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Ultimate Pain Management

Consultants

Let us together rewrite a part of Rheumatology.

I am working in Pain Management since last twenty years. Not only that I have vast and valuable experience in the treatment of Pain syndromes but I have devised new modalities and established new algorithm for the treatment of Osteo-Arthritis Knee Joint, Chronic low back Pain and other major myalgic problems. My work has given new concepts that are supplemented by clinical results. Our findings are:

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Institute

Patients

Cervical spondylosis

Expectations (prognosis)

Most patients with cervical spondylosis will have some long-term symptoms (Chronic Pain Neck). However, they respond to nonsurgical treatments and do not need surgery.

"Unmasking and treating the underlying problem" is the best treatment regimen to be followed. It will prevent the patient from prolonged undue illness and will also prevent the danger of injudicious management. This new algorithm gives positive results within a week.

It is advisable that even though there may be marked changes in the cervical vertebrae on radiological examination, still it is worth treating the patient through the trigger spots injection technique. There is strong evidence that "Unmasking the underlying problem" finally exhibit trigger spots that when treated give complete relief to the patient and the question of having cervical spondylosis then remains immaterial.

Syed Zahid Hussain Bokhari, Latest on Osteoarthritis and Myalgia: The Technique of "Unmasking and treating the underlying problem. ISBN: 978-3-8454-3712-5 " LAP LAMBERT Academic Publishing, 2011

Trigger spots of the cervical region:

Often the lesions are found in the neck alongside the cervical vertebrae. The trigger spot is always an isolated lesion that gradually gets the surrounding cervical region involved. Thus the patient when reports to the clinic, would have generalized diffuse pain in the neck. However he may be able to indicate that the major side involved is the right or the left. It gives him hours of discomfort, mental tension and anxiety every day.

Trigger spots are found scattered in the trapezius muscles alongside the lower cervical and upper dorsal vertebrae. However the trigger spots are often found in the suprascapular region also (Table 2).

Most Common sites of Lesion and Treatment Indicated Pain Cervical Region

Trigger spot

Corresponding to

symptoms

 Muscles involved

Treatment of the point unmasked.

On the side of the neck

C-2 to C-5

  • Pain in the neck causing discomfort spreading towards the shoulder.
  • Pain referred towards head.

Splenius Capitis and cervicis,
Sternocleidomastoid

10-20 mg of triamcinolone acetonide in 2ml of Xylocaine 2%

On the side of the lower part of neck

C-5 to D-2

  • Pain in the lower part of neck causing pain and discomfort with feeling of instability in the neck.

Trapezius and the underlying muscles

20 mg of triamcinolone acetonide in 3ml of Xylocaine 2%

In the Scapular region

Region above the Scapular Spine

  • Pain is diffuse involving the whole of the side involved.
  •  This pain may radiate to the shoulder and beyond to the arm.
  • Pain may involve group of muscles as low as

     dorsal 4-5

Trapezius and the underlying muscles

20 mg of triamcinolone acetonide in 3ml of Xylocaine 2%

Table 2

Syed Zahid Hussain Bokhari, Latest on Osteoarthritis and Myalgia: The Technique of "Unmasking and treating the underlying problem. ISBN: 978-3-8454-3712-5 " LAP LAMBERT Academic Publishing, 2011

ISBN: 978-3-8454-3712-5 :Syed Zahid Hussain Bokhari

Follow up of cervical spondylosis:

After ten days Patient is examined and any remnant problem is dealt with. Patient may complain of dull pain or mild discomfort in the strong muscles of the thoraco-scapular region. This problem can be effectively dealt with heat treatment with infra-red rays therapy or by Cupping (an ancillary technique of acupuncture).

In pain neck the patient will completely recover. However if there is any element of nerve irritation the pain in the neck will completely recover while numbness or paresthesias in the hand or fingers may persist. This is because of the reason that the lesions of fibrositis have healed thus relieving pain and chronic muscle spasm. However as the organic cause leading to irritation of nerves persists, this reflects as the symptoms of paraesthesias in the arm and hand. Such cases finally turn out to be only a fraction among the cases labeled as cervical spondylosis mostly on their radiological findings.

Cervical Collars :

Having studied the clinical response of the cases of pain neck to the new treatment regimen that has been explained, it can be concluded with certain level of confidence that advising Cervical collars to the patients for pain neck is not a commendable measure. All the way these measures are aimed at palliative treatment and seem to be giving some support to the neck. But in fact in these cases as the etiological cause are the lesions in the muscles causing pain in the group of muscles, mimicking a condition that is erroneously termed as cervical spondylosis, thus their treatment shall also take a different course that is indicated for them.

The effects of use of cervical collars had remained controversial. At times they seem to be adding to patient's pain and discomfort rather than to alleviate their problem. It seems to be another wrong practice that is going on since long. Hard cervical collars had been known to cause trigger spots and lesions in the muscles.

These cervical collars that may be of good use under certain other conditions indicated, are being mostly misused and wrongly being prescribed. Keeping in view this new treatment modality the indications of cervical collars will become very limited and may become remote.

Syed Zahid Hussain Bokhari, Latest on Osteoarthritis and Myalgia: The Technique of "Unmasking and treating the underlying problem. ISBN: 978-3-8454-3712-5 " LAP LAMBERT Academic Publishing, 2011