The Assuaging Touch of ‘Dr. Pain-Killer’
Kochi: Not all of us are professional doctors, yet most of us often believe that we know the underlying cause of it whenever we feel pain in any part of the body and start self-treatment. So what is pain? According to International Association for Study of Pain (IASP), ‘pain is what the patient say hurts.’ Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. In other words, pain is a somatopsychic phenomenon and is modulated by the patient’s mood, morale and the meaning of pain to him or her. Any pain which lasts more than three months is defined as ‘chronic pain.’
While we assume that medicines we ‘self-prescribe’ give us immediate relief, doctors are against it with some even highlighting the serious side-effects of such a practice. Expert doctors say that pain in human body, especially when it impedes mobility, may even lead to depression and other psychological issues. However, people are not yet aware of pain-relief medication. Here’s where Dr. A M Aksar – who runs Epione Pain Clinic at Vazhuthacaud in Thiruvananthapuram – is trying to make a difference. His target audience are patients who suffer pain from post-trauma, post-operative, geriatric and other orthopaedic conditions.
Dr. Aksar completed MBBS from Yenepoya University in Mangaluru and worked at the ICU of SP Fort Hospital in Thiruvananthapuram for two years. Realising his interest in Anaesthesia, he joined for MD in Anaesthesiology at AJ Institute, Bengaluru. He returned to Thiruvananthapuram after completing the programme and worked with the Super Specialty Block of Thiruvananthapuram Medical College for a year. Currently, he is working with NIMS Hospital in Thiruvananthapuram.
The career-changing moment in his life came during a regular consultation session at the hospital.
“In 2016, a cancer patient approached me with severe pain on her back. There’s a small anaesthesia procedure by which the doctor administers a mild epidural to help reduce such kinds of pain. I was touched by the feel of tremendous relief on her face after the procedure. That was when I started thinking seriously about pain-relieving procedures in medical sciences. That incident encouraged me to pursue a course in pain management. I went to Kolkata where I spent three months to finish the course. Subsequently, I got a chance to train under expert doctors in Delhi and Germany,” Dr.Aksar said.
Interventional pain clinics are relatively new to Kerala. “I have known people who self-medicate to get rid of severe pain, sometimes for years together. Finally what happens to them is very sad. It need not lead to a person’s death always but if one has some other health problems it may take his or her life,” he said.
Dr. Aksar takes the example of knee pain to explain further. The surgical option to fix a painful, worn-out knee is arthroplasty or a Total Knee Replacement (TKR) surgery. “If a patient comes at a very early stage it is possible to mitigate the knee problem to a large extent, through modification and regeneration. Regenerative therapy could be used to save the joint,” he says.
“If the patient approaches at least before the knee starts bending, which is common in the advanced stage of Rheumatoid Arthritis, I can start regenerative therapy to save the joint.” Dr. Aksar uses platelets harvested from the patient’s blood to make Platelets Rich Plasma (PRP), bone marrow aspirate and stem cells to regenerate the worn-out parts joints in knee, hip, Sacroiliac joint, shoulder and other arthritic joints. He uses imported, FDA approved machine (HARVEST) for processing all the above procedures.
“The knee pain becomes severe when two bones start rubbing against each other. When the plasma component developed from harvested platelets/bone marrow aspirate and stem cells is administered to the affected joint area. After two or three sessions, the patient will get tremendous relief,” Dr. Aksar assures.
Due to obesity and overweight, even younger people complain about knee-related problems. The absence of proper exercise and medication in such cases makes TKR surgery inevitable. But Dr. Aksar says that TKR surgery offers relief only for a decade or so, after which the patient starts experiencing the problems again. It is often the lack of awareness among people which take them to the inevitability of undergoing TKR. “We recommend TKR surgery to only those who are above 60 years of age. They will be able to lead a comfortable life after the surgery. If a patient at 40 undergoes TKR surgery, she will start suffering the pain again after a decade,” he says Further, he opines, only professionally trained surgeons alone should conduct TKR surgeries. “Now, most of the orthopaedics seem to be doing it. Earlier, the failure rate was about 20 per cent. Now it has risen to 35 per cent. So what happens is people will start losing trust in medicine,” says Dr. Aksar.
Cooled RF Ablation
So what can be done if knee-joint pain is not reduced even after undergoing TKR surgery? Dr. Aksar performs Cooled Radio Frequency (RF) Ablation in such cases. Cooled RF Ablation is a patented technology from the US. “Recently, a 90-year-old man came to me complaining of severe knee pain. He readily agreed to undergo Cooled RF Ablation after I assured him two years of pain relief,” the doctor says. “Cooled RF Ablation is the best solution for joint, bone and arthritis-related pains in old age.” he adds.
How does it work?
During Cooled RF Ablation, the doctor will ablate specific sensory nerves that generate the feeling of pain at a particular part of the body. The nerves which are to be ablated will be identified using latest technologies. The heat generated through high frequency electrical impulses lesions the nerve, disconnecting signals from body to brain.
In some cases, Dr. Aksar says, Cooled RF Ablation is done along with PRP/stem cells administration so that the patients will be free from pain the moment it is done.
Dr. Aksar also has experience in using Cooled RF Ablation to mitigate pain on facial muscles due to Trigeminal Neuralgia, which is a chronic pain condition that affects the trigeminal ganglion. It carries sensations from the face to the brain.
He uses Cooled RF Ablation kits known as ‘Coolief’ imported from the US for the therapy. According to Dr. Aksar, PRP/stem cells is successful in 90 per cent of the cases. The platelets will help accumulate stems cells that promote growth in the body. “After PRP/stem cell therapy patients usually remain pain-free for about five to six years.”
Dr. Aksar has solution for back pain related problems, too. “Lower backache is a common problem among people who sit and work for long hours. A most common symptom is early morning stiffness. It is the result of the wear and tear happening to the facet joints on the lower spine area. Facet joints help us bend,” he says. Early morning stiffness of back, can also be the result of arthritis in Sacroiliac joint, he adds.
Dr. Aksar cautions against the use of lumbar belt to support the back in the event of lower back ache. “Belts should be worn only in the case of fracture. Wearing belts can lead to reduction of muscle strength, worsening the situation,” he says. For low back aches due to disc bulge, Dr. Aksar says it could be rectified by locally administering steroid if the bulge is small or ozone if the bulge is moderately large. “Local steroids and ozone help shrink the disc bulge, thus preventing contact between the disc and nerves surrounding the vertebral column. However, only regular exercise will help lessen the pain in the long run,” he adds.
Likewise, the doctor also suggests the use of PRP/stem cells for tendonitis, heel pain and sports injuries. According to him, a patient can be relieved of pain at least for a period of five to six years following the administration of PRP/stem cells and rehabilitation.
Dr. Aksar signs off by warning the general public against the use of non-prescribed ‘pain-killer’ tablets. A major reason for liver and renal dysfunction at early stages is the unwarranted use of non-prescribed analgesics, he cautions.