Articles filed under 'Chronic Pain'
Pain and weakness in the shoulder joint is often described medically as “impingement syndrome. This condition results when tendons of the rotator cuff are pinched as they pass between the top of the upper arm and the tip of the shoulder. A group of four muscles and bones, the rotator cuff, share a common tendon. Tendonitis of the shoulder joint is another frequently used term.
Impingement syndrome of the shoulder joint occurs when muscles and tendons don’t slide easily and normally. Tendons and bursae, fluid-filled sacs that protect the tendons, become irritated and swollen. Typical symptoms of this syndrome are pain, tenderness and the inability to move the shoulder joint fully and normally. An injury or repetitive motions over many years may result in the onset of a cycle of inflammation, swelling, and misery.
Other symptoms can include pain or weakness in raising the arm above your head or away from the side of the body; a grating or catching of muscles when you rotate or raise your arm; and inability to sleep on the affected side due to pain.
Risk factors for impingement syndrome:
* Injuries to the shoulder joint
* Age 50 or older
* Athletes engaging in activities such as tennis, swimming, baseball, and football that involve repetitive movements of arm and shoulder
* Persons who develop bone spurs or rough spots on bone that can irritate surrounding tissue and cause swelling
* Those whose bones are shaped in a manner that allows less space between the joint than the average person
Treating Impingement Syndrome:
Treatments may be as simple as taking aspirin and resting the arm, or it may ultimately involve surgery, depending on the severity of the condition. Some treatments that may be effective in resolving the condition are the following:
* Conservative care: rest the joint and use ice packs for up to 20 minutes at a time, as needed, up to three or four times a day.
* Take anti-inflammatory drugs such as aspirin or ibuprofen.
* Avoid activities that cause pain such as lifting something heavy or stretching to reach past your comfort zone.
* Physical therapy, including exercises or stretching to strengthen, preserve or extend your range of motion; faithfully perform exercises at home.
* Cortisone or steroid injections given if other approaches don’t eliminate the symptoms; some doctors give a cortisone injection early in the syndrome to reduce pain and swelling.
* Surgery, the last resort
Impingement syndrome may take many months or even a couple of years to heal. This is especially true when it is complicated by the frozen shoulder syndrome, where one cannot raise the arm overhead. Patience, your doctor’s guidance, physical therapy, and prescribed home exercises should help to ultimately resolve the condition.
Sources: Cedars-Sinai Medical Web site and personal experience; blog article by Anna Dabney
http://www.cedars-sinai.edu/9837.html
June 11th, 2009
For over 50 years, Darvon or Darvocet has been prescribed to treat pain. Recently, an advisory panel of the Food and Drug Administration (FDA) recommended that the risks and benefits of the drug be re-examined. Problems such as addiction and suicide have been associated with its long-term use.
First approved in 1957, Darvon was one of the few drugs at that time for treating pain. The alternatives were aspirin or powerful narcotics. Today, it continues to be marketed as Darvocet and it is one of the top 25 most commonly prescribed medications. Over 20 million prescriptions of the Darvon/Tylenol combination are written annually.
Dr. Sidney Wolfe, a drug safety expert with Public Citizen, is spearheading the drive to ban Darvon. He first spoke out and proposed a ban against the painkiller in the 1970s. It is Dr. Wolfe’s opinion that Darvocet offers weak pain relief and poses a risk of overdose and potential for use in suicide.
The two companies that market Darvocet say that the medication is safe and effective when used as directed. They argue that physicians need a range of medications for use in treating pain. Some company representatives point out that many other painkillers have become drugs of abuse, and with considerably worse consequences.
A professor of medicine at Harvard and critic of the pharmaceutical industry commended FDA advisers for looking hard at Darvon. His point, that it is not the most dangerous drug in its class, but that doesn’t mean that Darvon is a good drug.
The United Kingdom banned its version of Darvon in 2005. If the FDA decides to take the advisory panel recommendations, it could mandate stiffer warning labels, safety studies, and more efforts to educate doctors and patients about its shortcomings and potential risks.
In the U.S., Davon-related deaths in 2007 rose to 503 from the 446 that occurred the previous year. In both years, about 20 percent of these emergency room visits and deaths were considered suicides. Only about one-third of the U.S. population is tracked in these reported statistics from emergency rooms.
On a personal note: I took Darvocet for chronic pain for many years as prescribed by my physician, and I believe it can become a problem with long-term use. It is, in my opinion, a good drug to ease pain following surgery – especially for those who can’t tolerate a more powerful pain reliever such as Vicodin or Percocet. Chronic pain in itself is a debilitating and depressing condition. Few options are available that have no risks or undesirable side-effects. I eventually tried the strategies urged by Dr. Dean Edell, who recommends that persons taking drugs for chronic pain over long periods try phasing off painkillers. They might find, as I did, that their pain can be managed without them. Sometimes the drug itself can be responsible for recurrent cycles of pain and depression. I have felt much better since gradually phasing off Darvocet.
Source:Â Associated Press story; January 31, 2009; and, personal experience.
Written by Anna Dabney
February 4th, 2009
According to the Center for Health Statistics, deaths from Methadone nationwide are increasing at a faster rate than other deaths related to drug use. The number of Methadone deaths nationwide rose from 786 in 1999 to 4,462, a nearly six-fold increase. As a comparison, fatal cocaine overdoes rose 63 percent.
Most cocaine users realize they are dealing with a drug with potentially lethal consequences. In contrast, Methadone is not widely perceived as being especially hazardous. Substance abusers are often given Methadone as a heroin substitute, but generally under tight controls. In addition, chronic pain clinics are increasingly prescribing Methadone for pain relief. Because methadone is slow-acting and patients seek immediate relief, they may take a pill or more than the prescribed dose. Methadone does not give a high and is sometimes dangerously combined with other drugs or alcohol.
Some chronic pain patients obtain multiple prescriptions for Methadone from different medical providers. These prescriptions are difficult to track. Other persons get their prescriptions illegally from friends or buy them from individuals. Those who take Methadone without appropriate medical supervision may be unaware of its potential risks. The drug oxycodone, or OxyContin, belongs to the same class of drugs as Methadone. In states such as Vermont, OxyContin is the leading cause of 80 drug-related deaths last year.
For someone with a low tolerance for certain drugs, even low doses of Methadone or OxyContin can be dangerous. While the Northeast is seeing Methadone as the street drug of choice, methamphetamines are the predominant street drugs in other parts of the U.S. Deaths from Methadone are beginning to drop in New England and the Eastern Seaboard where educational campaigns are emphasizing the potential hazards of its use.
Source:Â San Francisco Chronicle; April 18, 2008; Holly Ramer, A.P.
April 20th, 2008
The artificial hip is indeed a medical miracle, but the joint replacement surgery usually lasts only 20 years or so. Each year about 300,000 Americans undergo hip joint replacement surgery. As younger patients avail themselves of this type of hip surgery, the problem of “outliving†the joint replacement must be faced.
Middle-aged or younger people with hips damaged by disease or injury are often cautioned to put the surgery off as long as possible. In the meantime, many are plagued with pain and disability.
Now, an alternative surgical procedure may make the waiting game a thing of the past. Because extracting and replacing a worn-out or defective artificial hip is difficult, more surgeons are turning to hip resurfacing. Surgeons using this procedure preserve enough of the healthy bone to allow for a future total hip implant when benefits of hip resurfacing wear out.
In the past decade, tens of thousand of patients worldwide have undergone hip resurfacing. Many U.S. “medical tourists†had the procedure done overseas, where doctors are experienced in the technique and costs are lower. Popular destinations are Britain, Belgium or India, where costs may be half what they are in the U.S.
Hip resurfacing surgery is no easier for the patient or physician than hip replacement, and the incision is usually larger than with a total joint replacement. Complete healing can take six months or longer. The advantage is that the patient will still be eligible for a total hip replacement using an entirely new artificial joint rather than having a revision of the old one.
Hip resurfacing and total hip replacements both involve implanting a metal cup in the pelvic socket. The difference is mainly the way each procedure treats the top of the femur, the long thigh bone that fits into the socket. In resurfacing, the femur is shaved to a rounded shape and covered with a metal cap, with a spike that is cemented into a small hole drilled into the center of the femur.
With total hip replacement, surgeons saw off the entire head of the femur and replace it with a larger, hemispherical device that is anchored with a much longer spike and driven deeper into the femur. This procedure leaves too little strong bone to allow for follow-up with an entirely new total hip replacement if this joint wears out.
Hip resurfacing is not minor surgery. It requires a highly skilled surgeon, and the operation usually takes a bit longer than the three or four hours of total hip replacement. In addition, patients lose more blood, although transfusions are rarely needed.
With either procedure, problems can occur, but they are unlikely. Complications that are possible with either surgery include infections or fractures. Since hip resurfacing is so new, we are unlikely to know how durable the resurfaced hips are until the 20-year mark is reached in the earliest patients.
Doctors advise patients, especially younger ones, not to even think about either procedure unless they are in pain every day. Most people won’t want to take on the risks of either type of surgery, and the complications that could arise, just to improve their golf game or to be able to resume jogging.
Source:Â New York Times
April 16th, 2007
If you’ve ever experienced chronic pain (lasting more than six months), you were probably depressed. Pain and depression can form a vicious cycle, with one fueling the other. When your quality of life takes a big nosedive, you generally get depressed. If a significant disability is also involved, your chances of depression are even greater.
Most physicians who treat patients with chronic pain also treat the depression that usually accompanies it. Your internist may wish to give you a prescription or refer you to a psychiatrist. Sometimes you may be referred to a licensed “behavioral medicine†specialist. So-called cognitive therapy classes may be especially useful in helping you find new ways of thinking and thus reduce your pain levels.
Talk therapy usually takes a back seat to prescription antidepressants these days. In fact, sometimes talking about your pain can actually make it worse because you focus on it more. Antidepressant medications are often a primary treatment for depression, especially when chronic pain syndromes or nerve-related disorders are involved.
The earlier your depression is treated, the better the outcome can be. Early diagnosis and appropriate medications can reduce distress and even prevent suicide, in many cases. Those receiving treatment for depression that takes place while experiencing chronic pain often have an improvement in their overall medical condition.
Antidepressants work by altering certain chemical levels in the brain. It may take a while to find a particular antidepressant with minimal side-effects that works well for you. Every person experiences pain and reacts to medications differently. Among the antidepressants which are commonly prescribed today are the following:
- Celexa
- Prozac
- Zoloft
- Elavil
- Norpramin
- Effexor
- Serzone
- Wellbutrin
- Cymbalta
- Paxil
- Remeron
If you are depressed about a serious, life-changing event or due to severe, unremitting pain and disability, you should consult a physician about treating your depression.
Source: WebMD
March 11th, 2007
Epidural steroid injections to treat chronic back pain and sciatica do little to give lasting relief, according to medical researchers in the field of neurology. Back pain is often accompanied with leg pain along the path of the sciatic nerve. Depending on which vertebral disks are involved, sciatica runs down the back or the side of the leg and can be excruciating.
Based on findings of four studies, a group of neurology professionals is advising against use of epidural injections for long-term back pain relief, improving back function, or avoiding surgery.
Patients who received epidural shots had mild improvement in pain for two to six weeks after their injections. Compared with patients who got epidural shots with no medications (placebo injections), the steroids failed to relieve back pain more than the placebo at 24 hours, three months or six months after the treatments.
The neurologists agreed that some pain relief is positive, but they concluded that the results fell short of expectations and are not “clinically meaningful.†Not only did the shots fail to give significant pain relief, they also did not improve the patients’ average back function or help to avoid back surgery.
Study results were recently published in a news release from the American Academy of Neurology. The report indicates that the team of neurologists did not have enough data to evaluate the use of epidural steroid shots for neck pain. Researchers call for more studies of these types of injections for neck and back pain.
Source:Â WebMD
March 8th, 2007
Researchers in Germany have used a technique called diffusion tensor imaging (DTI) in a study that examined brains of healthy volunteers and those with chronic back pain. They discovered that the brain in patients with chronic back pain had a more complex, active microstructure in regions associated with pain-processing, emotion and stress response.
The study findings were presented at the annual meeting of the Radiological Society of North America, held in Chicago recently. Researchers indicated that DTI demonstrates chronic pain is real and could help treatment research. Patients who suffer back pain sometimes have difficulty convincing their physicians, relatives, and insurance carriers of their genuine distress. Spinal MRI images do not always clearly demonstrate the source of pain.
According to the lead researcher, a radiologist in Munich, Germany, the objective and reproducible correlates in brain imaging should change the way chronic pain is perceived. It need no longer be a subjective experience. For pain diagnosis and treatment, the consequences could be huge. As a result, clinicians may direct therapeutic attention from the spine to the brain.
What is unclear is whether the brain in certain individuals is predisposed to developing chronic pain, whether ongoing pain causes hyperactivity and change in the brain’s organization or a combination of both.
Physicians who treat patients with chronic back pain have long known that chronic pain can begin with a serious injury. Even after healing has occurred, the brain continues to send pain signals for these individuals. The new imaging technology DTI will be able to validate their theory that the nervous system has been “rewired.â€
This study adds to the growing body of research showing that chronic pain is associated with physical changes in the brain. Chronic is defined as lasting more than six months.
In some cases, back pain plagues individuals for many years after their initial injuries.
This study helps the medical community to understand how the central nervous system is involved in back pain. More research is needed to determine what the brain’s physical changes mean and how to most effectively treat the pain.
Source:Â BBC News
February 20th, 2007
Low back pain sufferers can look forward to a potential cure for their damaged disks and resulting pain. A research team at the University of Manchester, England, hopes that the new, patented treatment can be available within three years.
The therapy, developed by Dr. Stephen Richardson, would use injected adult stem cells taken from the patient’s own bone marrow. These mesenchymal stem cells (MSCs) have the ability to differentiate into many different cell types. The extracted stem cells are then embedded in a gel-like material where they are grown in a culture. The gel-like substance is similar to natural collagen already used to treat cartilage defects.
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Dr. Richardson has been successful in turning MSCs into cells that make up the nucleus pulposus (NP) to provide cushioning between vertebrae. Because the stem cells are harvested from the patient’s own body, there is no chance of rejection by the immune system.
The British medical team reintroduces the cultured material into the damaged spinal disks through a tiny incision and using an arthroscope. The patient should be able to return home the same day after the procedure or the following day.
With treatments currently available to treat debilitating low back pain, success may be limited, and the cause of the pain is not completely addressed. This new procedure is expected to correct the root cause of the pain and give welcome relief from symptoms.
Pre-clinical trials will begin next year, after which full patient trials will take place. Although still in the early stages of development, the treatment appears very promising based on initial results.
Source:Â BBC News
December 2nd, 2006
The Center for Disease Control voted in October to make vaccination with the FDA-approved Zostavax shingles vaccine routine for all Americans 60 and older.
The older generation did not have the benefit of the chicken pox vaccine, now available to children and teens or older persons who never had the viral disease. Chicken pox was once a common disease of childhood.
Shingles will afflict about 20% of people who had chicken pox. For those who live to be 85, their chance of getting shingles rises to 50%.
A major clinical trial indicated that Merck’s Zostavax vaccine is more than 60% effective in minimizing shingles symptoms. It reduces painful PHN by 60% or more.
Shingles is caused by a herpes-type virus that remains dormant in the nerves until the individual’s immune system is suppressed due to aging, disease or immunity-suppressing drugs. An outbreak appears as clusters of red blisters above an underlying nerve path. It can vary considerably in size, severity, and length of time before it heals.
In about 30% of cases, shingles turns into an excruciatingly painful disease called postherpetic neuralgia (PHN). A smaller number get a painful disease called ophthalmic zoster which can cause blindness in one or both eyes. The worst part is not going blind, but the accompanying all-consuming pain experienced every moment without relief for years.
The patient’s and family’s lives are profoundly affected by this horrible affliction.
Severe cases of PHN pain can cause some to commit suicide to escape the unremitting pain.
Everyone 60 and over should welcome the opportunity to get the vaccination.
Medicare and Medicaid Part D are expected to cover the cost of the vaccination.
Source:Â WebMD
November 1st, 2006
