“Unlocking Relief”
Transforming Chronic Pain Management
Through Minimally Invasive Innovations
Dr. Shahzad Anwar
MBBS (Pb), Lic. A.C. (China), DOM (China)
Diplomat Pain Medicine Harvard University (USA)
M.Sc. Pain Medicine (UK & RIU)
Fellowship in Interventional Pain Medicine (Hungary)
Fellowship in Interventional Pain Practice-FIPP (WIP-USA)
Diplomat American Board of Regenerative Medicine-DABRM (USA)
Fellow American Academy of Regenerative Medicine- FA ARM (USA)
Interventional Pain & Spine Physician
Regenerative Medicine Specialist
CEO
Center for Pain & Regenerative Medicine
Director
School of Pain & Regenerative Medicine The University of Lahore.
https://sprm.uol.edu.pk/
Owner & CEO Iffat Anwar Medical Complex, Lahore.
Director
School of Pain & Regenerative Medicine
The University of Lahore.
Faculty & Examiner World Institute of Pain (WIP)
Faculty Member Pain School International Budapest, Hungary.
Faculty Member International Academy for Endoscopic Spine Surgery Istanbul,
Turkey.
President Society for Interventional Pain Medicine (SIPM) Pakistan.
Disclosures President Society for Regenerative Medicine (SRM) Pakistan
No financial disclosures.
Questions?
1. What %age of patients we work with, suffer from pain?
2. Were we taught pain as a subject during undergraduate or
postgraduate training?
3. Were we taught the multidisciplinary/multimodal aprroach for pain
management?
4. Were we taught about the role and importance of biopsychosocial
model?
What is Pain?
As As defined
defined by by IASP
IASP
(International
(International Association
Association forfor Study
Study
of of Pain)
Pain)
PAIN
“Pain
“Pain is an
is an unpleasant
unpleasant
sensory
sensory andand emotional
emotional
response
response associated
associated with
with
actual
actual or or potential
potential tissue
tissue
damage
damage or or defined
defined in terms
in terms of of
such
such damage”
damage”
TYPES OF PAIN
Acute Pain
Chronic Pain
Nociceptive Pain
Neuropathic Pain
Mixed Pain
Widespread pain
Cancer Pain
Pain Management?
Multidiscipli
nary or
Multimodal
Aprroach
Pain Management?
WHO ladder?
INTERVENTIONAL PAIN
MANAGEMENT
INTERVENTIONAL PAIN MEDICINE
Interventional Pain Medicine is a supra-specialty, devoted to
decrease or eliminate pain with use of minimally invasive and non-
invasive techniques
It fills the gap between pharmacological management of pain and
more invasive surgical procedures.
This can be accomplished in the following ways:
Interrupting the pain signal along the neuronal pathway
Remodeling anatomical source of pain (Neuromodulation)
Neuroaugmentation (SCS, PNS)
Implantable drug delivery system.
CONDITIONS TREATED
Back Pain : Slip disc/Sciatica/Lumbar radiculopathy, Spinal stenosis
Disc herniation – protrusion/extrusion/sequestration/DDD
Facet arthritis, Sacroilitis, Vertebral compression fracture
Failed back surgery syndrome, Spondylolysis, Spondylolisthesis
Neck pain : Cervical radiculopathy, Cervical disc bulge, Cervical Facet arthritis,
Cervical myofascial pain
Nerve pain : Trigeminal neuralgia, Reflex sympathetic dystrophy/Complex
regional pain syndrome, Post herpetic and Intercostal neuralgia, Diabetic
neuropathy, Phantom limb pain
Musculoskeletal pain : Fibromyalgia, Scapulocostal,
Shoulder/Arm/Elbow/Leg/Knee and Foot chronic pain
Facial pain and Headache : Trigeminal neuralgia, Intractable headaches
(Migraine, Cluster, Tension, Cervicogenic, Occipital Neuralgia)
Cancer and other pain : Cancer (Thoracic, Abdominal, Pelvic), Post
chemotherapy pain, Ischemic leg pain, Any pain more than 3 months.
Chronic Pelvic Pain : PID, Endometriosis
Dry needling, Trigger point injections
Facet Joint Blocks
Diagnostic Nerve Blocks
INTERVENTIONAL
PAIN Selective nerve root blocks
MANAGEMENT Radio frequency rhizotomies & neuromodulation
PROCEDURES
SI joint injections
Sympathetic nerve blocks
Trigeminal Nerve Block/ RF at ganglion or branch
Sphenopalatine ganglion Blocks/ RF
THERAPEUTIC Glossopharyngeal nerve block
INTERVENTIONAL Stellate ganglion block/ PRF
PAIN
T1 T2 sympathetic block/ RF
MANAGEMENT
PROCEDURES Splanchnic Nerves RF & Celiac plexus block
Superior Hypogastric plexus block
Ganglion Impar block/ RF
Endoscopic
Discectomy
Epidurolysis
Spinal cord (RACZ) and
Stimulator
THERAPEUTIC Epiduroscopy
PROCEDURES
FOR SPINAL Implantable Laser
Drug Delivery
PAIN System
Nucleoplasty
Percutaneous Plasma coblation
Vertebroplasty/ Nucleoplasty
Kyphoplasty
EPIDURAL INJECTIONS
Caudal ESI
Interlaminal
JOINT INTERVENTIONS
RADIOFREQUENCY
ABLATION OF MBs
RADIOFREQUENCY
ABLATION OF MBs
PULSED RF NEURO-MODULATION OF
DRGs
OZONE NUCLEOPLASTY
DECOMPRESSION DISCECTOMY
DISC NUCLEOPLASTY
DISC NUCLEOPLASTY
DISC NUCLEOPLASTY
DISC NUCLEOPLASTY
SPINAL CORD
STIMULATOR
INTRATHECAL PUMP
VERTEBROPLASTY &
KYPHOPLASTY
TRIGEMINAL GANGLION PRF/
RHIZOTOMY
ENDOSCOPIC DISC DECOMPRESSION
ENDOSCOPIC DISC DECOMPRESSION
T H E W AY F O R W A R D
We need to learn from others and our own experiences.
Integrate all possible modalities with good and promising evidence for treating
different diseases.
There is no DISEASE for which
ALLAH ALL MIGHTY has not provided the
CURE.
We simply have to discover it.
CONCLUSION
Chronic pain is a very complex disease and not
a symptom
Interventional pain management along with
Regenerative Medicine should be considered
with every pain condition. These may work in
situations where all other options have failed
Pain is most effectively treated with a multi-
disciplinary approach
We should utilize all resources that are
available
Thank you very much for your patience.
Pudendal Nerve Entrapment: A Hidden Cause of Chronic Pelvic Pain
Pudendal nerve entrapment (PNE) is a frequently overlooked cause of chronic
perineal pain. Despite being the most common peripheral neuropathy in this region,
it often goes undiagnosed for years, with patients seeing multiple clinicians before
receiving the right diagnosis.
A 2024 clinical perspective published in Pain Medicine highlights the complexity of
diagnosing and managing PNE and underscores the need for heightened awareness
among healthcare providers
