Decoding Pain: Conversation with Dr. Vijay Bhaskar B, Founder, Indo-British Advanced Pain Clinic

Dr. Vijay Bhaskar Bandikatla, MBBS, DA, MBA, FRCA, FFPMRCA, CCT, and Fellow in Neuromodulation, is a distinguished pain physician in Hyderabad with over two decades of extensive experience.

As a result of his extraordinary journey in medical innovation, he has received widespread recognition and accolades from prestigious national and international organisations. His unparalleled expertise in pain medicine, neuromodulation, and groundbreaking research in spinal cord stimulation have transformed the healthcare landscape, inspiring peers and patients.

In honour of Doctor's Day on 1st July, we spoke exclusively to Dr. Vijay Bhaskar Bandikatla to learn about his inspiring journey.

Podcast Link : https://youtu.be/WO3tsJnGw-E?si=NNJWC1LCE3AzDnjs

1. While we know that you are a renowned pain physician, can you let us know about your background and how you became interested in pain management?

The specialty of pain is quite intriguing; in contrast to other specialties that are organ-specific, pain is symptom-specific. The importance of this field has not been adequately recognised. Every patient wishes and expects that they will be relieved of pain upon entering a hospital; however, this is not the case. In the case of a variety of pains, including back pain, knee pain, shoulder pain, cardiac pain, sports pain, knee pain, and many others, physicians must conduct a more comprehensive examination of the case in order to determine the appropriate course of treatment. Neglecting the symptoms, which are the source of the pain, is done in anticipation of expedited treatment and patients' anxiety regarding their condition. There is a gap in the management of pain due to the fact that physicians are not adequately trained to address pain beyond a certain threshold. The management of pain in complex situations is a significant gap that specialised pain physicians such as me are working to fill. There are numerous modalities that are utilised in the treatment of pain, including a variety of medications, therapies, interventions, and surgeries. These modalities are both simple and complex, with varying degrees of complexity. Here is the critical juncture where pain specialists intervene, assisting the patient in making the most appropriate decision for their needs.

2. You have studied and worked extensively in London, UK. What prompted you to come back to India, your homeland, and start the incredibly famous Indo-British Advanced Pain Clinic in Hyderabad?

The idea was always to learn, work, gain experience, and bring back what’s new to India to serve my patients here. I’m deeply rooted in India because of my culture, family, friends, and well-wishers. Pain is the first and foremost symptom that brings patients to the hospital. Reducing the pain and bringing a smile and a heave of relief is the most satisfying experience for a doctor. According to WHO statistics, 70% of hospital visits are due to pain. Relieving pain by the correct diagnosis, investigations, medications, and procedures, if necessary, is the primary responsibility of a doctor. Unfortunately, the doctors are not trained well enough during training to handle the pain cases in India. In the UK, pain is a major specialisation with structured training that I opted for, which is now giving me the compassion and time to spend with my patients and create a special bond with them, providing solutions that no one else can. My extensive knowledge of pharmacology, physiology, and anatomy helps me dive deep into the patient’s pain condition. Upon the completion of pain training at Cambridge Hospital, I enrolled for a Fellowship in Neuromodulation at Thompson’s Hospital in London, the latest field emphasising the usage of electricity to alter the nerves, chemicals to alter the functioning of the pain-producing nerves, and stimulating the nerves. I worked extensively on the research on cluster headaches, migraines, and blotched back surgeries.

3. Can you share a few groundbreaking research results of yours and how all the honours, accolades, and the recent award of the best pain doctor in the state endow your responsibility in this niche field of pain management further?

When we are in a new specialty that’s being practiced by only a few select doctors in India that’s not as developed as in Western countries, the responsibility is further increased. I have certain degrees, qualifications, and experience gained overseas in pain management that I put in to serve the patients, setting the bar rather high here. We don’t have specialised pain departments in India, such as for the spine, pelvis, head, shoulder, etc. My motto is to build up the standards to an international level for the upcoming doctors willing to take up pain specialisation in India. Pain is a vast subject, and immense efforts have to be put into it for the development of its specialisations and sub specialisations, which I’m vying for. At the Indo-British Advanced Pain Clinic, I have the best technology and expertise, pioneering the advanced technologies of PRP, stem cell therapy, and virtual reality in medicine.

4. Can you share a memorable success story from your experience treating chronic pain patients?

Most of the patients come to me after hundreds of hospital visits and exhausting all the other options, mostly through word of mouth. In a heart-wrenching scenario, I treated a woman in her mid-sixties with blood cancer, struggling at home with intense pain even to breathe properly during the pandemic. With an injection to the spine and injecting a catheter to run an infusion, we reduced her pain by 70%. Her oxygen levels came up significantly, and started to eat and walk better, spending time with family. She lived peacefully for another 9 months without constant, nagging pain. Even though cancer was invading her body, she found respite from pain. Experiences like these make my life as a pain specialist rewarding and fulfilling.

5. Where do you see the future of pain management heading in our state and the country, and what are your hopes for improvements in patient care and outcomes?

In a developing country like India, the issue is multi-layered. In the past, access to a doctor in rural areas was a huge concern. Preventive healthcare has not yet developed to the anticipated level, as general practitioners themselves are caught up with multiple admissions and surgeries, filling up their practice. Primary and secondary preventive healthcare is yet to be improved based on the level of our population to prevent the occurrence of diseases and, in turn, the number of surgeries. The government must step up to encourage people in the medical field to try to prevent diseases. Treatment of lifestyle diseases is on the rise, which is a welcome sign and protecting the health of the people rather than firefighting when the situation arises is crucial. The number of unwanted surgeries being performed in India for pain compared to other countries should also be reduced. The level of evidence-based treatment understanding, both in doctors and patients, must increase as we progress in adapting new-age technologies in the medical field, like non-invasive procedures, laparoscopy and robotic surgery. I'm glad that all the doctors are stepping up and keeping themselves abreast of the innovations.

6. As you mentioned above, given the cost of getting the latest equipment and training, many healthcare providers are hesitating to step up. How do you look at it?

There is a rift between the best and most affordable care. The best possible care comes with highly trained doctors, teams, machinery, and medicines. Providing it at every place and time is a challenge,

but 90% of the time, we concentrate on affordability with better training, resource usage, and existing technology; we cater to patients with low-cost care. The NHS in the UK works on a similar principle, and our Indian government has to concentrate on incentivisation and quality-metric care to avoid the burden of preventive medicine on the patients. We have to strike a balance between affordability and high-quality care without compromising medical code and conduct.