to shave at home and you are not supposed to bend your neck then what would you do? An occupational therapist can help you in this regard.

Nature has placed humanity under the governance of two sovereign masters, pain and pleasure. We have become used to inconvenience as a significant part of our lives. Most days it pays to have a very good disposition and a sense of humour. To be well is not to avoid neck pain; it is to have the wherewithal to cope with it effectively and repeatedly.

Dr. Preeti Agrawal is Occupational Therapist at Axon Pain Center, Hyderabad, India

Posted in Acute pain, Analgesic, Arthralgia, Neckpain, Neckpain treatments, Pain, Pain management, Physical exercise, Physical therapy | Tagged , , , , , , , | Comments Off on Managing your Neck pain

Fibromyalgia, opioids and pain

Our weekly review is back after a hiatus of a few weeks. The best articles, blogs, and research in pain medicine, is here for you. This week, we have covered controversies with opioids, fibromyalgia, psychology and neuroscience.

The problem with pain, of course, is that it’s designed not to be ignored.  Normally, acute pain indicates something is wrong in our bodies that needs our attention.  But in many chronic pain syndromes this isn’t the case.  Rather, the pain itself becomes the disease, often centered in an “overactive” nervous system response rather than chronically injured tissue (though the latter is certainly common as well).  Distracting oneself from such chronic pain requires consistent effort that’s difficult to sustain. More…

No one asks to become a caregiver. When you’re thrust into that role unexpectedly, it can be truly devastating, particularly when your loved one is experiencing chronic pain. If you are a caring for a loved one living with chronic pain, it’s important to know that there is hope and there are resources available — you are not alone. Remember to educate yourself about your loved one’s condition, draw strength from family and friends, and take the time to care for yourself. More…

Feeling like they can’t be there for their children is one of the hardest things many women with fibromyalgia fear. It is hard enough taking care of yourself and your relationship with your spouse when you have fibromyalgia. But sometimes it breaks women’s hearts as they worry about the effect on their children. The good news? Fibromyalgia in parents usually results in their children feeling even more loved and closer to their parents! You may wonder how you can explain having fibromyalgia to your children without scaring them. Simply let your children know that you have a problem, but that it isn’t dangerous. It just leaves you feeling tired and achy sometimes – kind of like when you have a cold or flu. So you can’t do everything you’d like to do. More…

Fibromyalgia syndrome (FMS) is a difficult-to-treat chronic pain condition with relatively few specifically approved and effective pharmacotherapies. A recent review examined the relative benefits and harms of pregabalin, the only antiepileptic FDA approved for fibromyalgia, and the antiseizure medication gabapentin in the treatment of FMS. However, the evidence supporting their efficacy was somewhat disappointing. More…

As a life-saving alarm system, pain keeps us focused on distress, for the purpose of relieving it. Pain motivates behavior that will help heal, repair, or improve. A pain in your foot, for example, will motivate you to take the rock off it, get more comfortable shoes, soak it in a tub of warm water, or visit a podiatrist. When pain intensifies and generalizes over time, it becomes suffering. Suffering is repeated failure to act successfully on the natural motivation of pain to do something that will heal, repair, or improve. More…

Human chorionic gonadotropin (hCG), a drug frequently used in fertility therapy, relieved intractable pain for most patients in a small pilot study, according to a recent conference report. However, while hCG might be a viable adjunct to the limited other treatments for intractable pain, more and better research is needed to confirm this. More…

Across cultures and language divides, people talk about the sting of social rejection as if it were a physical pain. We feel “burned” by a partner’s infidelity, “wounded” by a friend’s harsh words, “crushed” when a loved one fails us, “heartache” when spurned by a lover.
There’s a reason for that linguistic conflation, says a growing community of pain researchers: In our brains too, physical and social pain share much the same neural circuitry. In many ways, in fact, your brain may scarcely make a distinction between a verbal and physical insult. More…

More than a million people in the United States will develop acute herpes zoster each year, and a large portion of this group will develop Post Herpetic Neuralgia (PHN). With better disease-modifying treatment, perhaps the severity and duration of PHN can be reduced. The addition of gabapentin to antiviral therapy resulted in low levels of zoster pain at 3, 4, and 6 months. More…

As prescription drug abuse ravages communities across the country, doctors are confronting an emerging challenge: newborns dependent on painkillers. More…

In the late 1980s and early ’90s, it was almost impossible to avoid hearing about the plight of “crack babies” — infants born to mothers who had used crack cocaine during pregnancy. These offspring were predicted to become a generation of either superpredator criminals or mentally disabled government aid recipients, unable to care for themselves. Now, the New York Times reports on the children of mothers who misuse prescription painkillers like Oxycontin. More…

As an epidemic of narcotic painkiller abuse raged across America in 2006, researchers at the U.S. Centers for Disease Control and Prevention issued a medical journal report connecting deaths from those drugs to up to a 500% increase prescriptions. In that same journal, a couple of officials with a little-known group at the University of Wisconsin School of Medicine and Public Health took issue with the paper, issuing their own warning against any attempt to increase regulation of the drugs. But the article from the UW group did not disclose that over the last decade or so, as this group advocated for greater use of narcotic painkillers, it had received about $2.5 million from companies that make those drugs — with most of that money paid before they published their arguments defending the use of opioids, as a Journal Sentinel/MedPage Today investigation found. More…

Put together by Dr.P.Vijayanand, Director, Axon Pain Center, Hyderabad, India.

Posted in Acute pain, Analgesic, Fibromyalgia, Gabapentin, Health Psychology, India, Interventional Pain Medicine, Neuropathic pain, Opioid, Pain, Pain management, Peripheral nerve | Tagged , , , , , , , , , , , , , , , , | Leave a comment

Could physiotherapy relieve your heel pain?

Foot ailments are very common, a common cause being plantar fasciitis. Put simply, it is the irritation and swelling of the thick tissue in the bottom of your foot. Plantar fasciitis is more common in active men aged 40 – 70.

What causes it?

The plantar fascia is a very thick band of tissue that connects the heel bone to the toes. This band of tissue is what creates the arch of the foot. A series of minor injuries to the plantar fascia due to continued stress of weight bearing is the culprit. When the fascia is overstretched or overused, it can become inflamed and painful, making walking difficult.

Plantar fasciitis is commonly thought of as being caused by a heel spur, but research has found that this is not the case. On x-ray, heel spurs are seen in people with and without plantar fasciitis.

What are the signs and symptoms?

The most common complaint is pain in the bottom of the heel, which is usually worse in the morning and may improve throughout the day. By the end of the day the pain may be replaced by a dull ache that improves with rest. When the doctor examines you, there will be a tender point usually at the inner part of the heel bone and at the site of beginning of plantar fascia.

X-rays may be taken to rule out other problems, but having a heel spur is not essential to make the diagnosis.

So, what are the risk factors?

  • Problems with the arch of the foot (both flat feet and high arches)
  • Obesity, particularly sudden weight gain
  • Repetitive loading on the feet from long-distance running, especially running downhill or on uneven surfaces
  • Tight Achilles tendon (the tendon connecting the calf muscles to the heel)
  • Ill-fitting shoes with poor arch support or soft soles

©Damon Hart-Davis


You would almost always get better with simple conservative treatments. It takes time though. The treatment should be continued for several months before you start feeling better.

Simple measures such as

  • Rest
  • Applying  ice to the painful area at least twice a day for 10 – 15 minutes
  • Wearing properly fitting shoes, and
  • Paracetamol or anti-inflammatory such as Ibuprofen could be helpful.


We recommend exercises to the small muscles of your foot in warm water, in the morning. Done dutifully before you stand out of bed (initiating weight bearing in medical speak), it is useful in lessening the morning pain.

Strengthening exercises such as sustained toe curl, performed even with shoes on, is an excellent exercise. Holding the foot in a contracted position inside the shoe several times a day is very effective, provided it is done at frequent intervals within your levels of comfort.

Walking slowly in barefoot on the outer border of the foot, and at the same time curling your toes is effective in moulding the longitudinal foot arch. Doing these exercises in small doses, several times a day, would help.

Modified foot wear

An appropriate wedge in the shoe provides relaxation to the fascia. This can be achieved by adjusting the height of the heel to a level where the pain disappears. Elongated soft heel pad or well padded inside arch support covering the longitudinal arch is effective too.

The UC-BL (University of California Biomechanics Laboratory) Orthoses, while correcting and holding the heel in a neutral position, also controls the inside arch of the foot and the outside border of the forefoot. These three corrective forces keep the foot held in a neutral position, and reduce tension and constant irritation of the inflamed fascia.

Using night splints to stretch the injured fascia and allowing it to heal, could help too.


Ultra sound therapy and TENS can be an effective measure to induce contractions in the intrinsic muscles, improving their tone, power and circulation. This, followed by local application of pain relieving gel could be helpful.

Medical management

Steroid injections can provide lasting relief in many people.

In a few patients, nonsurgical treatment fails and surgery to release the tight, inflamed fascia becomes necessary


To prevent the symptoms from coming back to trouble you, the following are useful

  • Avoiding prolonged standing on a hard surface with a hard in-sole foot wear
  • Avoiding flat footwear
  • Using soft foot wear with proper wedge

Calcaneal spur or Heel spur are spikes of bone seen on the x-ray of the foot. The heel spur is seen under the heel bone and seems to be seen more commonly in patients who have plantar fasciitis. About 70% of patients who have plantar fasciitis are seen on x-ray to have a heel spur.

However, heel spurs are also seen in patients without plantar fasciitis; about 50% of middle aged adults have at least a small heel spur seen on the x-ray of their foot. Furthermore, the heel spur is not located at the insertion of the plantar fascia, as was once thought. Therefore, heel spurs themselves are probably not that important, rather the plantar fasciitis is the more important issue.

The treatments which have been discussed are all provided at Axon Pain Center.

Pradeep Kumar is physiotherapist at Axon Pain Center, Hyderabad, India

Posted in Acute pain, Analgesic, calcaneal spur, heel pain, painkiller, plantar fasciitis | Tagged , , , , , , , , , , , , , , | Leave a comment