The term “fibromyalgia” may be relatively new, but the condition itself has been around for quite a while. After several name changes, a definite set of diagnostic parameters are finally established for fibromyalgia.
The first known mention of fibromyalgia was in the 1800s, but at the time it was simply called “muscular rheumatism.”
When “muscular rheumatism” was first written about, doctors noted that it caused stiffness, aches, pains, tiredness, and difficulty speaking. In 1824, a doctor in Scotland first described the tender points that characterize fibromyalgia.
A psychiatrist in the United States described a condition called “neurasthenia” in 1880, which he believed was caused by stress. He ascribed the symptoms of widespread pain, fatigue, and psychological problems to neurasthenia.
The term “fibrositis” was introduced in 1904 by Sir William Gowers. “Fibro” refers to the body’s connective tissues. “Itis” indicated inflammation or swelling, so “fibritis” meant inflammation of the connective tissues. In 1913, a physician wrote more about fibritis, describing a worsening of symptoms as air pressure fell and rains came on. He also described temperature variations and fevers.
In the 1970s, Hugh Smythe described fibritis in papers and medical textbooks. This was the clearest, most cohesive description of the disease and its symptoms so far. The name was changed from “fibritis” to “fibromyalgia” in 1976, since inflammation was no longer believed to be the cause. “Myo” means muscles and “algia” means pain, so “fibromyalgia” means pain in the muscles and connective tissues.
Certain antidepressants were found to be effective in treating fibromyalgia in 1986. The Journal of the American Medical Association (JAMA) published an article about fibromyalgia in 1987. Also in that year, fibromyalgia was recognized by the American Medical Association (AMA) as a defined disease and cause of illness and disability. The American College of Rheumatology first published diagnostic criteria for fibromyalgia in 1990.
There is no definitive test for fibromyalgia, so it’s typically a diagnosis of exclusion, meaning that a person can only be diagnosed with fibromyalgia when every other possibility has been excluded.
The Mayo Clinic website explains why diagnosing fibromyalgia is so difficult, stating:
“Fibromyalgia symptoms include widespread body pain, fatigue, poor sleep and mood problems. But all of these symptoms are common to many other conditions. And because fibromyalgia symptoms can occur alone or along with other conditions, it can take time to tease out which symptom is caused by what problem. To make things even more confusing, fibromyalgia symptoms can come and go over time.”
Tender points are still used by many specialists during diagnoses. There are 18 potential tender points on the body, and the physician must be able to elicit a response on at least 11 of these tender points. However, knowing precisely where the tender points are and how much pressure to apply can be tricky, so general doctors use a different set of diagnostic criteria.
Widespread pain that’s lasted for at least three months
Presence of other symptoms, such as fatigue, waking up tired, or trouble thinking (often called “fibro fog”)
No other conditions that could be causing the symptoms
Additionally, some physicians may score patients’ responses to a series of questions to judge the severity of the widespread pain being experienced. For instance, several symptoms are given a score as far as symptom severity. Zero means no problems at all, while three means severe, pervasive, or life-disturbing. Then the scores for all the symptoms are added together. If this score is above a certain level, it’s considered positive for fibromyalgia. This positive result, in addition to other positive results and the absence of any other conditions that could explain the symptoms, will usually lead to a diagnosis of fibromyalgia.
Gender, health condition, genetics, and trauma are all thought to play a role in fibromyalgia. However, it’s not known if all or any of these are the actual cause of the condition. It’s only known that these factors play a part in determining an individual’s risk for developing fibromyalgia.
External triggers, such as viral infection or repetitive strain, and some preexisting conditions, such as rheumatoid arthritis or lupus, may make people more likely to develop fibromyalgia. Depression, post-traumatic stress syndrome, or other mental illnesses are often found in people who have fibromyalgia. Additionally, being overweight, being inactive, or smoking might increase the risk for fibromyalgia. Women are also much more likely to develop fibromyalgia, although men and children can develop the condition, too.
Studies have been conducted looking at the role of stress in triggering fibromyalgia. Employees in a stressful job environment tended to experience more pain. Also, women who’ve experienced relationships with violent abuse are at an increased risk for fibromyalgia. People who feel as though they have very little support or who had a poor psychological response to pain also seem to be an increased risk for fibromyalgia.
Even though the cause behind fibromyalgia is still unknown, and diagnosing it remains a challenge, it’s thanks to the collective history of fibromyalgia that we have any understanding of it today. The symptoms and tender points described in the 1820s, the psychological (cognitive) problems acknowledged in the 1880s, and the issues with temperature regulation noted in the early 1900s all helped define the condition as it’s understood today.
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:
Living with fibromyalgia can be difficult and painful. When traditional treatments do not work, many patients turn to alternative therapies for pain relief. Chinese herbs and over-the-counter supplements have become popular in many patients’ efforts to relieve their pain. At Chronicillness.co Site, our pain management specialists recommend a comprehensive plan when treating the pain of fibromyalgia.
5-HTP (5-Hydroxytryptophan). This supplement is a building block of serotonin. Serotonin is a powerful brain chemical, and serotonin levels play a significant role in fibromyalgia pain. Serotonin levels are also associated with depression and sleep.
For those with fibromyalgia, 5-HTP may help increase deep sleep and reduce pain. In one study published in the Alternative Medicine Review, researchers reported that supplementation with 5-HTP may improve symptoms of depression, anxiety, insomnia, and fibromyalgia pains. However, there are some contradictory studies that show no benefit of 5-HTP.
5-HTP is usually well tolerated. But in the late 1980s, the supplement was associated with a serious condition called eosinophilia-myalgia syndrome. It’s thought that a contaminant in 5-HTP led to the condition, which causes flu-like symptoms, severe muscle pain, and burning rashes.
Melatonin. This natural hormone is available as an over-the-counter supplement. It is sometimes used to induce drowsiness and improve sleep patterns. Some preliminary findings show that melatonin may be effective in treating fibromyalgia pain. Most patients with fibromyalgia have sleep problems and fatigue, and it’s thought that melatonin may help relieve these symptoms.
Melatonin is generally regarded as safe with few to no side effects. Due to the risk of daytime sleepiness, though, anyone taking melatonin should use caution when driving until they know how it affects them.
St. John’s Wort. While there’s no specific evidence that St. John’s wort is helpful in treating fibromyalgia, this herb is often used in treating depression, and depression is commonly associated with fibromyalgia.
There are several studies that show St. John’s wort is more effective than a placebo and as effective as older antidepressants called tricyclics in the short-term treatment of mild or moderate depression. Other studies show St. John’s wort is as effective as selective SSRI antidepressants such as Prozac or Zoloft in treating depression.
St John’s wort is usually well tolerated. The most common side effects are stomach upset, skin reactions, and fatigue. St. John’s wort should not be mixed with antidepressants as can cause interactions with many types of drugs. If on medication, tell a doctor before taking St. John’s wort or any supplement. In addition, be careful about taking St. John’s wort with other drugs, including antidepressants.
SAM-e. It’s not known exactly how SAM-e works in the body. Some feel this natural supplement increases levels of serotonin and dopamine, two brain neurotransmitters. Although some researchers believe that SAM-e may alter mood and increase restful sleep, current studies do not appear to show any benefit of SAM-e over placebo in reducing the number of tender points or in alleviating depression with fibromyalgia. Additional study is needed to confirm these findings.
The studies are limited, but it’s thought that L-carnitine may give some pain relief and treat other symptoms in people with fibromyalgia. In one study, researchers evaluated the effectiveness of L-carnitine in 102 patients with fibromyalgia. Results showed significantly greater symptom improvements in the group that took L-carnitine than in the group that took a placebo. The researchers concluded that while more studies are warranted, L-carnitine may provide pain relief and improvement in the general and mental health of patients with fibromyalgia.
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.
Chronic pain is usually defined as pain that’s lasted for more than three months. This may not seem like a terribly long time–unless you’re the one in pain. When something hurts for so long, it can easily eat away at every aspect of a person’s life, from mood to friendships.
The loss of a social life can have significant negative effects on a person’s chronic pain and general health.
Not only can constant pain affect an individual’s ability to perform household chores or go to work, but it can create feelings of isolation and loneliness. A person with chronic pain may feel alone or as though no one understands what he or she goes through. He or she might become resentful of those who don’t have to deal with pain on a regular basis. His or her loved ones might become frustrated by their inability to help. These feelings can multiply and eventually damage friendships and relationships.
Patient.co.uk defines “passive coping” as giving up one’s social life and relying entirely on doctors and medications for pain relief. While having a team of doctors and some carefully-chosen medications is certainly important, it’s not recommended to depend so heavily on them that the rest of a person’s social life is abandoned. In fact, passive coping is associated with increased pain, increased disability, and depression.
On the flip side, a strong support system can have big benefits.
According to one study, chronic pain patients who reported having a supportive family did significantly better than those who described their families as unsupportive. Those with a supportive family reported less pain intensity, had greater activity levels, and were less reliant on medications. They also were more likely to be able to continue working.
Support from loved ones, like family and friends, can make a big difference. Even having a loving pet at home can be helpful. However, connecting with others who have chronic pain is just as important.
Find that pain and its accompanying emotions aren’t unusual
Being part of a chronic pain support group can provide an outlet for rough days and a place to celebrate successful pain management techniques. It can give people with chronic pain a place to say, “It’s one of those days,” and know that others understand what that means.
Many people don’t realize how many others suffer with pain on a daily basis. A chronic pain support group can make it easier to talk about chronic pain, even with those who don’t have it. This can increase awareness of chronic pain and, by extension, increase support from family, friends, and coworkers.
It’s for these reasons and more that the Faces of Pain support group exists.
The Faces of Pain support group allows people to load a picture and a little information about themselves. The simple act of sharing really can help. Additionally, for anyone having a rough day, reading through the many stories at Faces of Pain will inevitably inspire and encourage. Some of the entries are short and to the point, such as Lisa’s: “The way I cope with Chronic Pain is to just trying to fake it ’til I make it…”
Some entries really drive home why support groups are vital, such as Ivy’s:
“My primary goal is to rejoin life again. I’m afraid to go out anymore because I never know when my back will go out or my Meniere’s disease will hit. I’m so out of touch with people and afraid they’ll judge me for my health issues. So my goal is to move past that and learn to enjoy life again despite my health issues. I need strength and courage to move past it.”
Without groups like Faces of Pain, it would be much more difficult for people in situations like Ivy’s to reach out for support. In addition to posts that allow people to share their pain, there are posts that share people’s goals and inspiration. Many people recount their dependence on faith as a source of strength. Many others list their goals, such as traveling, writing, or animal rescue. A significant number of people at Faces of Pain describe their desires to cope with pain by helping others.
Some people also share their successes, which can serve as inspiration for others. One of these is Jess’s. Below a picture of Jess with her young son next to her, she writes:
“On the right, that was as close as my son and I could get from January til May. Now we don’t have limitations in that way and get super close. Love my little guy.”
In addition to the Faces of Pain site, the Fibromyalgia Support Group on Facebook provides a way for those with chronic pain to interact with each other.
The Fibromyalgia Support Group currently has 15,000 members. People in this group sometimes reach out for support while experiencing pain. For example, in a recent post, a woman described the pain that was keeping her from sleep. Several people commented, commiserating with and comforting her. Other posts are jokes and jabs to encourage laughter, which can often reduce pain. Also often posted at the Chronic Pain Support Group are requests for advice. Because the group is so large and varied, there’s almost always someone able to provide suggestions.
Chronic pain doesn’t have to be suffered through in silence and isolation.
Carrying a heavy load can do more than hurt the back. According to Tel Aviv University researchers, nerve damage, specifically to the nerves that travel through the neck and shoulders to animate our hands and fingers, is also a serious risk. At Chronicillness.co Site of United States, our pain doctors recommend not only always lifting heavy objects correctly, but also never lifting more than is safe.
The research, published in the Journal of Applied Physiology, and partially supported by a grant from TAU’s Nicholas and Elizabeth Slezak Super Center for Cardiac Research and Biomedical Engineering, was done by Prof. Amit Gefen of TAU’s Department of Biomedical Engineering and Prof. Yoram Epstein of TAU’s Sackler Faculty of Medicine, along with Ph.D. student Amir Hadid and Dr. Nogah Shabshin of the Imaging Institute of the Assuta Medical Center. They have determined that the pressure of heavy loads carried on the back has the potential to damage the soft tissues of the shoulder, causing microstructural damage to the nerves.
The result could be anything from simple irritation to diminished nerve capacity, ultimately limiting the muscles’ ability to respond to the brain’s signals, inhibiting movement of the hand and the dexterity of the fingers. In practice, this could impact functionality, reducing a worker’s ability to operate machinery, compromising a soldier’s shooting response time, or limiting a child’s writing or drawing capacity.
The researchers focused their study on combat units in which soldiers must carry heavy backpacks. They discovered that, in addition to complaining of discomfort or pain in their shoulders, soldiers also reported tickling sensations or numbness in the fingers.
Hoping to explore this issue in a non-invasive manner, they used biomechanical analysis methods originally developed for investigating chronic wounds. The analyses show how mechanical loads, defined as the amount of force or deformation placed on a particular area of the body, were transferred beneath the skin to cause damage to tissue and internal organs.
Based on data collected by MRI, Profs. Gefen and Epstein developed anatomical computer models of the shoulders. These showed how pressure generated by the weight of a backpack load is distributed beneath the skin and transferred to the brachial plexus nerves. The models also account for mechanical properties, such as the stiffness of shoulder tissues and the location of blood vessels and nerves in the sensitive areas which are prone to damage.
Extensive mechanical loading was seen to have a high physiological impact. “The backpack load applies tension to these nerves,” explains Prof. Gefen. He notes that the resulting damage “leads to a reduction in the conduction velocity – that is, the speed by which electrical signals are transferred through the nerves.” With a delay or reduction in the amplitude or the intensity of signals, nerve communication cannot properly function, he says.
The researchers were most concerned about how heavy backpacks may affect children. To help children ease the burden on their backs, try to encourage them to bring home everything every night and leave some things in their locker. It’s also helpful to find a well-designed backpack and adjust it properly to fit the child securely.
