The Technology Changes; The Pain Does Not

Introduction

No longer is the ever-growing trend of smartphones, tablets, and computers popular solely with the younger generations. People of all ages are now using all the latest and greatest tools; however, the pain that can arise from overusing these devices is nothing new. If you find yourself playing Pokémon-Go on your iPhone for too long, spending hours reading on your Kindle, or replying to numerous emails on your iPad; you run the risk of placing your upper body in some serious pain. Fortunately, if you find your shoulders, neck, and head in pain from using your device for too long, there is an easy fix! Let’s take a look at how our devices can place strain on our bodies and then provide some solutions for correcting the problem.

The Pathology of Too Much ‘Words With Friends’

Let’s start by looking at the anatomy of our upper bodies. Our shoulders are comprised of a number of bones (scapula, clavicle, and upper humerus) that is surrounded by thick and heavy tendons, ligaments, and muscles. Some of these muscles connect with the neck (cervical spine) which is composed of 7 bones, stacked on top of one another (vertebras) that goes all the way up into the back of our heads. Here too, tendons, ligaments, and muscles surrounding the vertebra connect to the bones of the head (occiput). Numerous studies have shown that holding a computer device too low in your lap can force the vertebrae, and the surrounding muscles, to bend forward too much. This may result in shoulder, neck, or head strain to the muscles, nerves, tendons, ligaments, and spinal discs. Fortunately, studies have concluded that when study participants viewed a tablet that was on a table or propped at an angle, there was a reduction in their neck strain and impending pain.

Practical Suggestions for Each Device

Now that we got all the big language out of the way, let’s get into some practical situations with each of your devices providing some tips on how to correct from overstraining your upper body.

Smart Phones

  • We have to put in the obligatory suggestions to never text and drive. This should go without saying when using any device.
  • Sit up straight and have your arms on a table when using a smart phone.
  • If you find yourself straining your vision, get a cheap pair of readers. This will keep you from bending your neck forward towards your phone.
  • Get a case large enough where you are comfortably able to grip the phone thus not straining your arms and hands.

Tablets

  • Get a tablet case that allows you to prop your tablet in an upright position.
  • Again, force yourself to sit up straight. You should almost be looking straightforward towards your tablet for the best position.
  • Take short breaks.
  • Take the time to shift your weight, stretch your upper body, or simply stand up for a couple of seconds to prevents possible stiffness and pain.

Laptops or Desktop Computers

  • Make sure to sit up straight where you’re almost looking at your computer monitor at eye-level.
  • Keep shoulders relaxed and elbows close to your body
  • Keep hands, wrists, forearms and thighs parallel to the floor
  • Avoid placing your laptop in your lap. Yes, ironic, isn’t it?
  • Invest in a good ergonomic chair. These types of chairs almost force you to keep a proper position thus covering all of the steps above.

You most likely picked up on a pattern between these tips. Proper posture is important regardless of the device you’re using where it simply comes down to adjusting the angle of your head and neck. We must stress that if your pain becomes more than just an irritant, please consult your doctor. The last thing you need is an injury that keeps you from doing your job or hobby on any of these devices.

What kind of device do you use and did any of these tips help in relieving any associated pain? Let us know!

Tags: chronic pain, pain management, headache, neck pain, back pain, smartphones, tablets, computers, laptops

The In’s & Out’s of Complex Regional Pain Syndrome

We have been getting quite a few questions about Complex Regional Pain Syndrome as of late; thus we would like to take this time to go into detail about this condition as well as some treatments that have been shown to be effective. Please talk to your doctor before implementing any of these treatments and if you have any questions, please comment below!

Introduction

Complex Regional Pain Syndrome (CRPS) is a long-term and a very painful condition. CRPS can affect any age, but it becomes more common with increasing age. It is 3-4 times more common in women, in whom it is also likely to be of a more severe type, than in men. Patients with CRPS describe the pain as a constant and extreme burning sensation in the affected arm or leg. Cases of CRPS affect the arm over more than the leg where 60% of cases affect the arm, and the remaining 40% have an impact on the leg. Unfortunately, the exact cause of CRPS remains unclear; nonetheless, it appears to be triggered by an abnormal response to an injury. Such an injury may result in damage to the nerve fibers at the site of harm. Examples of an injury are an infection, surgery (12%), trauma, stroke, sprain (18%) or a fracture (45%) to name a few. Typically, the injury that triggers CRPS is mild compared with the pain that follows. However, the condition also can develop into more severe injury or paralysis. The medical community agrees that the nerves do in fact become overly sensitive in CRPS, for example, painful signals become more painful. And common stimuli, such as light touch and temperature changes also are experienced as pain.

Classifications

To offer a little bit more clarification into CRPS, the medical community has broken down this condition into two classifications:

  • CRPS I: Pain that develops in the absence of a nerve injury.
  • CRPS II: Pain that develops in the presence of damage to a major nerve.

Causes

As mentioned above, the exact cause is unknown; but we did give a few typical examples as to what may trigger CRPS. There have also been documented uncommon causes of CRPS that include abnormal nerve impingement from having a cast on the limb, vasculitis, herpes zoster, as well as leg ulcers. Again, the exact cause is not known, but all of the conditions or events mentioned have been shown to be precipitating factors for CRPS.

Symptoms

The symptoms of CRPS vary in severity and duration. The characteristic symptom is that of pain – typically burning in nature and out of proportion to the seriousness of any injury. The affected area, which may not be localized to any particularly damaged nerve fibers, may have other symptoms such as:

  • Sweating
  • Sensitivity to touch
  • Symptoms of depression
  • Muscle weakness or tremors in affected limb
  • Swelling or pitting edema in the affected limb
  • Pain from otherwise non-painful stimuli (e.g. light touch)
  • Severe pain from mild to moderate painful stimuli (i.e. hyperalgesia)
  • Spontaneous temperature changes between the injured and non-injured limb. Occurs in 80% of CRPS cases.
  • Abnormal skin changes; for example, skin can initially be smooth then become dry, hair can initially be coarse then become brittle, nails can grow fast then suddenly grow slow, as well as abnormal goosebump activity.

Diagnosis

Your doctor will complete a comprehensive history and physical exam. For most cases, your doctor will also evaluate the range of motion, nerve function, and any tissue texture abnormalities of the affected limb. You doctor will also be using specific criteria to make a definite diagnosis of CRPS. Such measures include severe pain that was not present before injury, temperature differences between the limbs, reduced range of motion or weakness, sporadic swelling or sweating occurrences, and dermal changes to name a few. It is worth noting that X-rays, electromyography (EMG), nerve conduction studies, CT scans, MRI, and blood tests may all be entirely normal. Thus in most cases, your doctor will make a diagnosis of CRPS based on your personal history as well as their objective assessment of your symptoms.

Treatment

Medications

Most cases of CRPS can are treated with a conservative treatment of a drug regimen. Drugs that have been shown to be effective in treating CRPS:

  • Non-Steroidal Anti-Inflammatory Drugs (NSAID’s)
  • Analgesics
  • Neuropathic drugs (e.g. gabapentin, neurotin)
  • Antidepressants [e.g. tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRI’s)]
  • Baclofen for cases of CRPS with sudden muscle contractions
  • Bisphosphonates which stop the breakdown of bone tissue

Therapy

  • Physical Therapy. This is most likely one of the most important treatments for CRPS. Regardless of what stage CRPS has progressed to, everyone dealing with this condition should be taking some physical therapy. The regular exercise, stretching, as well as muscle strengthening that come with doing physical therapy will help to reduce the pain and stiffness associated with CRPS.
  • Behavioral Therapy. Research has shown that patients with CRPS are more likely to suffer from depression and anxiety when compared to a control group. For this reason, seeing a therapist or learning cognitive behavioral therapy will help when it comes to reducing the negative thoughts that accompany suffering from CRPS.
  • Support Groups. These groups allow you to meet others that may be going through similar experiences where you can receive as well as offer emotional comfort and moral support. Please click on the link to find a group near you: http://rsds.org/find-a-support-group-near-you/

Other Treatments

  • The N-methyl-D-aspartate (NMDA) receptor antagonist ketamine has been used in intractable CRPS but has to be given in anesthetic doses.
  • Steroid or local anesthetic injections into the affected limb have been shown to be an effective treatment for pain reduction.
  • Spinal cord stimulation trials have also been used to reduce pain over time.

It is very unfortunate that there has yet to be a cure for CRPS, but with an effective therapeutic regimen, proper education, as well as a willingness to get better, symptoms can be controlled and often reduced. The duration of CRPS varies yet we cannot stress enough that if you are experiencing symptoms of CRPS, it is crucial that you see your doctor as soon as possible. If undiagnosed and untreated, CRPS can spread to other extremities such that this condition becomes extremely debilitating. This can make subsequent rehabilitation much more challenging. Researchers hope to discover the mechanisms that cause the spontaneous pain of CRPS; that discovery may lead to new ways of blocking pain. So do not give up hope if you find yourself with this condition. Again, with your willingness to be proactive and control your care, you can still live a full and happy life!

Are you looking for which treatment option may be best for you? Please make an appointment and let us know.

Tags: complex regional pain syndrome, medications, physical therapy, cognitive behavioral therapy, support groups, CRPS I, CRPS II

 

References:

  1. Harden RN, Oaklander AL, Burton AW, et al; Complex regional pain syndrome: practical diagnostic and treatment guidelines, 4th edition. Pain Med. 2013 Feb;14(2):180-229. doi: 10.1111/pme.12033. Epub 2013 Jan 17.
  2. Logan DE, Carpino EA, Chiang G, et al; A day-hospital approach to treatment of pediatric complex regional pain syndrome: initial functional outcomes. Clin J Pain. 2012 Nov-Dec;28(9):766-74. doi: 10.1097/AJP.0b013e3182457619.
  3. Logan DE, Williams SE, Carullo VP, et al; Children and adolescents with complex regional pain syndrome: more psychologically distressed than other children in pain? Pain Res Manag. 2013 Mar-Apr;18(2):87-93.
  4. Marinus J, Moseley GL, Birklein F, et al; Clinical features and pathophysiology of complex regional pain syndrome. Lancet Neurol. 2011 Jul;10(7):637-48. doi: 10.1016/S1474-4422(11)70106-5.

Breaking Down Opioids: A Look Into The Controversial Class of Drugs

Introduction

Opioids are one of the oldest drugs used by humankind. Yet as of today, a lack of understanding can lead to destructive habits, which is finally being noticed by the medical community.2

What Are Opioids?

Opioids are a class of medication where it’s chemical properties act on opioid receptors (specifically MU-receptors) throughout the entire body to elicit morphine-like effects. Your doctor may prescribe you an opioid after lesser effective pain medications have not given pain relief. Thus opioids can be identified as a strong “painkiller” class of drugs.2 Opioids have also gone by other names; for example, an opiate (derived from opium, including morphine) and a narcotic. Not only can the names vary, but also there exist a broad range of medications that are classified as an opioid. Morphine is a potent agonist opioid and is used as the standard for all other opioids. Other well known opioids are semi-synthetic and synthetic drugs such as hydrocodone (Vicodin®), oxycodone (OxyContin®), and fentanyl (Actiq®); and a weaker class of opioids known as antagonists, for example, drugs such as naloxone (Narcane®).3

Even though these drugs are being prescribed at an alarming rate for chronic pain conditions, opioids have been discovered not to be the best choice when combating persistent pain, especially long-term pain.3 The medical community is beginning to agree. As mitigating agency become stricter and guidelines become more rigid; it is rare that a doctor will prescribe an opioid for chronic pain unless it is a cancer-induced pain. So why are the most well known strongest painkillers not the best option?

Figuring It Out The Hard Way

Doctors reducing opioid prescriptions are a relatively new circumstance. From the late 1980s to the early 2000s, medical professionals attempted to aggressively improve the way they treat chronic pain by prescribing opioids for even more people. They believed that prescribing a patient an opioid and having them under observation of a physician would prevent anyone from becoming addicted. This thinking had been quickly proven wrong.4

In reality what the medical community began to observe is that someone taking an opioid can become dependent on the drug in a very short timeframe.

We have all seen opioids as a major story on our news stations. A couple of headlines are:

  • There are 15, 000 to 20, 000 U. S. fatalities per year as a result of an overdose from prescription opioids.5
  • An estimated 2 million people in the United States used opioids recreationally or were dependent on them, during 2014.5
  • Heroin is a less-expensive alternative when addicts can no longer afford their prescription or when they are turned away.5

It Gets Worse

As we have seen, not only are opioids extremely addictive, they have a plethora of side effects. A few examples are: itchiness, sedation, nausea, respiratory depression, constipation, and euphoria, to name a few.1 Recall that opioids taken by chronic pain sufferers for a longer time than is prescribed may begin to offer no pain relief whatsoever. A fascinating quandary also occurs. Yes, it is counterintuitive but overuse of opioids over an extended period can start to cause more pain than before. You can check out our blog on opioid-induced hyperalgesia for more information on this topic. But for now, realize that a drug that is supposed to decrease pain over time can worsen pain if not used according to how it was prescribed.

When Are Opioids Appropriate?

Opioids are highly recommended for acute and short-term pain symptoms. Chronic pain is approached in a different manner. In chronic pain, physicians prescribe this class of drugs usually for cancer-induced pain as well as a VERY last resort for other pain conditions when other therapies have failed. Even then, opioids are prescribed at a very low dose and are usually discontinued as soon as a patient’s condition improves.2

What To Do Next?

If you find yourself in this category, it is wise to consult a pain management expert as soon as possible. The physician will be able to re-evaluate your pain condition and may be able to approach a better prognosis using an alternative medication or method.

Pain management physicians offer an array of even more potentially successful treatments than just prescribing a drug. Talk to your pain management physician as to the best option is for you in cutting down your pain.

Are you currently on an opioid and looking to get off of it? Please come see us and let us help!

Tags: opioids, morphine, addiction, chronic pain, pain management, medication, drugs, painkiller

References:

  1. Benzon, Honorio; Raja, Srinivasa N.; Fishman, Scott E.; Liu, Spencer; Cohen, Steven P. (2011). Essentials of Pain Medicine. Elsevier Health Sciences. p. 85. ISBN 1437735932.
  2. Hemmings, Hugh C.; Egan, Talmage D. (2013). Pharmacology and Physiology for Anesthesia: Foundations and Clinical Application: Expert Consult – Online and Print. Elsevier Health Sciences. p. 253. ISBN 1437716792.
  3. Offermanns, Stefan (2008). The natural products morphine, codeine, thebaine and many semi-synthetic congeners derived from them Encyclopedia of Molecular Pharmacology 1 (2 ed.). Springer Science & Business Media. p. 903.
  4. “Report III: FDA Approved Medications for the Treatment of Opiate Dependence: Literature Reviews on Effectiveness & Cost- Effectiveness, Treatment Research Institute”. Advancing Access to Addiction Medications: Implications for Opioid Addiction Treatment. p. 41.
  5. “Status and Trend Analysis of Illicit Drug Markets”. World Drug Report 2015 (PDF). Retrieved 26 June 2015.

8 Tips On How To Treat Sciatica Naturally

Introduction

Sciatica, also known as lower extremity radiculitis at L5/S1 or radiculopathy, is a common condition defined by sensory changes or weakness along the pathway of the sciatic nerve. The sciatic nerve roots start at the lower spine and descend through the buttocks, down the posterior portion of the leg (back of the thigh), and ends at the foot. Patients often describe the sensory changes similar to that of “pins and needles” and can be felt along the entire backside of the leg.

Sciatica can be a severe condition, especially when symptoms do not solely affect with the lower limb. Some serious results of Sciatica are bowel incontinence, bladder incontinence, severe nerve impingement, lower extremity weakness, and overpowering loss of sensation. The loss of bowel or bladder function resulting from sensory weakness is Cauda Equina Syndrome and is a critical medical emergency.

Picking A Treatment That Works For You

There are a number of treatments available for treating Sciatica. Your doctor will start you off on a conventional regimen of prescribed medication and bed rest. For more advanced cases, epidural/trigger point injections and spinal cord stimulations may be used; however, these procedures come with their risks.

Fortunately, if you would like to seek a more noninvasive approach as well as without relying on medications, we have put together eight tips on how to find pain relief. It is worth noting that these treatments are to be used for mild to moderate conditions of sciatica. For more advanced cases, surgical or injection treatments are going to be the optimal and only choice. Be sure to consult your doctor before implementing any of the following tips.

 

  1. Nutrition & Exercise

Reducing the pain associated with sciatica could be as simple as implementing an exercise regimen and a healthy eating plan. Physical activity over time can increase your range of motion, consequently increasing your flexibility. This flexibility allows the muscles that may be impinging the sciatic nerve to become relaxed. Our muscles require an exurbanite amount of nutrition, and if we lack in any vital nutrients, our muscle could be more prone to muscle cramps, stiffness, and even sprains.

  1. Physical Therapy

Doing activity when you’re in pain does sound counterintuitive when your buttocks are in severe pain. Nevertheless, activity could be just the treatment to reduce the pain associated with sciatica. Physical therapy focuses on stretching and exercising the muscles that are activated by the sciatic nerve. Lower limb exercises increase blood flow to the affected area, which subsequently may improve flexibility, reduce inflammation, strengthen muscles, as well as stabilize your core. Physical therapy helps improve symptoms of sciatica by increasing flexibility, range of motion, posture, and improving muscle strength.

  1. Trigger Point Massage Therapy

The major muscle in the buttocks that lies directly over the sciatic nerve is known as the piriformis and is most often the muscle that becomes inflamed, leading to impingement and irritation of the sciatic nerve. Trigger-point massage therapy applies direct pressure to the piriformis to loosen the muscle and alleviate the compression that causes pain, numbness, and tingling down the affected leg. Numerous studies have found trigger point massage therapy to be advantageous, especially when done on a weekly basis. There are also available foam rollers and therapy balls that can be used to focal rub tender areas in the hope of relieving muscle spasms or contractions and improve the discomfort associated with it.

  1. Alternate Ice & Heat

There has been an agreement in the medical community that alternating between ice then heat for periods of 15 minutes each can reduce the discomfort associated with sciatica. Although this method does not diminish the inflammation associated with sciatica, it can still be a beneficial practice for it provides alternating stimuli, which may reduce the pain.

  1. Acupuncture

Be sure to consult your doctor before you try acupuncture. With that being said, acupuncture has been shown to be beneficial for those suffering from sciatica. One study found that over 50% of participants reported some level of pain relief. Acupuncture is the practice where small needles are inserted into the skin. These needles cause your body to release neurotransmitters known as endorphins, which are your body’s natural pain relievers. The release of endorphins has been shown to reduce muscle-spasm contractions, reduce stress, as well as reduce tension.

  1. Yoga

Research has shown that a consistent regimen of gentle yoga has been demonstrated to improve muscle strength, flexibility, and mobility. There are numerous types of yoga classes that you can find are suitable for you. Once you and your doctor have decided an appropriate intensity level, ask yoga instructors as to what practice will best fit your needs.

  1. Biofeedback

Biofeedback therapy involves training a patient to control internal physiological processes such as heart rate, blood pressure, and even muscle tension. By becoming more in tune with your body, ailments such as sciatica pain can influence and reduce your level of pain. A better awareness of your body teaches you to relax effectively, and this can help relieve your pain.

  1. Natural Oils and Ointments

An array of natural creams and oils has been shown to have positive effects on sciatica. Simple over-the-counter skin creams include a compound known as capsaicin that is naturally found in peppers. These compounds work by obstructing the release of pain-causing compounds from the nerves. Thus an efficient and noninvasive route in reducing pain can be to simply use a cream or patch.

It is worth mentioning that some treatment options might work for some but not others. Thus pick a couple from the list above that you believe would be beneficial and give it a try. If you are not finding relief, try another option. Also, a combination of treatment options is often the most practical course, and many patients will try some combination of treatments listed above. Let us know if these tips helped you!

 

References:

  1. Basmajian, J. V. (1967). Muscles alive: Their functions revealed by electromyography. Baltimore: Williams and Wilkins.
  2. Casey, E (February 2011). “Natural history of radiculopathy.”. Physical Medicine and Rehabilitation Clinics of North America. 22 (1): 1–5.
  3. Dorsher PT (May 2006). “Trigger points and acupuncture points: anatomic and clinical correlations”. Medical Acupuncture. 17 (3).
  4. Dupler, Douglas; Frey, Rebecca (2006), Gale Encyclopedia of Medicine, 3rd ed, ISBN 978-0787618681; Retrieved 30 August 2012.
  5. Fattori, V; Hohmann, M. S.; Rossaneis, A. C.; Pinho-Ribeiro, F. A.; Verri, W. A. (2016). “Capsaicin: Current Understanding of Its Mechanisms and Therapy of Pain and Other Pre-Clinical and Clinical Uses”. Molecules. 21 (7): 844.
  6. Gothe, N.; Pontifex, M. B.; Hillman, C.; McAuley, E. (2013). “The acute effects of yoga on executive function”. Journal of physical activity & health. 10 (4): 488–495.
  7. Hagen, KB; Hilde, G; Jamtvedt, G; Winnem, M (Oct 18, 2004). “Bed rest for acute low-back pain and sciatica.”. Cochrane database of systematic reviews (Online) (4): CD001254. doi:1002/14651858.CD001254.pub2. PMID15495012.
  8. Hsueh TC, Cheng PT, Kuan TS, Hong CZ (November–December 1997). “The immediate effectiveness of electrical nerve stimulation and electrical muscle stimulation on myofascial trigger points”. American Journal of Physical Medicine & Rehabilitation. 76 (6): 471–6.
  9. Leininger, Brent; Bronfort, Gert; Evans, Roni; Reiter, Todd (2011). “Spinal Manipulation or Mobilization for Radiculopathy: A Systematic Review”. Physical Medicine and Rehabilitation Clinics of North America. 22 (1): 105–125.
  10. Ropper, AH; Zafonte, RD (26 March 2015). “Sciatica.”. The New England Journal of Medicine. 372 (13): 1240–8.
  11. Valat, JP; Genevay, S; Marty, M; Rozenberg, S; Koes, B (April 2010). “Sciatica.”. Best practice & research. Clinical rheumatology. 24 (2): 241–52.

Can Drinking Water Really Help With Chronic Pain?

Introduction

Have you ever wondered where the “drink 8 glasses a day” adage to stay hydrated came from? Is there such a thing as being chronically dehydrated? How much is actually in a glass? Is being thirsty a sign of being dehydrated? Will drinking water actually decrease my pain symptoms? If you’ve ever found yourself asking these questions, then you’re way ahead of the crowd in cracking the myth as to how much water we should consume in a day.

Getting Down To The Numbers

There is actually a bit of truth behind some of these cryptic questions, especially pertaining to pain management. Let’s start with a couple of the first questions. The “drink 8 glasses of water a day” mantra is generally believed to be from a Food and Nutrition Board Recommendation in 1945 that stated, “a suitable allowance of water for adults is 2.5 liters daily in most instances. An ordinary standard for diverse persons is 1 milliliter for each calorie of food”. Do a little math and that calculates out to 2.5 liters more or less works out to be around eight glasses. But what’s usually ignored from that report is the crucial next sentence: “Most of this quantity is contained in prepared foods.”

The eight glasses a day myth, along with the chronically dehydrated myth, are two claims that have no empirical data to support such notions. What recent evidence does show is that the amount of water a person needs is going to depend on that person and as to how physically active they are in a given day. Do some experimenting with how much water works for you. Some people may function better with more water than usual, while for others it only causes the inconvenience of more frequent trips to the bathroom.

Water: A Rule of Thumb

Let’s say you’d like a little more clarity as to how to go about experimenting as to how much water is right for you. To keep things simple, try these tips to get to your optimal daily amount:

  • When thirsty, drink.
  • When not thirsty anymore, stop.
  • During high heat and exercise, drink enough to compensate for the lost fluids.

Water & Pain Management

For starters, let’s talk about how water is distributed throughout the body. Blood is made up of 90% water, your muscles 75% and bone has water content of 25%. Your body needs water to function and without sufficient water your body struggles to perform all its necessary tasks, like flushing toxins from the system and lubricating your cells. Believe it or not, there is actually evidence that supports water decreasing pain symptoms. Let’s talk about a few pain conditions and how water can have an impact on the overall ailment.

Inflammation

Many health experts have recommended a diet high in anti-oxidants as well as drinking fresh water as being great ways to manage inflammation and pain. Water, in particular, is recommended because it can flush toxins and other irritants out of the system, decreasing the prostaglandin and histamine response that is associated with an inflammatory response.1, 6

Chronic Pain

Chronic pain has been documented to have multifactorial origins. Water is quantitatively the most important nutrient where past scientific evidence has shown that mild dehydration may also account for some morbidities. Decreasing mild dehydration will decrease the morbidities seen in chronic pain sufferers.1, 6

Headaches

It is well documented that water dehydration can lead to the development of headaches. Although the medical community has generally accepted this notion, some observational studies indicate that water dehydration, in addition to impairing concentration and increasing irritability, can serve as a trigger for a migraine and other forms of headaches. In those with a water deprivation-induced headache, ingestion of water provided relief from headache in most individuals within 30 minutes to 3 hours. It is proposed that water deprivation-induced headache is the result of intracranial dehydration and total plasma volume. Although drinking water may be useful in relieving dehydration related headaches, the utility of increasing water intake for the prevention of headache is less well documented.

Recently, one study examined increased water intake and headache symptoms in headache patients. This study found that water intake did not affect number of headache episodes, but was associated with a reduction in headache intensity and reduced duration of headache.2-4

Fibromyalgia

Folks struggling from fibromyalgia have many debilitating symptoms, including intense joint and muscle pains, disturbed or easily disrupted sleep, and frequent headaches; to name a few. According to several studies, people with fibromyalgia may also have lower levels of magnesium and zinc in their bodies.

Water can help reduce these symptoms in a number of ways. Researchers have found that fatigue and headaches can be caused by not keeping the body sufficiently hydrated, so its important to keep your water intake up to help relieve these two symptoms. Your immune system requires water to work at optimum levels. Having a healthy immune system will put less stress on the body and in turn may ease fibromyalgia symptoms.5, 6

On average, we lose about 10 ounces of fluids in a given day through, urinating and in bowel movements. This loses of fluid needs to be replaced to make sure the body is not put under further stress. By drinking water, these levels can be restored to normal, and the symptoms of fibromyalgia can be eased.

The Bottom Line

We have talked about the benefits of water and how to find what the right amount of water is for you per day. But let’s focus on water and pain management for the remainder of this article. Treating pain is easy when you understand how and why people say water cures pain. With any pain management, effectively treatment starts with the cause. Eliminating pain requires finding the underlying reason for the pain. As we have seen, water may eliminate your pain. Actually, it is our body that alleviates pain. The water and simply help our bodies stop the pain. It is important to include adequate amount of water in your day, especially if dealing with a pain condition. Because everyone is different, please work with your health professional to determine what’s right for you.

What amount of water works for you? Let us know!

Tags: water, chronic pain, inflammation, fibromyalgia, headaches, pain management

References:

  1. Bhalla A, Sankaralingam S, Dundas R, Swaminathan R, Wolfe CD, Rudd AG. Influence of raised plasma osmolality on clinical outcome after acute stroke. 2000;31:2043–2048.
  2. Blau JN, Kell CA, Sperling JM. Water-deprivation headache: a new headache with two variants. Headache. 2004 Jan;44(1):79-83.
  3. Blau JN. Water deprivation: a new migraine precipitant. 2005 Jun;45(6):757-9.
  4. Hebert LA, Greene T, Levey A, Falkenhain ME, Klahr S. High urine volume and low urine osmolality are risk factors for faster progression of renal disease. Am J Kidney Dis. 2003;41:962–971.
  5. Murray B Hydration and physical performance. J Am Coll Nutr. 2007 Oct;26(5 Suppl):542S-548S.
  6. Shirreffs SM, Merson SJ, Fraser SM, Archer DT. The effects of fluid restriction on hydration status and subjective feelings in man. Br J Nutr. 2004 Jun;91(6):951-8.

The Science Between Physical Pain & Mental Disorders

Introduction

Have you ever questioned how feeling mentally numb started after your physical pain? Ever feel that the intensity of your pain has increased when you’re in a state of sadness are despair? Do you feel confused and alone while physical pain and mental depression are occurring? Don’t fret; you’re not alone. In fact, research has shown that 30-50% of individuals suffering from chronic pain also have a behavior disorder where depression and anxiety were shown to be the two most significant behavior disorders. There is no doubt an association between chronic pain and mood disorders so let’s explore this connection and how consulting and strategizing with your doctor can go about treating these symptoms.

Acute Vs. Chronic Pain

Pain can be defined as either being acute or chronic based on the length that the pain has persisted. Any injury associated with pain that persists for three months or longer means that the normal healing process is irregular. Thus pain associated with this injury is identified as chronic. There is some disagreement within the medical community as to what identifies acute or chronic pain; nonetheless of physicians are beginning to consider chronic pain as an underlying factor that may contribute to mental illness.

Chronic Pain and Mental Disorders; Which Came First?

This is a question of which came first, the chicken or the egg? However, concerning chronic pain and mental illness, it can work both ways. Pain can cause depression and anxiety. Depression and anxiety can also cause pain. It can create a cycle where one continually worsens the other. For example, someone in pain from an injury may cut back on their activity because they are reluctant to exacerbate their injury.

Let’s look at another example. Chronic pain may be causing someone sleep problems. Lack of sleep has been shown to create the thought of anxiety, helplessness, and worthlessness. A continuation of these feelings may lead to someone to a diagnosis of mental illness.

Treatment Options

A comprehensive approach to treatment involves a thorough evaluation to determine what might be contributing to both the pain and the mood disorder. If it’s something physical, like arthritis contributing to pain, treating the pain may improve the depression. Treatment may involve medication, physical therapy or other treatments, such as nerve blocks. For other cases, it is important to address the psychological aspects of counseling or with drugs that may help improve both pain and depression.

Other options for treating both pain and depression include:

  1. Education. This is essential for both the one with the ailments as well as for their family. Talk to you doctor, ask questions, and absorb as much information as you can.
  2. Self-help Groups. These can be helpful because it will allow you to understand that you are not alone in your battle. Talking with others is not only therapeutic, but it can also begin changing your mental affect, which in turn may reduce your pain symptoms.5, 8, 9
  3. Cognitive Behavioral Therapy. This for of therapy may help you develop coping skills so that you can manage your pain as well as your mental thoughts.2, 3
  4. Hypnosis. This sort of treatment has been shown to help patients reach a relaxed state that may allow for positive suggestions.6, 11
  5. Exercise. Exercise has numerous health benefits. One being that it can boost your mood as well as reduce pain symptoms.1, 6, 10
  6. Meditation. This practice has been shown to contribute to reducing the stress response that often worsens pain and increases the symptoms of depression and anxiety.4, 7

It’s important for people to treat their pain and depression, and to take part in activities. Rather than focusing on what they cannot do, it is important that patients realize what they can do.

Did any of these alternative treatment options work for you? Let us know!

Tags: anxiety, chronic back pain, chronic conditions, chronic knee pain, chronic neck pain, chronic pain, depression

References:

  1. Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain. Report of the International Paris Task Force on Back Pain. Spine 2000; 25: 1 S–33S.
  2. Ayen I, Hautzinger M. [Cognitive behavior therapy for depression in menopausal women: a controlled, randomized treatment study] Zeitschrift fur Klinische Psychologie und Psychotherapie. 2004;33:290–299.
  3. Cuijpers P, Smit F, Bohlmeijer E, Hollon SD, Andersson G. Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. Br J Psychiatry. 196:173–178
  4. Felipe A. Jain, Roger N. Walsh, Stuart J. Eisendrath, Scott Christensen, B. Rael Cahn, Critical Analysis of the Efficacy of Meditation Therapies for Acute and Subacute Phase Treatment of Depressive Disorders: A Systematic Review, Psychosomatics, 2015, 56, 2, 140
  5. Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ. Collaborative care for depression – A cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006;166:2314–2321.
  6. Maren Nyer, James Doorley, Kelley Durham, Albert S. Yeung, Marlene P. Freeman, David Mischoulon, What is the Role of Alternative Treatments in Late-life Depression?, Psychiatric Clinics of North America, 2013, 36, 4, 577
  7. Michael de Manincor, Alan Bensoussan, Caroline Smith, Paul Fahey, Suzanne Bourchier, Establishing key components of yoga interventions for reducing depression and anxiety, and improving well-being: a Delphi method study, BMC Complementary and Alternative Medicine, 2015, 15,
  8. Paul N. Pfeiffer, M.D. Efficacy of Peer Support Interventions for Depression: A Meta-Analysis. Gen Hosp Psychiatry. 2011 Jan–Feb; 33(1): 29–36
  9. Rush AJ, Trivedi MH, Wisniewski SR, Nierenberg AA, Stewart JW, Warden D, Niederehe G, Thase ME, Lavori PW, Lebowitz BD, et al. Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: A STAR*D report. Am J Psychiat. 2006;163:1905–1917.
  10. Skouen JS, Grasdal AL, Haldorsen EM, Ursin H. Relative cost effectiveness of extensive and light multidisciplinary treatment programs versus treatment as usual for patients with chronic low back pain on long-term sick leave: randomized controlled study. Spine 2002; 27: 901–910.
  11. Tomonori Adachi, Haruo Fujino, Aya Nakae, Takashi Mashimo, Jun Sasaki, A Meta-Analysis of Hypnosis for Chronic Pain Problems:A Comparison Between Hypnosis, Standard Care, and Other Psychological Interventions, International Journal of Clinical and Experimental Hypnosis, 2014, 62, 1, 1

Do Energy Drinks Fit Into Your Pain Management Regimen?

Introduction

Energy drinks are a developing trend for those searching for a pick-me-up during their day. Some may use energy drinks as a substitute to the morning coffee; others may use energy drinks to enhance themselves during a workout believing it will give them the energy to push a little harder. No matter the reason, energy drinks are being consumed at a faster rate now than they ever have before, but does that mean they are a healthy choice? And, when it comes to pain patients, how do energy drinks affect you and impact your pain condition?

Energy Drinks: Statistics

Energy drinks, a relatively new product is starting to get more attention from the scientific community. A report from the Substance Abuse and Mental Health Services Administration, found that emergency room visits involving energy drinks doubled from 2007 to 2011. We cannot say that this is a cause an effect but there most certainly is a correlation between energy drinks and ER visits. For one, the energy drink industry had a 60% market growth during this time.1,2,4 What this correlation also shows is that some energy drinks can have serious health consequences.

Energy Drinks And Their Effect

Let’s first starts by identifying the main ingredients in energy drinks and then see how these components impacts your overall health.

Caffeine

One of the most widely used synthetic drugs in the world is caffeine. Soon it will be a part of the majority of people’s daily life. In fact, acceptable guidelines reveal that 400 mg of caffeine a day are deemed to be safe.

Even if you stay under the daily recommendation, be aware of the risks/rewards that you run when taking caffeine. In some it may worsen your pain condition. For example, a couple fibromyalgia sufferers found that even small dosages of caffeine can trigger a flare-up, or may negatively impact sleep in order to the point of creating more pain the following day. It has also been witnessed in migraine or headache sufferers whom also report that coffee can cause pain. However, there can be a reward by taking caffeine for some people. For example, some migraine sufferers find relief in taking caffeine in that caffeine can actually alleviate head pain symptoms; this has also been documented in fibromyalgia sufferers.

How your body reacts to caffeine will vary from person to person. Whenever it comes to caffeine, keep a pain and food diary to track what you eat and associated symptoms so you can start to figure out what helps and what hurts. It is also a good idea to consult your doctor if you are taking prescription medications, as caffeine is known to interact poorly with many other medications.

Getting back to energy drinks, they usually contain large amounts of caffeine compared to the accepted limit, and depending on the drink can have reported amounts of anywhere from 50 – 250 mg of caffeine per can. It is worth noting that caffeine is the main ingredient that produces a noticeable enhanced performance; increase in memory, and in increase in focus.

Although high caffeine consumption is sold with pretty a few drawbacks, the medical community is finally recognizing the deleterious effects it can have on our bodies. High caffeine consumption can cause decrease in bone density, increase risk in developing gout, high blood pressure, increase risk of heart attack, increase anxiety, and has even been shown to cause insomnia.3-5, 8

Sugar

Sugar is a simple carbohydrate that our body breaks down into glucose where our body uses as energy to fuel our cells. The American Heart Association suggests that adult women should consume no more than 25g and males no more than 37. 5g of sugar in a day. Commonly, an eight-ounce energy drink has somewhere between 21g and 34g of sugar revealing just how drastic of a toll a single energy drink can have on your daily recommendation limits.

Sugar does provide a couple of advantages like giving you an instant energy boost; but overall, sugar has more negative effects than positive ones. Sugar has been shown to increase swelling in joints, it could decrease an immune response, it can cause new pain flare-ups, it has been shown to be the direct cause of obesity, and not to mention the awful effects it can have on the teeth and gums. Ever hear of the saying, “What goes up, must come down”? The same holds true for sugar. Yes it may give a short-term energy boost but it will always be followed by the inevitable crash that can leave you feeling more tired and cranky as compared to before you consumed sugar. Sugar is one ingredient that we should all do our best to cut down on in our daily lives.

What about no calorie energy drinks that contain trace amounts of sugar? There simply hasn’t been enough research done within the more popular sugar alternatives to learn how they influence the body. However, even if an energy drink has a sugar substitute as an alternative to actual sugar, you should still consume these with a grain of salt.6, 7, 9

Guarana

Guarana is a South American plant compound that has a huge amount of natural caffeine – around 40g per 1g of guarana. What does that mean exactly? It ensures that beverage companies are not required to report that additional caffeine towards the total in an energy drink, which means that it is probable that your favorite energy drink has more caffeine than you might have realized.1, 6

Taurine

Taurine is a common amino acid that supports several bodily functions including mind development as well as water and mineral regulation within the blood. Currently, there is some preliminary evidence that taurine can help avoid and treat cardiovascular condition, stronger evidence is still required for a definitive answer. Nonetheless, diets in the U.S. are fairly abundant in taurine so it is still unidentified as to whether more of this specific compound has any additional benefits.

The ingredients we just talked about are usually the main ingredients seen in energy drinks and will vary in the amounts (as well as contain other ingredients we did not mention) based on the type of energy drink. So, just how do energy drinks impact your life, especially when you have chronic pain condition? Not always in the best ways. Based on their ingredients (and the levels of those ingredients), it will always be better and much healthier to look for an alternative to energy drinks particularly when you are dealing with chronic pain.5, 6, 10

Alternatives to Energy Drinks

Making an energy drink a staple in your routine does not exactly scream, :I live a healthy lifestyle.” When considering energy drink’s high amounts of caffeine and sugar. Rather than turning to an energy drink next time you are low on energy, try one of these delicious alternatives to truly get you energized and back on top of your game.

  • Coconut water is a great option as it offers fewer calories and a lot more potassium than most energy drinks. It also has many other essential nutrients such as magnesium, phosphorus, and calcium. This drink is rich and refreshing while still being great for your body.
  • Green tea has health benefits that trump energy drinks. Green tea is known for boosting your metabolism but it also has been reported to have positive effects on the heart and brain. Green tea usually does contain natural caffeine but only 25 – 40mg. That is just enough in order to get your body producing cortisol, a significant hormone within keeping up energy amounts.
  • Smoothies, particularly vegetable smoothies that include: spinach, kale, and/or parsley are great ways to keep your energy high as well as drinking something extremely beneficial to your health. Try adding a pinch of ginger to help boost your energy levels and even reduce pain. Throw in some fruits or honey to create different combinations so you never get bored, remembering to limit these choices to keep your daily sugar consumption low.
  • Water is one of the most crucial substances we can drink for our health. Not only does water allow for our muscles to be supplied with vital nutrients which can decrease pain symptoms, it is also essential for every single metabolic reaction that occurs in our bodies. It is a vehicle that can flush out toxins that are associated with inflammation. When you are dehydrated, your metabolism slows down; consequently decreasing your energy levels leaving you feeling sluggish. Drinking water can be just the solution to bring you out of a rut again and again. Everyone differs as to how much water they need in a day. Try to drink when you are thirty and stop when you are satiated. Check with your doctor as to how much water is appropriate for you.

Let us know if any of these alternatives helped you!

Tags: energy drinks, caffeine, sugar, guarana, taurine, insomnia, cardiovascular risk, obesity, pain management, chronic pain, coconut water, green tea, water

 

References:

  1. Clauson KA, Shields KM, McQueen CE, Persad N (2008). “Safety issues associated with commercially available energy drinks.”. J Am Pharm Assoc (2003). 48 (3): e55–63; quiz e64–7. doi:10.1331/JAPhA.2008.07055. PMID 18595815.
  2. “The DAWN Report: Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern”. samhsa.gov. Retrieved 2016-03-12.
  3. “Energy Drinks – Caffeine Levels”. org. 26 September 2014.
  4. FDA (November 3, 2010). “List of Manufacturers of Caffeinated Alcoholic Beverages”. U.S. Food and Drug Administration. Retrieved 11 November 2010.
  5. Heckman, Melanie A.; Weil, Jorge; De Mejia, Elvira Gonzalez (2010). “Caffeine (1, 3, 7-trimethylxanthine) in Foods: A Comprehensive Review on Consumption, Functionality, Safety, and Regulatory Matters”. Journal of Food Science. 75 (3): R77–87. doi:10.1111/j.1750-3841.2010.01561.x. PMID 20492310.
  6. McLellan TM, Lieberman HR (2012). “Do energy drinks contain active components other than caffeine?”. Nutr Rev. 70 (12): 730–44. doi:10.1111/j.1753-4887.2012.00525.x.
  7. Preszler, Buss. “How much is too much?”. org. Mayo Clinic. Retrieved 5 November 2014.
  8. “Scientific Opinion on the safety of caffeine | Europäische Behörde für Lebensmittelsicherheit”. efsa.europa.eu. Retrieved 2016-01-02.
  9. Smith, Leesa (3 September 2014). “‘My heart just hit the floor’: A mother’s pain after her son died from drinking FOUR energy drinks daily… as a doctor warns no more than two caffeinated beverages per day”. Daily Mail Australia. Retrieved 3 September 2014.
  10. United States Substance Abuse and Mental Health Services Administration (2013-01-10). “Update on Emergency Department Visits Involving Energy Drinks: A Continuing Public Health Concern” (PDF). Retrieved 2015-08-12.

When Medication Inflames The Problem: A Look At Hyperalgesia

The use of pain relief medications as well as other classes of similar medications is the most common routine when treating chronic pain conditions. Common and widely prescribed classes of pain medications are opioids, such as morphine or oxycodone.2, 7, 9 Opioids can vary from strong to weak and are prescribed according to what your physician deems appropriate, given your condition.1 Patients vary as to how effective a given pain medication works, whether it be strong relief to no relief whatsoever. Yes, pain medications are helpful for many patients, but they are not unanimously effective. In fact, pain medications may sometimes exacerbate someone’s symptoms overtime causing undesirable effects.2-6

It is well documented that long-term use of opioids may cause increased risked for constipation, hormone dysfunction, and memory/affect dysfunction to name a few.7-9 After extreme long-term use, there can actually be a reversal of an opioid’s effect where a patient’s pain actually increases. Such a condition is known as opioid-induced hyperalgesia (OIH).1-12

Opioid Induced Hyperalgesia

The main job of opioids is to block or activate certain receptors in the brain resulting in pain relief. However, in some cases opioids actually have the opposite effect where taking an opioid can increase the pain someone feels. For example, a mild sensation as being patted on the back may feel as extreme pain for someone suffering from (OIH).9, 10 (OIH) will likely cause an increase in the severity of their chronic pain condition; unfortunately they may also begin to feel pain in different parts of their body where there was not pain beforehand.5-7

Studies in humans have discovered that a higher dose of opioids during surgery is associated with greater post-operative pain (i.e. OIH) after those opioids have broken down.2, 3 Unfortunately, (OIH) is not limited only to surgery and can also occur while a person is still taking opioids on a daily basis. Though the occurrence of (OIH) is not well documented, doctors believe it is more prevalent than once thought, and as stated above, is more commonly seen in those patients who are taking a higher dose over a long period of time.5 In one trial, 23 patients were studied who experienced severe pain (8/10 on average) who felt no relief from high doses of opioids. Over the course of weeks, each patient was slowly taken off his or her opioid. The study discovered that these patients’ pain decreased to an average of about 3/10 after stopping their opioids, with 21 of the 23 patients experiencing reduced pain.8 Doesn’t make sense, right?

Why does opioid induced hyperalgesia occur?

(OIH) occurs as a result of the body adapting to the effects of an opioid. As a result, the central nervous system changes. These changes result in several neural systems, that normally regulates the perception of pain, to become overactive in response to the action of an opioid. The over-activity of these neural systems can block out or even surpass the pain relieving effect of the drug. The increase in pain may perpetuate until the opioid is discontinued.1-3, 6

What can be done for opioid induced hyperalgesia?

Only your provider can determine if you have (OIH), as several other conditions may have similar symptoms. In many cases when a patient is experiencing OIH, reducing or even eliminating opioids can produce a substantial reduction in pain. In other cases, switching to a different opioid may be effective in reversing OIH and restoring pain relief.6, 8

Have you dealt with symptoms of Opioid Induced Hyperalgesia? Let us know!

Tags: hyperalgesia, opioids, chronic pain, pain management, nervous system

References:

  1. Angst, Martin S.; Clark, J David (2006). “Opioid-induced Hyperalgesia”. Anesthesiology. 104 (3): 570–87. doi:1097/00000542-200603000-00025. PMID16508405.
  2. Célèrier, E; Laulin, JP; Corcuff, JB; Le Moal, M; Simonnet, G (2001). “Progressive enhancement of delayed hyperalgesia induced by repeated heroin administration: A sensitization process”. The Journal of Neuroscience. 21 (11): 4074–80. PMID11356895.
  3. Chen, Lucy, et al. “Clinical interpretation of opioid tolerance versus opioid-induced hyperalgesia.” Journal of opioid management 10.6 (2013): 383-393
  4. Chu, Larry F.; Angst, Martin S.; Clark, David (2008). “Opioid-induced Hyperalgesia in Humans”. The Clinical Journal of Pain. 24 (6): 479–96.
  5. Fine PG (2004). “Opioid insights:opioid-induced hyperalgesia and opioid rotation”. J Pain Palliat Care Pharmacother 18 (3): 75–9. doi:10.1080/J354v18n03_08 . PMID 15364634
  6. Lee, SH; Cho, SY; Lee, HG; Choi, JI; Yoon, MH; Kim, WM (2013). “Tramadol induced paradoxical hyperalgesia”. Pain Physician. 16 (1): 41–4.
  7. Mao, Jianren (2002). “Opioid-induced abnormal pain sensitivity: Implications in clinical opioid therapy”. Pain. 100 (3): 213–7.
  8. Mercadante S, Arcuri E (2005). “Hyperalgesia and opioid switching”. Am J Hosp Palliat Care 22 (4): 291–4. doi:10.1177/104990910502200411 . PMID 16082916
  9. Mitra, S. “Opioid-induced hyperalgesia: pathophysiology and clinical implications.” Journal of opioid management 4.3 (2007): 123-130.
  10. Reznikov I. et. al. “Oral opioid administration and hyperalgesia in patients with cancer or chronic nonmalignant pain.” British journal of clinical pharmacology 60.3 (2005): 311-318.
  11. Vella-Brincat J, Macleod AD (2007). “Adverse effects of opioids on the central nervous systems of palliative care patients”. J Pain Palliat Care Pharmacother. 21 (1): 15–25. doi:1080/J354v21n01_05. PMID17430825.
  12. Wilson GR, Reisfield GM (2003). “Morphine hyperalgesia: a case report”. Am J Hosp Palliat Care. 20 (6): 459–61.