Mathew Daniel's life took a turn for the worse last year when a severe pain in his abdomen was diagnosed as pancreatic cancer. Doctors told him that the cancer had already reached an advanced stage. A surgical removal of the tumour could give him some relief, but the unrelenting abdominal pain stopped doctors from doing the surgery. “All I needed was something to stop that unbearable pain. I tried various medications and therapies but the pain just didn't go. I couldn't live with it any longer,” says Daniel.
On a friend's advice, Daniel, 52, met Dr Madhan Kumar, senior consultant (pain management) at BGS Global Hospitals, Bengaluru. Kumar told him about a relatively new technique of pain management through robotic intervention. The technique—robotic assisted, computed tomography guided pain intervention—was new, and long-term data was not available on its efficacy. Desperate, Daniel decided to give it a try. Kumar did a 10 slice CT scan of the affected area and identified nerve fibres that were sending the signals of pain to the brain. With the help of Maximo, a robot, he placed the syringe on those nerve fibres and injected the drug to block them from sending signals to the brain.
Daniel was immediately relieved of the pain. “In his case, as the cancer was already in a metastasis stage, more than two nerve fibres were sending the pain signal. So, we couldn't eliminate the pain completely. But it is quite manageable now,” says Kumar.
For Karthikeyan Ponuswami, 78, the technique proved to be much more effective in managing his trigeminal neuralgia, a condition in which a blood vessel presses three major nerves in the facial region and causes unbearable pain. Considered the most painful condition, it almost crippled him as he was not able to eat, sleep or talk normally. At times the pain subsided in a few minutes, but often it would continue for months. Even analgesics couldn’t help much. There was no cure or relief.
Conventionally, rhizotomy, where the nerves causing pain are manually destroyed, was the only treatment available for trigeminal neuralgia. But the problem was, it was not done under real-time scan. So, there was the risk of damaging the motor nerves which run parallel to the nerve fibres. Nerves are delicate, and even the smallest margin of error can cause permanent disability. Other conventional pain management treatments like C-arm also have the same limitation. In C-arm, high-intensity X-rays are passed through the area where the physician has to inject the drug. However, as X-rays are harmful, one cannot use it in high intensity, which is needed for accurate imaging. If you reduce the intensity of X-rays, you compromise on the image quality.
In the robotic pain intervention, the needle is placed by the robot under a real-time CT scan. It is accurate, effective and a permanent cure for pain. The procedure is carried out under local anaesthesia. Karthikeyan was relieved of the pain immediately. The relief came after so many days that he fell asleep. “I have forgotten about that excruciating pain now,” he says.
Kumar has been using the robot for the past two years at Global Hospitals, Chennai, and he recently launched it in Bengaluru. His patients range from those suffering from chronic arthritis and knee pain to cancer patients. In an observational study which Kumar undertook in 2014, he found that the robotic procedure was 99.8 per cent accurate and needle placement took not more than seven minutes.
One of his patients, Raj, is a cricket enthusiast from Jharkhand. Raj, 27, loves spending his holidays playing cricket with his friends. But he had to stop it after he met with a minor accident and suffered a knee injury. An acute pain in his left knee restricted his movements. Doctors advised a surgery. But he feared that he might not be able to play his favourite game post surgery. He is now back in the cricket ground after his knee pain was cured by robotic intervention.
The robot was developed by Chennai-based Perfint Healthcare. It was primarily developed to carry out cancer treatments—biopsy and tumour ablation. In fact, it has been used for cancer treatment in Germany, Australia, China and many other Asian countries. “It was first used for pain management by Kumar,” says Nandakumar S., CEO of Perfint Healthcare. “Now many countries are using it for the same.”
Kumar was surprised that his improvisation with the equipment could be so effective. “Many a time my patients fall asleep on the CT scan table itself after I finish the procedure,” he says. “When they wake up, they tell me that it was their most comfortable sleep in many months.”