Shoulder Pain Without Surgery: Adhesive Capsulitis and the Three-in-One Block

That is not something done from pain medicine. Deep brain stimulation is coming up fast as a field, but at Artemis it sits with the neurosurgery team, not pain medicine. That question is better asked at a neurosurgery masterclass.

First establish whether it is lateral or central canal stenosis, and check for any sensory or motor deficit on examination. Without a deficit and with lateral canal stenosis, transforaminal epidural adhesiolysis gives wonderful results. With moderate to severe central stenosis, a real sensory or motor deficit, and pain that does not respond to a block, the patient needs surgery.

Used for chronic low back pain, knee pain or similar musculoskeletal pain, yes, opioids are habit-forming. Used for cancer pain, and for sickle cell pain, which is managed on the same principles as cancer pain, they are never habit-forming in this experience. Opioids sit near the top of the WHO analgesic ladder, are safe on organ function, and are potent enough that patients do not become dependent in this context. Countries that prescribe opioids freely for ordinary chronic non-cancer pain, as parts of the United States and Europe have, do see patients become dependent. For routine non-cancer chronic pain, that risk is real and opioids should be avoided long-term.

Because sickle cell pain and cancer pain are primarily visceral pain, and viscera carry opioid receptors. Back pain, knee pain, elbow pain and shoulder pain are peripheral, musculoskeletal or neuropathic pain, and that tissue does not carry the same opioid receptor expression. Visceral pain is also carried by the body's sympathetic nervous system, which does not respond to conventional painkillers, so it needs a neuropathic agent and an opioid in combination. That is the physiological difference.

Marijuana is a safer drug than a typical opioid, including for musculoskeletal as well as visceral pain, and some countries now use synthetic formulations of it. It just is not approved for medical use in India yet.

Not necessarily. Tears under 50% thickness are treated without surgery using ultrasound-guided PRP injection. Tears over 50% require surgical repair of the tendon.

Suprascapular nerve radiofrequency ablation is used for patients whose pain persists even after the tendon has been surgically repaired, typically in a single sitting followed by rehabilitation.

A single injection sequence that treats the supraspinatus muscle, the subacromial bursa and the AC joint together, rather than treating adhesive capsulitis, bursitis and AC joint arthritis as three separate procedures.