This document discusses pain management practices in India and opportunities for improvement. It addresses why pain management is important from human, recovery, legal and economic perspectives. It notes current common practices like periodic injections and infusions but lack of dedicated pain teams. The document recommends a multimodal approach using various analgesic medications and techniques tailored to each patient's condition, including regional blocks, nerve ablations, implanted infusions and stimulators. It also asks if aromatherapy could provide analgesia. In summary, it analyzes pain management issues in India and proposes a more comprehensive multidisciplinary approach.

1. Dr Rajeev Harshe MD
Consultant pain management
Apollo Hospitals, Ahmadabad.
(Hon. Pain consultant to H.E. Governor of Gujarat)

2. Why pain management ?
Current practices in India
How best can be done ?
Acute pain management-brief overview
Chronic pain management-brief overview.

3.  Human issue
 Recovery issue
 Hypersensitivity issue
 Legal aspect
 NABH/JCI issue
 Economic issue (faster turnover)

4.  I/M shots periodically
 I/V shots periodically
 Rectal suppositories
 I/V infusions ( 5% centers)
 Random use of patches

5.  Possibility of Inadequate analgesia
 Lack of dedicated person to look after pain relief
 Patients even if suffer.. feel it is a part of
experience.

6.  Multimodal analgesia
 Infusion better
 Bolus for breakthrough pain more gratifying
 Topical and regional analgesia better used
 Pain Team including pain nurse.
 Consider status of liver/kidney/brain

7.  Portable infusion pump ( Elastomeric)
 PCA
 PCEA
 Diclofenac/ketorolac/buprenorphine patches
 Lollypops / Lozenzes
 Nasal sprays

8.  NSAIDS
 Opioids: Morphine,
Fentanyl,buprenorphine,Tramadol
 Other: Paracetamol IV 1 gm qds
 Dexmedetomidine
 Clonidine/ketamine/neostigmine

9.  Tapentadol (dual action)
 Methadone (prolonged single shot preop.)
 Oxycodone
 Opioid antagonists
 Gabapentine in acute pain ( neuropathy)
 Opiorphine ( prevents degradation of
endogenous Opioids)
 ibudilast

10.  Diagnostic cum therapeutic nerve blocks-
 (somatic and sympathetic)
 Radiofrequency ablation of sensory nerves
 Epidural/ intrathecal infusions by
implantable pumps
 Peripheral plexus infusions by portable
pumps
 Percutaneous epiduroscopy and adhesiolysis
 Spinal stimulation by implanted stimulators
 Various disc procedures for IDDs

11.  Pain due to spondylitis
 Pain due to propalsed disc
 Listhesis induced pain
 Vertebral pain
 Myofascial pain
 Neuralgias –trigeminal / post herpetic
 Malignancy pain
 Pain of vascular origin
 Persistent pain after spine surgery

12.  Platelet rich plasma injections.
 Stem cell treatment
 Nasal sprays for any kind of pain

13. Can we have Aroma Therapy used for
analgesia?

14. Dr Rajeev Harshe MD
Consultant pain management
Apollo Hospitals, Ahmadabad.
(Hon. Pain consultant to H.E. Governor of Gujarat)