PGI introduces world’s first NaF PET-CT guided precision therapy for chronic pain

The multidisciplinary team behind this innovation includes Dr Anish Bhattacharya, Dr Sarvdeep Dhatt (Professor, Orthopaedics), Dr Babita Ghai (Professor, Anaesthesia and Intensive Care), Dr Rajender Kumar (Additional Professor, Nuclear Medicine), Dr Vishal Kumar (Additional Professor, Orthopaedics), Dr Harmandeep Singh (Additional Professor, Nuclear Medicine), and Dr Raza Abbas Mahdi (Senior Resident, Nuclear Medicine) working collaboratively to advance precision pain therapy.

Dhatt, while sharing the scope of the treatment, stated that this novel approach addresses a long-standing challenge in pain management, accurately identifying the exact source of pain. “Knee, lower back, Achilles heel, ankle, and chronic conditions such as lumbar facet joint arthropathy, sacroiliitis, plantar fasciitis, Achilles tendinitis, and coccydynia often remain inadequately treated due to limitations of conventional imaging modalities,” the professor said.

Dr Vishal Kumar, speaking about the genesis of the technique, said, “It all began with a debate that, despite having the best expertise, we were not doing enough for our patients. That introspection led to the development of this novel approach”.

Dr Rajender Kumar said that the technique involves identifying the active pain-generating site using NaF PET-CT, followed by highly targeted steroid injection under real-time PET-CT guidance, further enhanced by robotic assistance for “unmatched precision”. He clarified that only in patients where the pain-producing site is identified and located can treatment be done, with all patients reporting immediate relief after treatment.

Sharing an example, he said, a 36-year-old male reported to PGI with debilitating heel pain, restricting his movements and daily life, with the patient terming the pain score as 8 out of 10. The technique showed that the pain-generating site was the front foot, and after the OPD procedure, the patient, after three months, reported a pain score of only 2 out of 10.

Clinical outcomes from PGIMER demonstrate that nearly 84 per cent of patients experienced significant pain relief at three months. The study found significant improvements in disability and functional scores, and no major adverse effects, underscoring the safety and effectiveness of this novel technique.

In a step towards affordability, the procedure costs approximately Rs 1,000, with consumables around Rs 500, making it accessible to many patients. Appointments are currently available within one to two weeks of referral.

The innovation is backed by clinical evidence published in the European Journal of Nuclear Medicine and Molecular Imaging titled “Efficacy and safety of [18F]NaF PET/CT guided intra-articular block for lumbar facet joint and sacroiliac joint arthropathy: a single-arm phase 2 trial”.