Pain Clinic of India

Breast cancer is the most frequently diagnosed malignancy among women worldwide and represents a growing public health challenge in India. Rural populations face unique barriers, including delayed diagnosis, limited screening facilities, and restricted access to comprehensive oncology care. This chapter presents a detailed clinicopathological and molecular analysis of breast cancer cases managed at a rural tertiary care centre in Central India over a five-year period. A retrospective evaluation of 150 histologically confirmed breast cancer patients was performed, assessing demographic characteristics, tumour pathology, molecular subtypes, staging, and treatment patterns. The mean age at diagnosis was 47.8 years, with a predominance of advanced-stage and high-grade tumours. Triple-negative breast cancer constituted 55.3% of cases, followed by the Luminal A subtype. All patients underwent surgical management, predominantly a modified radical mastectomy. Adjuvant chemotherapy and hormonal therapy were administered based on receptor status. The results demonstrate a younger age at onset, predominance of advanced-stage disease, high-grade tumours, and a high burden of triple-negative breast cancer, underscoring the urgent need for early detection strategies and improved oncology infrastructure.

Background: Hypertension (HTN) is the primary modifiable risk factor for chronic coronary syndrome (CCS), which significantly contributes to morbidity and mortality. This study aimed to gather expert consensus from Indian cardiologists on managing HTN in patients with CCS, to optimize therapy and improve patient care. Methods: A consensus is based on Indian cardiologists’ inputs collected via an online survey. The questionnaire covered diagnostic practices, clinical patterns, and real-world treatment regimens for managing hypertensive CCS patients. Survey responses were analyzed and discussed during round table meetings. Further expert opinions were graded from Level A (strong consensus) to Level D (no consensus). Recommendations were formulated based on collective expert opinions. Results: The consensus highlights the clinical strategies for managing patients with CCS and associated comorbid conditions. The key diagnostic tools, such as ambulatory blood pressure monitoring and Holter electrocardiogram, are strongly recommended for comprehensive evaluation. Pharmacological management should prioritize the use of angiotensin II receptor blockers and beta-blockers combinations, particularly telmisartan–metoprolol fixed-dose combination (FDC) in the management of hypertensive CCS patients with type 2 diabetes mellitus or dyslipidemia. Conclusions: Indian cardiologists emphasized the importance of using, telmisartan–metoprolol FDC as a preferred drug regimen owing to their cost-effectiveness, improved efficacy, and enhanced adherence. These consensus recommendations aim to enhance therapeutic outcomes and guide future clinical practice in Indian context.

Abstract Chronic abdominal pain associated with exocrine pancreatic insufficiency (EPI) is often difficult to treat. Image-guided sympathetic interventions—particularly celiac plexus neurolysis (CPN) and thoracic splanchnic nerve radiofrequency ablation (RFA)—have shown benefits in pancreatic and upper abdominal visceral pain. A 42-year-old man with EPI, type 1 diabetes mellitus, and Von Willebrand disease presented with 3 years of severe upper abdominal pain radiating to the back. Conservative therapy, including enzyme replacement and analgesics, was ineffective. He underwent ultrasound-guided CPN followed by fluoroscopic thoracic splanchnic RFA. Although the patient had a history of Von Willebrand disease, his coagulation profile (prothrombin time/international normalized ratio, activated partial thromboplastin time, and platelet count) was normal at the time of the procedure following hematology optimization. Immediate pain relief exceeded 50%. At 2 weeks, the patient had sustained 50% improvement, significantly improved sleep, and complete cessation of all analgesics. No complications occurred. Combined sympathetic intervention CPN and splanchnic RFA offered effective and durable pain control in a case unresponsive to conventional therapy.

Abstract Background: Genicular nerve ablation (GNA) is an effective minimally invasive intervention for pain relief in knee osteoarthritis (OA). However, the predictive role of pre-procedural ultrasound findings, particularly synovial effusion (SE) and hypertrophy, remains underexplored. This study aimed to evaluate whether these sonographic parameters predict short-term outcomes following GNA. Materials and Methods: This observational study included 24 patients with chronic knee OA who underwent ultrasound-guided GNA targeting the superior medial, superior lateral, and inferior medial genicular nerves. SE and hypertrophy were graded according to Outcome Measures in Rheumatology and quantitative effusion thickness. Pain and function were assessed using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline and 4 weeks post-procedure. Patients achieving ≥50% NRS reduction were defined as responders. Predictive factors were analyzed using Firth logistic regression. Results: Mean NRS improved from 6.75 ± 0.99 to 3.88 ± 1.83 ( P < 0.001), and mean WOMAC improved from 38.5 ± 3.9 to 15.7 ± 13.7 ( P < 0.001). Patients with mild or no SE showed greater improvement (WOMAC reduction = 33 points) than those with moderate/severe effusion (18 points). Similarly, mild/no hypertrophy showed a larger WOMAC decrease (28 vs 19 points). Firth logistic regression identified synovial hypertrophy (SH) as an independent predictor of response (adjusted odds ratios (OR) = 8.75; 95% confidence intervals 1.86–41.10; P = 0.007), whereas effusion showed a nonsignificant trend (OR = 0.67; P = 0.47). Conclusion: GNA provides significant short-term improvement in pain and function in knee OA. Ultrasound assessment of the synovial morphology enhances prognostication—patients with minimal SH and effusion demonstrate the greatest likelihood of favourable outcomes. Incorporating pre-procedural ultrasound phenotyping into routine evaluation may optimize patient selection and clinical success of GNA.

Background: Pemphigus is an autoimmune blistering disorder affecting skin and mucous membranes. Autoantibodies target desmoglein proteins, leading to acantholysis. Glucocorticoids (GCs) are the primary treatment, but long-term use leads to side effects, prompting the use of other immunosuppressants like cyclophosphamide, rituximab, azathioprine, methotraxate for steroid-sparing effects. Methods: Seventy-five pemphigus patients were included. Diagnoses were based on clinical and histopathological findings. Patients were treated with GCs alone or in combination with immunosuppressants like cyclophosphamide, rituximab, azathioprine, methotraxate. Clinical remission and adverse events recorded over an 18-month follow-up. Results: The 46 patients were treated with GCs alone, while 19 received additional cyclophosphamide. 89.5% of patients treated with GCs and cyclophosphamide achieved remission within 4 months, compared to 73.9% with GCs alone. Conclusions: Cyclophosphamide and other immunosuppressants enhances clinical outcomes by achieving earlier remission and reducing relapse rates in pemphigus patients compared to GCs alone. Its use as an adjunct may offer significant steroid-sparing effects.

The Ponseti method is a globally accepted treatment modality for Clubfoot or Congenital Talipes Equinovarus (CTEV). This study compares the kinematic and kinetic gait patterns in children with unilateral and bilateral idiopathic clubfeet with the age-matched control group. 40 children with a mean age of 9.61 ± 3.04 (6-15years) of which 23 (23 feet) were unilateral and 17 children (34 feet) were bilateral, who had completed 2years post weaning of splints. Clinical examination included a range of motion of the ankle, static and dynamic deformities, and rotational profile of the hip. 3D Gait analysis was performed with a multi-camera motion capture system. In unilateral CTEV, there was a significant difference in calf girth and foot size. Ankle dorsiflexion showed a statistically significant difference in mid-swing (p = < .001) although Initial contact and Loading Response and Terminal Stance were reduced and were not statistically significant for unilateral CTEV. A significant difference in ankle inversion p = < .001 was noted in mid-swing in Unilateral and Bilateral feet. On comparison to the control participant's normal, kinetic data showed Internal Ankle plantar flexor moments (p = < .001) to be reduced in the unilateral and bilateral groups. Internal ankle extensor movement was statistically significant in the bilateral group, while in the unilateral group, it was not. Ankle power was statistically reduced in both groups. Gait analysis shows subtle kinetic and kinematic changes in children with clubfeet, mainly deviations in ankle rockers and reduced ankle power generation which may impact clinical function.

Introduction There is a need for affordable dental treatment modalities like removable dentures (RDs). This study aimed to assess the validity and reliability of newly developed instruments (questionnaires and indices) in Hindi to measure patient satisfaction with all types of RDs. Methods Phase one involved the translation of validated and tested German instruments in Hindi, followed by backward translation. Phase two involved testing the face validity of the pilot questionnaires through 3 rounds of cognitive interviews with 13 participants. Trained examiners conducted the interviews in the presence of an external observer. Phase three involved distributing 291 questionnaires to 179 participants. A total of 178 questionnaires were completed by the participants after one week but not more than three weeks. Construct validity was evaluated using factor analysis. The reliability and appropriateness of the items in the indices were assessed using the intraclass correlation coefficient and Cronbach's alpha. Results The upper and lower jaw questionnaires had good face validity. Cronbach's alpha scores showed excellent reliability and consistency. The intraclass correlation coefficient values fell within the range of 0.72 to 0.95, indicating “moderate” to “excellent” reliability. Discussion The developed Hindi versions of the upper and lower jaw questionnaires and indices to study patient satisfaction with RDs were valid and reliable. These questionnaires can be applied in the clinical setting to test patient satisfaction with removable dentures. They can be used for research and can be integrated into routine patient assessment. Based on patient satisfaction, treatment modifications can be done in the follow-up visits. Further studies can be conducted to include more samples from various populations. Conclusion Patient satisfaction outcome measures are the most frequently used subjective assessments for dental treatments in clinical dentistry. The Hindi version of the upper and lower jaw questionnaire and index shows valid and reliable outcomes. This questionnaire can be used to measure patient satisfaction with all types of removable dentures and can be used for routine patient assessment.