Interview: Dr. Vivek Loomba, Pain Management Specialist

Interview with Dr. Vivek Loomba, Pain Management Specialist & Senior Consultant Pain Physician at the Indian Spinal Injuries Center

Dr. Vivek completed his MBBS from Maulana Azad Medical College, Delhi University in 1995 and Diploma in Anesthesiology from Baba Farid University of Health sciences in 2002.

Dr. Vivek Loomba is a dedicated hard working professional, who works around the clock for the welfare of his patients.

In addition to managing patients, Dr. Loomba is very passionate about teaching younger generations the art of pain management.

He is very keen on academic activities. His research has been published in leading national and international journals.

The current research topics of Dr. Vivek Loomba include the management of migraine and trigeminal neuralgia using various nerve blocks.

Dr. Vivek Loomba has vast experience in managing patients with both acute and chronic pain. Patients consult Dr. Loomba for a vast spectrum of diseases, including backache, facet arthropathy, headache, migraine, slipped discs, trigeminal neuralgia, cancer pain, CRPS, etc.

He has successfully managed patients using multimodal analgesia techniques. Dr. Vivek Loomba manages patients using medications, physiotherapy, nerve blocks, and radiofrequency ablation.

Can you tell us a little bit about your background and how you became interested in pain management?

Dr. Vivek Loomba: I am Dr. Vivek Loomba, Pain Management Specialist with over 27+ years of experience since graduating from medical school. Currently, I am a Senior Consultant at the Indian Spinal Injuries Centre, Vasant Kunj, Delhi. 

I remember seeing patients as a medical student who had undergone successful surgery but were still depressed from the pain.

In fact, the only question that bothered the patient before and after surgery was regarding their level of pain. This sparked my desire to treat and manage pain in patients 

To manage pain and to give relief to patients, I use a combination of medications and therapies for an effective treatment that includes oral medications, physiotherapy, intravenous injections, nerve blocks, radiofrequency, behavioral therapy, etc.

What are some common misconceptions about pain management?

Dr. Vivek Loomba: People are not widely aware of pain management. I have treated many patients who suffered from pain caused by several conditions, like disc prolapse, migraine, arthritis, knee pain, sciatica, etc.

Most of these patients were unaware of the several pain management techniques. They frequently believe that oral medications/ painkillers or surgery are the only option for pain management.

And at times, individuals postpone treatments/ surgeries out of a dread of pain because they don’t want to deal with the discomfort or trauma following surgery.

How do you go about diagnosing and treating chronic pain conditions?

Dr. Vivek Loomba: Treatment for persistent pain can be difficult because everyone experiences pain differently and one approach does not work for all.

So, without an appropriate diagnosis, patients with persistent pain are frequently referred from one doctor to another for many years without getting effective treatment or relief from the pain.

Thus, a complete medical history and physical examination is the first step to establishing a clear diagnosis.

Subsequently, patients may require further tests like X-Ray, Magnetic resonance imaging (MRI) depending on the condition.

First line treatment involves medications and physiotherapy. Second line treatment involves advanced procedures such as nerve block injections and radiofrequency ablation (RFA).

The third line of treatment involves insertion of an implant, like a pain pump or a spinal cord stimulator.

Though most patients respond well to conservative and non-surgical treatment, surgery may be indicated in some chronic pain patients.

What role do medications play in managing chronic pain, and what are some alternative treatments?

Dr. Vivek Loomba: Medication plays a significant role in pain management. Nevertheless, in order to get the desired outcomes, a person must also maintain a healthy lifestyle and engage in exercise.

Apart from this, there are various options that can be suggested to an individual depending on the cause of the pain.

To relieve pain, there are options such as skin creams, Transdermal skin patches, Nerve block injections, Radiofrequency Ablation of the affected nerves, epidural injections, etc.

How do you work with patients to create a personalized pain management plan?

Dr. Vivek Loomba: Depending on a particular patient, the treatment options are planned. For example, how long the patient is suffering from the problem, what is the age of the patient, lifestyle of the patient, if it’s a cancer patient, so depending on the life expectancy, the treatment is planned.

Each patient needs a unique approach depending on the conditions, so based on the problem, the treatment plan is modulated.

Can you discuss any recent advancements in pain management that you’re excited about?

Dr. Vivek Loomba: The field of pain management has progressed rapidly over the last few decades, and multimodal pain management techniques augment good prognosis for patients going through chronic pain.

Apart from the mentioned pain management techniques, there are a few more advanced procedures that can be used for chronic pain management without the need for surgery. Such as Spinal cord stimulators and intrathecal pain pumps. 

Spinal cord stimulation (SCS):  Also known as neurostimulation, SCS is a device which works like a pacemaker of the back.

There are leads implanted into the body under the skin that use small electrical pulses to block the brain’s ability to receive pain signals.

This is used to help patients suffering from refractory pain. It is an effective therapy for managing chronic pain conditions like lumbar radiculopathy, refractory headaches etc.

Intrathecal pain pumps: In Intrathecal pump, or targeted drug delivery/TDD a tiny catheter is inserted into your back connected to a motorised pump which delivers a modest dose of analgesics like morphine and fentanyl.

This is useful in controlling pain in patients who cannot be managed on Oral or intravenous painkillers like on cancer patients. The benefit of a tiny dose reduces side effects, making it highly helpful.

 This pump can also be used for patients with muscular spasticity caused by diseases like cerebral palsy etc, where muscle relaxants like baclofen are used in these pumps. 

Can you share a patient success story that you’re particularly proud of?

Dr. Vivek Loomba: There are many cases that I am proud of. I have dealt with a number of patients who have suffered from severe pain for years.

I would like to share a case study of 50yrs old Tania (name changed) from Thailand who was suffering from a condition known as Trigeminal Neuralgia.

The pain of Trigeminal Neuralgia is so intense that it is often called the “suicide disease”, as it can lead one to contemplate suicide.

It causes excruciating pain on one or both sides of the face. The pain is almost constantly present and it is so unbearable that even daily activities like washing, touching face, or chewing are difficult.

Same was the case with Tania. She was suffering from this condition for years and met many specialists, but there was no relief.

She stopped eating solid food because of the intense pain and even stopped going to the office and interacting with her family and friends.

Tania especially came to India to get a solution for her problem, for which she had been taking painkillers and other medications for a long time.

When she met us, we conducted a clinical examination and suggested an MRI of the brain to look for any intracranial abnormalities.

Based on the evaluation, we recommended trigeminal nerve block for Tania. For this procedure, a needle is passed from the affected side of the face until it reaches the particular nerve to be blocked.

The procedure is done under X-ray visualisation, which ensures correct needle placement. A local anaesthetic and steroid mixture is injected for the nerve block.

These procedures provide good relief, lasting for 1-1.5 years, sometimes even longer. If the pain recurs, the procedure can be repeated. Once the pain cycle is broken, the patients may experience long lasting relief from this monstrous disease. 

And thankfully, Tania’s discomfort reduced after receiving this injection and she resumed her normal life.

Would also like to talk about another case study:

Ahmad (name changed) was a patient with excruciating low backache, radiating down his leg. He was working in Dubai and was advised surgery for sciatica pain.

He came to India for treatment. After examining him, I recommended nerve block injection. I performed the procedure the very next day.

His symptoms improved, and he flew back to Dubai within a week. It has been several months, and he has been doing fine ever since, without any surgical procedure.

This poor guy was saved a spine surgery with a simple nerve block injection. Such stories do make you feel proud. 

How do you address the psychological and emotional aspects of chronic pain?

Dr. Vivek Loomba: Chronic pain patients feel depressed, they are under a lot of trauma and anxiety. Because of the pain, we have seen patients who lock themself in the room and don’t interact with anyone.

So, we work in a team, and depending on the condition of the patient; we refer them to a psychologist as part of a multidisciplinary team.

In some cases, we take help from our psychiatrist in managing chronic pain patients with associated mental illness. 

What advice would you give to someone who is struggling with chronic pain?

Dr. Vivek Loomba: Chronic pain can be distressing as it affects the quality of life and the ability to perform daily activities. Such patients need to see a pain management physician sooner than later.

Avoid managing symptoms at home. The field has advanced in the last few decades and early diagnosis can provide better relief with effective outcomes.

Additionally, a regular health checkup can keep a track of your health by identifying any early signs of health-related issues. 

Therefore, if you or anyone in your family is experiencing unexplained severe pain for months or years, it is advisable to visit an experienced pain physician who can assess, recommend, and suggest the right medication/ treatment as per your condition.

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