Shoulder blade pain treatment in Delhi - Removemypain

 Scapulae or shoulder blades are triangular bones in the upper back between the spine and the arms. Pain between shoulder blades is a common problem and is also addressed by various other names such as scapular pain or interscapular pain or upper back pain.The most common cause of pain in this region is muscular problems, however the list of possible causes is a long one and includes some serious causes as well.

Pain in this region may be like an aching, sharp, burning, throbbing or heaviness sensation and the underlying causes may be challenging to identify. The pain can interfere with daily activities and affect the shoulder and neck movements.

Causes

The common reasons of pain in this region, which I see in my day to day practice include

• Muscle injury or strain. Simple things such as poor posture, long sitting periods, improper lifting technique, sedentary lifestyle, unaccustomed sudden increase in physical activity, heavy lifting and sleeping in the wrong posture can predispose one to injury in this region. This is generally described as a pulled muscle sensation.

  Pain in this area can be quite annoying and frustrating as it interferes with your daily chores and keeps coming back. Overuse of arms and upper half of body (torso) as during activities such as ironing, washing dishes, gardening etc is often blamed for increased scapular pain. Front focussed workouts can produce muscular imbalance predisposing the back muscles to injuries, strains andsprains.

  Severe pain and localised spasm of muscles can be treated by trigger point injections. Physiotherapy is important in the long term strengthening of these muscles.
  To read more about trigger point injections click here

• Pain originating from Slipped disc in the neck. I see this commonly in my practice.A bulging disc in the lower part of neck can compress the nerves coming out of the spine and lead to shoulder blade pain. The pain resulting from pressure on the nerve may be felt more in the areas supplied by the pinched nerve including the shoulder blade, shoulder and the arm. These pains can be helped by injections close to the bulging discs such as cervical epidural injections.

  To read more about Cervical Epidural Injection click here

• Pinched nerve in the Neck or upper body. Specific nerves which supply the muscles in this area can get entrapped in the neck and lead to pain. This includes the Dorsal scapular nerve, and the suprascapular nerve. Unfortunately, the awareness regarding these nerves being a source of pain is low and hence this diagnosis is often missed. Ultrasound guided injections of the involved nerve can produce good relief in this condition.

  To read more about Dorsal Scapular Nerve Block and its treatment click here

• Pain originating from the Neck joints. Neck is made of seven bones called the vertebrae. These are stacked one above the other and join with each other at joints known as facet joints. Wear and tear or arthritis of the joints in the lower part of neck can give rise to pain in the scapular region. This condition can be present despite a normal MRI scan and the best way to diagnose this is diagnostic injections of the joints or the nerves supplying them. If the pain gets relieved after the injection then these joints are the likely source of one’s pain.

  To read more about Cervical Facet joint Injection click here

• Post Herpetic Neuralgia (PHN or Shingles). PHN is an infection caused by the same virus that causes chickenpox. Although it may affect any body part, back of chest wall including the scapular region is commonly involved. This infection can cause severe burning pain with increased sensitivity in the area, which can persist for long. Diagnosis is generally made with the help of the typical rash which appears in the distribution of the involved nerve.

  To read more about Post Herpetic Neuralgia and its treatment click here

• Pancreatitis and pancreatic cancer. This generally presents as abdominal pain associated with nausea, vomiting, constipation and increased pain with oral intake. The associated pain may be severe requiring strong painkillers. Shoulder blade pain is commonly seen with pancreatic disorders and is generallymore left sided although it may be located in the middle or may involve both sides.

  To find out more about Pancreatic Cancer and its associated painmanagement click here

• Thoracic Spine issues such as a compression fracture, arthritis of spinal joints, disc bulges or a spinal curve (scoliosis)– Osteoporosis or trauma can lead to vertebral fractures and pain in the shoulder blade region. In severe osteoporosis the fractures can occur with minimal or no trauma and can take a long time to settle, requiring strong painkillers. Elderly and those on long term steroids are more prone to this problem.

  To find out more about Thoracic Spine pain generators and their treatments click here

• Infections such as TB of the spine.
• Intercostal Nerve problems such as intercostal neuralgia. Intercostal nerves travel in between the ribs, from the spine posteriorly towards the front of the chest wall. These can be damaged as a result of previous injuries such as fractured ribs or operations. Sometimes involvement is also seen secondary to cancers or metastasis in the chest wall region. Pain originating from these nerves can be treated with modalities such as nerve blocks, radiofrequency treatment or cryoablation.

  To read more about Intercostal Nerve Blocks click here

• Fibromyalgia and Myofascial pain syndrome. In these conditionspain is the shoulder blade region is observed as a part of widespread body pain.Multiple trigger points may be present which can be treated by physical therapy, pain medicationsand local injections.

  To read more about Fibromyalgia and its treatment click here

Other causes include

• Abdominal and Pelvic causes such as gallstones, stomach ulcers, acid reflux, and liver disease
• Cancers such as lymphomas, abdominal cancers such as oesophageal, stomach, liver or pancreatic cancer can cause shoulder blade pain.Spread of cancers such as breast and colon cancer to the bones in the scapular area may also lead to shoulder blade pain.
• Heart and blood vessel problems such as inflammation of the lining of the heart (pericarditis) or tearing of the blood vessels (aortic dissection)
• Lung problems such as lung cancer, clots in the lungs (pulmonary emboli) or puncture of lungs(pneumothorax)

Treatment

As you can appreciate, pain is this region can result from numerous, varied causes. Identifying the cause is important as it determines thefurther course of action and thetreatment. Detailed history and examination can provide important clues to narrow down the investigations and the list of possible pain generators. Some of the treatments have been discussed in the links provided at the end of individual causes.

For the common muscular sprain or pulled muscle sensation, physical therapy can be helpful. Apart from that simple home remedies include

• Giving rest to the area
• Ice compression
• Simple pain relief medications including medicated rubs and ointments
• Massage and stretching may provide short term relief

Certain lifestyle modifications may be required as a part of long term management plan. These include

• Adding exercise, stretching to the daily routine
• Being more mindful of correct posture
• Physical therapy aimed at strengthening of back muscles
• Ergonomic changes to your workstation such as height of computer screen, chair type etc.

If the pain is severe or non-resolving or if there are any warning signs of a underlying serious problem, then its best to seek early help early from experienced medical professionals.

Tag = Shoulder blade pain treatment in Delhi, Removemypain, Pain Treatment in delhi

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Pancreatic Cancer Pain Management Coeliac Plexus & Splanchnic Nerve Blocks

 

What causes pain in pancreatic cancer?

One of the common presenting complaints of cancer is pain. Often pain is the reason behind a series of investigations culminating in the eventual diagnosis. Nearly 75% of pancreatic cancer patients suffer from pain at the time of diagnosis and these increases to over 90% in advanced stages.

The pain may be moderate to severe with adverse effect on quality of life, functional ability and mood. Most patients complain of intermittent or constant, deep pain in the upper part of tummy just below the ribcage. It may be squeezing, cramping, sharp, burning or aching in character. Pain is often more on the left and can spread towards the back. It is often aggravated by oral intake of fluids or solids.

Pain management in pancreatic cancer can be challenging because of the aggressive nature of the disease. There is evidence supporting earlier treatment of pain, so it’s better to seek help early.

Pain in cancer may be related to

• Cancer itself due to

• Increased pressure or the blockage of pancreatic ducts
• Inflammation of the pancreas /nearby areas

• Pressure/ spread to the neighbouring structures such as

• Nerves (in approximately 70–90% of cases)
• Blockage of the duodenum (the first part of the small intestine) impeding the flow of food
• Liver
• Bowel or peritoneum (inner covering of the tummy)
• Bone (not very common)

• Other associated problems such as constipation and digestion issues
• Distension of abdomen due to increased fluid (ascites)
• Irritation of diaphragm leading to the shoulder pain
• Side effect of treatments such as chemotherapy, radiotherapy, surgery (as in peripheral neuropathy (nerve damage) /enteritis)
• An unrelated coincidental problem such as arthritis of joints of the spine

What are Splanchnic nerves and Coeliac plexus?

Coeliac plexus is a network of nerves located in upper part of tummy (abdomen) just behind the pancreas. It lies deep in the tummy in front of spine and around a big blood vessel called aorta. This network of nerves plays an important role in sending messages from the upper abdominal organs to the brain.

Splanchnic nerves are a group of nerves located on both sides of the spine. They are closely related to the Coeliac ganglion and carry pain information from organs in your abdomen to the brain.

What kinds of procedures are performed to reduce pain in pancreatic cancer and how can they help?

The below mentioned procedures are utilised not only for pancreatic cancer but also for other upper abdominal cancers such as those of liver, gall bladder, stomach, some parts of intestine. These can also help in some non-cancer pains such as in chronic pancreatitis.

These procedures may not be a permanent cure for the pain but have the potential to offer significant & lasting relief. Nerve blocks work well for some people, but they don’t work for everyone and may take some time to show the full effects.

These procedures can be classified as

• Diagnostic blocks– Blocking the coeliac plexus of the splanchnic nerves involves injecting local anaesthetic with or without steroids around these nerves to interrupt the pain signals being sent to the brain. This can reduce the pain one perceives and help in predicting if other procedures such as neurolysis will work or not.
• Neurolytic blocks– these procedures involve use of chemicals such as alcohol / phenol to achieve prolonged interruption of pain signals being transmitted by nerves.
• Radiofrequency procedures for splanchnic nerves– these procedures utilise radiofrequency energy to heat the needle tip which in turn reduces the pain signals being transmitted to the brain.

Which intervention and approach is most suitable for a patient will depend on individual factors such as the extent of disease, concomitant problems such as breathing issues or ascites, ability to lie on the tummy/ back etc. Sometimes multidisciplinary review is required (such as reviewing the scans with radiologists) for deciding on the most suitable option.

Depending on the approach chosen the procedure may require for the patient to lie on their back or tummy for a period of approximately 45 min to an hour. A guiding modality is used to accurately place the needles close to the target nerves. This may include

• X Ray (Fluoroscopy) guidance
• Ultrasound guidance
• CT guidance
• Endoscopic guidance
• OR a combination of above mentioned modalities

Once the needles are in the correct place a dye may be used to assess how the medications would spread and to confirm the accurate placement of needles. An attempt is then made to reduce the pain signals being transmitted by these nerves via radiofrequency or drugs.

How much pain relief can be expected after the procedure and for how long will it last for?

The pain relief after the injection can vary depending on the cause of pain, location and extent of disease. In some studies it has been observed that the outcomes are better if the block is performed soon after the onset of pain asin advanced disease large tumours can act as mechanical barrier preventing the spread of the drugs hence achieving only partial relief.

These procedures have the potential of reducing the pain and the medication requirement for medium term. Overall, 70%–80% of patients undergoing these procedures report decreased pain for 1–6 months.

What are the risks of having these procedures?

No intervention is risk free. The decision to perform or not perform an intervention is taken by evaluating the risk/benefit ratio. The risks will vary depending on the intervention chosen and the patient’s medical issues. When performing these procedures, precautions are taken to reduce the risks as much as possible such as performing the procedure under guidance (x-ray, ultrasound, CT etc), use of contrast (dye) to assess the spread of medications and use of electrical stimulation in radiofrequency procedures etc.

Common side effects of these procedures include local pain (96%), lowering of blood pressure (10%) and loose stools (44%). Fortunately most of the common side effects are short lasting.

Some of the risks can be serious. Studies have reported the risk of serious adverse events as approximately 2%. It is best to discuss these with your treating doctor as the list of these can be long and vary with the intervention chosen.

What else can be done to reduce the pain?

Painkillers Medications

Different types of pain killers can be used based on the type of pain and other medical problems. Often the painkillers dose needs to be changed or new ones need to be added as the disease changes.

Morphine and Morphine like drugs (collectively known as Opioids) are one of the strongest pain killers. Other drugs in this class include fentanyl and oxycodone. These painkillers can be given by different routes lincluding orally, intravenously (directly into the veins), subcutaneously (below the skin) or as patches. Oral medications also come in a slow release form which provide more consistent pain relieve throughout the day. These drugs have often been in the limelight due to the wrong reasons such as addiction/ abuse potential and hence the social taboos associated with their use. Patients often do a disservice to themselves by harbouring preconceived notions and putting up barriers. It is important that you openly discuss any such issues with your Pain Specialist. 

Other types of pain may require different class of pain killers such as anti-inflammatories for pain due to inflammation, neuropathic medications such as gabapentin and pregabalin for nerve type of pain etc.

As with any other medication there are side effects associated with all these medications and these can be dealt with in most cases by patient education, pre-emptive action, use of medications and lifestyle modification.

Pain control in cancer is not just about medications or injections… there is more to it. To achieve a satisfactory control it often requires addressing the concomitant factors which can serve to enhance the pain experienced. For example

• Relationship between one’s emotional state such as low mood /anxiety and pain is well known. These factors can magnify the perceived pain and hence addressing them is important. Relaxation therapies such as meditation, mindfulness may help in managing thoughts, coping with feelings and produce a calming effect.
• Abdominal and back pain worsen with coexisting problems like constipation and abdominal distension and hence the importance of addressing these.

Refractory end of life pain can be dealt by delivering pain killers directly into the spine by using intrathecal/ epidural route.

Tags >> Cancer Pain Management In Delhi, Cancer Pain Management In Gurgaon, Cancer Pain Treatment in Delhi, Cancer Pain Treatment in Gurgaon, pancreatic cancer pain management in Delhi

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