Pain is a common symptom in multiple sclerosis (MS), with a significant proportion being chronic pain. The profile of MS shows differences based on geographical regions and it has been inadequately studied in South India. The aim of this study was to understand the profile of MS in South India, with specific reference to pain. Patients admitted to a quaternary care center with an MS clinic between 2002 and 2009 were included in the study. Out of 51 patients with MS, 30 patients were followed up and their disability and quality of life (QoL) were assessed. The instruments used were the Kurtzke expanded disability status scale (EDSS) and SF-36 questionnaire. We found that there is a clustering of patients from three districts of Kerala (Eranakulam, Thrissur, Kottayam) probably suggests genetic and environmental factors in the pathogenesis of MS or it may be because of a referral bias. The predominant clinical features were motor and sensory system involvement, which is similar to studies from Northwest India. We conclude that pain is a major symptom compared to similar studies from other Indian regions and as found in other cross-cultural studies. We also sugest measures to improve the current scenario in India.

Background: This study is intended to evaluate the transversus abdominis plane (TAP) block for analgesia over the first 24 postoperative hours after lower segment cesarean section. Materials and methods: Fifty female parturients of American society of Anesthesiologists (ASA) physical status II undergoing lower segment cesarean section were randomized to undergo a bilateral TAP block with ropivacaine (group 1 = 25) or to undergo a bilateral TAP block with 0.9% saline (group 2 = 25). In addition, all patients received standard analgesic injection tramadol 100 mg and im injection diclofenac 75 mg as required in the postoperative period. All patients received standard spinal anesthesia, and TAP block was performed at end of the surgery. Each patient was assessed after operation at each half an hours up to 24 hours after surgery in postoperative period. Results: The mean visual analog scale (VAS) score of group 1 was statistically less than mean VAS score of group 2 (p < 0.001). The mean of total number analgesic requirement for first 24 hours postoperatively was significantly less in group 1 (1.68 ± 0.9) than group 2 (2.8 ± 0.33) respectively. Conclusion: Transversus abdominis plane block holds considerable promise as part of a multimodal analgesic regimen for post cesarean delivery analgesia. Transversus abdominis plane block is easy to perform and provided reliable and effective analgesia.

Introduction: There are situations in which block anesthesia would be the technique of choice, if the technique or techniques of blocking the lumbar and sacral plexus could be simplified, as they have been for brachial plexus. Aims and objectives: Aim of the study is to evaluate the effect of adding fentanyl and clonidine to Lignocaine with adrenaline in lumbar/sciatic block with regard to the following parameters: onset of complete motor and sensory block, duration of motor and sensory block, duration of analgesia, sedative effect of fentanyl and clonidine, hemodynamic changes, complications due to adjuvants and to compare both these adjuvants. Method study design: Patients were randomly allocated into 2 groups of 30 each. Groups: Groups L and C (lignocaine with adrenaline + clonidine)— 30 patients received 35 ml lignocaine with adrenaline + 10 ml distilled water diluted clonidine containing 100 μg + 5 ml distilled water, and groups L and F (lignocaine with adrenaline + fentanyl)—30 patients received 35 ml lignocaine with adrenaline + 10 ml distilled water diluted fentanyl containing 100 μg + 5 ml distilled water. Results: From present study, it can be concluded that Clonidine appears to be better adjuvant for prolongation of anesthesia and analgesia in lower limb surgeries under lumbar plexus/sciatic block.

Piriformis syndrome constitutes a constellation of sign and symptoms and has always remained as a diagnostic dilemma for pain physician. Piriformis syndrome not only causes pain due to its myofascial trigger point but also due to nerve compression and injury on sciatic nerve and its branches. The neural irritation to the sciatic nerve will cause radiculopathy like pain which is misleading the diagnosis to a lumbar nerve root pain. Piriformis syndrome remains a challenge to physician and burden to patients having this syndrome and costly to the society. Diagnostic piriformis block remains a standard for diagnosis and modalities like magnetic resonance imaging (MRI) and nerve conduction velocity (NCV) testing would be helpful in ruling out other diseases. This is a case report of a piriformis syndrome patient presented with radicular symptoms of the leg.

Platelet-rich plasma prolotherapy (PRPP) helps to heal the injured tissue. Connective tissue repair is the platelet function that PRPP operates on. Platelet concentrations, when increased in a specific area, stimulate rapid healing. The main focus of PRPP is on the alpha granules, as these structures house all of the growth factors essential to PRPP in inactivated forms. Here, we report a case of lumbar facet arthropathy, which was successfully treated with intra-articular PRP injection. Patient was pain free after 12 months follow-up. We want to highlight that intra-articular PRP injection may be a future potential alternative therapy for facet arthropathy.

Background: It is sometimes difficult to clinically delineate genitofemoral and ilioinguinal neuralgias because of the overlap in the clinical symptomatology. Case description: A young male with a past history of transurethral removal of ureteral calculi presented with severe, debilitating neuropathic pain in the groin. He had hyperpathia and allodynia in the distribution of genitofemoral nerve, and hence a clinical diagnosis of genitofemoral neuralgia was made. An ultrasound guided diagnostic block of the genitofemoral nerve with local anesthetic produced only a mild reduction in pain (VAS 2 reduction). A repeat diagnostic block of the ilioinguinal nerve produced complete resolution of pain. Literature search showed a limited number of case reports of ultrasound guided blocks for genitofemoral neuralgia; and overlap syndromes have been addressed with differential nerve blocks. Clinical relevance: Our hypothesis is that an aberrant reinnervation from the ilioinguinal to genitofemoral nerve may present with features favoring a genitofemoral neuralgia. In situations where radiofrequency treatment is being considered, such cases may pose a failed intervention if both nerves are not separately targeted.

Objective: This case report presents a patient that had an atypical presentation of radiculopathy which was misdiagnosed as plantar fasciitis. Clinical features: A 67-year-old male patient had presented with primary complain of continuous, aching, pain involving the sole of both feet, aggravated with walking. He had been treated as a case of plantar fasciitis, including depot steroid injection. He had presented to our clinic failing these measures. Clinical evaluation and neurophysiologic study diagnosed him to be a case of bilateral S1 radiculopathy. Conclusion: This case emphasizes the importance of differentiation between neuropathic and nociceptive pain by clinical examination and nerve conduction study.

Lipoma arborescens (LA) is a benign rare synovial neoplasm characterized by hyperplastic proliferation of fatty tissue that replaces the subsynovial connective tissue layer. Lipoma arborescens usually grows inside the joints, but it is also rarely found inside a bursae. This is a case of LA inside bicipitoradial bursae of a 50 years lady. Although six cases of LA in bicipitoradial bursae had been previously described in literature, this case is unique as features of two different types of morphology documented in the same lipoma. Here, in this write-up we describe common clinical features and sonographic findings LA in a middle-aged Bangladeshi woman.