A detailed guide to Chronic Fatigue Syndrome (CFS), including its symptoms, causes, and effective treatment strategies to improve energy and well-being.
Our United States pain specialists are often confronted with one very prominent question; How can I increase my energy levels even as I live with chronic pain? The easy answer is exercise and a proper diet. The answer that most people want to hear is energy drinks and coffee. With that said, nothing beats maintaining a healthy lifestyle, decreasing toxins, eating right, and exercising to keep energy levels high and stress low. However, energy drinks are all the rage right now, so let’s take a moment to evaluate how detrimental these drinks can be to your already compromised health.
While many studies have shown how small amounts of coffee can be beneficial to our bodies in terms of decreasing the overall risk for certain cancers, Parkinson’s, and heart disease, it can also be detrimental for those who already suffer from chronic pain. Caffeine increases stress and tension, two of the main factors for increased pain in many of our United States patients.
“The effects of coffee drinking are long-lasting and exaggerate the stress response both in terms of the body’s physiological response in blood pressure elevations and stress hormone levels, but it also magnifies a person’s perception of stress” Caffeine’s Effects are Long-Lasting and Compound Stress – Duke Health
Large amounts of caffeine can also disrupt sleep patterns, something that is crucial to keeping stress, tension, and pain levels low for our chronic pain patients. When the body is allowed to sleep and recover from the day’s events, pain decreases and the immune system is more capable of handling stress. However, when caffeine disrupts sleep patterns, increased pain and stress very possible results.
Energy Drinks
Since Red Bull burst onto the market in 1997, energy drinks have been huge. They propose increased energy through supplements like taurine and extreme levels of vitamin B. But what are these supplements and are they even good for you?
The problem isn’t the taurine, which is naturally found in meats and fish, or the vitamin B, which is also a natural supplement that is found in nearly every food, or the ginseng, which has been found to actually relieve stress. The problem is the massive amounts of caffeine stored within energy drinks. While energy drinks are not regulated as other foods because they are sold as “dietarysupplements,” they contain a great deal of caffeine that consumers might not know about. Energy drink companies do a wonderful job of distracting consumers from the caffeine amounts by focusing them on the supplements such as taurine and ginseng; the ‘natural’ energy-producing aspects of the drinks. However, it’s still the caffeine that does the trick:
(The caffeine content is in milligrams per serving. Although serving sizes vary, Griffiths contends that most people will drink the entire can, whatever the number of ounces.)
Living with chronic pain is not easy, and when it’s time to seek out a pain specialist who understands the intricacies of chronic pain and the options for treatment, your family physician is your first resource. Most pain clinics require a referral from that family physician in order for the pain clinic to accept you as a patient. Chronicillness.co Site of the United States is no exception. In order to receive award-winning medical treatment from our pain specialists, a referral from your family physician is needed.
One of the most common questions that we get is “why do I need a referral?” The most common answer is that it’s really up to your insurance company, and to alleviate any insurance discrepancies we ask that patient’s come by referral. Without getting too complicated, referrals depend on whether you have a PPO or an HMO, whether you are using a provider within your network or not, and whether it’s an emergency situation. In any situation where you’d need to see one of our pain specialists, it’s your best bet to get a referral.
Can’t my family physician just treat the pain? The short answer is yes and no. Your family physician can prescribe over-the-counter medications to help alleviate the pain, but simply alleviating the pain is not diagnosing the problem or treating its source. If you’ve tried pain medication from your physician, and you’ve tried options such as massage and exercise (things that are probably not covered by insurance), and you’re still in pain, it’s time to get that referral to see a pain specialist.
How do I ask for a Referral?
Many family physicians have become much like family friends, treating you and your family for generations. So when it comes to asking to seek out a professional that isn’t your physician, sometimes it can be difficult to ask for that referral. And, in some cases, physicians don’t want to give you that referral. Either way, if you have been on pain medication and it’s not working, you must ask for a referral to see a pain specialist. Here are some tips for asking:
Discuss with your family physician the amount of pain you’re still in. Let him know that the medication is not working well enough, and you’d like to get to the source of the problem to solve it, not just cover it up with painkillers.
Discuss the various treatment options that you’ve already tried with your physician, and ask if he can suggest any others. If he has run out of options, it’s time to see a specialist.
Asking for a referral is like ripping off a band-aid. You know it has to be done, but you don’t want to make anyone feel bad.
As you ask for your referral, it is also a great time to ask your physician to send a letter to Chronicillness.co Site of United States explaining your medical situation.
Finally, check with your insurance to make sure that Chronicillness.co Site is within your network.
Do you have a high pain tolerance? How do you know it’s higher than another patient? One of the most difficult aspects of pain management that our doctors deal with is an individual’s pain tolerance. The infamous one-to-ten pain scale is unscientific, and inaccurate when dealing with individuals who feel pain differently. What might be a two-to-one person might be an eight. Even when the patient explains to the pain doctor the amount of pain they’re in, we’re still stuck as to how much pain they are truly feeling. But all of that might be changing.
Pain is subjective and unquantifiable. When you visit the physician for chronic pain symptoms, or perhaps when you’re in labor, your doctor will have you rate your pain on a scale of 1 to 10. When my wife was having our first little one, the nurse said “rate your pain on a scale of 1 to 10, 10 being the kind of pain you’d feel if you were hit by a truck and then run over twice.” It’s an interesting way to describe pain, but effective.
The pain scale, though not entirely effective, does make pain measurable for doctors. On your first visit, your pain might be an 8, but on your third visit, your pain might be down to a 3. This tells the pain doctor that they are doing the right things to get you back into life and relieve your pain.
Recently, scientists at Brigham and Women’s Hospital in Boston were able to “observe changes in blood flow to specific regions of the brain as chronic back pain patients held uncomfortable positions inside the scanner,” according to ABCNews.com. “As the patients’ brains were registering the distressing sensation, the investigators watched blood flow activate or ‘light up’ different regions. They could then measure that blood flow during those painful episodes.” This, many believe, is a huge step to categorically defining the amount of physical pain that a patient is feeling.
According to Dr. Ajay D. Wasan, an assistant professor of anesthesiology and psychiatry involved in the research study, the “network involved in processing pain” is well understood. The fact that a person’s attention to their pain is a key element in their pain tolerance leads Dr. Wasan to believe that “drugs that might change a person’s ability to pay attention to their pain or be distracted from their pain” might become exceedingly important aspects of pain management down the road.
Many of our United States pain patients love the outdoors, and the United States is a wonderful place to be over Memorial Day Weekend. Everyone in the valley heads north to escape the start of summer and relax with friends and family. However, if you can’t afford an RV, tent camping can be a seriously daunting aspect of the weekend.
Have the mindset that tent camping will be a breeze because mindset truly plays a large role in how you will feel this weekend.
Don’t take on too much. We can’t stress this enough. When it comes to tent camping, setting up the tent and getting it organized should not be one of your priorities. Do not overstress your body. Allow friends and family to do the work as you take on less strenuous tasks.
Have a big enough tent to give you room to stand up. Make it as convenient as possible for when you must climb into the tent, change in the tent, or anything else.
Place the tent in a shaded area. As we all know, this United States sun can sneak up on you and just a few moments of direct sunlight can truly heat up that tent and make it very uncomfortable.
Spend the money on a nice air mattress. United States pain specialists can’t stress this enough. Sleep is paramount, and being able to sleep comfortably while camping can make or break your Memorial Day Weekend. Have enough blankets to keep warm and a comfortable pillow.
Maintain a healthy diet and exercise routine. I know, it’s vacation, but that doesn’t mean you should skimp on your healthy lifestyle. One of the biggest downfalls of every patient’s camping trip is their lack of healthy alternatives to camping food. Changing your diet can dramatically affect your chronic pain.
Have a comfortable chair available. Whether you enjoy the hammock or a simple fold-up chair, make sure it’s comfortable for long periods of time. You want this weekend to be relaxing and calming, and a comfortable chair will help.
Choose a campsite near a bathroom. Once again, we can’t stress this enough. If you began to have a rough episode, walking to a bathroom that’s even 20 feet away can seem like miles.
Getting outdoors and back into life is paramount for patients living with chronic pain. Breathing in that fresh air, relaxing under those towering pine trees, and listening to the breeze without a care in the world can bring about much-needed calm and peace. The kind of calm and peace that has been known to ease chronic pain. While getting up north for a camping trip might not be your favorite thing to do, consider the benefits of spending time away from the stress of life. Those positives might outweigh the negatives when it comes to camping, whether you have an RV or tent.
Pain management is difficult, and if you’ve got a chronic pain condition, it can sometimes feel impossible to find just the right balance of medications to control your pain. Sometimes, though, pain management isn’t about treating your pain at all. Things like getting a good night’s rest, finding stress relief, and treating mental illnesses may not technically be pain management, but they still might be able to provide you with a lot of relief. This month at Pain Doctor, we tried to present with you as many round-the-clock pain management techniques as we could.
Sleep is a big part of life, so it’s no surprise that sleep can also play a big role in pain management.
Scientists still aren’t quite sure why we need sleep, but it’s abundantly clear that sleep is essential for health. Even infants and children who get less than the recommended amount of sleep experience increased health risks – specifically, an increased risk of obesity and overall body fat.
Adults who don’t get enough sleep are at an increased risk of obesity, too, along with a higher risk of heart disease, stroke, diabetes, and high blood pressure. A reduced sex drive, impaired decision making, and increased risk for mental disorders also accompany sleep deprivation. We also noted the relationship between sleep and pain, stating:
“Sleep deprivation lowers the pain threshold. This means that the more tired an individual is, the more likely he or she is to experience sensations as painful. The increased pain can make falling asleep and staying asleep difficult, which often leads to more sleep deprivation. This becomes a repeating cycle, until it’s difficult to tell which came first – the sleep deprivation or the pain.”
To help you manage your pain by getting a better night’s rest, we put together seven ways to help you sleep better at Pain Doctor. Some of these tips, like avoiding caffeine and getting a comfy mattress, aren’t too surprising. A few, though, might be surprising, such as avoiding electronic screens before bed to sleep better. However, if you’ve tried it all and still can’t get a good night’s rest, talk to your physician. He or she should be able to help.
Another potential way to both sleep better and find some pain relief is to find ways to manage your stress.
Stress is insidious. Short-lived, acute stress might make your heart pound or your palms sweat, but it’s frequent bouts of acute stress and long-term chronic stress that can really have an impact. Unfortunately, it’s long-term chronic stress that tends to sneak up on people, becoming such a regular part of life that it’s eventually unnoticed. Digestive issues, headaches, and even more severe allergy flare-ups can all be attributed to stress. Additionally, pain and stress are closely linked, as we stated on the Pain Doctor blog:
“Chronic stress causes changes in the brain. Over time, these changes can negatively impact the parts of the brain that manage pain, meaning that it can confuse the brain into thinking it’s experiencing new or worsened pain.”
If your stress feels overwhelming, talk to a physician or therapist. Along with your doctor’s recommendations, there are also ways to manage your stress levels yourself, though, check out our eight ways to reduce stress. Meditation, laughter, exercise, and lots of other at-home activities can help you get rid of your stress, which can help you lower your pain.
The Pain Doctor post on self-care might help you out with this, too. Self-care is, for all intents and purposes, pampering yourself. It’s doing something that you find relaxing or enjoyable to reduce stress. Taking a short break during a stressful day and doing a self-care activity, such as reading a book or savoring a cup of tea, can cut back your stress before it gets too bad. Keeping up with regular self-care can lower your overall stress levels, which can in turn improve pain, sleep, and overall health.
We also gave some of the best news ever to all the bookworms out there: reading and writing are scientifically proven to be good for you.
For National Library Week, we broke down the many ways that the library can help you. There is, of course, the obvious: libraries have lots of books, and reading is a fantastic way to lower stress. Additionally, libraries give you the chance to learn about your chronic pain condition. Aside from books, libraries have reliable internet access, journal and newspaper archives, movies, and audiobooks, all waiting for you to explore so you can get to know your pain condition inside and out.
The sense of empowerment from this knowledge might help to ease your stress a little, as well as make you better prepared to deal with your disease. Librarians, too, can be a big help with this. Ask for help, and a librarian will be able to direct you to the right book shelf, help you find and print off materials for yourself (and for friends or family, if you want), and find local support groups.
Your librarian might also be able to direct you to a few books that can help you through difficult times. As we explained in our post about reading and writing, the written word can do wonders for stress. The rule of thumb when picking out a book to lower your stress is to pick a book that you’ll enjoy, so go ask your librarian about your favorite topic.
Journaling can also lower stress. You may choose to write down your stressors, which can help you work through them, or you might prefer to keep a gratitude journal. Maybe you’d like to do both, or maybe you’d like to take up poetry or fiction writing. Writing can lower your stress no matter what it’s about, so long as it’s what makes you feel better. Keep in mind, though, that some types of writing – like keeping a stress-relief journal – might be difficult or upsetting at the time, but after a while you’ll likely start to feel better.
For a great example of how both knowledge and writing can make life a little easier, we introduced you to the chronicwoman this month on Pain Doctor. The Hurt Blogger has lived with chronic pain since childhood, but she’s learned as much as possible to help herself live with her pain. Hurt Blogger runs marathons and climbs mountains, and she also blogs about her life and the things that matter to her. She’s also got lots of tips, tricks, and information about living with chronic pain on her website.
Finding some support when you’re struggling is always a good idea, so we did our best to help.
Sometimes, no matter what you do, you may need help with your mental health. Taking the first step and reaching out for professional help is one of the most difficult and brave decisions that anyone can make, so we tried to break down the types of therapists and therapy for you in our Counseling Awareness Month post.
Chronic pain can sometimes be a result of untreated mental illness. Other times chronic pain can be a symptom of mental illness. Whatever the case, struggling with pain on a regular basis can increase the risk for mental illnesses. If you’ve ever wondered if you might have a mental illness, err on the side of caution and speak to your physician. They can help.
We also took a look at the use of antidepressants for pain patients on the Pain Doctor blog. Antidepressants are traditionally used to treat mental disorders, such as depression. However, there are a lot of pain conditions that can be relieved by antidepressants, too, such as:
If you’re not taking an antidepressant already and you’re experiencing pain, despite taking pain medications, consider speaking to your physician about trying an antidepressant.
As far as unusual pain management techniques, no one knows more than someone who’s lived with chronic pain. This is just one benefit of a support group; everyone there knows something that no one else knows. A support group can remove the isolation that often affects anyone with a pain condition. Both online and offline support groups have benefits, so we gave you tips on finding both.
We also gave you some information on mental health in children and older adults. These populations aren’t the typical groups thought of when you discuss mental health, but problems are just as prevalent here as everywhere else. Hopefully the warning signs of mental illness, such as mood and appetite changes, will help you keep an eye on your loved ones and know when to ask for help.
To top it off, we put together some general information we thought you might benefit from.
A lot’s been happening in Colorado. Our post about the latest medical news covered the highlights. From Colorado’s single case of measles to changes in healthcare to the ongoing fight against hospital-acquired infections, we tried to touch on the topics that would matter most to you.
As Dr. Siwek mentions in this week’s episode of the Pain Channel, April is Alcohol Awareness Month. When we think of alcohol awareness, the first things that pop into our minds are drunk driving, designated drivers, and sobriety tests, right? Popular culture has taught us to correlate drinking with driving consequences. But Alcohol Awareness Month is truly about the health consequences associated with alcoholism such as neurologic complications, vitamin deficiencies, liver disease, and much more.
Neurologic complications of alcohol abuse may also result from nutritional deficiency because alcoholics tend to eat poorly and may become depleted of thiamine or other vitaminsimportant for nervous system function. Persons who are intoxicated are also at higher risk for head injury or for compression injuries of the peripheral nerves. Sudden changes in blood chemistry, especially sodium, related to alcohol abuse may cause central pontine myelinolysis, a condition of the brainstem in which nerves lose their myelin coating. Liver disease complicating alcoholic cirrhosis may cause dementia, delirium, and movement disorder. _Healthline.com
Alcoholic neuropathy, also known as alcoholic polyneuropathy, is the direct result of overconsumption of alcohol over extended periods of time. Unfortunately, alcoholics do not eat right, nor exercise, so their bodies slowly become deficient in several nutritional areas. There is a continual debate over whether it is the alcohol itself, or malnutrition that accompanies alcoholism, which is the root cause of alcoholic neuropathy.
The causes of alcoholic neuropathy are extensive, from irregular lifestyles leading to missed meals and poor diets to a complete loss of appetite, alcoholic gastritis, constant vomiting, and damage to the lining of the gastrointestinal system. All of these symptoms cause nutritional deficiencies, and when the lining of the gastrointestinal system becomes compromised, the body is not able to absorb the proper nutrients.
Alcohol consumption in extremes can also increase the toxins within a person’s body such as ethanol and acetaldehyde, which many believe are directly linked to alcoholic neuropathy.
In most cases, alcoholic neuropathy sets gradually into the body so that the individual does not realize they have this condition until it is deeply rooted within their system. While weight loss is an early warning sign, it is also a side effect of heavy drinking, so most individuals with alcohol conditions do not realize what their body is trying to tell them. Painful paralysis and motor loss is the first symptom that individuals tend to truly take notice of. According to Alcoholism-Solutions.com, the following is a list of possible symptoms of alcoholic neuropathy:
autonomic functions are involuntary, like the heartbeat and respiration.
Because this chronic condition affects the brain and nerves, pain can be intense and constant, sharp and quick, or dull and prolonged, and cramping may occur in muscles without warning.
Most pain doctors in the United States will tell you that there is no known cure for alcohol neuropathy, but there are successful pain management and treatment methods to help patients get back into life. At this point, when a patient has been diagnosed with alcohol neuropathy, a pain doctor’s best intention is to control the pain. Once that damage has been done from this chronic condition, unfortunately, it cannot be undone. However, the pain can be controlled.
Obtaining alcohol consumption will be the pain doctor’s first course of treatment. Whether it’s through counseling, Alcoholics Anonymous meetings, or in-house psychological evaluations, kicking the habit is the first step. This will be the toughest step for anyone living with alcohol neuropathy.
Next, your pain doctor will want to manage your nutritional intake through medication and a strict diet. Using a multidisciplinary team of industry experts, your pain doctor will no doubt sit you down with a nutritionist to determine the best course to get you back on track with a healthy diet. Multivitamins are also a key aspect of nourishing your body.
Physical therapy is usually called for in cases of alcohol neuropathy due to the great damage that has been done to the nerves. Since motor loss is a symptom of this chronic condition, your pain doctor will want to bring blood flow and life back into the affected areas of your body. One of the best ways to do this is through exercise and physical therapy.
Most individuals who abuse alcohol are also at great risk for abusing pain medication while going through pain management treatment, which is always a concern for pain doctors in the United States. According to NYTimes Health, the least amount of medication needed to reduce symptoms is advised, to reduce dependence and other side effects of chronic use.
Common medications may include over-the-counter analgesics such as aspirin, ibuprofen, or acetaminophen to reduce pain. Stabbing pains may respond to tricyclic antidepressants or anticonvulsant medications such as phenytoin, gabapentin, or carbamazepine.
While it’s deemed impossible to reverse the damage already done to the body’s nerves, pain doctors can help patients living with alcoholic neuropathy reduce and control pain and get back into life. Of course, the best way to prevent this chronic condition is to respect your alcohol intake, but if you are suffering from this debilitating condition speak immediately to a United States pain specialist about your options.
In the fight against lower back pain, many people and their doctors reach for the same weapons: common over-the-counter (OTC) and prescription medications. New research on commonly recommended and prescribed lower back pain medications has found that many may actually be virtually ineffective for treating lower back pain and that medication for lower back pain may actually do more harm than good.
Nsaids are a standard go-to medication for lower back pain, but their effectiveness is being called into question. The common over-the-counter pain medications Tylenol, Advil, and Aleve are all types of nsaids. More powerful nsaids are also available by prescription from your physician. For many people with chronic back pain, it’s not unusual to keep a bottle of over-the-counter nsaids on hand to treat pain as needed.
A great many medications fall into the classification of nsaids, but all of them function in a similar way. Nsaids block an enzyme called cyclooxygenase (COX), which in turn inhibits the production of certain inflammatory responses like fever, swelling, and pain. Since many instances of pain are caused by inflammation or swelling, inhibiting inflammatory responses should reduce pain.
However, COX enzymes also aid in protecting the stomach lining, which is why using nsaids can sometimes lead to ulcers or bleeding in the stomach. Potential side effects of nsaids include digestive symptoms like heartburn, diarrhea, vomiting, or stomach pain.
Tylenol in particular has been widely advertised all over the world as a catch-all OTC medication for aches and pains of every variety. From acute back pain to achy knees and chronic pain, advertisements would have you believe that Tylenol is effective and safe for pain. A study from theBMJ(formerly the British Medical Journal) found that Tylenol’s claims of efficacy in the treatment of both back and knee pain were false.
A meta-analysis of randomized controlled studies focusing on Tylenol’s ability to relieve spinal pain and pain due to osteoarthritis found that for spinal pain, Tylenol showed no effect on pain in either short- or intermediate-term follow-ups. For osteoarthritis, the short-term efficacy of Tylenol for spinal pain was more pronounced than for intermediate use, but pain reduction was still rated as moderate. Any pain relief reported was clinically insignificant and similar to the placebo group. The studies included in the meta-analysis focused on just over 5,300 patients with lower back pain and knee pain and excluded any patients with previous surgeries for either condition.
While some patients suffering from chronic and acute back pain may find that any minor reduction in pain is worth the risk, the side effects may not be worth it. Since 2011, the Food & Drug Administration has required medications that use acetaminophen to carry a “black box” warning that highlights its risk for liver failure.
Many who take Tylenol for pain do not realize that other medications (e.g. Cold medicines) also contain acetaminophen. Exceeding the maximum daily dose by even a small amount can cause serious side effects and may even cause death. For anything other than acute, short-term pain, taking Tylenol is not recommended as a medication for lower back pain.
Opioids are a narcotic pain reliever. Previously used primarily for short-term relief of acute pain, or for pain relief in patients with a chronic condition like cancer, opioids have become part of mainstream pain management over the last two decades. The number of prescriptions written for oral opioid medications, such as hydrocodone, oxycodone, or hydromorphone, has more than tripled over the last 20 years. Despite the risks associated with opioid medications, they are becoming increasingly widespread as a prescribed medication for lower back pain, even though new research suggests opioids aren’t very effective for this type of pain.
While the risks of opioids have been well-documented, a study by the American Academy of Pediatrics found that the use of prescription opioids is linked to fewer positive outcomes after spinal surgery. The study of just over 500 patients used patient reporting to measure health preoperatively and at three, six, and 12 months post-operatively. Differences in recovery, mental health, and decreased pain was significantly influenced by opioid use in the following ways:
Patients who increased opioid use before spinal surgery did significantly worse post-operatively at three and 12 months
For every ten milligrams of increase in opioid use, the study found a significant decrease in mental and physical health scores
Patients who also suffered from comorbid conditions such as depression and anxiety were more likely to take opioids
Lead study author Clinton J. Devin, MD, assistant professor of orthopedic surgery and neurosurgery at the Vanderbilt Spine Center had this to say about the treatment implications of study’s findings:
“Our work highlights the importance of careful preoperative counseling with patients on high doses of preoperative opioids, pointing out the potential impact on long term outcome and working toward narcotic reduction prior to undergoing surgery.”
Even for those patients who choose not to undergo surgery, opioids have very little effect on chronic low back pain. While there seems to be some short-term analgesic benefit, the risk of dependence and other side effects likely outweighs the minimal benefit in intermediate- and long-term use for this medication for lower back pain.
Researchers have also been reevaluating the trials and evidence that support the effectiveness of opioid pain medications, and the evidence doesn’t hold up. The National Institutes of Health (NIH) convened a seven-member panel to examine the evidence for opioid medications. An article by the University of Connecticut summed up the results, noting:
“A National Institutes of Health white paper that was released today finds little to no evidence for the effectiveness of opioid drugs in the treatment of long-term chronic pain, despite the explosive recent growth in the use of the drugs.”
Additionally, a University of Colorado Boulder study showed that opioid use (specifically morphine) actually prolonged neuropathic pain in rats, suggesting that it could have the same effect on humans.
Finally, the BMJ published a clinical review of the efficacy of opioids as a medication for lower back pain. The conclusions in this article include:
Opioids don’t speed injured workers’ return to work
Opioids don’t improve functional outcomes of acute back pain in primary care
There is little evidence of opioid efficacy for chronic back pain
It was also pointed out that controlled trials of opioids for back pain tend to experience a high dropout rate among participants. The trials also have a short duration (generally four months or less) and have highly selected patients. This all suggests that the controlled trials that do support opioid efficacy for back pain are perhaps not reliable, or at least are not thorough enough.
Opioids also have a high risk of abuse and dependence. Using opioids before spinal surgery has been linked to a higher risk of negative surgical outcome. Slow-acting opioids, which have been assumed to be safer than fast-acting opioids, have been shown to make men five times as likely to develop low testosterone. More and more evidence continues to point to the fact that opioids are not a suitable medication for lower back pain, unless used for highly-controlled, acute cases.
Steroids are commonly used to treat inflammation associated with back pain, but they may not be as effective as previously believed. Steroids, also called corticosteroids, are a synthetic (man-made) version of a hormone naturally found in the body. Steroids are used to treat many different conditions, largely because they are cost-effective and can be applied in many different forms (oral, injected, inhaled, topically, etc.). Long-term or illicit use of steroids is associated with several potentially-serious side effects, but when used as directed, steroids are generally considered safe.
In a randomized controlled trial of 267 people with herniated disc, researchers found that there was no significant difference in pain relief between the group receiving oral steroids (prednisone) and the group receiving a placebo. Both groups saw improvement, but even after a year, there was no difference between the two (except in rate of disability, which was slightly lower in the prednisone group).
Likewise, a study originally published in the Journal of the American Medical Association (JAMA) looked at the efficacy of the oral steroid prednisone in treating sciatica-related back pain. In this study, half the participants were given a 15-day course of prednisone to treat sciatica resulting from a herniated disc, while the other half were given placebos to treat the same condition. Although both groups’ symptoms improved, there were no statistically significant differences in pain or disability by the end of six weeks.
Again, this is a case of the side effects outweighing the negligible benefits. In addition to headache, mood swings, and irregular heartbeat, long-term use of prednisone is a risk factor for osteoporosis, which may increase the risk of spinal injury leading to pain. Steroid injections, on the other hand, provide a targeted approach to using these medications which may work more powerfully for lower back pain patients.
Even with this research, this does not mean that you should stop your medication for lower back pain, especially if they’ve been prescribed by a physician.
If you’re taking a medication that relieves your symptoms of back pain, that’s great. Keep taking it. If your current medication doesn’t seem to be doing the job, keep taking it until you’re able to talk to your pain doctor and get an alternative medication or treatment (or are given the go-ahead to stop taking it). Stopping a medication prescribed by your doctor could be unsafe if you haven’t discussed it with them before.
And keep in mind that pursuing alternative, complementary, or interventional pain management techniques – either in conjunction with or (with your physician’s permission) instead of medication – might help you control your pain much more effectively than medication for lower back pain alone.
Staying physically active is an important treatment option for lower back pain. While it may seem counterintuitive to move when you are in pain, keeping your muscles strong and engaged can be the key to a healthy back. Focus on stretches and core work, but don’t forget low-impact cardiovascular exercise such as biking, swimming, and hiking.
Although it may not work as quickly as medication for lower back pain, eating a healthy diet full of anti-inflammatory foods can make a tremendous difference in treating chronic back pain. Adding these foods while eliminating common inflammation-causing foods like sugar, wheat, and dairy can help you manage pain.
The more weight we carry on our bodies, the more stress there is on our joints. Maintaining a healthy weight with diet and exercise can be an important part of treatment for back pain, especially in cases where back pain is due to compression injuries such as herniated discs or inflammation caused by spinal stenosis.
Acupuncture is gaining traction as an effective treatment for low back pain. Chiropractic care can also be an excellent first-line treatment that minimizes the chance of spinal surgery in the future. Mindfulness meditation and biofeedback have both been shown to diminish the perception of pain. All of these treatments are nearly side-effect free, and many are now covered by insurance.
Finally, if your pain doesn’t respond to medication for lower back pain or these complementary approaches, you could try more targeted therapies for resolving your back pain. This will involve identifying the underlying causes of your back pain and finding a therapy that can work to resolve or treat the symptoms of your pain. Once a correct diagnosis is made, your doctor may recommend any of the following therapies:
It’s been about a year since we became Pain Doctor and began sharing information with you about everything pain- and health-related. In that time, we’ve covered a lot of information, but we’ve tried to make sure that all of it is centered around the topics that you, as a health–conscious pain patient, might care about the most. It was tough, but we narrowed down a year’s worth of information into our top ten favorite posts from Pain Doctor, covering everything from resources to lifestyle changes.
In no particular order, here are our top ten favorite posts on Pain Doctor.
It can be hard to start a new exercise routine, especially if you’re in pain, but the payoff will be worth it. In this post, we touched on a few studies that looked at the benefits of exercise for people with chronic pain, noting:
“Several studies have looked at the effects of exercise on chronic pain conditions. The results are often very similar: decreased pain and a better quality of life.”
We also gave you some suggested types of exercise, along with a few tips, to get you started on your fitness journey.
We’ve mentioned several times on Pain Doctor that stress is bad for you, particularly if you live with chronic pain. Self-care is one of the absolute best ways to combat chronic stress and, by extension, improve your health and reduce your pain. Also, the more often you allow yourself a few minutes of self-care, the better, because your body will eventually come to associate a certain activity or routine (like the motions of brewing a pot of tea for an afternoon break) with relaxation. Once your body has built up this association, you’ll begin to experience the physiological signs of relaxation more quickly. If you need ideas for self-care or relaxation, look no further: this post has plenty.
Health literacy is all about knowing how to find and understand health information so you can make informed decisions about your own healthcare. Pain conditions, like lots of medical conditions, can get confusing and overwhelming very quickly, so having the health literacy skills to do research, find information, and know what questions to ask your physician is vital. This post breaks down how to judge the reliability of an online resource by asking five simple questions:
After you’ve been dealing with a chronic pain condition or medical condition for long enough, managing your medications will become almost automatic. If you’re newly diagnosed, or if your medication regime has changed recently, it can be scary trying to keep all those pills (and maybe even injected medications) straight. Here we gave you some tips and tricks about medication management, like using a medication sheet and letting your everyday activities (such as meals or bedtime) act as reminders. The bottom line is to make sure you talk about your medications with your physician and then take them as directed.
Sleep might not seem like that much of a deal, but it is. Getting enough sleep can have big benefits on your health, just as being chronically sleep deprived carries some serious risks. If you deal with pain on a regular basis, sleep can be a struggle. Hopefully this post convinced you that, if your pain is interfering with your sleep, you should talk to your physician about it. After all, as we noted:
“Sleep deprivation lowers the pain threshold. This means that the more tired an individual is, the more likely he or she is to experience sensations as painful. The increased pain can make falling asleep and staying asleep difficult, which often leads to more sleep deprivation. This becomes a repeating cycle, until it’s difficult to tell which came first – the sleep deprivation or the pain.”
There are a lot of surface similarities between chronic pain and depression. For instance, people suffering from these conditions often face similar misconceptions, like the problem being “all in your head” or that you can “just get over it.” With both chronic pain and depression, though, this is certainly not the case. Both conditions are serious, diagnosable medical conditions that need attention from a physician. And the similarities go even deeper, right down to some of the same centers of the brain being involved in both chronic pain and mood disorders.
This post is a must-read for anyone who takes opioids (or who has a family member or friend who takes opioids). It covers all the nuts and bolts of opioids, from how they work to the different types to what they treat best to the risks involved.
A common opioid painkiller, hydrocodone, was reclassified last year, along with hydrocodone-based painkillers. We know that for a lot of people with chronic pain, opioids are commonly used for as-needed or breakthrough pain relief, until a less risky pain management technique can be found. In this post we delved into why hydrocodone-based painkillers have been reclassified and how it might impact you.
Dogs are good for your health in lots of ways, and they can even help you manage your pain. For some people, it’s only thanks to their assistive or service dogs that they’re able to function independently. Therapy dogs can make a huge difference to people who are hospitalized or living in assisted care. What it boils down to, though, is that no matter the breed, age, size, or training, your canine best friend does more for you than you realize.
Hopefully this post was as interesting to read as it was to write. Dogs’ super-sensitive noses have been used for jobs like search and rescue or bomb-sniffing for years, but now they’re being trained and put to work in the medical field. Some of these amazing dogs can detect oncoming seizures, allergic reactions, or blood sugar fluctuations in their owners. Others are taught to identify infections or cancers. The really amazing thing is that oftentimes, the dogs are more sensitive than modern medical equipment.
At Pain Doctor, we try to help you live your best life possible, and we truly think that part of that is arming you with all the knowledge you need to make the best decisions about your lifestyle and healthcare. We hope we’ve accomplished that for you, and we hope that we can continue to help you control your pain and enjoy your life to the fullest.
If you’re wondering how to prevent knee pain in old age, the answer often comes down to taking steps today to reduce your risk. By reducing your risk for the nine most common causes and risk factors for knee pain, you can prevent a large possibility of knee pain in your future.
The knee is a joint made of four bones: the femur, tibia, fibula and patella. There are a series of muscles that also support the knee, including the quadriceps and hamstrings. Finally, these are all joined together by a carefully woven set of ligaments, meniscus, and tendons. Precious cartilage provides necessary cushioning for comfortable movement.
The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are perhaps most critical for proper knee movement. The knee is also surrounded by fluid filled sacs called bursae that provide additional cushioning.
Since it’s such a complex joint, it can sustain most of the demands we place on it every day. However, these same joints and tendons can become inflamed, leading to pain. Likewise, the delicate structures of the knee can become injured leading to pain. We’ll talk about some of the risk factors you can work to reduce today to prevent knee pain in the future from these causes.
The knee moves in two ways: bending (flexion) and straightening (extension). However, the knee can also twist, which is the common cause of many injuries to ligaments. Those who have ligament injuries to the knee often report hearing a popping, followed by the inability to place weight on the knee.
Such twisting-related injuries can also cause damage to the knee’s tendons and meniscus. These injuries will likely cause pain, swelling, and limited movement. Often surgery is required. However, the knee is a major joint that takes the weight of the body daily; with time, wear and tear injuries may occur that leads to knee pain as people get older. Also known as degeneration injuries, these include osteoarthritis and chondromalacia patella. Both are the result of degeneration of cartilage, causing bone-on-bone rubbing and pain.
One of the largest risk factors for knee pain is age. Age increases the risk for a variety of conditions leading to knee pain, including osteoarthritis. Older people are also more likely to have weakened muscles. They are also more vulnerable to injury while playing sports or participating in normal daily activities.
A study in the journal Osteoarthritis and Cartilage found that the risk factors for knee pain and osteoarthritis are essentially the same: age, extra weight, history of knee injury, and having a job that places extra stress on the knee. Increased age and unhappiness with a person’s job had a greater impact on the incidence of knee pain than the other factors.
However, the best way how to prevent knee pain in old age is to avoid risk factors when you’re younger. Knee pain often results from osteoarthritis or sports injuries. These other nine risk factors for knee pain involve lifestyle choices that can you can manage to reduce or prevent knee pain in the future.
Extra weight is one of the largest risk factors for knee pain. The knee supports much of the body’s weight, and too much weight taxes the joint and increases the likelihood of pain. Anterior knee pain, which develops at the front and center, is one of the more common types of knee pain associated with carrying extra weight. Inactivity or muscle weakness, both associated with being overweight, can exacerbate the condition.
Obesity stresses the structure of the knee, including the patella—the medical term for the kneecap. The patella already supports forces that are equivalent to as much as five times the body’s weight, according to the University of Michigan, Ann Arbor’s school of Orthopaedic Surgery. A combination of weight loss and muscle strengthening can alleviate chronic pain related to obesity, although surgery is sometimes needed.
The knee connects the thighbone—also known as the femur—to the shinbone—also known as the tibia. Having strong quadriceps muscles helps to stabilize the knee joint and keep it healthy.
And improving muscular fitness can be one of the best ways how to prevent knee pain, even if you’re older. A study in the journal Osteoarthritis and Cartilage studied a group of people aged 50 to 79 with osteoarthritis in the knee or risk factors for developing the disease. Women who had weak quadriceps were found to experience worse knee pain over the 5 years of the study, even when accounting for weight, level of exercise, and any history of knee surgery. Women with the weakest quadriceps experienced a 28% greater risk that their knee pain would worsen.
The connection between strength of the quadriceps and knee pain did not hold true for men.
Developing the right muscles can also help protect against one of the more serious knee injuries—a torn anterior cruciate ligament (ACL). Athletes involved in sports where they jump and quickly accelerate and decelerate are particularly susceptible to torn acls. However, strong quadriceps and hamstring muscles can help insulate the knee from stress.
A cause of muscle weakness and obesity—inactivity—is also another factor for knee pain. People who are inactive are less strong, less flexible, and more sedentary. When the time comes to move and exercise, there is a greater risk of injury.
Inactivity has also been found to make knee pain from arthritis worse, according to webmd. Being sedentary results in muscle deterioration that weakens the knee and increases pain.
Injured people who don’t rest their knees for a long enough period of time increase their risk of re-injury, according to webmd. Although recovery periods can last anywhere from several weeks to several months, taking the time to allow the body to adequately repair and heal is critical for allowing the knee to regain its strength.
Resting is particularly difficult for athletes and other active people, but spending some quality time on the couch will go a long way to keeping the knees healthy and protecting against future injury.
Smoking increases the risk of a host of health problems, and knee pain can be added to the list. Quitting smoking is one of the best ways how to prevent knee pain when you get older. A study published in Annals of the Rheumatic Diseases found that smoking increased the risk for both cartilage loss and knee pain in men who had developed osteoarthritis in the knee. Because smoking affected the amount of cartilage the men had in their knees, it increased the amount of pain they experienced.
Much of knee health is related to the underlying structure of the leg. And that structure is due to genetics, according to a study published in the British Journal of Sports Medicine. Researchers recruited a set of female twins and videotaped them while watching them land from jumps and execute cutting maneuvers. Scientists examined the angles of the women’s knees and the structure of the joints themselves.
At the time of the videotaping, the girls were healthy. Over the next year, however, both women tore their acls, giving the scientists and opportunity to gauge the impact of genetics, the New York Times reported. Researchers found that the twins had excessively flexible knee joints and narrow notches in the knee where the ACL connects to the bone. Another study published in the American Journal of Sports Medicine identified a gene that affects the composition of collagen and increases the risk of torn acls.
Unfortunately, there’s no way to reduce your genetic risk. But, you can be informed. If family members suffer from knee pain, take even more precautions now.
People who work in intense, manual-labor jobs are more likely to develop knee pain, according to research published inOsteoarthritis and Cartilage.
Occupations associated with increased risk factors for knee pain included carpenters, miners, and construction workers. Carpenters and miners are at the highest risk. These jobs involve frequent knee bending, sitting, or standing for long periods of time in unnatural positions, along with heavy lifting. Of those individuals studied, 28% reported knee pain.
If you are in one of these fields, make sure you talk to your doctor about ways to prevent your risk. These may include physical therapy or the use of braces.
People who are depressed report worse knee pain related to osteoarthritis, according to research published in The Journal of Bone and Joint Surgery. The effect was most pronounced in people with mild or moderate osteoarthritis, who reported severe pain despite less significant cartilage damage. Simultaneous emotional and physical pain feed off each other, exacerbating the effects of each, researchers say. Talk to your doctor about therapy options for reducing both your knee pain and depression.
Many knee injuries, from tendinitis to iliotibial band syndrome, also known as runner’s knee, result from overuse. Repetitive motions involved in sports, such as running, often lead to inflammation. They can also cause structures in the leg and knee to rub against each other and cause pain. Although sports are a frequent contributor to knee pain, gardening, hobbies, or repetitive motions occurring during household activities can also be to blame. Injuries are the most common cause of knee problems, according to webmd.
If you’ve suffered from any injury, make sure to rest and wear a brace or other supportive device when you do take up activity again.
If you’re already suffering from knee pain, there are non-surgical options for reducing your pain. The first lies with the basics tenets of how to prevent knee pain in the first place: exercise, consistently and with low-impact activities to reduce inflammation and reduce tension.
From there, initial knee pain may respond to ice and anti–inflammatory non-steroidal medications. Additionally, neuropathic medications, such as gabapentin or lyrica, may help those reporting burning, numbness, or pins and needles. For those who have ongoing issues, perhaps the best tool for treating knee pain is an MRI. An appropriate diagnosis is absolutely critical to create a plan to effectively reduce your pain.
Once a pain physician has the MRI results and can make a diagnosis, treatment options may include corticosteroid injections directly into the joint. These injections immediately reduce inflammation, which can effectively reduce pain. Watch one of these injections take place in the following video.
Other treatments include visco-supplementation. This is used for those who may need additional lubrication to the knee joint as a result of osteoarthritis. Nerve blocks are an additional treatment option.
A saphenous nerve block may provide those with chronic knee pain – at times present after knee replacement – relief. Additionally, chiropractic therapy, gait analysis, bracing and TENS Unit may provide relief. A comprehensive knee pain treatment may also include physical therapy. This can help those with knee pain strengthen muscles surrounding the knee to improve stability.
Finally, neuromodulation via a spinal cord stimulator may be an option for those patients who otherwise fail to respond to more conservative treatment options. Spinal cord stimulation includes the implantation of small electrodes in the epidural space of the spine. Through this device, large nerve fibers are stimulated to inhibit small nerve fibers, thereby blocking the sensation of pain.
The pain management doctors at Chronicillness.co Site of the United States knows that pain tolerance can be a funny thing. Neck pain or a foot injury can be agony to one person while just a slight annoyance to another. Why does pain tolerance vary so much among us, and can we actually control pain tolerance?
There are actually two steps to feeling pain. The first is the biological step (the pricking of the skin or a headache coming on). These sensations signal the brain that the body is experiencing trouble. The second step is the brain’s perception of the pain. This is what divides us, as some shrug off these sensations and continue their activities while others stop everything and focus on what is hurting.
Chronic pain actually changes the way the spinal cord, nerves, and brain process unpleasant stimuli causing hypersensitization, but the brain and emotions can moderate or intensify the pain. Even past experiences and trauma can influence a person’s sensitivity to pain.
Managing pain and people’s perceptions of their symptoms is a challenge. According to the American Pain Foundation, persistent pain is often reported by 30% of adults aged 45 to 64, 25% of adults aged 20 to 44, and 21% of adults aged 65 and older.
More women than men report pain (27.1% compared with 24.4%), although whether women actually tolerate pain better than men remains up for scientific debate.
Pain tolerance is influenced by people’s emotions, bodies, and lifestyles. But many different factors can influence pain tolerance, such as depression and anxiety, which can make a person more sensitive to pain, athletes who can withstand more pain than people who don’t exercise, and people who smoke or are obese who report more pain.
Biological factors, which include genetics, injuries such as spinal cord damage, and chronic diseases such as diabetes that cause nerve damage, can also shape how we interpret pain.
There are some surprising biological factors that may also play a role in pain tolerance. For example, recent research shows that one side of your body may experience pain differently than the other side.
A study published in the December 2009 issue of Neuroscience Letters showed that right-handed study participants could tolerate more pain in their right hands than in their left hands. This study also showed that women were more sensitive to pain than men, but women and men were equal in their ability to tolerate pain intensity.
A dominant hand—your right hand, if you’re right-handed, for example—may interpret pain more quickly and accurately than the nondominant hand, which may explain why the dominant side can endure longer. Hand dominance may also be linked to the side of your brain that interprets the pain, the researchers note.
Someone’s biological makeup can also affect whether he or she develops resistance to pain medicines, which means a treatment that once worked no longer eases the pain. While changing genetic receptors is not possible, nor is which hand you write with, there are coping mechanisms that can influence the brain’s perceptions of pain.
Researchers have focused on trying to alter the psychological interpretations of pain by retraining the mind and alternative remedies, such as relaxation techniques like biofeedback, teach people how to divert their mind from zeroing in on the pain. People can empower themselves by learning relaxation techniques, such as breathing practices during natural childbirth, Cope says. When it comes to pain, mind over matter can work.
