Category: Chronic Pain

In 2007, arthritis and conditions related to it cost the U.S. economy almost $128 billion in medical care and indirect expenses. The most widespread form of arthritis is osteoarthritis, which is sometimes called “wear and tear” arthritis.

Osteoarthritis is characterized by the chronic degeneration of the cartilage that cushions our joints. This cartilage allows for easy, smooth movement. When cartilage is worn away, bone rubs directly on bone, causing pain, stiffness, inflammation, and tenderness. Weight-bearing joints like the hips and knees are often most affected by osteoarthritis.

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Although osteoarthritis of the knees and hips can affect nearly anyone, certain populations are more at risk than others.

The 2 largest risk factors for osteoarthritis are age and gender. Women are much more likely to suffer from osteoarthritis, and they are more apt to develop this disease after age 45. However, before age 45, men are more likely than women to have osteoarthritis. Other risk factors include obesity, past injuries, or a job with repetitive actions or a lot of lifting.

Early warning signs of osteoarthritis of the knees or hips include stiffness or swelling. Among those whose X-rays show osteoarthritic degeneration, only about 1 in 3 report feeling pain. Those who do experience pain might only feel it after physical activity, and pain might fade during rest. Patients might also experience the sensation of bone rubbing on bone or hear a crunching or popping sound during movement. In extreme cases, the sound of bone rubbing across bone can even be audible to the people surrounding the patient.

If the knee joints have degenerated as a result of osteoarthritis, it may become difficult to walk, climb stairs, or get in and out of chairs, cars, or bathtubs. When the hips are affected by osteoarthritis, movement can be even more severely limited. Bending may become difficult, and everyday activities like dressing or putting on shoes can become a challenge. Osteoarthritis pain from the hip joints might even be experienced in the inner thigh, buttocks, groin, or knees.

If osteoarthritis of the knees and hips is significantly advanced and causing a serious decline in a patient’s quality of life, joint replacement surgery is sometimes suggested. Both knee and hip joints can be partially replaced or, if the degeneration is significant enough, completely replaced. During this surgery, the damaged joint will be cut away and a prosthetic joint made of plastic, metal, or ceramic will be installed. Although highly invasive, joint replacement is successful at reducing pain in 90% of patients. However, there is a risk that the artificial joint might eventually become loose or worn out.

There are several non-invasive treatments to consider for osteoarthritis pain before pursuing a more invasive joint replacement.

Often, actions as simple as resting the affected joint can provide relief. Weight loss can be extremely helpful, especially with knee osteoarthritis, since every pound of weight lost removes approximately 3 to 6 pounds of pressure from the knee joints.

Stiffness from osteoarthritis can be relieved by the application of heat, while pain or muscle spasms from osteoarthritis can be alleviated by cold. Over-the-counter pain creams can also be helpful. Assistive devices, such as a cane or walker, can help remove some of the burden from degenerated joints.

Though exercising while suffering from osteoarthritis may seem counterintuitive, it can be very beneficial.

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Exercises for people with osteoarthritis should be gentle and low-impact. For example, easy stretches can relieve stiffness. Aerobic exercises like walking can help keep off excess weight, which will reduce strain on joints affected by osteoarthritis. Strong muscles from strengthening exercises can help support and protect joints.

However, overexertion during exercise can exacerbate osteoarthritis pain. Therefore, osteoarthritis sufferers should introduce activity gradually and pay attention to the body’s fatigue signals.

If a person is still experiencing osteoarthritis pain, medications can be helpful.

Oral opioids can block pain signals, but extended use carries the risk of dependency. Non-steroidal anti-inflammatory medications (nsaids) work by reducing inflammation around the joints, which can be very effective for reducing discomfort and alleviating pain.

Some injected medications also reduce osteoarthritis pain. Nerve block injections are injected into the nerves of the painful area. These injections include a local anesthetic, such as lidocaine, and often include a corticosteroid to reduce inflammation as well. Another treatment designed to benefit the nerves is radiofrequency ablation (RFA). During RFA, radiofrequency heat is applied to the nerves to cause the formation of a lesion that can stop pain signals.

Other non-invasive treatments for osteoarthritis of the knees and hips include acupuncture or transcutaneous electrical nerve stimulation (TENS). Acupuncture is the insertion of small needles to block the transmission of pain signals along the nerves. TENS includes the placement of a cap or small pads on the body, through which a slight electrical charge is transmitted to interfere with pain signals.

Bio-medical products can provide more non-surgical options for treating osteoarthritis of the knees and hips. The loss of cartilage in osteoarthritis is often accompanied by the loss of synovial fluid, which is the fluid that encapsulates joints. During a procedure called visco-supplementation, hyaluronate bio-medical fluid is injected into the joint to replace lost synovial fluid. This procedure has proved effective in relieving osteoarthritis pain in the knee joint, but no studies have been carried out to test the potential benefits of visco-supplementation for treatment of osteoarthritic hip pain.

If non-surgical methods fail to alleviate osteoarthritis pain, the patient should discuss the possibility of joint replacement with his or her physician. If the surgery is performed, the person should be sure to take his or her physician’s advice after the procedure. Physical therapy is necessary to help the person regain full mobility and avoid pain. Additionally, lifestyle changes like weight loss or abstinence from alcohol or tobacco use can benefit the recovery process.

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Did you know that the majority of people who have had a limb amputated still report feeling some sensation in the removed limb, such as itching or tingling? As many as 80% of amputees experience a type of this phantom limb pain. This can manifest as almost any sort of pain, such as stabbing, throbbing, or burning. Pain can last anywhere from minutes to hours to days, with some amputees in constant pain for decades.

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While no one is quite sure what causes phantom limb pain, many experts suspect damaged nerves or scar tissue. Some also blame the mixed signals sent to the brain when an entire limb suddenly stops sending information. When the brain stops receiving input from a limb, it emits the most basic message it can to convey that something’s wrong: pain.

Because no one is certain of the cause of phantom limb pain, no single treatment has been proven to work without fail.

Medications and noninvasive therapies are often a doctor’s first suggestion. Oral drugs, like antidepressants, anticonvulsants, or narcotics, are sometimes effective. Injected pain medications or steroids have also shown some success. Noninvasive techniques like acupuncture or transcutaneous electrical nerve stimulation (TENS) can be helpful, too.

Spinal cord stimulation, during which the doctor inserts small electrodes into the spinal column, might also reduce pain. An electrical current is transmitted through the electrodes, hopefully blocking pain signals. Similar to spinal cord stimulation, deep brain stimulation employs electrical currents to block pain signals, but the currents are instead delivered directly into the patient’s brain. If all else fails, surgery might be suggested to remove scar tissue or damaged nerves. However, this risks worsening the pain if the surgery is unsuccessful or other complications arise.

Other therapies used for phantom limb pain are meant to trick the brain into thinking that the amputated limb still exists.

For example, if a patient only has 1 remaining leg, a mirror box is used to make it appear that the missing leg is still there. Patients perform symmetrical exercises with the remaining limb while imagining that the phantom limb is performing the exercises simultaneously.

Recently, virtual reality (VR) programs have taken the place of traditional mirror therapy. Patients wear VR goggles while performing tasks with their remaining limb, but the goggles show the same tasks being performed by the missing limb instead. Alternatively, a patient can perform tasks in front of a screen equipped with motion tracking equipment and the screen shows the tasks being performed by the phantom limb.

These methods have had mixed results. Some patients report no difference in their phantom limb pain at all.  Additionally, these therapies are useless for patients who have lost both arms or both legs, because there’s nothing for the mirrors to reflect or for the VR programs to mimic.

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A new treatment for phantom limb pain takes this idea to new heights, while also providing a novel option for double amputee patients.

Max Ortiz-Catalan, a researcher at Chalmers University of Technology, recently carried out a case study with a patient who suffered from constant phantom limb pain for 48 years. The patient, who lost his arm below the elbow after a traumatic accident, had attempted drug therapy, acupuncture, traditional mirror therapy, and even hypnosis, but his pain remained. Researchers attempted a new treatment method with the patient that was detailed in a recent article in Frontiers in Neuroscience.

For the study, electrodes were attached to the patient’s arm stump. The patient was instructed to attempt 8 different movements with his phantom arm and hand, such as opening and closing his hand or flexing his wrist. These attempted movements “trained” the researchers’ computer program to translate myoelectric muscle signals in the stump and allowed the patient to control a superimposed arm on a screen. The superimposed arm responded in real time, fooling the brain into thinking it was controlling a real arm.

Not only does this method allow a patient to visualize the amputated limb, as in existing mirror and VR therapy, but it also engages the areas of the brain that control the limb’s movement. This, suggests Max Ortiz-Catalan, is the reason that this method is more effective at treating phantom limb pain. Even when the superimposed arm wasn’t visible, such as while playing a racing video game, the patient was able to achieve the same control over the arm and experienced the same benefits. Additionally, this therapy method’s function is based on muscle signals in the stump, rather than the reflection of a remaining limb, so it will work just as well for double amputees.

So far, the results are promising.

After 48 years of continuous phantom limb pain, the patient in Ortiz-Catalan’s case study reported being pain-free for 15-60 minutes after each therapy session. He experienced lessened pain at home between therapy sessions, and eventually reported experiencing periods of time at home with no pain at all for the 1st time since losing his arm. He also no longer experiences such severe pain at night that he’s woken up by it. When asked about the perceived position of his missing hand, the patient stated that it was relaxed and semi-open, as opposed to the strongly clenched fist he’s experienced until now.

This therapy is similar in function to myoelectric prosthetics. Indeed, a myoelectric prosthetic utilizes electrodes on a patient’s skin to control movement of the prosthetic arm, just as electrodes allow patients control of the superimposed arm in Ortiz-Catalan’s study. While data is somewhat unclear, there is some suggestion that use of a myoelectric prosthesis could relieve phantom limb pain to some degree. However, these sorts of prosthetics are not very common. A great deal of training is involved, both for the doctor and for the patient. Also, a myoelectric prosthesis is extremely expensive, with prices ranging up to $100,000.

Ortiz-Catalan’s therapy method could provide a much more accessible, cost-effective means of treating phantom limb pain, especially if patients are able to carry out this therapy at home. An at-home system has already been developed and is awaiting approval. The patient in the case study is using it regularly.

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Neuralgia is sharp, and often severe, pain that runs along the path of a nerve. The basic cause of neuralgia pain is damage or irritation of a nerve. This damage or irritation can be caused by several different conditions, from disease to trauma.

Causes of neuralgia

To understand the cause of neuralgia, it’s first necessary to understand how nerves work.

The nervous system is responsible for carrying information back and forth from the brain to the rest of the body. Nerves are the long bundles of fibers that connect sensitive nerve endings to the rest of the nervous system.

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Nerves are protected by a layer of protein and fatty substances called the myelin sheath. If the myelin, or the nerve that’s insulated by it, is damaged, the impulses sent along the nerve can be slowed or interrupted. This can lead to problems like neuralgia or neuropathy.

Both neuralgia and neuropathy are nerve-related and caused by damage to the nerves. However, by breaking down the origins of each word, it’s possible to see how the two conditions are different. Neuro- (or neura-) means nerve. –algia means pain, while –pathy means disease. Therefore, while neuropathy can be accompanied by pain, it’s also characterized by tingling, numbness, weakness, or other symptoms. Neuralgia, however, refers only to nerve pain.

Neuralgia pain is usually a side effect or symptom of something else.

According to the Better Health Channel:

“Generally, neuralgia isn’t an illness in its own right, but a symptom of injury or a particular disorder. In many cases, the cause of the pain is not known. Older people are most susceptible, but people of any age can be affected.”

Sometimes simple old age can be blamed for neuralgia. Other times, a disease might cause damage to the nerves, as in diabetes or multiple sclerosis. Infections like HIV, Lyme disease, or syphilis can also sometimes cause nerve damage. Even a bacterial infection, such as an abscessed tooth, can irritate nearby nerves and cause neuralgia. Pressure on a nerve might cause neuralgia pain, too; bone, tissue, or tumors that press on a nerve can cause painful irritation.

Unfortunately, some medications—including the medications used to treat cancerous tumors—might also lead to neuralgia. Sometimes even trauma, whether from an injury or from a surgical procedure, can cause neuralgia pain. Essentially, anything that can damage the myelin sheath can potentially cause neuralgia.

Types of neuralgia

The different types of neuralgia are generally characterized by the cause or the location of the pain.

For example, the two most common types of neuralgia are post herpetic neuralgia and trigeminal neuralgia. Post herpetic neuralgia is characterized by its cause. It is the result of nerve damage from the herpes zoster virus, commonly called shingles.

Trigeminal neuralgia is diagnosed according to which nerve is affected and where the pain is felt. In this type of neuralgia, the trigeminal nerve is damaged or has painful pressure exerted on it. Trigeminal neuralgia pain affects the face. In addition to pain, there might also be such intense hypersensitivity that even brushing the teeth or feeling a breeze on the cheek can cause severe pain. The pain may begin in just one area or on one side of the face, but it can spread as the condition worsens.

Another type of nerve pain is glossopharyngeal neuralgia, which is somewhat uncommon. This occurs when the glossopharyngeal nerve is irritated or damaged, which produces pain in the neck and throat. Sometimes the pain can also extend to the tongue, back of the throat, tonsils, or ears.

Occipital neuralgia occurs when the occipital nerves, or the nerves that run from the top of the spinal cord up to the scalp, are injured or inflamed. This often causes pain that starts at the back of the head and radiates forward, but it can also cause pain on one or both sides of the head or behind the eye. Sensitivity to light or a tender scalp may also occur. This condition can sometimes go undiagnosed because its symptoms are easy to mistake for headaches or migraines.

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Conditions related to neuralgia

There is a host of conditions that can cause or be accompanied by neuralgia pain.

Multiple sclerosis is well-known as a nerve-related disease, and it can indeed cause neuralgia pain. In fact, nerve pain is one of the best-known symptoms of multiple sclerosis. However, it’s not the only disease that can cause neuralgia pain.

Other conditions that might be accompanied by neuralgia include:

• Diabetes
• Porphyria
• Chronic kidney disease (also called chronic renal disease or insufficiency)
• Lupus
• Hypothyroidism
• Complex regional pain syndrome
• Stroke
• Spinal stenosis
• Fibromyalgia
• Sciatica

Neuralgia treatment options

People with neuralgia pain have a lot of treatment options.

Each individual’s treatment for neuralgia pain might be different, depending on what caused the pain. For example, since the high blood sugar levels associated with diabetes are responsible for damaging nerves, someone with diabetes-related neuralgia pain might benefit from stricter control of diet (and possibly diabetes medications) to keep blood sugar levels at heathier levels. Treating the underlying condition causing the neuralgia is often a good way to treat the pain.

If treating the condition doesn’t relieve neuralgia pain—or if the cause of the pain can’t be identified—there are many other non-surgical treatment options. In some cases, over-the-counter pain medications may be sufficient. Heat therapy, massage, or rest might also do the trick. If not, a physician might be able to prescribe stronger medications, such as antidepressants, antiseizure drugs, or narcotics. Skin patches or creams that contain pain-relieving medications might also help. Physical therapy can sometimes be indicated, as well.

If the pain still persists, the physician may suggest injections of pain medications, such as an occipital nerve block injection for occipital neuralgia. He or she might also suggest radiofrequency ablation, which is focused heat that damages a painful nerve in order to cut off pain signals before they’re sent to the brain.

If non-surgical methods have failed to alleviate neuralgia pain, there are surgical ways that can treat it. The most common surgical procedures to correct neuralgia attempt to relieve the pressure on a painful nerve, perhaps by moving the blood vessel that’s pressing on the nerve. Other surgical procedures have a similar goal as radiofrequency ablation: the interruption of the nerve to stop pain signal transmission.

Unfortunately, some people are unable to find relief from neuralgia pain despite attempting all available treatments. However, most neuralgia pain is relatively minor and responds well to treatment.

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