Dr. Nandi thank you for taking time out of your busy schedule to talk to our readers
Pain management is something I am passionate about so thank you for giving me this opportunity
1) you have worked in the specialised branch of pain management for years now, but isn’t that what every doctor do?
explain to us what exactly pain management is and how it’s different from other branches please.
Pain Management is a very new branch of modern medicine.
In this universe all of us experience pain since the era of ADAM and EVE. Previously it was thought that God punishes us by offering Pain due to our sin.
Pain is not about only physical pain, but it has also a psychological component, social component and spiritual component. That’s why we need a comprehensive approach to treat pain. Now pain is not only a symptom of disease, according to World Health Organization Pain is also a disease. That’s why a specialized branch is needed to treat Pain addressing all the above-mentioned components of pain.
2) How many dedicated pain centres are there right now in West Bengal?
In West Bengal, ESI Institute of Pain Management Kolkata has a dedicated pain department.
They also conduct a West Bengal Medical Council affiliated one-year fellowship on pain management under the aegis of West Bengal University of Health Sciences.
Anaesthesia Department of R G Kar Medical college runs a Pain clinic and conducts a one-year fellowship.
Other than these two institutes, Bangur Institute of Neurosciences, National Medical college, North Bengal Medical College, B R Singh Hospital have Pain clinic.
In private set up also pain clinic started growing such as Bhattacharya Orthopedics and Related Research Centre, Daradia Pain Clinic, KPC Medical College, Tata Medical Centre, GD Hospital, Narayan Hridayalaya Hospitals, Bellevue Clinic etc.
3) what are the areas that you focus most commonly in your centre?
We normally focus on multidisciplinary approach to treat mainly chronic pain and we also offer palliative care to terminally ill patients. We actually treat pain by medicines of different types, some interventions in operation theatre, psychological counselling and physiotherapy.
4) how can a spine patient benefit from pain management?
we give some special types of medicines first. If pain does not subside then we give different types of injection under USG or X-Ray guidance in operation theatre. We also offer all types of modern intervention such as radiofrequency ablation of nerves, vertebroplasty for vertebral fracture, ozone therapy for slipped disc, neucleoplasty for degenerated disc. Thus, we treat the pain generators.
5) how long the effect of such a procedure/treatment last in your experience?
Actually, it depends on the type and grade of the disease. Normally if patients can change
their life style and do some exercises regularly, the effects of procedures last long.
6) how a patient or arthritis of knee or other joints may benefit from you?
There are plenty of new treatment modalities available to treat knee arthritis and the effects are pretty good. We offer visco supplementation injection, prolotherapy (dextrose/ Dextose and ozone-oxygen mixture) and PRP (made from patient’s own blood) into the knee. We ablate the nerves which are the causative factors of knee pain. Then we ask the patient to do some very easy exercises which can be done by patient at home only.
7) how long the effect of such a procedure/treatment last?
Again same, if patients do some exercises and follow some life style modification, the effects of these procedures last for year. Besides that, these all are day care procedures, there are no need to hospitalization. So, if we consider the cost, benefit cost ratio is high.
8) is there a role of pain clinic in managing sports injuries and tendon injuries?
Absolutely, pain management now plays a big roll to manage sports injuries and tendon injuries. If we can relieve pain, they can do physiotherapy better which ultimately leads to early return to play. Now we are using modern regenerative therapy such as PRP in knee and shoulder injury. We are using dry needle to treat muscle pain. There are enough research works are going on where they showed that the results are pretty good.
9) is pain clinic only deals with symptomatic pain? or is the treatment done by you help in the remission of the diseases as well?
As I previously told that according to WHO pain is now a disease. So if we can break the pain cycle by any means (it may be by medicines, procedures, physiotherapy or life style modification), we are treating the disease also. We are using regenerative therapy to heal the ligament tear or cartilage injury. So pain management is not limited to symptomatic management only now a days.
10) tell us about the newer upcoming technologies in your field?
There are a number of new advanced technologies in our field also. We are treating vertebral fracture without a big operation by vertebroplasty. We are using spinal cord stimulator for nerve pain which is just like a pacemaker. We are implanting intrathecal pump which slowly delivers medicines in a controlled fashion. We are using regenerative therapy which helps to grow muscle fibre, cartilage. We are ablating pain generating nerves by radiofrequency machine.
11) how much new research is going on in your field in our state and in the country in general?
In this field we are lacking behind, though in our institute we are doing a lot of research work funded by DST. Our fellows of pain management also are assigned to perform research work under guidance of the faculties. We have a gait analysis lab to see the changes of posture and walking patterns of chronic pain patients. But there is a lot of scope and need to do the good research work.
12) how costly are these procedures that you describe?
Actually, cost depend on the procedures. Most of the procedures are very much cost effective. Vertebroplasty, radiofrequency ablation, spinal cord stimulator or intrathecal
devices are a bit costly. But if we consider the benefit cost ratio, it is high enough.
13) do u need specialised setup for the procedures or can they be done in any local nursing home or hospital?
Most of the procedures can be done in local nursing home and hospital where C-Arm facility is available.
Dr. Nandi thank you again for agreeing to do this