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

Written by Anna Dabney

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:  San Francisco Chronicle; April 18, 2008; Holly Ramer, A.P.

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:  New York Times

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

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:  WebMD

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.”

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:  BBC News

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.
 
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:  BBC News

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:  WebMD