5 Ways To Prevent Golfer’s Elbow

What a great time to be in Arizona! With a high of 80° and sunny weather, it is the perfect time for Phoenicians and snowbirds to partake in the wonderful outdoor activities the Valley of the Sun has to offer; one of the more popular activities being golf. There is not a better place than Arizona in the winter to experience the plethora of picturesque and world-renowned courses. Nonetheless, the great weather or game of golf is not immune from injuries. An injury that we see on a regular basis is golfer’s elbow (i.e. medial epicondylitis). Here we would like to discuss what golfer’s elbow is and provide some stretching tips on how you can reduce the injury and pain associated with golfer’s elbow.

What Is Golfer’s Elbow?

To begin describing this type of injury, let’s begin by briefly going over the anatomy. Golfer’s elbow involves a tendon known as the common flexor tendon that connects the flexor forearm muscles to the inner (medial) side of the elbow bone (epicondyle). Constant repetition of bending the wrist, for example, as when holding and swinging a golf club, can lead to inflammation of the medial epicondyle. This repetitive motion and cumulative stress can cause the tendons at the inner side of the elbow to deteriorate. Generally, patients experience symptoms of pain and tenderness at the inner side of the elbow that increases during wrist flexion or grasping motions. The pain may radiate down the forearm and if not treated immediately, further micro-deterioration of the tendons could lead to severe pain, inability to play golf, and even surgery.

5 Ways To Prevent Golfer’s Elbow

Fortunately, there are a number of stretches and exercises that can treat and even prevent golfer’s elbow. We have compiled 3 exercises and 2 stretches that work to strengthen the forearm muscles in the hopes of preventing golfer’s elbow. Try to incorporate these stretches and exercises during your golf season (especially if pain does arise on the inside part of your elbow) as well as during the off-season.

  1. Wrist Curl

Place your forearm on your quadriceps with your palm facing the sky. Next hold a lightweight dumbbell in your hand. Very slowly extend your wrist as far as you can (your fingers will move towards the ground), followed by slowly curling the dumbbell moving towards your body. Your flexor forearm muscles should be completely flexed at this point. Do about 10 repetitions with one arm, and then repeat with the other arm.

  1. Reverse Wrist Curl

Place your forearm on your quadriceps with your palm facing the ground. Next, hold a lightweight dumbbell in your hand and very slowly drop your wrist as far as you can (your fingers will move towards the ground). Then, bring the dumbbell upwards towards the sky by contracting the muscles on the outside of your forearm. Your extensor forearm muscles should be completely extended at this point. Again, do about 10 repetitions with one arm, and then repeat with the other arm.

  1. Hand Grip & Squeeze

Simply take a tennis ball and alternate between squeezing and releasing the ball. Perform this for about 5 minutes at a time for each arm.

  1. Parallel Ulnar Nerve Floss

The ulnar nerve runs along side the medial epicondyle and can become “trapped” by constant inflammation and build-up of scar tissue. This floss (stretch) works to break-up the scar tissue, which may “entrap” the ulnar nerve and decrease inflammation. Start by curling your forearm to your biceps. Point your fingers towards your head where your palm is facing the sky. Your hand should be parallel with your shoulders. Gently take your other hand and place it on the pinky and ring finger of your bent arm. Gently push down on these two fingers while bending your neck in the opposite direction of the bent arm. Remember not to push too hard; aim for a gentle stretch. Hold the stretch for only 5 seconds, repeat 5 times and aim to stretch at least 3 times a day.

  1. Perpendicular Ulnar Nerve Floss

This floss technique is similar to the one above; only differing in the direction of the stretch. Straighten your arm in front of you with your palm facing outward. Have your arm about shoulder level and perpendicular to your shoulder. Again with the opposite hand, gently grab the pinky and ring finger of the straightened arm. Gently pull the two fingers towards you. Hold the position for 30 seconds and repeat 5 times. Aim to stretch at least 3 times a day.

These simple and yet effective exercises will go a long way in preventing serious problems associated with golfer’s elbow. Again, these techniques are all working to strengthen as well as loosen the muscle of your forearm. Although these are simple exercises that can be performed at your convenience, please consult your doctor before doing so. Only your doctor will be able to determine if medial epicondylitis is the cause of your pain and will recommend the best rehabilitation option for you. What stretches or exercises work best in keeping you on top of your golf game? Let us know!

Tags: golfer’s elbow, medial epicondylitis, stretches, exercises, pain management, chronic pain

References:

  1. Bisset L, Beller E, Jull G, et al; Mobilisation with movement and exercise, corticosteroid injection, or wait and see for tennis elbow: randomised trial. BMJ. 2006 Sep 29
  2. Buchbinder R, Johnston RV, Barnsley L, et al; Surgery for lateral elbow pain. Cochrane Database Syst Rev. 2011 Mar 16;(3):CD003525. doi: 10.1002/14651858.CD003525.pub2.
  3. Coombes BK, Bisset L, Vicenzino B; Efficacy and safety of corticosteroid injections and other injections for management of tendinopathy: a systematic review of randomised controlled trials. Lancet. 2010 Nov 20;376(9754):1751-67. doi: 10.1016/S0140-6736(10)61160-9. Epub 2010 Oct 21.
  4. Luk JK, Tsang RC, Leung HB; Lateral epicondylalgia: midlife crisis of a tendon. Hong Kong Med J. 2014 Apr;20(2):145-51. doi: 10.12809/hkmj134110. Epub 2014 Feb 28.
  5. McCreesh K, Lewis J; Continuum model of tendon pathology – where are we now? Int J Exp Pathol. 2013 Aug;94(4):242-7. doi: 10.1111/iep.12029.
  6. Olaussen M, Holmedal O, Lindbaek M, et al; Treating lateral epicondylitis with corticosteroid injections or non-electrotherapeutical physiotherapy: a systematic review. BMJ Open. 2013 Oct 29;3(10):e003564. doi: 10.1136/bmjopen-2013-003564.
  7. Orchard J, Kountouris A; The management of tennis elbow. BMJ. 2011 May 10;342:d2687. doi: 10.1136/bmj.d2687.
  8. Pattanittum P, Turner T, Green S, et al; Non-steroidal anti-inflammatory drugs (NSAIDs) for treating lateral elbow pain in adults. Cochrane Database Syst Rev. 2013 May 31;5:CD003686. doi: 10.1002/14651858.CD003686.pub2.
  9. Petrella RJ, Cogliano A, Decaria J, et al; Management of Tennis Elbow with sodium hyaluronate periarticular injections. Sports Med Arthrosc Rehabil Ther Technol. 2010 Feb 2;2:4. doi:10.1186/1758-2555-2-4.
  10. Shiri R, Viikari-Juntura E; Lateral and medial epicondylitis: role of occupational factors. Best Pract Res Clin Rheumatol. 2011 Feb;25(1):43-57. doi: 10.1016/j.berh.2011.01.013.
  11. van Rijn RM, Huisstede BM, Koes BW, et al; Associations between work-related factors and specific disorders at the elbow: a systematic literature review. Rheumatology (Oxford). 2009 May;48(5):528-36. doi: 10.1093/rheumatology/kep013. Epub 2009 Feb 17.

4 Reasons Why A High-Protein Diet May Reduce Chronic Pain

Introduction

It’s very simple to believe that a plethora of diseases and illness have their own recommended diets. For example, conditions like diabetes, obesity, atherosclerosis, hyperlipidemia all have their own recommended diets and parameters as to what nutritional changes will truncate symptoms of these conditions. In no way are we saying this is a bad thing; in fact, we support associations that disseminate these diets. However, what we do see as not being so common, are diets on how to truncate symptoms of chronic pain. In recent years the clinical/scientific research community has gathered a considerable amount of data that chronic pain, particularly the debilitating, severe form that requires opioid treatment, needs a “chronic pain” diet. Unfortunately, there has yet to be any official recommendation for a diet that may reduce symptoms of chronic pain. This is exactly what we would like to discuss.

It is well documented that the foundational principles of a diet for those suffering from chronic pain is a high-protein–intake diet with minimal amounts of carbohydrates. The goals of a high ratio of protein-to-carbohydrates are to promote weight loss, mental function, energy, and strength. It is also recommended that a dietary supplement (e.g. glucosamine chondroitin) be taken to assist regeneration of tissue and prevent osteopenia and osteoporosis.

Background

Before we jump into this mechanism, we want to stress that the release and action of hormones is similar to a circular mechanism. For example, say you just ate a meal and you have increased the amount of sugar in your response. This signal will alert the pancreas to secrete a hormone known as insulin. The job of this hormone is to readily uptake glucose (sugar) in the blood and stores it in tissues. Normally, insulin is regulated by a negative feedback loop where once the sugar in the blood has dropped to a certain minimum, the pancreas will stop producing insulin to prevent the cardiovascular system from becoming hypoglycemic (low blood sugar). However, in unstable circumstances, insulin production will continue past the minimum point. Over a long period of insulin secretion, as well as combining with other anabolic effects, the body can be induced into a state of hypoglycemia.

Now that we got that out of the way, let’s be quick in giving some background as to why this high protein-to-carbohydrates ratio diet is physiologically and biochemically important for those suffering from chronic pain. Chronic pain no doubt puts quite a bit of stress on the body as well as inducing mental stress. When the body is in a state of stress, the adrenal glands (which sit on top of the kidneys) release a large amount of stressor hormones known as catecholamine and cortisol. Such excessive production of these hormones takes a toll on the body by causing the blood glucose levels to become unstable; levels may vary from hyper-(high) to hypoglycemia (blood sugar). Overtime, with so much overproduction of these hormones, the adrenal glands can become in a state of exhaustion where the net hormone–nutrition effect of uncontrolled pain is poor mental state, deficient protein intake, muscle wasting, weakness, and food intake consisting almost solely of carbohydrates (sugars and starches). Thus do to the nature of carbohydrates, overconsumption may lead to weight gain with an unstable release of insulin.

Nonetheless, pharmaceutical management (typically opioids) also has a profound effect on the hormone–nutrition system, compounding the necessity of a pain diet. Those individuals taking opioids typically prefer sugary foods (opioids can induce a state of hypoglycemia causing a “sugar desire effect” on the opioid receptors) and who often experience weight gain; there have been cases where some people have actually doubled their weight in only a matter of a few years from being on opioids. Therefore, the combination of stress from severe chronic pain and opioid management can cause unhinged glucose metabolism in patients and a potent desire to ingest primarily sugars and starches, with little protein or fat intake.

Why Is Protein So Critical?

It is worth noting that there have been studies that have shown that patients will experience an increased intensity of pain only after a few hours of eating a meal high in carbohydrates. It has been speculated that the increase in pain is caused by a sharp increase in insulin; along with the other two factors mentioned above can leave them in a state of hypoglycemia. Thus a major element of the diet recommended here is stabilization of blood sugars. So let’s now jump into some reasons as to why a high-protein intake diet may lead to the reduction of chronic pain symptoms!

  1. Protein Decreases Inflammation

Research has shown that foods high in protein (e.g. fish, cruciferous vegetables) contain high levels of anti-inflammatory mediators. Such agents promote a decrease in inflammation by reducing free radicals as well as immunological agents that are responsible for an inflammatory response.

  1. Protein Builds Muscle-Cartilage

All protein is simple a varying chain of 20 different amino acids. One of the main amino acids that makes up collagen is a nonpolar-hydrophobic amino acid known as proline. A high-protein diet can provide the body with a proper amount of proline that can be available for collagen regeneration, which is essential for the development of cartilage and intervertebral discs.

  1. Protein Balances The Insulin-To-Glucagon Ratio

Just like insulin, glucagon is secreted from specific cells in the pancreas. However, glucagon does the complete opposite job of insulin. After a long period without eating where blood sugar may be low, glucagon is released to mobilize sugar deposits (glycogen & amylopectin) thus increasing blood glucose levels. Also, glucagon is the only hormone that blocks glucose storage as fat. Eating a diet high in protein and low in carbohydrates will balance the ratio of glucagon-to-insulin. Such a diet may prevent a sharp increase in insulin, which prevents a blood sugar rebound by avoiding a sharp decrease in blood glucose (i.e. hypoglycemia that results in carbohydrate cravings and possible pain flares). A high-protein diet may also avoid excess sugar consumption which decreases the amount of excess glucose that might be stored as fat, thus avoiding weight gain.

  1. Endogenous Pain Relievers Are Protein Derivatives

Back to the amino acids! Again all proteins are composed of 20 variations of amino acids. Proteins a chemically digested beginning in the stomach and ending in the duodenum (first section of the small intestines where most absorption takes place). Three main enzymes: pepsin, secreted by the stomach; trypsin and chymotrypsin, secreted by the pancreas are responsible for breaking down proteins into their varying sorts of amino acids. This is important because out of the twenty amino acids that make up proteins, eight of them are known as essential amino acids (these are isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan, and valine.) that the body cannot make, thus must be supplied through one’s diet. By eating a diet high in protein will ensure adequate levels of these eight amino acids where they can be absorbed into the blood system via the jejunum and ilium of the small intestines to the liver, exocrine/endocrine glands, and brain; providing the body with the “building blocks” of all compounds crucial for pain relief. Such compounds are known as epinephrine/norepinephrine (endorphins), dopamine, serotonin, and γ-aminobutyric acid (GABA). We must stress that it has yet to be identified as to how much protein someone with chronic pain needs to take in order to provide enough amino acid substrate for the production of these pain-controlling compounds.

So What Does The Diet Look Like?

The diet is actually very simple and can be easy to follow. After discussing with your healthcare provider as to how many calories and number of meals you are going to consume in a day, try to make sure that each meal is at least 50% comprised of protein. Also, ensure at most 30% fat and 20% carbohydrates. Try to avoid consuming sugary drinks. For example, juice, milk, regular sodas, and energy drinks are loaded with sugar. These drinks, as well as other high sugary foods, will cause a sharp increase in insulin and could potentially lead to a rebound effect where hypoglycemia may occur. By avoiding these drinks and foods we hope to reduce overall carbohydrate intake thus preventing hypoglycemia and weight gain. Let’s go back go reason #4 real quick. Although it has yet to be identified as to how much protein someone with chronic pain needs to take in order to provide enough amino acid substrate for the production of these pain-controlling compounds, given the other three reasons, as well as the chemical composition of these compounds, it is safe to say that 1 gram of protein per body weight is sufficient enough to provide adequate levels of amino acids. With that being said, please consult your doctor as to how much protein you should be consuming daily. Also we know that this number may sound high where historically “high protein as been known to cause liver/kidney failure”. But such a claim has been proven to be false or severely exaggerated. Always make sure to drink plenty of water with and between each meal. If you would like to discuss a diet specific for you, please come see us! Please call our office at (480) 222- PAIN (7246) to make an appointment.

Tags: diet, protein, carbohydrates, chronic pain, pain management, inflammation

 

References: 

  1. Cooper C, Atkinson EJ, Hensrud DD et al. Dietary protein intake and bone mass in women. Calcif Tissue Int 1996;58:320-325.
  2. Dawson-Hughes B, Harris SS, Rasmussen H et al. Effect of dietary protein supplements on calcium excretion in healthy older men and women. J Clin Endocrinol Metab 2004;89:1169-73.
  3. Geinoz G, Rapin CH, Rizzoli R et al. Relationship between bone mineral density and dietary intakes in the elderly. Osteoporos Int 1993;3:242-8.
  4. Ginty F. Dietary protein and bone health. Proc Nutr Soc 2003;62:867-76.
  5. Hill AJ, Blundell JE. Composition of the action of macronutrients on the expression of appetite in lean and obese human subjects. Ann N Y Acad Sci. 1990;580:529-31
  6. Hu FB, Stampfer MJ, Manson JA et al. Dietary protein and risk of ischemic heart disease in women. Am J Clin Nutr 1999;70:221-227.
  7. Kerstetter JE, Svastislee C, Caseria D et al. A threshold for low-protein-diet-induced elevations in parathyroid hormone. Am J Clin Nutr 2000;72:168-173.
  8. Klahr S, Levey AS, Beck GJ et al. The effects of dietary protein restriction and blood-pressure control on the progression of chronic renal failure. N Engl J Med 1994;330:877-884.
  9. Layman DK. Protein Quantity and Quality at Levels above the RDA Improves Adult Weight Loss. J Am Coll Nutr. 2004 Dec;23(6 Suppl):631S-6S.
  10. Layman DK, Baum JI. Dietary protein impact on glycemic control during weight loss. J Nutr. 2004 Apr;134(4):968S-73S.
  11. Layman DK, Boileau RA, Erickson DJ, Painter JE, Shiue H, Sather C, Christou DD. A reduced ratio of dietary carbohydrate to protein improves body composition and blood lipid profiles during weight loss in adult women. J Nutr. 2003 Feb;133(2):411-7.
  12. Mendellhall C, Moritz T, Roselle GA et al. A study of oral nutrition support with oxadrolone in malnourished patients with alcoholic hepatitis: results of a Department of Veterans Affairs Cooperative Study. Hepatology 1993;17:564-576.
  13. Mohanty P, Ghanim H, Hamouda W et al. Both lipid and protein intake stimulates increased generation of reactive oxygen species by polymorphonuclear leukocytes and mononuclear cells. Am J Clin Nutr 2002;75:767-772.
  14. Navder KP, Lieber CS. Nutrition and alcoholism. In: Bronner, F. ed. Nutritional Aspects and Clinical Management of ChronicDisorders and Diseases. Boca Raton, FL: CRC Press, 2003, pp. 307-320.
  15. Poortmans JR, Dellalieux O. Do regular high-protein diets have potential health risks on kidney function in athletes? Int J Sports Nutr 2000;10:28-38.
  16. Stubbs RJ, van Wyk MC, Johnstone AM, Barbron CG. Breakfasts high in protein, fat or carbohydrate: effect on within-day appetite and energy balance. Eur J Clin Nutr 1996;50:409-17
  17. Suzuki K, Kato A, Iwai M. Branched-chain amino acid treatment in patients with liver cirrhosis. Hepatol Res. 2004 Dec;30S:25-29.
  18. Walser M. Effects of protein intake on renal function and on the development of renal disease. In: The Role of Protein and Amino Acids in Sustaining and Enhancing Performance. Committee on Military Nutrition Research, Institute of Medicine. Washington, DC: National Academies Press, 1999, pp. 137-154.

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

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.