When Immunity Works Against Us: Lupus

Introduction

Our immune system is a very tenacious system. Our bodies are confronted with hundreds if not thousands of microbes a day. The reason why we are not constantly plagued with illness is because our immune system combats these microbes with a vigilant effort without us even realizing it. Picture your immune system as the “warriors” and “defenders” of your body and overall health. Our body’s defense cells have naturally evolved into perfect machines for fighting off the majority of foreign microbes that we may encounter in a given day. Under normal circumstances, your immune system’s “defenders” are known as proteins called antibodies. These antibodies are specific to each microbe where their job is to identify and kill any foreign threat. Now imagine if your immune system’s antibodies began to attack your body’s healthy tissues and cells. Your immune system can no longer distinguish between a foreign invader and a normal cell. Consequently, antibodies would have the same killing effect on normal and healthy cells as it would on foreign microbes. Your immune system, the defender of your body, has for lack of better words turned into the worst Benedict Arnold and now threatens your own vitality.

Unfortunately, it is very common when the bodies’ own immune system begins to attack normal cells. These types of conditions are term autoimmune diseases (“auto” meaning “self”) and can display a plethora of symptomologies. A common, but a disease that is difficult to detect is a disease known as lupus.

Defining Lupus

The U.S. National Library of Medicine defines lupus as an autoimmune disease that can damage almost any part of the human body specifically skin, joints, and/or organs. Due to the nature of this disease, it is frequently defined as a chronic disease due to signs and symptoms lasting for six week and longer. In lupus, the immune system produces autoantibodies that attack the healthy parts of the body resulting in severe damage and inflammation. It is a disease that is marked by cycles of “flare-ups” followed by periods of remission. The reason lupus can be difficult to detect is because it displays many symptoms that mimic other disease-states. Lupus is a very serious condition; however, it is well known that lupus is not a universally fatal disease and with proper medical care, it is still very possible to live a complete, and happy life.

According to the Lupus Foundation of America it is estimated that 1.5 million Americans, and at least 5 million people worldwide have a form of lupus; systemic lupus being the most common type (more on this later). Even though lupus can threaten men and women, 90% of individuals diagnosed with the lupus are women. Most people will develop lupus between the ages of 15-44. It is also more frequently diagnosed in African-American, Hispanic, and Asian decent. Given that there are many forms of lupus and each one in a given person can present differently, it is very difficult for doctors to produce an exhaustive list of symptoms. However, doctors have been able to observe a couple conventional symptoms that are associated with the majority of cases, including:

  • Chest pain upon deep breathing
  • Butterfly-shaped red rashes, most commonly on the face
  • Extreme fatigue
  • Mouth ulcers
  • Painful or swollen joints and muscle pain
  • Unexplained fever
  • Hair loss
  • Pale or purple fingers or toes from cold or stress (Raynaud’s phenomenon)
  • Sensitivity to the sun
  • Swelling in legs or around eyes
  • Swollen glands

Several Kinds of Lupus

According to the John Hopkins Lupus Center, there are five main types of lupus:

  • Systemic Lupus Erythematosus (SLE). As mentioned above, this is the most common type of lupus with 70% of cases being of this type. Systemic simply put means that the disease can affect many parts of the body. Symptoms of (SLE) can range from mild severe where chronic inflammation presents itself in the skin, kidneys, and joints. This form of lupus can also have serious effects on the lungs, nervous system, and heart.
  • Discoid Lupus Erythematosus. This kind of lupus only affects the skin. Symptoms observed are large, red, and raised rashes that appear on the face, scalp, or elsewhere. These rashes are scaly but are not itchy and may last for a couple of days to years. A small number of cases of (DLE) may develop into (SLE).
  • Subacute Cutaneous Lupus Erythematosus. This kind of lupus is caused by a high sensitivity to the sun where large, red, raised rashes appear on parts of the body exposed to sun. The lesions typically do not cause scarring.
  • Drug-Induced Lupus Erythematosus. This kind of lupus is caused by medications. Many classes of medications can cause this type of lupus. Some better known classes are: oral contraceptives, blood pressure medications, thyroid medications, antiseizure medications, antibiotics, and antifungals. Symptoms are similar to those of (SLE) and typically go away after the drug is discontinued.
  • Neonatal Lupus Erythematosus. This is a form of lupus that affects babies of women who carry certain antibodies. Doctors suspect that neonatal lupus is caused in part by autoantibodies in the mother’s own blood. At birth, the child may have a skin rash, liver problems, and low blood counts. These symptoms gradually go away over several months. In rare instances, babies with neonatal lupus may have congenital heart block. Only 40% of women who give birth to children with neonatal lupus actually have lupus themselves; on the contrary, neonatal lupus is rare, and most infants of mothers with (SLE) are entirely healthy.

Understanding the Cause of Lupus

Lupus is a very complex disease and the direct cause is not fully understood. Researchers are beginning to understand that genetics and the environment play a significant role in developing lupus; but more is still to be discovered. Scientists believe there is no single gene that predisposes someone to lupus but rather a number of different genes that may be involved in determining someone’s chances of developing lupus. Hopefully, in the near future researchers will have completely identified the genes involved, which could eventually lead to better ways to treat and perhaps even prevent lupus.

Diagnosing Lupus

As mentioned above, it can be very difficult to diagnose lupus. It may take months to even years for your medical team to accurately diagnose you with lupus. Because of the transient symptoms of lupus, your doctor will conduct a thorough medical exam as well as have complete knowledge of your medical history. These two components, along with laboratory tests will give your physician a more clear understanding as to if you truly have lupus or a disease-state that is mimicking the symptoms of lupus.

There is not one test alone that can determine if someone has lupus. Usually your doctor will order several laboratory tests to rule in or out lupus. The most useful tests identify certain autoantibodies often present in the blood of people with lupus. For example, the antinuclear antibody (ANA) test is commonly used to look for autoantibodies that react against the nucleus of a normal and healthy cell. Most people with lupus test positive for ANA; however, there are a number of other causes of a positive ANA besides lupus, including infections and other autoimmune diseases. In addition, some doctors may order a blood test to identify specific antibodies that are frequently observed in people with lupus, although not all people with lupus test positive for these and not all people with these antibodies have lupus. A medical exam, history, laboratory tests, and even certain biopsies will give your doctor a complete picture to determine if a person has lupus.

Treating Lupus

Thanks to the advances in medicine, there is not a wide range of effective treatments for treating lupus. Given that lupus is such a varying disorder, the symptoms, age, sex, and lifestyle will all contribute to what your doctor decides is the best plan for you. Physicians use a wide spectrum of medications throughout the lifetime of the patient when combating lupus. Some patients have found relief from the following options when treating lupus:

  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
  • Antimalarials
  • BLyS-specific inhibitors
  • Corticosteroids
  • Immunosuppressives

Your physician has several goals in mind when developing a tailored treatment plan. Some goals include: treat and prevent flares ups, reduce inflammation, minimize organ damage, and stabilize other symptoms such as fatigue and joint pain. Making a correct diagnosis of lupus is going to require great communication between you and your physician. Be honest and upfront with your physician as to what is or is not working within your treatment plan. Staying in regular contact with your physician about new symptoms and your treatment plan will lead a much more fulfilled and happier life when having to live with lupus.

How long have you suffered from lupus and what has helped you persevere? Please let us know!

Tags: Systemic Lupus Erythematosus, lupus, butterfly rash, autoimmune disorder, immune system, pain management, chronic pain

References:

  1. Danchenko, N.; Satia, J.A.; Anthony, M.S. (2006). “Epidemiology of systemic lupus erythematosus: a comparison of worldwide disease burden”. Lupus. 15 (5): 308–318.
  2. Giannouli, S (1 February 2006). “Anaemia in systemic lupus erythematosus: from pathophysiology to clinical assessment”. Annals of the Rheumatic Diseases. 65 (2): 144–148. doi:10.1136/ard.2005.041673. PMC 1798007. PMID 16079164.
  3. Hughes GR (1998). “Is it lupus? The St. Thomas’ Hospital “alternative” criteria”. Exp. Rheumatol. 16 (3): 250–2. PMID 9631744.
  4. Tebbe, B; Orfanos, CE (1997). “Epidemiology and socioeconomic impact of skin disease in lupus erythematosus”. Lupus. 6 (2): 96–104. doi:10.1177/096120339700600204
  5. Weinstein, A; Bordwell, B; Stone, B; Tibbetts, C; Rothfield, NF (February 1983). “Antibodies to native DNA and serum complement (C3) levels. Application to diagnosis and classification of systemic lupus erythematosus.”. The American Journal of Medicine. 74 (2): 206–16. doi:10.1016/0002-9343(83)90613-7. PMID 6600582.

Tips On How Your Diet Can Reduce Chronic Inflammation

Introduction

We have all heard the adage “food is medicine,” but there is more evidence to that saying than we give credit to, especially if you suffer from chronic pain symptoms. The caveat is that diet alone is not the most effective way to reduce inflammation. A combination of diet, exercises, and stress control are what make up an effective pain management regimen (we will get more into this in a bit). For now, understand that, unlike fad diets that have their own set of rigid rules and regulations, a diet that reduces inflammation isn’t even really a diet at all. It is more of a lifestyle, or rather an improvement to your overall eating habits. So even though we will use the word diet throughout this article, do your best not to associate it with self-deprecating regimens that fitness gurus preach.

There is strong evidence that diets high in inflammatory foods (e.g. vegan and Mediterranean diets) have been shown to greatly reduce pain symptoms associated with chronic illnesses; for example fibromyalgia, arthritis, and diabetic neuropathy. Thus we would like to give you a quick overview as to what inflammation is as well as provide a few tips that have been shown to reduce a prolonged, or rather abnormal inflammatory response.

What Is Inflammation & How Can A Diet Reduce Inflammation?

Inflammation is a biological response that our body’s produce as a protective measure against pathogens, irritants, or damaged cells. The goal of an inflammatory response is to eliminate the cause of the damage, initiate cell repair, and remove the immune system’s mediators responsible for the initial inflammatory response. Most everyone is familiar with the symptoms of inflammation. Symptoms can range from swelling, tenderness, redness, and mild pain. However, when circumstances become abnormal, as in many chronic illnesses, the body’s immune response does not return to normal and an inflammatory response can be exacerbated where severe pain and chronic conditions are triggered. For example, congestive heart failure or atherosclerosis can be caused by high cholesterol, diabetic neuropathy can be caused by hyperglycemia, and rheumatoid arthritis can be caused by autoimmune attacks. All of these examples have in common an abnormal situation that produced severe inflammation, ironically causing more damage to the tissue.

When Drugs Alone Don’t Work

There is a broad range of treatments that can treat chronic diseases, from pharmaceuticals to homeopathic alternatives. However, both of those examples just mentioned do not work for everyone, and they too have their fair share of side effects. Along that spectrum is a treatment that may not only reduce the symptoms associated with chronic pain; it is also one of the more organically natural approaches available. That approach would be an anti-inflammatory diet. An anti-inflammatory diet takes on both aspects of a vegan and a Mediterranean diet where these foods work by reducing cholesterol, blood sugar levels, insulin levels, cortisol levels, and other irritants that can lead to chronic inflammation.

Tips For Reducing Inflammation

As we mentioned above, although this is termed an anti-inflammatory diet, the tips below are easy changes to add to your daily regimen; thus do not look at these tips as rules; look at them as a lifestyle change. Do your best to implement some, if not all of these tips after you have consulted with your healthcare provider:

Reduce Red Meat: Red meat is high in saturated fat as well as some traces of trans fats. Both of these fats trigger fat tissue inflammation, which is not only an indicator for heart disease but it also worsens arthritis inflammation. Try to eat plant-based, chicken, or fish as your main dish. Certain types of fish are packed with inflammation-fighting omega-3 fatty acids so try to add in fish a couple times a week.

Cut Out The Sugar: The American Journal of Clinical Nutrition warns that processed sugars trigger the release of inflammatory molecules known as cytokines. Thus it would be wise to cut sugar out of your lifestyle.

Reduce The Refined Carbohydrates: White flour products (breads, rolls, crackers) white rice, white potatoes (instant mashed potatoes, French fries) and many cereals are all known to be refined carbohydrates. A study done by the Scientific American, found that processed carbohydrates are more readily used over fats as the main cause of obesity and other chronic conditions. To keep things short, refined carbohydrates have been shown to directly stimulate inflammation. Opt for whole grains, including barley, buckwheat, oats, quinoa, brown rice, rye, spelt and wheat.

Eat Specific Types of Fruits: Cherries, berries, watermelon, and grapes each have their own level of antioxidants; for example, ascorbic acid (vitamin C), anthocyanins and carotenoids. These antioxidants help rid the body of free radicals that promote inflammation. These fruits high in antioxidants have also been shown to help prevent heart disease and certain cancers as well. Try your best to add a couple of servings of these fruits into your day.

Eat The Right Kinds of Vegetables: Consume eight to nine servings of vegetables each day — make a couple of those servings fruit, if you like. The best vegetables that promote anti-inflammation are cruciferous vegetables (such as broccoli, brussels sprouts, cabbage, and cauliflower), soybeans, bell peppers, carrots, onions, and sweet potatoes for they are all high in vitamins and antioxidants that are responsible for eliminating free radicals; a major pro-inflammatory irritant.

We must stress how important it is to consult your doctor before implementing any of the above tips into your daily meal plan. Your healthcare provider can help you pick and choose which anti-inflammatory foods will work best for you. We hope this quick overview of what inflammation is and how diet can reverse its effects will be beneficial for you. It is worth noting specific foods can promote or shut down the inflammatory cycle. For instance, simple carbohydrates promote it, while vegetables shut it down. So remember although there are no magic foods, putting the right combination of foods into your daily lifestyle can produce remarkable results.

What foods are included in your anti-inflammation diet? Please let us know!

Tags: chronic inflammation, chronic pain, dairy, fibromyalgia, fruits and vegetables, healthy diet, inflammation, joint pain, Mediterranean diet, red meat, whole grains

References:

  1. Esposito K, Chiodini P, Maiorino MI, Bellastella G, Panagiotakos D, Giugliano D. Which diet for prevention of type 2 diabetes? A meta-analysis of prospective studies. Endocrine 2014;47:107–116
  2. Esposito K, Maiorino MI, Petrizzo M, Bellastella G, Giugliano D. The effects of a Mediterranean diet on the need for diabetes drugs and remission of newly diagnosed type 2 diabetes: follow-up of a randomized trial. Diabetes Care 2014;37:1824–1830
  3. Estruch R, Ros E, Salas-Salvadó J, et al.; PREDIMED Study Investigators. Primary prevention of cardiovascular disease with a Mediterranean diet. N Engl J Med 2013;368:1279–1290
  4. Li S, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA 2009;302:179–188
  5. Wang X, Bao W, Liu J, et al. Inflammatory markers and risk of type 2 diabetes: a systematic review and meta-analysis. Diabetes Care 2013;36:166–175

How To Classify Your Pain

Did you know that over 1.5 billion people worldwide suffer from chronic pain and roughly 100 million Americans deal with chronic pain on a daily basis? Did you know chronic pain costs society at least $560-$635 billion annually, an amount equal to about $2,000.00 for everyone living in the U.S.? Did you also know that chronic pain is a general, “non-descriptive” term used for a plethora of conditions? We would have to admit that such a generalized and universal phrase that affects such an astounding number of people and at such astronomical costs needs more clarification. That is why we would like to get more specific and talk about what chronic pain entails and how we can be more specific when identifying a chronic pain condition. Such understanding would certainly bring more awareness to each condition in the hopes of truncating the number of sufferers and associated costs.

Let’s begin by classifying pain as either acute pain or chronic pain.

Acute Pain

Acute pain is a quick and sudden onset of pain. It can range from being mild to extremely severe. Typically acute pain is identified as any pain that lasts less than six months. A vital identifier of acute pain is that it is associated with an identifiable cause; for example, a bacterial or viral infection, an injury, or a cut to the skin. Acute pain is typically well treated where the pain gradually resolves at the injury begins to heal. It is worth noting that untreated or improperly healing injuries may cause acute pain to develop into chronic pain.

Chronic Pain

Chronic pain is a little bit more complex to categorize. The simplest determination of chronic pain is pain that lasts longer than 6 months (again, from improper healing from an acute pain injury or from other causes we will get into) and just like acute pain, can range from mild to extremely intense pain. Now it gets a little tricky. Chronic pain should more appropriately be identified as [persistent pain].

2 Types of Intensities of Chronic Pain

Nonetheless, since chronic pain is a more acceptable term, we will use it for the remainder of this article. Chronic pain based off its duration of intensity can be broken down into:

  • Recurrent pain. This can be thought of as a short-lived increase in pain, especially for someone who has relatively stable and controlled level of baseline pain. It may be caused by changes in an underlying disease, withdrawal symptoms from a medication, emotions such as stress & anxiety, involuntary physical actions such as angina, or voluntary physical actions such as getting out of bed.
  • Continuous pain. Continuous pain is any condition that causes pain that is typically present for at least half the day.

Subclasses of Chronic Pain

In either case of recurrent or continuous, chronic pain is characterized by the underlying pathophysiology as being:

  1. Nociceptive pain. This type of pain is caused by harmful stimuli anywhere on the body that then travels along nerve fibers via the spinal cord to the brain. The various types of nociception are proprioception, thermoception, and chemoception; but in simpler terms, damaging mechanical, thermal, or chemical stimuli are sensed by pain receptors (i.e. nociceptors) which are found internal organs & surfaces, joints, and skin. Some common conditions causing nociceptive pain are internal organ referred pain, arthritis, myofascial pain, bone fractures, and chemical burns to name a few. You would be correct that some of these examples seem to be injuries causing acute pain but remember, improper healing injuries may develop into nociceptive pain.
  2. Neuropathic pain. This type of pain caused by disease or damage to the brain, spinal cord, or peripheral nerves. Neuropathic pain is typically caused by an injury to the spinal cord with there being a few exceptions such as diabetic neuropathy and other metabolic diseases. Common conditions causing neuropathic pain are cancer, carpal tunnel syndrome, multiple sclerosis, Parkinson’s disease, tumors, toxins, HIV-related symptoms, immunological disorders, or direct trauma to the brain or spinal cord. Symptoms are often described as being numbness, burning, or pin-and-needles sensations. Again, the pain could be recurrent or continuous.

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  1. A mixture of nociceptive and neuropathic pain. Migraine headaches are an excellent example of a mixed chronic pain condition.
  2. From an undetermined cause. This can also be known as psychogenic pain where there is no visible sign of damage or past injury that is causing the pain. A couple good examples of conditions that cause pain are fibromyalgia and in some cases myofascial conditions such ad complex regional pain syndrome.

Each Pain Type Has A Specific Treatment

As we mentioned above, from a doctor or patient’s perspective, it is very difficult to treat “acute” or “chronic” pain. However, by knowing the type of pain it will be much easier and more efficient in communicating with your healthcare provider your symptoms. Injuries causing acute pain can be treated with antibiotics, braces or casts, stitches, and prescribed or over-the-counter medications to name a few. Chronic pain types are generally treated with physical therapy, holistic approaches, and a very strategic and specific drug regimen. For example, in some cases opioids are more effective in treating nociceptive pain over neuropathic pain. Various interventional procedures may also be used for different forms of chronic pain.

The Bottom Line

So what is the benefit of knowing all this information? It provides us with the understanding of how to best treat each pain type in the hopes of improving someone’s quality of life, well-being, and overall level of function Please consult your healthcare provider if you are experiencing any level of pain for he or she will tailor a regimen that will give you the most pain relief. Nonetheless, by being equipped with this knowledge as a patient, you will be able to be more efficient in identifying different types of pain allowing you to control your symptoms better.

Think you can identify what type of pain you’re having? Come and talk to us for more information on how to treat your specific pain-type.

Tags: neuropathic pain, nociceptive pain, chronic pain, acute pain, pain management

References:

  1. Fishbain, David A.; Cole, Brandly; Cutler, R. Brian; Lewis, J.; Rosomoff, Hubert L.; Rosomoff, R. Steele (1 November 2006). “Chronic Pain and the Measurement of Personality: Do States Influence Traits?”. Pain Medicine. 7 (6): 509–529.
  2. Foley P, Vesterinen H, Laird B, et al. (2013). “Prevalence and natural history of pain in adults with multiple sclerosis: Systematic review and meta-analysis”. Pain. 154 (5): 632–42.
  3. Grichnik KP, Ferrante FM. The Difference Between Acute and Chronic Pain. Mt Sinai J Med. 1991 May;58(3):217-20.
  4. Hansson P (1998). Nociceptive and neurogenic pain. Pharmacia & Upjon AB. pp. 52–63.
  5. Institute of Medicine Report from the Committee on Advancing Pain Research, Care, and Education: Relieving Pain in America, A Blueprint for Transforming Prevention, Care, Education and Research. The National Academies Press, 2011.
  6. Portenoy RK (1989). “Painful polyneuropathy”. Neurol Clin. 7 (2): 265–88.
  7. Rusanescu G, Mao J (2014). “Notch3 is necessary for neuronal differentiation and maturation in the adult spinal cord”. J Cell Mol Med. 18 (10): 2003–16.
  8. Vadivelu N, Sinatra R (2005). “Recent advances in elucidating pain mechanisms”. Current Opinion in Anesthesiology. 18 (5): 540–7.
  9. Vaillancourt PD, Langevin HM (1999). “Painful peripheral neuropathies”. Clin. North Am. 83 (3): 627–42

10 Awesome Methods for Treating Low Back Pain

Back pain is one of the most widespread pain conditions in the U.S, with approximately 80-90% of the population experiencing it at some point in their life. If you have experienced lower back pain, you can speak for others in saying that it can be a very debilitating condition to live with. Fortunately, there are many different treatments for low back pain. However, we cannot stress how important it is to get an appropriate diagnosis as to what is causing your back pain. It could be as simple as an impinged nerve or something more severe that may require more serious treatment, such as surgery. For those who have a non-serious diagnosis, and your back pain is mild-to-moderate, we have compiled a list of 10 tips that may help in reducing your back pain.

1. Low-Inflammation Diet

The majority of cases of low back pain may be caused by inflammation or impingement of the nerve roots exiting the spine. Thus eliminating inflammatory foods from your diet can be a great way to help control pain. Gluten, dairy, and sugar are common inflammatory foods. The good news is that there are all kinds of options to make these changes easier. There are also many delicious anti-inflammatory foods to add to your diet; for example, fish high in omega-3 fatty acids, cherries, ginger, almonds, and turmeric.

2. Weight loss

This also fits with tip number 1. The lower back is in some sense a weight bearing aspect of our bodies. Thus the heavier we are, the more weight we are going to be placing on our lower backs. This can lead to further impingement of nerves or even arthritis later down the road. Also, for those who have gained weight and are carrying it mostly in their belly, the lumbar curve can become overly pronounced (i.e. lordosis), placing extra strain on the lumbar vertebrae that results in low back pain. Losing weight and adding muscle to the core can decrease this strain and help support the spine

3. Exercise

In many cases, low back pain may be caused by inadequate use of the muscles in the body, and the key treatment to start with is exercise. Low impact exercise like walking is a great place to start, and swimming, a low impact exercise that utilizes the whole body, is even better. Talk to your doctor then start your new exercise plan slowly, adding length to the workout or intensity as you build strength.

4. Physical Therapy

Often used in conjunction with other methods of pain relief, physical therapy can be a great way to learn proper and appropriate rehabilitation techniques for low back pain. Exercise is great, but many people with good intentions hit the gym and use equipment improperly, causing further injury. A physical therapist can work in conjunction with your doctor to help design a specific program that teaches proper form to get the most benefits.

5. Prescription Medications

While we do not recommend prescription medication for long-term chronic pain, some prescription medications can be very effective in treating short-term, acute back pain. Opioids have a controversial history that includes an increase in the rates of dependence and a decrease in effectiveness, but in some specific cases they may help offer short-term relief of low back pain.

6. Over-The-Counter Medications

Sometimes all your low back needs is a mild anti-inflammatory over-the-counter drug like ibuprofen to provide you with the relief you are looking for. Again, these medications have their share of risks, especially when used for long-term pain conditions. A major side effect of non-steroidal anti-inflammatory drugs (NSAID’s) is their prevalence of causing gastrointestinal bleeding. Nonetheless, for an acute injury or in the case of a minor back strain, NSAIDs and analgesic may be a safe, effective treatment.

7. Various Types of Injections

Facet joint injections and medial branch blocks are two minimally invasive surgical procedures that can be used both as a diagnostic tool and as a way to relieve low back pain. In this outpatient treatment, doctors inject a numbing agent either directly into the joint (facet) or into the affected nerve (medial branch). If pain relief is achieved, the treatment is successful and can be repeated up to three times per year. If it is not effective, then the doctor has eliminated a possible cause of pain. Side effects may be minimal and may usually decreased by proper placement of the needle.

8. Massage

Massage is a great way to encourage tight muscles to relax. In the beginning of treatment, patients may only be able to tolerate the lightest of touches. By the end, the massage therapist may be leaning into crunchy places with an elbow, working the kinks out of the deepest tissues in the body.

9. Acupuncture

Acupuncture is an ancient Chinese medical practice that focuses on opening up the energy channels in the body by inserting hair-like needles into specific points in the body. The data concluding that acupuncture is effective in treating chronic pain is mixed, nonetheless many people report pain relief in their lower back pain with few or no side effects.

  1. Biofeedback

Biofeedback training is the process whereby a patient learns to recognize the physical signs of stress in the body brought on by pain. They then learn techniques to help control the stress response, easing the pain and working through it. While this does not necessarily eliminate the physical cause of pain, research has shown that biofeedback training may greatly decrease the sensation of pain in the body. There are no side effects to practicing biofeedback responses, and once the technique is learned the treatment is free.

Lower back pain can be a very debilitating condition to live with. It most certainly can make the simplest tasks a huge burden on your life. Although these 10 tips have been shown to be effective for treating lower back pain, what may work for some, may not work for others. Experiment a little and see what works best for you. Again, please talk to your doctor and get their input as to what they believe is the best regimen for you to implement.

Which treatment options work best for relief of your low back pain? Let us know!

Tags: chronic pain, back pain, diet, weight loss, exercise, physical therapy, massage, acupuncture, pain management

References:

  1. Deshpande A, Furlan AD, Mailis-Gagnon A, Atlas S, Turk D (2007). “Opioids for chronic low-back pain”. Cochrane Database of Systematic Reviews: CD004959.
  2. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ (April 2006). “A Cochrane review of superficial heat or cold for low back pain”. Spine. 31 (9): 998–1006.
  3. Furlan AD, Imamura M, Dryden T, Irvin E (2008). “Massage for low-back pain”. The Cochrane Database of Systematic Reviews (4): CD001929.
  4. Hayden JA, van Tulder MW, Malmivaara A, Koes BW (2005). “Exercise therapy for treatment of non-specific low back pain”. The Cochrane Database of Systematic Reviews (3): CD000335.
  5. Henschke N, Ostelo RW, van Tulder MW, Vlaeyen JW, Morley S, Assendelft WJ, Main CJ (2010). “Behavioural treatment for chronic low-back pain”. The Cochrane Database of Systematic Reviews (7): CD002014.
  6. Heymans MW, van Tulder MW, Esmail R, Bombardier C, Koes BW (2004). “Back schools for non-specific low-back pain”. The Cochrane Database of Systematic Reviews (4): CD000261.
  7. Levin JH (August 2009). “Prospective, double-blind, randomized placebo-controlled trials in interventional spine: what the highest quality literature tells us”. The Spine Journal. 9 (8): 690–703. doi:10.1016/j.spinee.2008.06.447. PMID 18789773.
  8. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, Lappi S, Paloheimo R, Servo C, Vaaranen V (February 1995). “The treatment of acute low back pain—bed rest, exercises, or ordinary activity?”. The New England Journal of Medicine. 332 (6): 351–5.
  9. Roelofs PD, Deyo RA, Koes BW, Scholten RJ, van Tulder MW (2008). “Non-steroidal anti-inflammatory drugs for low back pain”. The Cochrane Database of Systematic Reviews (1): CD000396.
  10. Rupert MP, Lee M, Manchikanti L, Datta S, Cohen SP (2009). “Evaluation of sacroiliac joint interventions: a systematic appraisal of the literature”. Pain Physician. 12 (2): 399–418.
  11. Sarno, John E. (1991). Healing Back Pain: The Mind-Body Connection. Warner Books. ISBN 0-446-39230-8.
  12. Shiri R, Karppinen J, Leino-Arjas P, Solovieva S, Viikari-Juntura E (January 2010). “The association between smoking and low back pain: a meta-analysis”. The American Journal of Medicine. 123 (1): 87.e7–35. doi:10.1016/j.amjmed.2009.05.028. PMID 20102998.
  13. Staal JB, de Bie R, de Vet HC, Hildebrandt J, Nelemans P (2008). “Injection therapy for subacute and chronic low-back pain”. The Cochrane Database of Systematic Reviews (3): CD001824. doi:10.1002/14651858.CD001824.pub3
  14. Van Middelkoop, M; Rubinstein, SM; Kuijpers, T; Verhagen, AP; Ostelo, R; Koes, BW; van Tulder, MW (January 2011). “A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.”. European Spine Journal. 20 (1): 19–39. doi:10.1007/s00586-010-1518-3.
  15. Van Tulder MW, Touray T, Furlan AD, Solway S, Bouter LM (2003). “Muscle relaxants for non-specific low back pain”. The Cochrane Database of Systematic Reviews (2): CD004252.

Most Effective Ways to Treat Trigeminal Neuralgia

Have you ever asked yourself, “Why do I have to have a condition that is so noticeable”? Do you feel embarrassed that your face is going through constant cycles of intense burning and stabbing sensations yet do not know where to start on getting treatment? We understand how you feel, especially how having a chronic illness on such a personal part of your body like your face can be quite debilitating. What we have done is compiled a list of tips that you can use to seek relief from trigeminal neuralgia. What exactly is trigeminal neuralgia? It is a chronic pain illness that affects the muscles that are innervated by the 5th cranial nerve, also known as the trigeminal nerve. Some common symptoms of trigeminal neuralgia are sharp stabbing, aching, and burning pain throughout different regions of the face. So, if you think you are suffering from the symptoms we just described, the tips below may help alleviate some of your pain.

Keep in mind, that consulting your physician is always a great option when trying to get an accurate diagnosis and trying to determine what might be of help for you. Once your doctor has completed a medical history and a physical exam; they may prescribe some medications that treat trigeminal neuralgia.

Relief Through Medications

Below is a list of most commonly prescribed medications for trigeminal neuralgia:

  1. Antispasmodic Agents. Antispasmodic agents are used to ease pain sensations caused by trigeminal neuralgia attacks. These agents may also be used in conjunction with anticonvulsant medications.
  2. Anticonvulsant Medications. Anticonvulsant medications are one of the most commonly prescribed medications for this condition. Your doctor may prescribe one or more anticonvulsants until he or she determines which medication is the most beneficial in reducing your pain symptoms.
  3. Botox injections. If you become unresponsive to anticonvulsants, tricyclic antidepressants, and antispasmodic drugs, your doctor may consider putting you on a regimen of Botox. Botox has been shown to be effective for pain management in a high percentage of patients with trigeminal neuralgia, especially those with rapid muscle twitching.
  4. Nonsteroidal Anti-Inflammatory Drugs (NSAID’s) & Analgesics. NSAID’s and analgesics can be purchased without a prescription and are very efficient in reducing the inflammation and pain associated with trigeminal neuralgia. Your doctor may recommend an anticonvulsant medication before starting a NSAID or analgesic because these may not be as effective at blocking the electrical signals from the misfiring neurons that are causing the sensations of pain. Also, be sure to talk to your doctor before beginning a NSAID or analgesic for they do pose a risk for developing ulcers.
  5. Tricyclic Antidepressants (TCA’s). Tricyclic antidepressants are commonly used to manage symptoms of depression, but they can also be prescribed to manage chronic pain. Tricyclic antidepressants are often effective in managing chronic pain conditions, such as atypical facial pain, but may not be useful in classical trigeminal neuralgia.

Pain Relief Through Medical Procedures

Although medications may be helpful for stabilizing symptoms over time, more aggressive cases of trigeminal neuralgia can lead to permanent damage of the trigeminal nerve. Such damage could result in severe pain or partial permanent facial numbness. If you do not respond well to medications, more complex procedures may be a viable option. The degree of severity of your trigeminal neuralgia, prior history of neuropathy, and general health all factor into the options that are available to you. You doctor can help make treatment determinations. The overall goal of these procedures is to minimize damage to the trigeminal nerve as well as to improve the quality of life when medications no longer useful in managing pain.

  1. Balloon Compression. This type of procedure has been shown to provide up to two years of pain relief, which is great! Also, many patients have mentioned that they experience temporary facial numbness when doing actions such as chewing; but this goes away within a short amount of times after the procedure. How this method works is a small balloon is inserted into the skull through a catheter and as it inflates, the trigeminal nerve is pressed against the head. This is typically an outpatient procedure that is performed under general anesthesia.
  2. Glycerol Injection. This process has been shown to offer 1 to 2 years of pain relief. Glycerol injection is used to “damage” a portion of the trigeminal nerve. Sounds counterintuitive but the damage caused by the glycerol injection results in pain relief. This is typically an outpatient procedure where a thin needle is inserted through the cheek into the base of the skull and near the portion of the trigeminal nerve.
  3. Microvascular Decompression (MVD). This is the most effective surgical treatment for trigeminal neuralgia where about 70-80% of patients have immediate, and complete pain relief and 60-70% remain pain-free for up to 10-20 years. Nonetheless, MVD is also the most invasive surgical procedure for treating trigeminal neuralgia. During surgery, your doctor makes a hole behind the ear. Then, using an endoscope to visualize the trigeminal nerve, your doctor will place a cushion between the nerve and the blood vessel that compresses the nerve. The recovery time for this procedure varies from person to person and often requires a hospital stay.
  4. Neurectomy involves removing a part of the trigeminal nerve. Much like MVD, this too is an invasive procedure and is reserved for patients who do no respond to other treatments. Neurectomies are often performed when a blood vessel is not found pressing on the nerve during an MVD. During the procedure, different portions of the trigeminal nerve’s branches are removed thus allowing pain relief.
  5. Radiofrequency Thermal Lesioning. Radiofrequency thermal lesioning (or RF ablation) has been shown to offer pain relief up to 3 to 4 years following the procedure in about half of patients. RF Ablation is an outpatient procedure where a needle with an electrode is inserted into the trigeminal nerve. Once the area of the nerve that causes the pain is located, your doctor sends small electrical pulses through the electrode to damage the nerve fibers, resulting in numbing of the site.
  6. Stereotactic Radiosurgery (or Gamma Knife). Most patients who undergo gamma knife report pain relief after a few weeks or months, but pain often reoccurs within three years. This procedure uses computer imaging to send focused radiation to the trigeminal nerve. During the procedure, the radiation creates a laceration of the trigeminal nerve, which disturbs sensory signals to the brain and reduces pain. A gamma knife procedure is typically an outpatient procedure where patients can leave the same day.

Pain Relief Through Holistic Approaches

More and more doctors and patients are looking towards more conservative and noninvasive approaches for treating pain condition, trigeminal neuralgia included. Although the data in these approaches is mixed, you and your doctor can decide if you would benefit from one of them. Always make your doctor aware if you do consider trying one of these approaches.

  1. Acupuncture is a traditional Chinese medical technique that involves inserting small needles into specific points throughout the body for pain relief. A recent study in the journal Medical Acupuncture demonstrated a significant beneficial effect when acupuncture treatments were administered to patients who were suffering from trigeminal neuralgia. Thus this would be a good option for anyone looking for a more “holistic” approach to pain relief.
  2. Chinese Herbs. Several Chinese herbs provide pain relief for those suffering from trigeminal neuralgia. Such herbs are available from Chinese medicine practitioners and acupuncturists who include herbal medicine in their practices. They are also sold at herbal shops selling traditional Chinese medicines. They can guide you as to what combinations are most suited for offering pain relief for trigeminal neuralgia. However, please talk to your healthcare provider before beginning a regimen of any herbs.
  3. Creams & Ointments. Topical use of capsaicin cream or cayenne pepper for pain relief for trigeminal neuralgia has been shown to be effective. Creams or ointments such as IcyHot can be purchased at almost any pharmacy or grocery store. Alternatively, a pinch of cayenne pepper can be mixed with olive oil or other unscented facial cream and applied to the painful area.

Trigeminal Neuralgia is a very painful and debilitating condition to live with. Fortunately, as you can see, there are some treatments, regardless of what level of pain your case may be at, to treat your symptoms. It is worth noting that many of these approaches can be done concertedly and different methods will work better for some and not for others. With that being said, your healthcare provider is your number one resource for obtaining a therapeutic regimen that works for you.

What methods have been shown to help relieve your symptoms? Let us know!

Tags: trigeminal neuralgia, face pain, medications, medical procedures, holistic, chronic pain, pain management