How to cite this article: Bhattacharya D. New Insights in Chronic Pelvic Pain. J Recent Adv Pain 2017;3(3):111-112.

Immediate postoperative period is very crucial and pain is maximum during first 24 hours. If patients are kept pain free during this period, it leads to vitally stable postoperative period, which in turn leads to early recovery. The aim of this study was to compare the analgesic efficacy of diclofenac sodium via two different routes, intramuscular (IM) and transdermal, in the management of postoperative pain.

After informed written consent, 60 patients of American Society of Anesthesiologists (ASA) grades І to III scheduled for abdominal hysterectomy under subarachnoid blockade were randomized into two groups. Group TP (n = 30) received transdermal diclofenac patch 3 hours before surgery and group IM (n = 30) received IM diclofenac sodium 30 minutes before the end of surgery. Transdermal or IM diclofenac was repeated 12 hours later. Postoperative visual analog scale (VAS) scores, hemodynamic data, requirement of rescue analgesic, patient satisfaction, and adverse reaction if any were recorded every 2 hourly over 24 hours period. If VAS values were >4, 2 mg/kg tramadol was given intravenously as rescue analgesia.

Postoperative VAS, hemodynamic data, requirement of rescue analgesia, and patients’ satisfaction were comparable in both the groups (p > 0.05). Intramuscular diclofenac has more side effects.

Diclofenac transdermal patch provided postoperative pain relief as effectively as IM diclofenac for abdominal hysterectomy, without any significant side effects.

Gupta M, Trivedi LH, Tripathi DC, Chavda P. Comparison of Diclofenac Patch and Intramuscular Diclofenac for Postoperative Analgesia in Abdominal Hyster­ectomy under Spinal Anesthesia: A Prospective, Randomized Clinical Study. J Recent Adv Pain 2017;3(3):113-118.

Low back pain and sciatica (LBPS) is a major health and socioeconomic problem in modern India. Inadequate treatment of pain leads to loss of valuable man-hours for the country.

The study aims to validate the effect of ultrasonography (USG)-guided caudal epidural steroid (CES) injection in the management of pain due to LBPS.

This is a noncomparative clinical study in patients with LBPS due to lower lumbar and sacral nerve root involvement. Under USG guidance caudal epidural space was identified; mixture of local anesthetic and methyl prednisolone is injected as bolus dose; and visual analog scale (VAS) score and straight leg raising test (SLRT) were recorded pre- and postprocedure. Patients are followed up to 6 months for assessing the pain relief.

The mean VAS score before the procedure is 7.78, postprocedure is 2.95. The SLRT before the procedure is 28.58, and the postprocedure is 71.83. Our study showed statistically significant improvement in pain relief and SLRT.

The USG guidance enables us to perform the procedure in real time and helps us to avoid inadvertent vascular deposition of drug. Caudal approach minimizes the possibility of dural puncture. The USG-CES injection is effective in managing the chronic LBPS of lower lumbar and sacral nerve root involvement.

Kanthimathy R, Durairaj AK, Annamalai G. A Prospective Analysis of Ultrasonography-guided Caudal Epidural Steroid in the Management of Chronic Low Back Pain and Radicular Leg Pain. J Recent Adv Pain 2017;3(3):119-124.

Femoral nerve block (FNB) is a popular, minimally invasive postoperative pain management procedure following total knee arthroplasty (TKA). Prolonged motor blockade has been associated with increased risk of fall. The primary objective of the present study was therefore, to evaluate the risk of falling or near falling for FNB in patients who underwent TKA.

After Institutional Review Board approval, prospective cohort (142) of patients was randomized into two groups: the intervention (FNB as an adjunct to analgesia) vs the control (standard treatment) at our hospital for unilateral primary conventional TKA. The risk of falling as assessed using Tinetti Gait and Balance Instrument and Timed Up and Go (TUG) test was evaluated on the day of hospital discharge, and 1, 2, and 3 months after TKA. All data were collected and critically analyzed and p < 0.05 was considered statistically significant.

Patients in FNB group displayed significant low visual analog scale (VAS) scores than control (p < 0.05). Thirty-seven patients (26.05%) reported falls in the 3 months after surgery. Patients who received FNB following TKA experienced an expected significant worsening of physical function and had increased risk of falling as evaluated by TUG test and Tinetti Gait and Balance Instrument (p < 0.05). Due to unexpected fall, eight patients (28.57%) in FNB group sustained periprosthetic fractures and two patients (22.2%) in control group had opening of arthrotomy. At 3 months, 55 patients in FNB group had reported postoperative neuritis. Significant delay in rehabilitation and early ambulation in patients received FNB, which in turn increases the risk of prolonged hospitalization (p < 0.05).

The Tinetti and gait index and TUG test time showed increased risk of fall for the patients who received FNB owing to substantial functional deficits.

Shah VI, Upadhyay S, Shah K, Sheth AN, Kshatriya A, Jain A, Sharma P, Sanandia JG. Risk of Falling after Femoral Nerve Block for Total Knee Arthroplasty: Periprosthetic Fractures—A Serious Concern. J Recent Adv Pain 2017;3(3):125-130.

Magnetic resonance Imaging (MRI) is the additional diagnostic modality in a patient with low back pain. Being a non-invasive and non-radiation modality MRI is preferred to explore the soft tissues of the back . MRI back doesn’t only confirm the diagnosis, but also gives information about the site of pathology and correlation with clinical findings can be done simultaneously. There may be many incidental findings in MRI. On the other hand there are many MRI findings which are not presented clinically but being treated by interventions. We must use MRI as an adjunct of the diagnosis to correlate clinically, not just treat the MRI findings.

Parida S, Dey S. Magnetic Resonance Imaging in Low Back Pain: A Review of Current Recommendations and Its Usefulness in Low Back Pain Evaluation. J Recent Adv Pain 2017;3(3):131-135.

Interventions in pain management hold an important aspect in diagnosing as well as treating patients in today’s practices. Knowing proper procedural technique is an important aspect for a pain practitioner to avoid complications. Each individual patient is not the same, thus producing a challenge for any pain intervention. In this article, we discuss the standard procedure of cervical epidural, contralateral interlaminar approach with its complications and troubleshooting

Singh P, Das G, Nagalingam N. Cervical Epidural Steroid Injection in Pain Management. J Recent Adv Pain 2017;3(3):136-139.

Malik S, Puri A. Genicular Branch Radiofrequency Ablation: A New Modality for Pain Relief in Osteoarthritis Knee. J Recent Adv Pain 2017;3(3):140-141.

Facet joint arthropathy refers to a degenerative disease that affects the joints of the vertebrae. Lumbar facet joints (zygapophyseal joint) were first suggested in the medical literature as a source of low back pain (LBP) and lower extremity pain in 1911. These joints have been implicated as the cause of pain in 15 to 45% of patients with chronic LBP. The majority of published clinical investigations report no correlation between the clinical symptoms of LBP and degenerative spinal changes observed on radiologic imaging studies, including radiographs, magnetic resonance imaging (MRI), computed tomography (CT), single photon emission CT, and radionuclide bone scanning. Low back pain from the facet joints often radiates down into the buttocks and down the back of the upper leg. Pain is rarely present in the front of the leg or below the knee. Our case report is about a 24-year-old female patient who presented with left-sided paramedian LBP with severe lower abdominal pain, who underwent several investigations for her abdominal pain and was treated for abdominal pain without any significant relief. Careful history and clinical examination revealed lumbar facet joint tenderness involving left L4–L5 and L5–S1 facet joint. Diagnostic block followed by radiofrequency (RF) ablation of medial branch supplying the corresponding facet joint was performed with near-complete pain relief.

Chavda P, Das G, Sharma RS. An Unusual Case of Lumbar Facet Arthropathy presenting with Pain Abdomen. J Recent Adv Pain 2017;3(3):142-144.

Murthy AE, Das G, Singh P, Nagalingam N. Fibromyalgia in Male—Uncommon, but not Rare. J Recent Adv Pain 2017;3(3):145-146.

Gupta S, Das G, Misra A, Gupta A. Burst Compression Fracture in Ankylosing Spondylitis: A Challenging Case of Vertebroplasty. J Recent Adv Pain 2017;3(3):147-150.

How to cite this article: Roy C. Addressing Procedural Pain during Interventional Pain Management. J Recent Adv Pain 2017;3(3):151-152.