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   Table of Contents - Current issue
Coverpage
May-August 2020
Volume 6 | Issue 2
Page Nos. 1-25

Online since Monday, March 8, 2021

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REVIEW ARTICLES  

“Ozone” - A better alternative in COVID-19 pandemic p. 1
Khaja Javed Khan, Gautam Das
DOI:10.4103/jrap.jrap_2_20  
Ozone is a molecule consisting of three atoms of oxygen in a dynamically unstable structure. Ozone gas has been used in pain medicine practice for intraarticular injections, intradiscal, periforaminal or intraforaminal injections. Ozone is inherently bacteriostatic, fungicidal, and virucidal. The world is now facing one of the biggest crises known to humankind, the Coronavirus pandemic. This COVID-19 is multiplying at an unprecedented pace, affecting the population worldwide. Coronaviruses have abundant cysteine in their spike proteins that may be easily and safely exploited with ozone (or other oxidation) therapy. Cysteine residues are also abundant in viral membrane proteins and must be “conserved” for viral cell entry. Ozone has a unique ability to inactivate cysteine dependent proteins. Ozone injections in pain medicine have reported encouraging effects in pain control and functional recovery. All of these factors, coupled with the comparatively low cost of Ozone make it an attractive alternative option compared to platelet-rich plasma or steroid injections in the present COVID-19 pandemic crisis.
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Cervicogenic Headache p. 5
Gautam Das, Mary Benita Jeyakumar
DOI:10.4103/jrap.jrap_10_20  
Cervicogenic headache is a secondary headache that occurs due to referred pain from the cervical region, perceived in the trigeminal nerve distribution. It is a rare entity which is often seen in patients following whiplash injuries belonging to the early 30s age group. The pain generators are facet joints, atlanto-occipital joint, intervertebral discs, neck muscles, and cervical nerves from various pathologies. Clinically, it is a side-locked headache worsened by abnormal neck postures and neck strain. The flexion–rotation test is positive in most cases. Diagnosis is made based on the ICHD-3 criteria. The mainstay of treatment involves physical therapy for 6 weeks along with psychological therapy and pain medications. Interventional pain therapy options include cervical epidural steroid injections, trigger point injections, selective nerve root injections, and radiofrequency thermal neurolysis.
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CASE REPORTS Top

Intravenous ketamine for pain relief in a patient with supraglottic laryngeal cancer (Stage IV-C) p. 8
Prashant Chaudhari, Bhumika Shah, Sagar Karia, Nilesh Shah, Avinash De Sousa
DOI:10.4103/jrap.jrap_8_20  
Patients diagnosed with cancer often suffer from chronic pain. Management of pain is essential to improve the quality of life of patients. When the standard methods for pain management fail, novel techniques can be implemented. Ketamine is a dissociative anesthetic agent which acts by reducing the central sensitization to pain. We report the case of a patient suffering from intractable pain as a result of Stage IV-C supraglottic laryngeal malignancy that responded well to intravenous ketamine.
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Percutaneous cryoneurolysis: An alternative in metastatic bone lesion involving sacroiliac joint p. 10
Laxmi Pathak, Debjyoti Dutta, Gautam Das, Indranil Ghosh, Chinmoy Roy, Subhra Das Mistry
DOI:10.4103/jrap.jrap_7_20  
Cryoneurolysis is a very recent and advanced procedure in interventional pain management practice. Application of cold allows second-degree nerve injury resulting in analgesia. Here, we are presenting a case of effective pain relief by cryoneurolysis of the lateral branches for the right sacroiliac joint in a patient suffering from hepatocellular carcinoma with bone metastasis.
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Simple approach to a complex problem: Abdominal cutaneous nerve entrapment p. 14
Nandita Mehta, Amanpreet Kaur
DOI:10.4103/jrap.jrap_1_20  
The aim was to show the efficacy of simple ultrasound-guided trigger point injection of local anesthetic in combination with steroid for the management of postoperative abdominal cutaneous nerve entrapment syndrome (ACNES). Abdominal cutaneous nerve entrapment can be the cause of severe, undiagnosed, abdominal pain. The entrapment of the nerve can be secondary to various conditions which cause increased abdominal pressure, leading to herniation of fat or connective tissue into the fibrous ring in the rectus abdominis muscle through which the nerve passes. Due to the compression of the nerve, there is ischemia which leads to pain. The nerve can be entrapped in scar tissue causing the compromised blood flow to the nerve and hence leading to postoperative pain. None of the available radiological investigations is helpful in diagnosing the abdominal cutaneous nerve entrapment. Clinical examination looking for tender trigger point on the abdominal wall and the eliciting a positive clinical sign, i.e., Carnett's sign can lead to the possible diagnosis of this frustrating condition. We successfully managed three cases of abdominal cutaneous nerve entrapment following laparoscopic meshplasty of abdominal hernia. All these cases were injected with a mixture of local anesthetic and steroid, i.e., 1 ml of 2% lignocaine and 1 ml of 10 mg triamcinolone at each trigger point under ultrasound guidance. The patients were prescribed pregabalin for 3 months and an anti-inflammatory COX-2 inhibitor for 10 days postprocedure. All the 3 patients were pain free at 6 months following the injections. A simple approach to a very disturbing problem of managing the severe pain due to abdominal cutaneous nerve entrapment in the postoperative period is a trigger point injection of local anesthetic and steroid under ultrasound guidance. Ultrasound-guided trigger point injections using a local anesthetic and a steroid offer an almost noninvasive option to the management of a very complex problem of ACNES.
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Dry needling: A promising treatment modality for greater trochanteric pain syndrome Highly accessed article p. 19
Archana Y Nankar, Yashwant L Nankar
DOI:10.4103/jrap.jrap_6_20  
Greater trochanteric pain syndrome (GTPS) is a common cause of lateral hip pain, seen more commonly in females between the ages of 40 and 60 years. GTPS is presently attributed to tendinopathy of the gluteus medius and/or minimus with or without coexisting trochanteric bursitis. Conventionally, cortisone injection into the lateral hip, with the intention of injecting the bursa, was accepted treatment for this condition in cases not responding to conservative treatment. But since the etiology of GTPS is not necessarily the bursa, injecting it with steroid is not as logical. As trigger points and myofascial pain of the affected hip and thigh musculature are being implicated as sources of pain, dry needling (DN), that has shown potential in treating a variety of soft-tissue injury and neuromyofascial pain, and which requires the insertion of thin monofilament needles into sensitive loci (trigger points) in the muscles and soft tissue could be an effective option. Hereby, we present a case of a 52-year-old woman, who came to us with chronic lateral lower limb pain since 1 year. The pain was dull aching in quality, extended from the right buttock region to the lateral aspect of thigh and was specially felt on abduction of thigh while sitting in cross-legged position on the ground. The patient had tenderness along proximal lateral thigh around the greater trochanteric region. One-week course of nonsteroidal anti-inflammatory drugs had minimal effect. We decided to treat her with DN in her pain area. The patient reported more than 75% pain relief after the session.
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Stellate ganglion blockade as a treatment modality in ischemia and gangrene following insect bite p. 23
Bhaben Chandra Boro, Pratibha Sahoo
DOI:10.4103/jrap.jrap_13_20  
We describe the case of a 34-year-old female patient who had ischemia of the hand and fingers following insect bite and underwent stellate ganglion block as treatment. She was otherwise fit without any significant past history. We recommend an early recognition of such cases with prompt treatment for a better outcome.
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