Category Archives: Pain

Pain

Misconceptions About Pain – Grinning and Bearing It!

February 6, 2010 – 12:46 am

Doctors differ in how they deal with pain. Older ones – of the family doctor variety who have a lot of experience in treating a variety of non-life-threatening injuries and illnesses – often dismiss pain with a hearty, “You’ll feel better soon.” Younger specialists, who have to fight much harder to earn their livelihoods and are also more materialistic, are much more solicitous of their patients’ comfort and prescribe painkillers as easily as they would offer a child sweets.

But on the whole doctors tend to under-treat pain. There is a feeling that pain is just a fact of life. It accompanies all illnesses and it has to be borne. There is also the fear – both among doctors and among patients – that if painkillers are taken too often, they could become a habit.

But, as doctors are realising, pain can take a heavy toll on a patient’s health and spirits. Compared to this, the risk of becoming addicted to painkillers is small. OTC (or over the counters) drugs are medicines that can be bought without a prescription and can relieve pain quite miraculously if they are used before the pain becomes really bad. And if one medicine does not work, a stronger one can be tried.

But does this mean that OTC medicines can be popped as nonchalantly as we pop chocolates into our mouths? Many people think that they can, but they are wrong. In fact, there are many misconceptions about pain. Here are the myths and the true facts about them.

Misconception 1. If pain goes away with OTC medication, it cannot be anything serious.

This is not true. Your response to OTC medicines has nothing to do with the seriousness of your medical problem. A sprained ankle is definitely not life-threatening, but the pain can be excruciating and may not respond to OTC medicine at all. On the other hand, serious illnesses like cancer or strokes may cause so little pain (at times) that OTC medicines work fine for patients.

So when do you take pain seriously? A rule of thumb is that minor ailments, even if the pain is agonising at first, normally heal or get much better in a week. They also don’t come on very suddenly. You should see a doctor if the condition does not improve, if the attacks of pain are sudden and strong and if OTC medicines do not work at all.

Misconception 2. Women deal with pain better than men do.

Actually, research has proved that neither sex is better in dealing with pain per se. There are different kinds of pain and men and women deal with them differently. Women are able to deal better with chronic pain than men are, but men can deal better with sudden, acute pain – like when you hit your thumb with a hammer or touch something very hot.

Women, however, recover from pain quicker than men do. So in the case of, say a tooth extraction, women suffer more initially, but are less bothered by the lingering discomfort over the next few days.

Research on people suffering from osteoarthritis has given a reason for this ability of women to deal with chronic pain. They cope because they complain to friends, seek support, pray and ask their doctors for help. So they get emotional support and this helps them. Men, on the other hand, try to grin and bear it, to keep up their macho image and, as a result, they do not cope as well.

Misconception 3. Breast cancer does not cause pain.

It is true that breast cancer doesn’t cause pain in the initial stages, but this does not mean that if something is causing you pain in your breast, it cannot be breast cancer. Certain uncommon types of breast cancer can cause pain – for example, cancer that affects the skin and lymph glands in the breast.

But generally, tenderness in the breast is nothing to worry about. This can be caused by the peaking of the hormone progesterone just before one’s periods and also by hormones that older women take after menopause.

Harmless cysts, too heavy a workout and even a bra that doesn’t fit properly can cause pain in the breasts and this is nothing to worry about. But one should visit the doctor if one notices a lump in the breast, if there is a change in the appearance of a breast or nipple, if there is a swelling, redness, a persistent nagging pain in either breast or if one experiences unusual sensations in a breast, whether painful or not.

Misconception 4. Everyone responds to pain in the same way.

Not only do men and women respond to pain in different ways, but different individuals have different thresholds of pain. Some bear the pain of a broken arm without a murmur while others weep and moan over a small bruise. Again the same individual may react differently to pain when she is upset, is under stress, is with a friend, is calm and when she knows that she has to cope by herself. Hormone levels can affect response to pain too. Women are generally more sensitive to pain just before their periods.

Misconception 5. One should always take medicine for a headache.

No, one should not take medicine for a headache because, though the pill makes you feel better immediately, headache medicine actually makes the brain more susceptible to pain and so popping pills can, in the longer time period, cause “rebound” headaches.

So analgesics should be reserved for really bad headaches and for times when you have to function at your best. At other times, a short nap in a quiet, preferably dark, room is a good way to get rid of a headache. So is meditation or the application of a cold pack to the area in front of the ear on the side one has the headache.

Misconception 6. A pain that is strong in the morning and then decreases as the day progresses can be ignored.

This often happens with joint pains. Muscles, joints and tendons tend to be stiff in the mornings and hence cause pain. But, as the day progresses and you move around, these loosen up and the pain subsides. Such pains can be ignored when you know that they are caused by minor injuries which will get cured.

But if the pain is not caused by an injury, it is not going to get cured by itself and something has to be done about it. If this kind of pain (which is worse in the morning and gets better as the day advances) persists, becomes worse and becomes chronic, it could be something like osteoarthritis and you should see your doctor.

Misconception 7. No pain, no gain.

This is what all trainers and fitness experts say when they start you off on a new exercise regimen or fitness programme. Yes, sore and painful muscles are a part of all these programmes when you start, but if your workout leaves you in real pain even after a while, it could mean that you are overdoing it, that you are developing an overuse injury or that you are exercising incorrectly.

So you should ease into a new exercise regimen slowly and work different muscle groups on alternate days. Jog and cycle one day and swim the next. Of course, walking is the best. It rarely results in injury and it can be done every day.

Misconception 8. OTC pain relievers are safe and can be taken in any quantity.

Most people feel that the medicines a doctor prescribes are strong and that one has to be careful about using them. They also feel that OTC medicines that one can get without prescriptions are safe and that one can take any amount of them. But this is not true. Overuse of OTC medicines can increase the risk of ulcers and gastrointestinal bleeding or damage to the liver. So watch out as you blithely pop those analgesics and cold medications.

Misconception 9. Doctors prescribe anti-depressants when they should be giving you pain relievers.

This is the complaint when a patient who is ill and is suffering from pain is given antidepressants. But it is just not true that the doctor is messing up. Constant pain causes people to be depressed and this worsens the physical symptoms of their illness. Depression can also trigger certain types of pain. Antidepressants on the other hand, help by increasing levels of chemicals that control our moods and the way we perceive pain. So they are good for the treatment of pain.

Misconception 10. All pain can be banished for good by a good doctor.

Unfortunately, this is not so. There are some chronic pains – like backache – that just cannot be cured. But people can learn to manage these pains so that they can function better. Today, doctors are less afraid that patients will become addicted to painkillers and so prescribe them for even chronic pains – to be taken when the pain gets worse, when the patient is under stress or when he or she has to function particularly well.

Today, many doctors operate on the principle that people have the right to be free of pain. They weigh the dangers of becoming addicted to painkillers against the relief that they bring and then take a decision.

Even young patients are given painkillers when the doctor knows that recovery is going to be quick enough for addiction not to be a risk. And at, say, the terminal stage of cancer, they decide to let the patient leave the world free of pain, even if “addicted”.

Doctors also prescribe relaxation exercises and suggest behaviour modification that will help avoid pain. For example, people suffering from back problems should learn not to make sudden movements, to always carry a small pillow for the small of the back when they know they have to sit for a long time and to learn to pick up weights without straining the back.

Physiotherapy can also strengthen the surrounding muscles and having a pain-reliever while this takes place does no harm.

Pain management also includes biofeedback. Many doctors allow post-surgery patients to use a pump that allows them to decide when they need intravenous narcotic painkillers. And doctors have discovered that this way, patients take small and more frequent doses that reduce the total amount of medication they take to be comfortable.

Pain may be a part of life, but we need not suffer from it too much.



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Pain

Back Pain – SI Joint Dysfunction

February 4, 2010 – 2:15 pm

 

Sacroiliac joint pain

 Sacroiliac (SI) joint pain has gained a lot of attention in the last ten years as an underappreciated cause of back pain with some studies indicating it is responsible for 15% to 40% of low back pain. The increased attention is due to the increasing knowledge of the SI joints intimate role in pelvic stability.  I hope more physicians consider SI joint pain in their differential after reading this article.

Pathophysiology

SI joint dysfunction due to inflammation within the joint itself is called sacroilitis. Pain from within the SI joint is common in rheumatoid patients and spondyloarthropathies.

The other cause of SI joint dysfunction stems from instability of the SI joint.  Many experts feel that SI joint pain is a component of a larger problem of pelvic instability (1). Pelvic instability has traditionally been underappreciated as a cause of low back pain, buttock pain, groin pain, and leg pain. Physical therapists and doctors of osteopathic medicine have been teaching these concepts for years but only relatively recently has this dissemination of knowledge trended towards mainstream thinking among medical doctors.

The SI joint complex (the SI joint and its associated ligaments) is the major support structure of the pelvic ring and is the strongest ligament complex in the body.  The complex consists of interosseous sacroiliac ligaments, iliolumbar ligaments, posterior sacroiliac ligaments, and the sacrotuberous and sacrospinous ligaments. The SI joints are two of the three joints involved in the stability of the pelvic ring.  The pelvic ring is the meeting place of the force vectors from the upper body and the lower extremities.  The third joint in the pelvic ring is the pubis symphysis. Pelvic instability causes pelvic rotation which can also cause twisting of the pubis symphysis.  Coupling this with its anterior location appears to provide an explanation as to why patients with SI joint instability can also experience anterior groin pain. Anecdotal evidence for this is seen when patients undergo a successful SI joint intra-articular injection relieving all of their posterior back, buttock, and leg symptoms but the patient still has groin pain. Groin pain is almost never eliminated by SI joint injections unless pelvic symmetry is corrected.

 If the SI joints are unstable, it can lead to significant pain and discomfort over the SI joints as well as numerous referred areas.  If an individual affected by SI joint pain has pain only over his or her SI joint, he/she  should be considered lucky. Most often SI joint instability causes unnatural strain on the entire low back and pelvic region causing a sometimes confusing clinical picture. Pain referral patterns of SI joint pain are often confused with L5 or S1 radiculitis or radiculopathies.

Referral patterns of SI joint dysfunction (2)

SI joint dysfunction often presents with a confusing clinical presentation.

1.       Buttock pain 94%

2.       Lower lumbar pain 74%,

3.       Lower extremity pain 50%, with 28% of these lower extremity pains going distal to the knee

4.       Pain goes all the way into the foot 13%. Younger patients are more likely to refer pain distal to the knee.

5.       Groin pain 14%. 

Most patients with SI joint instability also experience pain over the buttock region due to secondary muscle spasm of the gluteus muscles and piriformis complex.  Lower extremity symptoms are explained by the piriformis muscles natural tendency to spasm or tighten over the sciatic nerve whenever the SI joint is out of alignment.  This spasm of gluteus and piriformis muscles can cause a mechanical crowding or impingement of the sciatic nerve as it exits just below the SI joint (see figure 1. note the intimate association of the piriformis muscle, SI joint, and sciatic nerve).  Patients often complain of buttock pain and radiation of pain down to the knee and even down to the foot. Not all back pain and leg pains are due to a pinched a nerve from an intervertebral disk herniation.  SI joint dysfunction very closely mimics S1 or L5 radiculitis’ or radiculopathies because of the above described sciatic nerve irritation or impingement.

Groin pain and abdominal pain are not uncommon with SI joint instability.  Often times the groin pain is mistaken as a urologic problem like pudendal neuralgia, prostatitis,  genitofemoral neuralgia, or sterile epidydymitis(1). This is likely either due to unnatural tension on the nerves and ligaments around the pubis symphysis or actual impingement of the pudendal nerve which lies between the sacrospinous ligament and sacrotuberous ligament. The distance between these two ligaments abruptly narrows when the Ilium and sacrum are out of alignment i.e. SI joint instability.

The typical history of SI joint dysfunction consists of lateral or bilateral low back pain almost always below the pelvic rim. Pain can also radiate into the hip, groin, pelvis, leg, and foot.  The most common location of pain is in the buttock with pain extending down to the knee. Females are much more affected than males though the ratio is unclear.  The mechanism of injury is a continuum from completely atraumatic events to more obvious trauma like motor vehicle accidents, childbirth, or falls. A little over one third of failed back surgery patients suffer from SI joint dysfunction. In my practice, I often see patients who lose a substantial amount of weight and then develop SI joint dysfunction.  The etiology of this is unclear. Women who have had multiple births also seem to have a higher incidence of SI joint dysfunction.  The symptoms may be acute or may present as a remote or cumulative injury with chronic waxing and waning of symptoms with slow progression over time.  Patients often experience some degree of temporary relief with manipulation.  Patients must change positions frequently to avoid pain.  This is called “Theater Party Cocktail Syndrome”. Patient’s legs can also feel like they’re going to give out, but with objective testing of motor strength, no dysfunction is found. This is called a “Slipping Crutch syndrome”. Patients usually have a difficult time sleeping and getting out of bed in the morning can be excruciatingly painful. Continued movement after waking up tends to improve the pain.

There are many provocative physical exam maneuvers used to help establish the diagnosis of SI joint dysfunction. Going through each one of these provocative maneuvers is beyond the scope of this article.  It is important to note that the predictive value of provocative SI joint maneuvers in determining SI joint dysfunction is only 60%(4).  The conclusion of a recent study by Slipman et al(5), was that physical exam techniques can at best enter SI joint dysfunction into the differential diagnosis of a patient’s low back pain.  Of the alleged signs of sacroiliac joint pain, maximum pain below L5 coupled with pointing to the PSIS or local tenderness just medial to the PSIS (sacral sulcus) has the highest positive predictive value (PPD) at 60%(4).

Diagnosis

The gold standard for making a diagnosis of SI joint dysfunction is a fluoroscopically guided SI joint injection. Fluoroscopy is needed to accurately and consistently inject the sacroiliac joint.  Only 12% of patients had intra-articular SI joint injections when fluoroscopy was not utilized (3).  Also important is to anesthetize the entire SI joint complex.  In my experience as an interventional pain physician this cannot be consistently done by palpation alone, especially in obese patients.  It is humbling to see anatomy change under fluoroscopic guidance. What you perceive with palpation is sometimes markedly different than the actual location of the structure that you palpate.  Also vitally important is that these diagnostic injections are followed up with another physical exam while the patient is in the recovery room. Sending a patient home, having them follow up in several weeks, and then determining if this “diagnostic” injection was successful has consistently been shown to be an inaccurate way of establishing a pathoanatomic diagnosis.

Treatments

There is no one specific treatment for SI joint dysfunction which helps all patients.  The treatment varies if the dysfunction is intra-articular (inflammatory), or if it’s a lack of stability. Conservative treatment should first be tried including the manipulation by a qualified physical therapist or osteopathic physician to restore normal motion and balance,  home self-correction exercises,  a walking program (avoid heavy axial loading maneuvers), and core strengthening exercises (Pilates, Yoga, or guided physical therapy). Some patients also benefit from a quality SI joint support belt.  If conservative therapy is not helpful then I recommend a diagnostic SI joint complex injection.  The injection should include the SI joint ( intra-articularly) and the supporting ligaments with pain relief lasting for the duration of the local anesthetic and achieving greater than 75% pain relief. If there is any question about the positivity of this diagnostic test,  it should be repeated.

Radiofrequency Denervation

If the diagnosis has been established by an intra-articular SI joint injection and pain relief using conservative therapy affords no long-term pain relief, then consideration for other treatments can be made.  Radiofrequency denervation of an SI joint carries about a 65% success rate for patients who have failed other conservative therapies and only mild instability around the joint. The procedure involves the neurotomy of the lateral branch nerves that lay over the sacrum and innervate the posterior SI joint. The advantage of SI joint radiofrequency is that it is a very safe procedure with almost no documented morbidity.

Prolotherapy

Another treatment for SI joint pain is Prolotherapy.  Prolotherapy works by stimulating an inflammatory cascade which leads to fibroblastic activity thereby strengthening the entheses of ligaments and tendons. Prolotherapy on SI joints usually requires very strong Prolotherapy solutions.  In my experience, hypertonic Dextrose Prolotherapy only relieves 20 to 30% of most patients’ pain.  More aggressive prolotherapy usually reduces pain by 50% or greater in roughly 75% of patients. The greatest advantage of Prolotherapy is that it is provides a level of permanent relief.

SI joint Fusion

If the patient fails radiofrequency and prolotherapy, the last treatment option would be consideration for an SI joint fusion.  The outcome data on SI joint fusions is not highly favorable.  However, there are new minimally invasive SI joint fusions that have recently been approved by the FDA that appear promising. Patients with very diffuse pelvic pain and leg pains are not good candidates for fusion surgery. 



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Pain

Causes and Complications of Chronic Pain – How to Manage

February 1, 2010 – 2:25 am

More people call out sick from work because of chronic pain than call out sick because of the common cold. Chances are you or someone you know suffers from chronic pain. Pain is a necessary part of life. It alerts us when something is wrong with our bodies. It’s normal to experience pain with an illness or injury. Normally, this pain fades as the injury heals or the sickness goes away. This is referred to as acute pain.

Pain becomes chronic when it continues after the healing time of the injury. This pain can hang on for months or even years and often causes depression in its sufferers. Chronic pain can also occur as the result of an ongoing condition, like fibromyalgia, arthritis, or cancer. Back injuries, carpal tunnel syndrome, and migraine headaches are some other examples of conditions that cause chronic pain. Some pain can result from injury to the nerves causing them send false signals to the brain. How massage affects your pain is partly dependent on its source.

If your pain is caused by a muscle injury massage can not only help ease the pain but also help speed the healing process. Acute or chronic – these are the two words that describe pain. Acute goes away easily and rarely lasts long. Chronic is its exact opposite. Chronic pain can last for six months and is expected to recur at anytime. The main cause of it is very hard to pinpoint. And it doesn’t help if doctors were more interested in addressing the pains rather than knowing what is actually causing it. As such, chronic pain relief can be elusive to patients.

But then again, there are certain medicines and therapies that are deemed effective for chronic pain. There are also a lot of medicines sold over-the-counter, which can truly help. While chronic pain is a major problem, patients do have options to treat it. Doctors normally prescribe medicines, antidepressants, and anticonvulsants, to address chronic pain. Chronic pain relief is also possible with physical therapy. Physical therapy corresponds to the low-impact exercises like swimming, walking, and stretching. If done regularly, these simple exercises can help your body a lot. It can help lower the intensity of the pain you’re going through.

However, these exercises are best performed along a trained physical therapist. Both occupational and behavioral therapies could also help. In occupational therapy, patients are thought how to pace and condition themselves when doing everyday tasks. Don’t get discouraged if you are one of the chronic pain sufferers for which a cause cannot be found. An unknown source doesn’t make the pain any less real. Fibromyalgia, for example, causes widespread pain in muscles and joints.

Yet, a person with fibromyalgia may not know the cause of the pain A healthcare provider may be able to link fibromyalgia to an injury or virus; but in other cases, a specific cause may go unidentified. Irritable bowel syndrome is another example of chronic pain for which the specific cause may not be known. Chronic pain may be related to changes in your nerve signals after a healed injury. Chronic pain may also be related to heightened pain sensitivity when your body produces lower than normal levels of painkilling endorphins. If you suffer from chronic pain do not ignore the warning signals. If you try to tough it out, the disease, illness, or injury may get worse. Left untreated, chronic pain can also mentally wear you down. Making massage therapy part of your treatment routine could help ease your pain and lessen your dependence on pain killing drugs. In the long run this will lead to less drug side effects and better health.



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Pain

Pain in Shoulder – How to Cure This

January 30, 2010 – 4:51 am

As people are subjected to various stressful activities everyday, it is not surprising how, at the end of the day, muscle pains and other stress related discomforts may be experienced. These stressful activities however may also include pain, persistent or not, in the shoulder area of the body. Specifically, one may suffer pain in the left shoulder blade area. A number of causes may account for such conditions. But before we proceed our exposition as to what may cause pain in the left shoulder blade, let us first identify which part of the body exactly do we refer to when we say “shoulder blade.”

The shoulder blade, which is also known as the scapula, is the part of the human body – specifically, a bony structure – which connects the upper arm to the chest wall. It may also form part of the joint socket connecting the upper arm to the body. This bony structure is surrounded by tendons, muscles and tissues which function as cushion for the shoulder blade. This cushion allows the arms and the shoulders to move smoothly.

Pain in left shoulder blade may be caused by some inflammation of the tendons or sinews in the left part of the shoulder blade. Strained and overworked muscles or torn tissues in the part of the left shoulder blade may also account for moderate to acute pain in left shoulder blade. If the large muscle called the trapezius becomes spastic in the left shoulder blade area, then one will feel pain in the left part of his shoulder blade. Spastic muscles may be due to trauma or overuse.

However, not all instances of pain in the left shoulder blade can be categorized as conditions resulting from strained muscles or tendons. One may feel pain in left shoulder blade although there really is nothing wrong in that particular region of the body. Rather, the pain felt may be pain transmitted from another part or organ of the body. It is a signal that another organ is in pain and is in need of immediate attention. This process of pain being transmitted from one organ to the left shoulder blade area is called referred pain. Radiated pain to the left shoulder area may actually indicate medical problems in the other parts of the body. Therefore, these radiated pains from the other organs of the body may properly be the cause of pain in left shoulder blade.

What all these imply is that the pain felt in specific areas of the shoulder blade may be indicative of which organ may have been affected and have been radiating the pain. Left shoulder blade pain may be a signal of some abdominal or stomach-related problems. This may include ulcers, pancreatic, and ectopic pregnancy among others. Pain in left shoulder blade may also indicate problems in the chest region. These problems would include pneumonia, heart attack and/or other heart-related ailments, aortic dissection, pleuritis etc. Although pain in left shoulder blade may just be caused by some strained muscles and tendons, it may also indicate diseases or pain radiated form the other organs of the body. To be safe, it is always prudent that when symptoms arise, one goes to consult with a physician to get proper diagnosis and medication.



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Pain

What Are The Causes Of Pain In Lower Right Back?

January 29, 2010 – 3:13 am

Back pain is a complaint doctors hear about frequently. People want information on backaches. They want doctors to treat pain in the back. Many want to know the causes of pain in the lower right back.



Information about the Lower Right Back

It is important to understand the structure of the lower right back if we are to understand what causes pain there.

Your back, with its spinal column of vertebrae, connecting ligaments, tendons, large muscles, and nerves, is designed to be incredibly strong and flexible. Yet things can go wrong with this awesome structure.

* Muscles can be strained

* Ligaments can be torn

* Joints can be injured

* Bones can be fractured

* Nerves can be irritated

* Discs can be herniated

* Stress can tighten back structure

The lower back seems especially susceptible to injury, since it bears the weight of the torso, and makes more movement than the upper back. Its constant work can cause parts to break down and wear out over the years.

The lower right back has soft tissues that can be involved in pain. Those large, complex muscle groups that support your spine and help you move can be strained by improper lifting or posture. In fact, muscle strain is the most common cause of lower back pain. Twisting or pulling one of the following muscles can produce pain in the lower right back.

* Extensor muscles: These paired muscles in the lower back and gluteus help support your spine. If the one on the lower right back is injured, it will be painful.

* Flexor muscles: Attached to the spine’s front, these muscles help you flex, bend forward, and lift things. Again, injury to the right flexor muscle can cause lower right back pain.

* Oblique muscles: This muscle group is attached to the sides of the spine. The oblique muscles help your spine rotate, and give you good posture.

In addition to simple muscle strain, injury to ligaments, joints, and bones can also cause muscle pain. If one of these structures is injured or inflamed, back muscles can go into spasm, drastically limiting your movement and cause pain in the lower right back.

Stress is a common cause of pain in the lower right back. Stress will make your back muscles tighten. This happens to every muscle in the body, as we move into a “fight or flight” response. Muscles that are tightened lack the energy they need to support the spine. If the stress is frequent, and measures are not taken immediately to relieve it, lower right back pain can easily develop.

Information on Chronic Lower Right Back Pain



If lower right back pain lasts more than two weeks, you are likely to stop using the aching muscles in order to protect yourself from that pain. With disuse, the muscles can waste (atrophy) and weaken. This will increase the pain, since your muscles are less able to support your spine. If you increase your protection, and continue to avoid using the muscles, the cycle will continue, with the pain worsening at each turn. Chronic lower right back pain will result. This is why doctors urge patients with lower right back pain to exercise daily.

Information about Lower Right Back Pain Symptoms



You need to understand the symptoms of your pain as well. It is difficult to treat pain without knowing clearly what and where the symptoms are. You will want to gain a sense of exactly where your lower right back hurts. Is the pain focused in one small area, or does it spread throughout the lower right back? Is it confined to the lower right back or does it radiate into other parts of the body? Here are two major kinds of pain in the lower right back.

Lower Right Back Pain Symptom #1

Is yours a deep, aching, dull, or burning pain? Does it travel down your leg? If so, your lower right back pain may be chronic back pain.

Lower Right Back Pain Symptom #2

Perhaps yours is a very sharp pain, deep in the lower right back. This symptom may be the result of a back injury.



Information on Relieving Lower Right Back Pain

My personal physician assures me that the best relief for lower right back pain is usually exercise. Gentle exercises, performed daily with warm-up and cool-down, will strengthen the core muscles around the lower back area, relieving the pain and making them less susceptible to future injury.



CAUTION: Pain in the lower right back may also be caused by kidney stones or other non-muscular problems. Be sure to ask your health care provider for advice on any back pain.



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Pain

Eight Tips for Managing Pain

January 27, 2010 – 6:32 am

Perhaps the hardest part of having arthritis or a related condition is the pain that usually accompanies it. Managing and understanding that pain, and the impact it has on one’s life, is a big issue with most arthritis sufferers. The first step in managing arthritis pain is knowing which type of arthritis or condition you have, because that will help determine your treatment. Before learning different management techniques, however, it’s important to understand some concepts about pain.

No. 1: Not All Pain is Alike

Just as there are different types of arthritis, there are also different types of pain. Even your own pain may vary from day to day.

No. 2: The Purpose of Pain

Pain is your body’s way of telling you that something is wrong, or that you need to act. If you touch a hot stove, pain signals from your brain tell you to pull your hand away. This type of pain helps protect you. Chronic, long-lasting pain, like the kind that accompanies arthritis, is different. While it tells you that something is wrong, it often isn’t as easy to relieve.

No. 3: Causes of Pain

Arthritis pain is caused by several factors, such as (1) Inflammation, the process that causes the redness and swelling in your joints; (2) Damage to joint tissues, which results from the disease process or from stress, injury or pressure on the joints; (3) Fatigue resulting from the disease process, which can make pain worse and more difficult to bear; and (4) Depression or stress, which results from limited movement or no longer doing activities you enjoy.

No. 4: Pain Factors

Things such as stress, anxiety, depression or simply “overdoing it” can make pain worse. This often leads to a decrease in physical activity, causing further anxiety and depression, resulting in a downward spiral of ever-increasing pain.

No. 5: Different Reactions to Pain

People react differently to pain. Mentally, you can get caught in a cycle of pain, stress and depression, often resulting from the inability to perform certain functions, which makes managing pain and arthritis seem more difficult. Physically, pain increases the sensitivity of your nervous system and the severity of your arthritis. Emotional and social factors include your fears and anxieties about pain, previous experiences with pain, energy level, attitude about your condition and the way people around you react to pain.

No. 6: Managing Your Pain

Arthritis may limit some of the things you can do, but it doesn’t have to control your life. One way to reduce your pain is to build your life around wellness, not pain or sickness. This means taking positive action. Your mind plays an important role in how you feel pain and respond to illness.

Many people with arthritis have found that by learning and practicing pain management skills, they can reduce their pain. Thinking of pain as a signal to take positive action rather than an ordeal you have to endure can help you learn to manage your pain. You can counteract the downward spiral of pain by practicing relaxation techniques, regular massage, hot and cold packs, moderate exercise, and keeping a positive mental outlook. And humor always has a cathartic effect.

No. 7: Don’t focus on pain.

The amount of time you spend thinking about pain has a lot to do with how much discomfort you feel. People who dwell on their pain usually say their pain is worse than those who don’t dwell on it. One way to take your mind off pain is to distract yourself from pain. Focus on something outside your body, perhaps a hobby or something of personal interest, to take your mind off your discomfort.

No. 8: Think positively. What we say to ourselves often determines what we do and how we look at life. A positive outlook will get you feeling better about yourself, and help to take your mind off your pain. Conversely, a negative outlook sends messages to yourself that often lead to increased pain, or at least the feeling that the pain is worse. So, “in with the good, and out with the bad.”

Reinforce your positive attitude by rewarding yourself each time you think about or do something positive. Take more time for yourself. Talk to your doctor about additional ways to manage pain.

Bruce Bailey, Ph.D.

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Hypnosis is a Method to Eliminate Upper Pain and Other Pain

January 27, 2010 – 5:35 am

You can really eliminate pain with hypnosis. The saying “no pain, no gain” is really not true. Do you remember all of the times pain has hindered you from taking part in activities that you enjoy? Partaking in sports and even sitting can be unbearable when you are in pain.

However, to say that “pain is all in your head” can really be true. If that is the case then the cure should be all in your head too! With help of self-hypnosis, pain can completely disappear. Despite what most people think, hypnosis is simply a mental state where messages can connect with the unconscious easier. The state of hypnosis is characterized by very deep relaxation. With regular practice of a hypnosis pain elimination regimen, you will feel more peaceful over all.

Pain signals that something in your body is amiss so pain is technically a good thing. Make sure a doctor check you out to ensure that the pain is not indicating a harmful condition. Then it’s time to manage and even eliminate the pain.

There is really no danger in a self-hypnosis pain relief program. It is not true that you can “get stuck” in a hypnotic state. The worst that might happen when you use hypnosis for upper pain reduction is that you could fall into a natural state of sleep for half an hour. Compare to all of the nights that discomfort has prevented you from sleep!

One can’t say that a hypnosis pain management system is the same as sleep though. That is probably the biggest misconception about hypnosis. When you are asleep, you are unconscious, and if you are unconscious you cannot hear anything. If you can’t hear anything, the hypnotist cannot help you. On the contrary, hypnosis is actually a state of keen awareness.

Being consciously aware of everything, a hypnosis pain management program can help both physical and mental causes and lead to many successful avenues to do away with pain. As you know, medications merely block the reception of the physical symptoms of pain on a temporary basis. Hypnosis pain regimens can in fact lessen the amount and strength of pain signals that you perceive. You can actually reprogram your body to send less pain-inducing chemicals to your receptors. This means that you can use fewer pain killing drugs, often no medications at all.

You have probably heard of endorphins, the opiate-like chemicals that are generated in our brains. Endorphins are the chemicals that cause people who train to get a high when they workout hard. Using hypnosis, you can also learn how to program your brain to create pain-relieving endorphins on demand! And send them to the painful part of your body where they are required.

With help of endorphins, the brain is capable of inducing analgesia, which is a mild anesthesia, as well as full anesthesia (numbness). Medical journals are full of accounts both in modern times, as well as in pre-anesthesia days, when invasive surgery has been done under hypnoanesthesia.

Hypnosis can also work to program the mind to direct your attention away from pain. In this way you will perceive far less discomfort. Also, hypnosis pain management programs can help our mind realize and understand that the pain is there, but not to let us suffer from it. A certified hypnotherapist will be familiar with how to fully address additional hypnotic suggestions that will aid in your recovery.

A really effective hypnosis pain remedy lies in neuro linguistic programming, NLP. No doubt that after living with chronic pain or left side pain, you may be cynical that a hypnosis pain program will help. In many cases, NLP methods really work far better for modern thinkers than traditional hypnosis does. It was actually developed for people like you who are brought up to analyze and question everything. Analyzing can mean that we tend to put up barriers to the acceptance of hypnotic suggestions.



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Pain

Diagnosing Low Back Pain

January 26, 2010 – 3:24 am

The diagnosis of lumbar back pain is difficult and uncertain due to the various conditions which can present with this problem. Effective back pain management depends on identifying what kind of back pain problem is present, and many people have suggested that there are many back pain subtypes which need to be identified before treatment can be well targeted. The variations in diagnoses for low back pain and related symptoms include: postural pain; trigger point pains; nerve root compression; neuropathic pain; facet joint pain; disc related pain and lumbar stenosis.

The spinal facet joints, intervertebral discs, muscles and ligaments are all potential sources of mechanical back pain, a pain derived from the damaged or injured tissues and transmitted by the nervous system. When the nervous system is damaged or injured it can start generating pain itself, leading to the production of what is termed neuropathic pain. Typical diagnoses of this kind of pain are post-shingles pain, phantom pain, nerve root damage pain and diabetic neuropathy pain. Patients suffer badly with this kind of unpleasant pain and it is difficult to treat.

A recent study performed by researchers from Massachusetts General Hospital in Boston and Addenbrooke’s Hospital in Cambridge, UK, has investigated this difficulty. They recognised that the assessment by taking a score of pain intensity does not reflect the reality of the complex nature of pain processes by which pain is generated. They set out to design an assessment which would take these complexities into account, allowing the clearer identification of the diagnosis and thereby a potentially more accurate treatment. They developed a standardised tool to use in the assessment of chronic pain with the aim of delineating differing pain subtypes.

130 people with peripheral neuropathic pain and 57 people with mechanical low back pain were surveyed and given a standardised assessment. An interview with 16 questions was then applied followed by a specific series of twenty-three physical tests. A list of words applicable to pain descriptions was provided and patients were asked to indicate which ones most accurately described their pain. In chronic pain patients often have an alteration in the ability to feel touch, vibratory and pin prick stimuli so the ability to discriminate these sensibilities is tested.

In neuropathic pain patients it was possible to identify six sub-groups and in non neuropathic patients two further subgroups were noted. Researchers were also able to distinguish the 6 questions and 10 physical tests which were best suited to making the most accurate discrimination between the pain subtypes. Testing this tool on one hundred and thirty seven further patients allowed the researchers to see it worked effectively and that patient acceptability was good. A particular group of neuropathic pain subtypes could be elucidated by a relatively low number of signs and symptoms which were not related to the presenting causative conditions.

The recording of the symptoms was less sensitive in distinguishing the neuropathic nature of the pains than the physical examination. The pain quality was less important than often noted and the pinprick testing more helpful. The researchers tried to link the pain subtypes with specific underlying biological mechanisms, with spontaneous pain of a burning nature linked to spontaneous discharges in heat sensitive pain nerves and pain from brushing related to increased sensitivity of cells in the dorsal horn of the spinal cord.

The physical examination was more sensitive in delineating neuropathic diagnoses of pains than the recording of the types and nature of symptoms.  The qualities of the pain were less helpful and the testing of pinprick more helpful. The researchers attempted to connect the underlying neural mechanisms with the pain subtypes. The heat sensitive pain nerves were linked to burning pains of a spontaneous type and heightened sensitivity of the spinal cord dorsal horn cells was linked to increased pain from brushing over the skin.



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Pain

Coping With Cancer Pain

January 25, 2010 – 3:20 pm

Patients with advanced cancer often have pain as their chief complaint. Although advances in cancer treatment have lengthened survival among cancer patients, cancer pain remains under treated in patients. It has been estimated that 25% of all cancer patients who die, do so without adequate pain relief, despite the fact that the tools for adequate pain control are available. With advanced disease, 90% of patients with cancer require strong opiates to control their pain. However, many physicians remain concerned about inadvertently making a patient an addict if they prescribe narcotics to treat pain. Cultural and attitudinal barriers, knowledge deficits among health care professionals, and the influence of state and federal drug regulatory agencies also contribute to the fact that the pain experienced by cancer patients, all too often, is under-treated.



Cancer pain is classified according to pain duration and quality. Duration of pain can denote the acute or chronic nature of pain. It is common to experience anxiety, apprehension and depression in patients with cancer pain. The types of pain most commonly experienced by cancer patients are:

- Acute cancer related pain

- Chronic cancer related pain

- Pain unrelated to cancer

- Pain in opiod tolerant cancer patients

- End of life pain

After an appropriate medical history review and a physical, a pain physician will tailor a suitable pain treatment program. Because everyone has a different response to medications and therapies, the other types of drugs with pain relievers. They include anti-inflammatory steroids, anticonvulsants, and antidepressants. These drugs may be effective treatments for specific types of pain or pain with specific causes. For example, the doctor may prescribe antidepressants to help relieve certain types of pain. However, it doesn’t necessarily mean that the patient is suffering from depression. Similarly, steroids often are effective in relieving pain associated with inflammation.

Cancer pain can be controlled effectively through therapies already available today. Pain treatments range from mild, nonprescription pain relievers, to stronger prescription medications, to neurological surgery, to alternative therapies such as relaxation, biofeedback, guided imagery, and acupuncture.

Oncologists and pain specialists can devise a treatment plan based on the type and severity of pain, side effects, and how the patient responds to the treatment. Some common approaches to treat cancer pain include:

1. Oral Medicines- Aspirin & NSAIDs, Opiods, Adjuvants

2. Intravenous drugs

3. Transdermal drug delivery systems

4. Nerve blocks

5. Interthecal drug pumps

6. Neuroablstive procedures

Although they have cancer pain, many patients are afraid of getting addicted to pain medicines. When cancer pain medicines are given and taken in the right way, patients rarely become addicted to them. To be sure, they should talk to the doctor, nurse, or pharmacist about how to use pain medications safely. Many patients only need pain medicines for a time, until the cause of the pain goes away due to other treatments like chemotherapy, radiotherapy or surgery. When they are ready to stop taking the medicine, the doctor gradually lowers the amount of medicine they take. By the time they stop using it completely, the body has had time to adjust. Some patients will need to take pain medicines for the long-term. Taking medicines regularly should not make patients feel like an “addict.”



Physical dependence, tolerance to medication and addiction are three different issues in people treated with strong pain medications. The patient’s physician can explain the subtle but important difference between them. It’s often easier to control pain in its early stages, because it becomes severe. Therefore, it is better for cancer pain patients to ask for adequate pain relief.

A primary care physician or oncologist can help explain the possible options for pain relief and can make a referral, when necessary, to a pain medicine specialist for optimal pain management.

About Walton Rehabilitation Health System:

Walton Rehabilitation Health Systems (WRHS) is a leading not-for-profit comprehensive, multi-specialty, dedicated provider of physical medicine and rehabilitation. Our mission is to be an advocate for wellness by providing a continuum of services to treat the whole person. WRHS, whose reputation extends throughout the south, is a trusted partner with just the right expertise and treatments to help people with disabling injuries and illnesses return to work and to a fulfilling life. By pursuing its mission, WRHS has grown to include Walton Pain and Headache Centers, Walton Community Services, Walton Options for Independent Living, Walton Foundation for Independence, and Walton Technologies. We are located at: 1355 Independence Drive, Augusta, GA 30901-1037. For more information visit www.wrh.org or call 866-4-WALTON.



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Pain

Back Pain Help

January 25, 2010 – 6:32 am

 

One of the most common questions I get is…..

“Please help with my back pain”

If you’ve never needed back pain help before, chances are 8 out of 10 you will. Getting help for your back pain is second only to the common cold when it comes to healthcare provider visits in the United States. And it’s right at the top of the list of occupational health hazards.

Although help for your back pain is readily available, terminology and methods used can be confusing at first. Here we’ll demystify some of the common back pain terms and diagnosis methods you’ll run into along the way as you seek help for your back pain.

Getting back pain help: Types of back pain

All back pain is classified as either acute or chronic back pain.

Acute back pain – Indicates a sudden onset of pain, typically with severe lower back pain and limited mobility

Chronic back pain – Chronic back pain refers to lower back pain or acute back pain episodes recurring for more than three months

Getting back pain help: Common back pain terms

You’ll likely hear one or more of these terms used as you seek back pain help at your healthcare provider.

Onset – How the pain begins: either acute (sudden) or insidious (gradually increasing pain over a longer period of time – days or longer)

Frequency / Duration – How often the pain happens and how long it lasts

Recurrence – Back pain with intervals of no pain in between episodes

Persistence – Back pain with pain always present

Location – Where it hurts – the spot on your body where pain is felt

Intensity – Your estimate of how bad the pain is on a scale of 0 (no pain) to 10 (worst pain of your life)

Getting back pain help: Steps to diagnosis

During your search for help with your back pain, when you ask almost any healthcare provider to “help with my back pain,” they will start with one or more of these diagnostic methods to better enable them to provide accurate help for your back pain.

Medical history – You’ll usually need to answer a number of questions related to your personal and family medical histories in addition to questions specific to your back pain

Physical examination – A physical evaluation to assess various postures and movements ranges and related back pain symptoms

Neurological testing – Testing with particular attention to reflexes, muscle strength, and general nervous system and circulatory system conditions

Diagnostic testing – Internal examinations including x-rays, MRIs, CAT scans, etc.

Getting Treatment – You should first research what might be causing your pain and once you have identified the causes you can treat them. In the meanwhile check out this video on how to eliminate back pain at work

If you suffer from back pain and would like to learn how to get relief, check out some of our back pain videos now.

Jesse Cannone



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