Introduction: The effect of duration, severity, response to treatment, family and social interactions with chronic pain and depression have been studied extensively. But, none of the studies have ever reported any association of the character of chronic pain particularly neuropathic pain with depression. The aim of this study is to find out the association of neuropathic pain (using painDETECT tool) and depression [using the patient health questionnaire (PHQ-9) scale]. Materials and methods: A prospective analysis of 250 patients, aged 18 to 65 years of either sex suffering from chronic pain for more than 3 months' duration with an average pain score of 4/10 or more on numerical rating scale (NRS) and moderate to severe depression diagnosed using PHQ-9 scale, were included in the study. Neuropathic character of pain was diagnosed using painDETECT tool. We analyzed the possible association of neuropathic pain with depression. Results: In 3.2% of patients were found to be suffering from neuropathic pain, 19.6% patients were non-neuropathic or nociceptive pain and 77.2% patients were suffering from mixed type of pain where neuropathic pain may be present. The average depression score on PHQ-9 scale was 14.58 ± 3.72. In 58.4% of patients the depression was moderate, 30.4% of patients the depression was moderately severe and 11.2 % of patients were suffering from severe depression. On analysis of data, we have found that there is no statistically significant association between neuropathic pain and depression (p = 0.8). Conclusion: We did not find any statistically significant correlation between neuropathic pain and depression.

Background: Osteoarthritis (OA) is the most prevalent chronic degenerative joint disorder worldwide and is associated with significant pain, disability and economic impact on society. The primary objective of the present research is to validate the hypothesis that combination of intraarticular injection of ozone and steroid has better outcome than using zone alone in patients with primary knee OA. Materials and methods: Cohort comprises of 80 patients of American Society of Anesthesiologists (ASA) I and II between age 45 and 70 years of either sex with primary knee OA with radiographic evidence (grade 0, I, and II; Lawrence and Kellgren radiological criteria) of severity of knee joint. The patients were randomized to receive single intraarticular injection of either ozone alone or combination of ozone with steroid. All patients were assessed using Western Ontario and McMaster University Osteoarthritis (WOMAC) index, and the visual analog pain scale (VAS) at 1, 3, and 6 months of follow-up. Statistical Package for the Social Science (SPSS) for Windows software was used for data management and statistical analysis. The level of significance was set at 0.05 for all statistical tests. Result: Both the group treated with the combination of ozone and steroid and the group treated with ozone alone demonstrated improvements from baseline parameters. At 1 month patients in both group showed significant improvement in VAS and WOMAC (p < 0.05). Group treated with combination of ozone and steroid showed significant difference (p < 0.05) with respect to WOMAC, or VAS results at the end of 6 months of follow-up. Conclusion: Ozone treatment was highly effective in relieving pain and improving functional outcome in patients with primary knee OA. Significant differences were detected between patients treated with intraarticular injections combination of ozone and steroid and those treated with the ozone alone with respect to pain relief or function at 6 months of follow-up.

Role of interventions in pain medicine is one of the important aspects. Even if we diagnose the condition correctly but if we are not familiar with the interventions and their troubleshooting we may land up in a problem. Every patient is different; every procedure is a challenge to the pain physician. S1 transforaminal is such a procedure which every pain physician should know including its troubleshooting. We must be through with the technical aspects of the interventions. In this article of practitioner's corner, the technique and troubleshooting is being discussed to increase our clinical and intervention accuracy.

Postherpetic neuralgia (PHN) is a painful condition affecting 2% of the patients suffering from herpes zoster (HZ). Most common risk factor for developing PHN is age. Pain has a dermatomal distribution; is confined to same dermatome as the rash. Various treatment modalities have been tried to reduce this pain and improve the quality of life of the patient. Varicella zoster vaccine has shown promising results in preventing the development of HZ as well as PHN. Early treatment with antiviral drugs within 72 hours is also helpful to decrease the incidence of PHN. There has been a gradual transition in the treatment modalities, from oral anticonvulsants, antidepressants, opiods, to combination therapies of these drugs, which reduces side-effects and improves efficacy. Now the focus had shifted to eliminate the oral route altogether. Nowadays topical applications are being used. Various topical modalities available are 5% lignocaine patch, 8% capsacian patch. Latest development is a 6% gabapentin patch. There is a combined patch which has a mix of gabapentin, ketoprofen, ketamine and lignocaine which has also been used in a case report. The most recent advance in the treatment modality is transcutaneous electrical nerve stimulation, which has shown to prevent development of PHN as well as has shown promising results to decrease the pain. When the pain is not responding to any of the treatment modalities mentioned above, ultrasonography (USG)-guided musculocutaneous peripheral nerve block has been used and it has shown positive results. Out of all the treatment modalities available in our armour, we can choose either one or a multimodal approach, depending on the patient's condition, and provide pain relief to our patients.

Ultrasound has emerged as an important and inseparable tool in the field of anesthesiology and pain management. Its use is increasing everyday to aid in regional anesthesia and in chronic pain interventions. It is replacing fluoroscopy to guide many chronic pain interventions, especially the sympathetic blocks like stellate ganglion block, celiac plexus block, superior hypogastric plexus block, ganglion impar block, etc. Stellate ganglion block is used in the treatment of wide variety of chronic painful conditions of head, neck and the upper limb. Hence, it is one of the commonest procedures in chronic pain management. Stellate ganglion block is commonly performed under fluoroscopy guidance. Use of ultrasound during this procedure has shown to be as effective as the fluoroscopyguided technique, more safe than fluoroscopy and can avoid radiation exposure. In this article, we have described the merits and demerits of the ultrasound-guided stellate ganglion blockade as compared to the fluoroscopy.

We report a case of 50 years old female diagnosed with carcinoma of breast posted for modified radical mastectomy (MRM). Her comorbidities included diabetes mellitus (DM), hypertension, ischemic heart disease (IHD) and chronic obstructive pulmonary disease (COPD). She was also anxious about postoperative analgesia. The surgery was successfully completed under general anesthesia (GA) with single level thoracic paravertebral block (PVB) using peripheral nerve stimulator (PNS). Regional techniques like PVB are preferred modalities for perioperative analgesia. It provides good intraoperative conditions with adequate postoperative analgesia with least hemodynamic alterations in high risk cases specially IHD.

We report a case of 45 years old female posted for cholecystectomy for gall bladder stone under combined epidural and general anesthesia. Epidural catheter was inserted at T9 to T10 and fixed by subcutaneous tunneling followed by suturing and looping. An insignificant dislodgement of 2 mm was observed with a good postoperative analgesia and patient satisfaction score with only mild signs of inflammation after 3 days.

This case report is about a patient with thoracic facet arthropathy presenting with abdominal pain, who underwent multiple investigations and treatment for abdominal visceral conditions with no relief of his pain. A 29 years male presented to our pain clinic with episodic, severe left chest wall, and upper abdominal pain. In the last 4 years, he had been treated for various abdominal visceral conditions. He was then diagnosed as a case of intercostal neuralgia and 12th rib (the twelfth rib syndrome). He was treated with anticonvulsants and antidepressants, as well as intercostal nerve block, tender point injection and intercostal nerve radiofrequency (RF), but with partial relief. Careful history and clinical examination revealed left lower thoracic facet joint involvement. Diagnostic block of medial branch of left 10, 11 and 12th thoracic dorsal rami was done with 90% pain relief. This case emphasises that in any case of abdominal pain, spine should be examined because referred pain from spine can be an important etiology of pain abdomen. Careful history, examination and appropriate investigations should be done to rule out abdominal pathologies, and to arrive at a diagnosis. A thorough history, meticulous examination, and diagnostic blocks if required are very important to localize the pain generators.

Entrapment of sciatic nerve due to spasm of piriformis muscle known as piriformis syndrome. It produces radiating pain in buttock, posterior thigh and lower leg that actually originate from the compression of nerve plexus under piriformis muscle, not from the nerve root. Diagnosis of piriformis syndrome is primarily based on patients history, physical examination and diagnostic piriformis muscle block. Diagnostic modalities, such as magnetic resonance imaging (MRI), electromyography (EMG)/nerve conduction velocity (NCV), ultrasonography and computed tomography (CT) scan mostly useful to rule out the other condition of low back pain includes prolapsed disk, facet arthropathy, spinal stenosis and muscle strain. We reported a case of piriformis syndrome with the signs and symptoms mimicking L5–S1 radiculopathy and diagnosed by diagnostic local anesthetic and corticosteroid piriformis muscle injection.