Pain Blog
Dec 25, 2007
Dr. Ajrawat's Dynamic Pain Management Model™
Biosychosocial Model for evaluation of chronic pain and
Multimodalty Treatments for effective pain management
by a qualified (fellowship trained and certfied) pain specialist
is the key.
Pain Management-Treatment Outcome
Myofascial Headaches
"From the Enigma of Disability & Pain
to the Path of a Happy & Productive Lifestyle"
By Susan Merritt
Sep 16, 2007
Enigmatic Pain Sufferer
Pain Patient's Enigma: I, as a qualified (fellowship trained and certified) pain specialist, frequently encounter pain patients, who are absolutely desperate and at their wits end because of not having been properly diagnosed and effectively treated. Such desperation leads to loss of mental and physical vitality. Often one's outlook about life changes with persistent pain, one loses ones capability to live effectively and one ages faster than one could imagine. Such was the plight of Michel Valois and millions of other pain sufferers, who seldom see the light at the end of the tunnel. What is frustrating for me as a pain specialist is my limitation and ability to treat very few patients, as every patient needs one to one expert & quality care for a favorable treatment outcome.To address that challenge, I am planing to start the Pain Radio on the internet to educate pain sufferers world wide, who seek right professional help. I am also committed to training more physicians in pain management who in turn can provide quality and effective care. Those of you who read this column please send me your suggestions. Thanks!
Dr.P.S. Ajrawat
Pain Management- Treatment Outcome
“Back from hell, slowly but surely”
By Michel Valois
On February 28, I had a radical prostatectomy for cancer, in one of the best place in the US for that surgery. I am 69, but I was, at the time, in the best possible shape: stretching every morning since ten years, treadmill two days a week since 5 years. In the 6 weeks before the surgery, I was running 4 miles in one hour every other day. I felt and looked younger than my age.
Unfortunately it was the beginning of the worst period in my life. After two months, I thought I had added ten years to my age. Even with a lot of pain killers I was suffering and even with sleeping pills I had to go to the bathroom eight or ten times during the night. No pill, no sleep. My surgeon, at the three-month post-surgery visit, was lost, not knowing what was going on and what to prescribe, except a routine pill for the bladder.
I decided to see another urologist, in my area, with a good rating from Consumer-Checkbook, to have a second opinion and hopefully get some relief. Perhaps I had another cancer somewhere? He ordered urine and blood tests and a CT scan and he did a cystoscopy. He saw nothing wrong. Good news, he said; no infection, no cancer. But from there on, what to do? As soon as there was no flesh to cut, I was not an interesting case and he rather rudely told, to my wife and I, he couldn’t do anything for me. Move along, I have other patients waiting!
If urologists couldn’t do anything for me, I had to find someone else able to alleviate my pain. I had no previous experience of pain management, but I had heard about that discipline. I thus looked after a “pain management doctor” on the web. I found Dr Ajrawat and took an appointment.
This first appointment was a pleasant surprise. I was used to doctors that keep you ten minutes the first time, and then 3 minutes each time. With Dr Ajrawat the diagnostic took one hour and a half. He told me “It’s an ethic choice: with my patients, I don’t look at my watch”. I was already going better!
It’s a lot of things: trigger point injections, nerve blocks, physical rehabilitation, Dr. Ajrawat's Air Pulse Meditation, psychotherapy, strengthening and stretching exercises, and medication. Not surprisingly it takes time: three more-than-one-hour sessions a week for 6 weeks or more, depending on the case. But, surprises succeeded to surprises. First I had leg shorter than the other and that caused posture compensations and then cramps. In fact I discovered that I had low-intensity pains in the muscular mass I didn’t know (or I didn’t want to know). Then I had the feeling of pains moving from one place of the body to another, from thighs to back or to shoulders for example.
In the meantime, I discovered by chance, a urologist knowing what I have: a supposedly rare and probably autoimmune illness, with no cure, interstitial cystitis. There is a remedy but with only long-term effect. The main thing is to follow a diet. That day, I discovered also that my first symptoms – 14 years ago – which were allegedly related to an early prostate hyperplasia were, in fact, the first signs of what I have and that the surgery had wreaked havoc in a weakened bladder. It was a relief to know what I have, even if there is no cure.
After one month of pain management, I discovered its first benefits. My first benchmark, was to recover sleep. Since one week, I sleep without sleeping pills. The level of pain is clearly lower, second benchmark. And I am regaining control on my bladder: yesterday, I didn’t put a diaper for the first time in six months, but a pad.
But there is another benefit of pain management. I had felt ten years older, and now I am going back in time. My body feels younger. The feeling and the appearance of age is strongly related to body stiffness. Knowingly or not, when we grow older, we let our body become less and less flexible. It’s like an inside ‘carapace’ limiting our movements scope. Right now, thanks to pain management, I am shedding away that carapace and going back in time. Thank you Dr. Ajrawat!
Michel Valois, Silver Spring MD
Sunday, September 3, 2007
updated
Understanding Skeletal Disproportion!
Short Leg, Short Hemipelvis
A Major Cause of Pain In The Body
Skeletal disproportion is one of the major factors perpetuating myofascial pain. Myofascial pain in turn is one of the major causes of pain in the human body. It often results from varieties of causes including mechanical stressors like skeletal disproportion (short leg, short hemipelvis), trauma, poor conditioning of muscles, nutritional deficencies, metabolic and endocrine deficiency such as hypothyroidism. psychological stressors, poor ergonomics including faulty posture and poorly designed furniture.
Skeletal disproportion i.e. a short leg, short hemipelvis, rounded shoulders are among the common causes perpetuating myofascial pain and often misdiagnosed. The resultant effect of this misdiagnosis is persistence and perpetuation of myofascial pain in different parts of human body including head, neck, shouldrs, low back, knees and others. This often leads to chronicity of pain.
Myofascial trigger points resulting from skeletal disproportion can produce a varietiy of symptoms including pain, weakness of muscles, nausea, vomiting, numbness, tingling, dizziness, blurriness of vision, limitation of range of motion, depression, fatigue, stiffness of muscle among others.
Because of old and prevalent frame of reference, practitioners often focus more on remote causes of pain like herniated disc, pinched nerve and degenerative (arthritic) changes in the bones and believe them to be the major causes of pain. The x rays and scans are commonly used to make that determination. This results in unnecesssary diagnostic testings, inappropriate invasive (surgical) and noninvasive interventions leading to more pain and disability while the underlying cause remains undiagnosed and untreated. Advanced pain management or adjunctive single modality treatments like physical therapy or chiropractic adjustments add little to patient's comfort and overall pain relief and restoration of loss functionality. The attempts to treat pain with pain medication and other highly advertised pharmaceutical agents leads commonly to serious side effects, drug dependence and addiction Pain patient often feel frustrated, fatigued, angry, depressed and disabled. Hence pain becomes a real ordeal.
Skeletal disproportion including short leg and short hemipelvis can be easily diagnosed by observing patient's face, gait and posture. Thorough physical examination including measurement of lower extremities manually (using tape measure; using book or magazine under the feet) and x rays can easily establish and confirm the diagnosis of skeletal disproportion. Facial asymmetry, atrophy of various muscles and compensatory scoliosis are commonly associated with skeletal disproportion.
Skeletal disproportion can be corrected and perpetuation prevented by using heel lift in the shoe on the affected side, padding under buttock on affected side while sitting and using side arms and proper posture for rounded shoulders. Myofascial pain resulting from skeletal disproportion when properly diagnosed and treated can bring long term pain relief. In order to break the cycle of pain and for pain patient to get the qualified and professional help,the qualification and skills of the pain specialist are very essential. Pain sufferers must seek a qualified and skilled pain specialist who can provide hands on treatment like trigger point injections, nerve blocks, correction of skeletal disproportion, physical rehabilitation, strengthening and stretching exercises, meditation, psychotherapy, medication management, other adjunctive and non adjunctive treatments. Close follow ups, treatments, patient education and patient's active participation in the treatment plan are essential for optimal and long term pain relief.
-P.S.Ajrawat, M.D.
FRIDAY | AUGUST 3, 2007
Attention Pain Sufferers!
Being a qualified and experienced pain specialist dedicated to quality care for the pain patient, education of public and committed to the professionals enhancement of field of pain management/medicine, I must share the following.
Pain patients around the world while desperately seeking the pain relief they deserve, often end up getting on a never ending merry-go-round which results in addiction, iatrogenic morbidity and pain, leading to anger, despair and depression, Some commit suicide, a grim scenario.
Why so?
Majority of the times it is not the health care professional's intentions or committment but rather their lack of training and understanding about pain which becomes the source of that frustration. Many health care professionals or providers often marketing themselves as pain specialists providing either too radical or only adjunctive and non specialized care further confuse the pain patient and complicate the care. It often leads to suppressed anger and contempt on the part of patient against the medical profession.
It has hence become imperative and essential that medical profession supply more qualified (fellowship trained and certified) pain specialists who as specialists will provide the necessary care i.e. hands on treatments and close follow up for much needy pain patients. Pain management should not be considered just as a hobby or some remote subspecialty where shear motivations and interest is not enough but must be advanced and propagated as a full fledged discipline of medicine ready to take on the challenge of all times, the pain in a most scientific, appropriate and effective manner.
At the same time it is incumbent upon the pain sufferers to look and explore for the qualified pain specialist or professional, educate themselves about their pain disorder and get the best help. In addition patient can ask their personal physician to refer them to a qualified pain specialist with necessary training and skills who will evaluate and treat their pain in a conservative manner. Not just mere relief of pain but rehabilitation and restoration of lost functionality constitute appropriate pain management. In addition the positive therapeutic alliance between pain specialist and pain patient is essential. It is the Gung Ho approach which will eventually bring the necessary paradigm shift.
Posted by P.S.Ajrawat, M.D.
FRIDAY | JULY 13, 2007
Hello!
I am Dr. Paramjit Singh Ajrawat, a pioneer pain specialist and a full time practitioner of pain management. I finished my training as a full time fellow from University of Texas Health Science Center in San Antonio, Texas in 1985 and introduced pain management as a discipline in washington metropoltan area and started my independent self supporting pain center.
Being a pioneer and the first qualified (Fellowship trained and certified) pain specialist in Washington,DC area, the challenge for me was immense. But I was fully determined and resolute in bringing the necessary paradigm shift in the understanding of pain by the public as well as the medical professionals.
I introduced the very basic definition of pain, Bio-psychosocial Model of Illness to evaluate pain and multimodality treatments also known as Dr. Ajrawat's Dynamic Model to treat pain effectively. My wife and colleague Dr. Sukhveen Kaur Ajrawat, who is a board certified psychiatrist has stood with me shoulder to shoulder by providing quality care for the psychologic and psychiatric needs of the pain patienst.
I took many initiatives like introducing pain management as a discipline to local medical societies like Fairfax, Montgomery , Washington, D.C. and Prince Georges county medical societies. In addition, I introduced it to local medical schools like George Washington University and Howard University College of Medicine. I also introduced pain management/ medicine as a new and independent discipline to local and national referral services like Dial Doctors and Prologue.
To enhance professional and public awareness I started the newsletter called Algology (Pain Management) update. I have over the years participated in local tv and radio talk shows. CBS news has done stories several times on the quality care we provide and positive therapeutic results we produce.
Our pain center continues to be the leader in the area for patient and public education. We as qualified professionals are committed to providing conservative and state of the art pain management for the much needy pain sufferer. Despite all the successes and triumph I feel rather frustrated to acknowledge the fact that there are millions of people in the US and other countries who need quality pain management desperately and are not getting from wont of qualified pain specialists and poor awareness, education and lack of training of medical professionals. My mission is to raise the awareness about pain and its proper management, help produce qualified pain specialists, so one day we can make our world pain free.
- Posted by P.S. Ajrawat, M.D.
