Mechanized “smart” undergarments may be the answer to back pain, according to researchers.
The Vanderbilt University engineers have created an undergarment that eases stress on the low back and activates only when a wearer needs it.
“I’m sick of Tony Stark [the fictional Iron Man] and Bruce Wayne [Batman’s alter ego] being the only ones with performance-boosting supersuits. We, the masses, want our own,” Karl Zelik, principal investigator on the project, quipped in a university news release. “The difference is that I’m not fighting crime. I’m fighting the odds that I’ll strain my back this week trying to lift my 2-year-old.”
That same kind of back strain got the assistant professor of mechanical engineering thinking about wearable tech solutions.
Made of nylon canvas, Lycra, polyester and other materials, the “smart” underwear feels and behaves like regular clothes, according to researchers.
It has one section for the chest and another for the legs. The sections are connected by straps across the middle back, with natural rubber pieces at the lower back and glutes.
A double tap that engages the straps activates the device. It can also be controlled wirelessly using an app.
The new device was recently unveiled in Brisbane, Australia, and is slated to debut in the United States at an American Society of Biomechanics meeting in Boulder, Colo., this week.
To test the undergarment, eight volunteers lifted 25-pound and 55-pound weights. The device eased muscle use in the lower back by 15 percent to 45 percent, according to the researchers.
“The next idea is: Can we use sensors embedded in the clothing to monitor stress on the low back, and if it gets too high, can we automatically engage this smart clothing?” Zelik said in the news release.
More than half of adults have low back pain at some point. The condition leads to an estimated $30 billion in medical costs and more than $100 billion in lost productivity each year in the United States.
Co-investigator Dr. Aaron Yang specializes in nonsurgical treatment of the back and neck at Vanderbilt University Medical Center. He’s seen many back devices and usually views them with doubt.
The “smart” undergarment is not meant to treat existing back pain, he emphasized. Instead, it aims to prevent pain by reducing stress and fatigue on muscles in the lower back, he said.
“People are often trying to capitalize on a huge societal problem with devices that are unproven or unviable,” Yang said in the news release. “This smart clothing concept is different. I see a lot of health care workers or other professionals with jobs that require standing or leaning for long periods. Smart clothing may help offload some of those forces and reduce muscle fatigue.”
Coordinated by Monica Mallampalli, PhD, Chronicillness.co’s Advisor for Scientific and Strategic Initiatives, our two-day event aimed to advance and amplify current dialogue on the impact of chronic pain on women’s health. We certainly accomplished our goals. The summit convened leading experts in chronic pain science and treatment, policy experts from federal agencies and national pain advocacy organizations. Pain activists with personal knowledge of the devastation caused by chronic pain conditions also provided their unique insights. Chronicillness.co is thankful to these trail blazers for illuminating the elusive aspects of chronic pain with the bright spotlight it demands.
I learned so much from our participants and from their commitment to ending the suffering connected with chronic pain. For example, artificial intelligence is now being applied to chronic pain study with tremendous potential. And, successful models for pain management programs exist, such as the one established for women veterans at the VA Connecticut Healthcare Center, can be emulated to benefit women and other populations in need.
My hope is that a reckoning for chronic pain in women is not far off. Improved awareness, louder patient voices and targeted research will elevate chronic pain’s status from “invisible” to “visible,” leading to faster diagnoses, innovative treatment and management strategies and, ultimately, will end long-term suffering.
This will be a triumph for women’s health because women bear a far greater burden of pain. Indeed, the prevalence of most common pain conditions (arthritis, back pain, headache, among others), is higher in women compared to men. In addition:
Seventy percent of chronic pain patients are women.
Women’s life expectancy is reduced by one year for every 10 years spent with chronic pain.
Women with chronic pain are more likely to be treated with prescription pain relievers, like opioids, and at higher doses and for longer periods, than are men, putting women at greater risk for developing opioid use disorder.
While some research has addressed sex differences in pain management, perception and pain threshold, this progress has not translated to improved pain treatment for women.
Sleep loss increases pain sensitivity and is a major risk factor for developing chronic pain, especially in women.
Our keynote speaker Anita Gupta, DO, PharmD, MPP, Professor, Rowan University School of Medicine and Senior Vice President, Heron Therapeutics, issued a call to action I am compelled to repeat. No stranger to the pain journey, Dr. Gupta shared her personal experience with treatment for a rare disease that has altered her approach to patient care. Like the World Cup-winning women’s soccer stars’ call for pay equity in their sport, it is time for “chronic pain equity” in women’s health, according to Dr. Gupta. No longer should women suffering from chronic pain caused by migraine, fibromyalgia, arthritis, debilitating complex regional pain syndrome, or pelvic pain conditions, such as endometriosis, be underserved.
There is no doubt that we still confront many challenges in the science and management of chronic pain. However, the following 10 highlights (and, it was hard to pick only 10) from our summit indicate to me that we are on the right path:
More informed research about sex differences in pain likely will lead to pain medication and devices tailored specifically for men and women.
Researchers and study proposal reviewers are now trained to ask questions and evaluate data with respect to biological differences important to understanding sex differences in pain and pain treatment.
Because few drug trials are designed specifically to study women with pain, an opportunity exists to raise awareness about the importance of recruiting women for clinical trials about pain research.
Innovative clinical approaches, such as motivational interviewing and functional pain inventories, can improve the patient-clinician dialogue and improve patient outcomes by setting goals for managing and living with chronic pain.
Re-thinking treatment for opioid use disorder (OUD) to consider women’s unique health needs and family responsibilities will improve OUD treatment for women and replace current OUD treatment models based on treatment for men.
More data on women of color and women of color experiencing chronic pain will inform policy, begin to eliminate health care disparities and will lead to changes in health care delivery for all women.
Working to eliminate the stigma associated with chronic pain—including self-stigmatization and inherent race and gender biases–will help to break down major barriers to accessing care and successful treatment.
A key to understanding pain is understanding the robust individual differences in pain experiences. Pain management innovation cannot be “one-size fits all.”
Pain research is getting better at measuring pain and increasingly more able to activate, isolate and study specific cell types.
The patient voice must be a partner in drug development, science and patient care.
Chronicillness.co is proud to lead this call to action with our first summit on chronic pain in women. We support the “super heroes” so aptly described by Lindsay Weitzel, PhD, a migraine strategist and author, in the battle to raise awareness of chronic pain-related issues. We will continue to connect women, their families, and their health care providers with resources designed to help them overcome barriers to treatment and pain-free lifestyles. And, we will continue to help women tell their stories about their journeys, providing hope for those for whom the journey awaits.
We know that “pushing back against pain,” urged by Kate Nicholson, JD, in her closing plenary presentation, “Pain, Resilience and How We Heal,” will help society recognize the existence and impact of chronic pain. If you have a minute, check out Kate’s TED Talk on the implications of undertreating chronic pain.
When it comes to pain–management options, not surprisingly, safe and effective pain relief should be priority number one. What may be surprising, however, is that some treatments have advantages that go beyond pain relief. In fact, there are a number of affordable and convenient pain treatments that work to alleviate symptoms—and come with bonus benefits. The following pain-relief treatments are sustainable, have additional advantages and most importantly they’re often times effective for many types of painful conditions when combined with a comprehensive treatment plan.
Massage is a popular pain-relief option as it increases blood flow and reduces muscle tension. It also decreases inflammation by activating genes that naturally reduce swelling. Furthermore, it improves muscle recovery by stimulating mitochondria, the “energy packs” driving cellular function and repair.
Stress can send the brain into overdrive causing adrenaline and cortisol to release into the body, manifesting in trouble sleeping, digestive issues and a host of other health problems. Pain and stress often go hand in hand, but thankfully massage is one way to manage both at the same time. In fact, recent studies found a reduction of cortisol in saliva samples after the participant received a massage. And while making an appointment at the spa can be prohibitive due to time and cost, there are great handheld massager options like the Wahl Deep Tissue Massager. The intensity can be adjusted for customized pain relief in the comfort of your own home.
Glucosamine supplements are commonly used to reduce joint pain because they don’t require a prescription. Many individuals use glucosamine sulfate orally to treat a painful condition caused by the inflammation, breakdown and eventual loss of cartilage as seen in osteoarthritis. Current research demonstrates that the oral use of glucosamine sulfate may provide some pain relief for people with osteoarthritis of the knee, hip or spine. Early research suggests that oral use of glucosamine hydrochloride might reduce pain related to rheumatoid arthritis when compared with placebo, an inactive substance.
Bonus Benefit – Reduced Risk for Cardiovascular Disease
Besides pain relief, a recent research study found that adding a glucosamine supplement to your diet may reduce your risk for cardiovascular disease and early death. In fact, it demonstrated that those who took the supplement regularly saw a 15% lower risk of overall cardiovascular disease and a 9% lower risk of stroke.
Acupuncture is a popular Chinese-based medicine that involves the insertion of fine needles at strategic points on the body. There are several ways in which acupuncture potentially helps to decrease pain and promote tissue recovery. For example, it can signal the body to release pain moderating chemicals called endorphins and enkephalins, which increase blood flow to the tissue and bring in nutrients and oxygen to stimulate healing. After an acupuncture session, studies have shown that the body is more likely to be receptive to naturally occurring painkillers and chemicals that help to alleviate muscle tension or discomfort.
While acupuncture is often used to treat pain symptoms, it is commonly used for overall wellness, including evidence as an effective treatment for insomnia. This is especially noteworthy as quality sleep plays a vital role in both our physical and mental well-being.
Being a mom is tough enough. When chronic pain is thrown into the mix, it can seem downright impossible sometimes. That’s why there’s one day devoted entirely to finding ways to tell moms how much we appreciate them.
Mothers who live with chronic pain have unique struggles that make everyday life a lot harder.
Chronic pain can be limiting. For mothers with chronic pain, these limits can interfere with the small, everyday things that other moms take for granted. Changing a diaper, coloring a picture, or lifting a child into a carseat can become insurmountable tasks. Despite this, mothers who have chronic pain manage to find ways to make it work.
Sarah Willson describes the struggles she has caring for her daughter, stating:
“I can’t push her stroller much farther than the three blocks between home and day care. I can’t dress her by myself, or tie her shoes. I can’t make the appropriate hand motions to accompany ‘Itsy Bitsy Spider,’ write out the alphabet, or brush her hair. But all that feels like mere window dressing for what I really can’t do: feel at all confident that I can take care of my child alone for more than an hour.”
She also describes ways she’s found to make things work a little better. For instance, she’s made sure her toddler knows how to scoot down stairs and climb into her own stroller. While this doesn’t seem like much, it does mean that Sarah doesn’t have to carry her toddler down stairs or lift her into the stroller, which saves Sarah from a lot of pain.
In addition to teaching kids how to be a little more independent, there are a few other ways to manage both motherhood and chronic pain, such as:
Focusing on what you can do, instead of what you can’t
Identifying pain triggers that you can change, such as adding a cushion to a hard bleacher seat
Ask for help from friends and family if you need it
Despite the challenges of being a mom with chronic pain, most mothers would still choose to feel pain themselves than have to watch their children live with chronic pain.
Unfortunately, there are children who live with pain on a daily basis. Where children are concerned, one of the most important aspects of being a parent is to be an advocate for your own child. This is particularly important in children with chronic pain, since their pain tends to be poorly managed.
Often this is because pediatric doctors focus more on finding the cause of the pain, rather than managing the pain, or because doctors aren’t experienced at treating children for chronic pain and are therefore unsure how to proceed. Other times, poor chronic pain management in children might be because children act differently when they’re in pain, which can make it difficult to tell when a child is hurting.
Some of the signs that a child might be in pain include:
Official pediatric pain programs aren’t too common. There are only about 30 to 40 hospitals nationwide that have pain programs for children. This is changing slowly, and there are researchers developing online programs for children with chronic pain who live in rural areas without a pain program. However, until these programs become more widespread and accessible, the most important thing any parent can do is be an advocate for his or her child. If you think your child is in pain or that his or her pain management program is insufficient, tell your physician.
For mothers who live in a house with chronic pain – whether it’s their own or their children’s – finding that perfect Mother’s Day gift can be a challenge.
If a mother in your life lives with chronic pain, consider getting her something to help control that pain for Mother’s Day. If you are a mother living with chronic pain, then print off a webpage with what you want and leave it somewhere your partner or child will see it – or just treat yourself. A few possibilities include a supportive pillow or Kinesio Tape.
You might also consider regular household items, chosen to be a little easier for those with chronic pain. An electric can opener, lighter dishes, or large-handled utensils make the kitchen a little less painful to work in. Long-handed tools of any sort can prevent the need to bend or twist, so look for long-handed dustpans, doggie pooper-scoopers, shower sponges, or even toilet paper holders. If there’s a particular daily activity that’s difficult, look for a tool or gadget that makes that activity easier. For instance, if putting on shoes or socks is hard, consider a sock aid or an extended-handle shoe horn.
Covering mom’s chores is also always a winner. Cook dinner, vacuum, weed the garden, or clean the bathrooms for your mother. These types of jobs can be difficult and draining for anyone with a pain condition (or anyone’s who’s exhausted from caring for a child with a pain condition), so shouldering a little of the burden will certainly make life easier.
Another possibility is an experience of some sort. Choose carefully; a person with painful knee joints won’t enjoy a walking tour of the museum much. Relaxing experiences like manicures or pedicures might be appreciated. Also, massage is a fantastic stress relief, and it can also help manage pain. A single massage, a subscription to a local massage parlor, or even an at-home massage might work wonders. If a mother in your life has been curious about trying yoga, acupuncture, or another type of alternate pain relief, get her a gift certificate to try it out.
Speaking of gift certificates, some people may think they’re a bit on the impersonal side, but that’s not true. A carefully chosen gift certificate to somewhere you know she’ll love is one of the best gifts out there.
If you yourself are a mom, spoil yourself a little. Splurge a little at your favorite store, go out for a day of pampering, take time to truly relax, or get that new gadget you’ve been wanting.
And if you need someone to watch the kids while you go out (or while you and your spouse or partner celebrate Mother’s Day without the little ones), tell your own mother (or mother-in-law) that her gift is an afternoon with the grandkids. Pack a couple movies, some low-energy board games or puzzles, and a gift card to order pizza, and drop them off for an afternoon or evening with grandma.
As anyone with a disability knows, a disability can definitely complicate life at times—but it certainly doesn’t make life impossible. The same is true of exercising with a disability. Exercise can seriously boost moods, decrease pain, and increase flexibility and balance. In addition, using remaining abilities can help prevent the future loss of those abilities.
Exercise is just as important for people with disabilities as for those without.
To get an idea of the potential positive effects of exercise on a disabled person, the National Center on Health, Physical Activity, and Disability (NCHPAD) relayed the story of a young man who was wheelchair bound. He suffered from persistent pressure sores, which forced him to stay in bed while the sores healed. While in his chair, the young man was supposed to do pressure reliefs regularly to prevent more sores, but he never did. Because of this, the young man was unable to attend school regularly, and he participated very little in life.
According to the NCHPAD website, this changed when the young man, Bobby, became interested in a very specific type of exercise:
“He began to focus upon how strong his upper body could be. He worked out and got stronger and bigger. Pressure reliefs, previously performed by leaning over on alternating elbows for 10 seconds, were now performed as full pushups from the armrests for a full minute, as Bobby would look over his shoulders to admire the development of his deltoid and tricep muscles. School attendance became regular. Bobby joined a swimming program and spent two winters participating in a downhill skiing program.”
Becoming interested in exercise not only improved his physical health, but it improved his mood, mental health, and social life. In fact, a recent study even found that physical activity could improve mental function in elderly individuals with cognitive impairments or dementia.
A professional can help figure out how to modify exercises to allow for disabilities.
Before starting any new exercise, talk to a physician. He or she may be able to give suggestions for length of workouts, positions or activities to avoid, and perhaps even exercise ideas. A personal trainer or physical therapist can also be helpful. A physician should be able to provide a referral for a therapist. To find a personal trainer, call or visit gyms and ask if anyone there has experience working with disabled people. A quick Google search can also turn up options for personal trainers.
Keep an eye out for exercise locations that offer disability-modified activities, too. For example, some yoga studios have classes in adaptive yoga. Indoor therapy pools, which are often heated and equipped with a wheelchair ramp, are sometimes open to the public.
Exercising from a chair is a good option for anyone with a disability.
For those with a disability affecting the lower limbs, arm exercises from a chair or wheelchair can get the blood moving. Something as simple as air-punching can help strengthen the arms. A resistance band can also be put to good use. Loop the resistance band under the chair, and stretch the arms forward and back, up and down, while holding the resistance band. Small weights are easy to use for chair exercises.
Additionally, a great piece of equipment for anyone who wants to exercise the legs is a portable pedal exerciser, like these. However, this can be useful for arm exercises, too. Firmly attach the pedal exerciser to a table, and it can be used to get a great upper-body workout.
To exercise the legs from a chair, simply straighten and lower the legs. Holding the leg out for a few seconds can increase the challenge, as can adding a Velcro-attached ankle weight.
If the traditional types of exercise are boring or uninteresting, play some video games.
Video games no longer constitute sitting on the couch for hours on end, moving nothing but the fingers and thumbs. Now, games encourage players to move around. Lots of these games can be done from a chair or wheelchair, and several are safer versions of real-life games.
For example, boxing is a very intense (and dangerous) sport, but playing Wii boxing can be done sitting down and carries no risk of suffering a knockout. In fact, using video games for exercise is so effective that some school districts use these games, sometimes called “exergames,” to provide special needs children with a way to do physical education classes.
Each gaming system is a little different, just as each game is different. Some systems, like the Kinect for XBOX 360, encourage players to stand and move, so that playing a soccer game is almost as intense as participating in a real-life soccer game. Other systems, like the Wii, focus mainly on arm-movements, with extra equipment, like dance pads or balance boards, that focuses on the lower body. When thinking of purchasing a gaming system or game for exercise, go to a game-focused store like Game Stop and ask the employees questions. This will ensure that the system or games are a good fit for each person and his or her disability.
However, be warned: The greatest benefit of video games is also its greatest challenge. When exercise feels like a game instead of exercise, it’s all too easy to accidentally spend hours playing, which leads to seriously sore muscles the next day. It might be a good idea to set a timer while playing video games that include exercise.
There are many resources available to help people with a disability find ways to exercise.
Medical professionals are often the first source for information, so be sure to ask lots of questions. Physicians, nurses, and therapists are often aware of small, local programs and opportunities that are nearly impossible to find without help. Talk to friends and coworkers, too. Nearly everyone has a friend or family member with a disability, and some might have great ideas for exercise.
Also, check out the NCHPAD’s directory. Programs and organizations for people with disabilities are listed by state. Additionally, there’s a state-by-state list of equipment suppliers with equipment that can be useful for anyone with a disability.
Chronic pain is often the after-effect of degeneration, injury, or illness. Part of the body is left damaged somehow, and that damage causes pain. Most pain therapies concentrate on controlling the pain with medications, injections, or devices that block pain signals in one way or another. However, an emerging type of therapy may actually be able to slow or reverse the tissue damage that’s often to blame for chronic pain.
Regenerative therapy encourages the body to heal itself, so it has the potential to help a huge array of conditions.
Regenerative therapies involve the use of different cells (usually from the patient’s own body) to stimulate the body to produce new tissue. As explained by the Pain Doctor article on regenerative medicine:
“The main goal of regenerative therapy is to extract, refine, and concentrate healthy cells from a person and then inject that compound into the same person to grow those healthy cells into substitute body tissue that replaces and restores old, damaged, and weakened tissue.”
Regenerative therapies are usually well-suited to musculoskeletal pain, or pain that’s caused by something in the muscles or bones. Conditions that can respond well to regenerative therapies include:
Stem cell therapy uses stem cells, which are a type of cell that’s able to differentiate, or become, other types of cells. They’re essentially cells that haven’t been assigned a job in the body yet. When an embryo is developing in the womb, it starts out as a mass of stem cells. As the embryo grows, the stem cells multiply and become the specialized cells that make up a body.
Embryos are one source of stem cells, but there are a lot of ethical questions involved in using embryonic stem cells. Fortunately, stem cells are also found in several locations in the adult body. The skin, blood, tissues, and bone marrow all have stem cells. Of these bodily locations, bone marrow is perhaps the most commonly-accessed source of adult stem cells for regenerative therapies. However, harvesting stem cells from bone marrow is a surgical procedure requiring anesthesia or sedation.
Amniotic membrane therapyis similar to stem cell therapy, except that cells from the amniotic membrane are used instead. The amniotic membrane is the inner layer of the placenta surrounding a baby during pregnancy. Usually the amniotic membrane is discarded, but if properly saved, it can be used later. It’s comprised of two types of cells, stromal and epithelial. Both types are, like stem cells, able to differentiate in to other cell types.
Platelet-rich plasmautilizes platelets found in the blood. Platelets contain growth factor proteins. These growth factor proteins play a part in clotting blood, stimulating wound healing, and promoting the growth of new soft tissue.
Compared to other chronic pain therapies, regenerative therapies have an extremely low risk of side effects.
Regenerative therapies typically involve nothing more than an injection to the painful area of the body, making them very safe. Because the injected compound, whether it’s stem cells, amniotic cells, or platelet-rich plasma, is usually from the patient’s own body to begin with, there’s almost no risk of infection.
Additionally, one of the biggest risks in the transplant of biological materials, such as organ transplants, is rejection. This is when the body realizes that the transplanted material is foreign and attacks it. However, since the cells used in regenerative therapy are the patient’s own natural cells, there is no chance at all of rejection.
Stem cell therapy utilizing adult stem cells from the bone marrow is the exception. The harvesting process requires a surgical procedure, which carries the same risks as any other surgery. If, however, the procured stem cells are used on the same person they’re from, this still has the benefit of being extremely low-risk for infection, with no risk of rejection.
The process for acquiring the cells for regenerative therapy is different for each type, but the application of the therapy is a simple, straight-forward process no matter the cell type.
The acquisition of adult stem cells typically requires surgery. Amniotic cells come from the amniotic membrane of the placenta, so a placenta is required. This can be a patient’s own placenta that’s been saved, or it can be from a family member. Immediate family members are more likely to be a close-enough match to ensure the cells won’t be rejected.
Platelet-rich plasma requires a blood draw. A patient’s blood is spun in a centrifuge to separate the platelets. The concentrated platelets are combined with residual blood, and the resultant compound is injected into the painful location on the body. From beginning to end, the process of drawing and preparing the blood and injecting the platelet-rich plasma takes between one and two hours.
After the regenerative cells have been injected, the patient is usually able to go home immediately. While physicians often suggest avoiding any strenuous activity for a few days, it’s possible to go back to regular day-to-day activities right away. Some irritation, soreness, bruising, or other minor discomforts might be present for a few days, but generally there are few side effects of regenerative therapy.
The injected regenerative cells should stimulate the healing and the growth of new tissue. For instance, in degenerative conditions like osteoarthritis, this may mean the growth of new cartilage around joints. With torn muscles or ligaments, regenerative therapy should support the growth of new tissues to heal the injury.
It often takes at least two weeks to notice any difference in pain after regenerative therapy, although in some people it may take even longer. In some cases, there may be no discernable pain reduction after regenerative therapy. However, because of its low risk of side effects, it may still be worth discussing with a physician.
The most common way to control pain is with oral medications, such as non-steroidal anti-inflammatory drugs (nsaids) or opioids. Some people don’t respond to these medications, though, while others are unable to tolerate oral pain medications. Nerve blocks are another way of treating pain with medication, but nerve blocks are injected, which increases efficacy and reduces the likelihood of other side effects.
Nerve block injections allow the delivery of pain-relieving medication directly to the location where the medication will have the most impact.
When a nerve block is performed, it usually begins with the application of a topical anesthetic to numb the skin before the injection. Then imaging equipment, such as fluoroscopy or X-ray, is used to ensure the correct placement of the nerve block needle. Often, contrast dye is injected before the medication, to make doubly sure that the needle is placed correctly.
The primary medication in a nerve block can vary. Usually it includes a numbing medication to deaden the nerves, such as lidocaine. Sometimes a steroid is also included to reduce inflammation. If the nerves or surrounding tissues are painfully irritated or inflamed, a steroid can help reduce pain, too.
Individuals undergoing a nerve block can experience pain relief immediately, although for some people it may take a few days to experience pain relief. The length of the nerve block’s efficacy can vary from a month or two, up to several months in some cases. Often, the nearness of the injection to the nerves influences how long the effects last. The closer the injection is to the nerves, the longer the medication works.
Because of their versatility, nerve block injections are able to provide relief from a wide variety of conditions.
Conditions that might respond well to nerve blocks include:
A physician will discuss pain symptoms and conduct tests and examinations. This will help him or her determine which nerves are being affected, and it’s why it’s so important to discuss pain symptoms as openly and fully as possible with the physician. For example, a complaint of leg pain is very general. However, shooting pain from the buttocks down the leg suggests a very different condition than aches in the knee joint. More specific knowledge about the type of pain being experienced will allow a more specific diagnosis, which will increase the likelihood that a nerve block will be successful.
Nerve block injections can be applied to almost any painful area of the body.
When a physician has determined which nerves are involved in a painful sensation, he or she will decide which type of nerve block will work best. For face pain, an occipital or sphenopalatine ganglion nerve block can provide relief. Back pain may respond to a facet joint, medial branch, or superior hypogastric plexus block. Celiac plexus or splanchnic nerve blocks may relieve abdominal pain. Pain in the chest may be lessened by intercostal or stellate ganglion blocks. Low back pain can potentially be relieved by a variety of nerve blocks, including cluneal, coccygeal, ganglion impar, lumbar facet, or lumbar medial branch blocks. Interscalene or sciatic nerve blocks may relieve limb pain.
Another type of nerve block is sympathetic, meaning it’s delivered directly to the sympathetic nervous system via the spine. Because all the body’s nerves eventually lead to the spine, a sympathetic nerve block has the potential to relieve several different kinds of pain, as explained by the Pain Doctor article on sympathetic nerve blocks:
“Reports show that sympathetic blocks are effective at treating pain in different body parts including the neck, head, back, tailbone, and limbs.”
The placement of a sympathetic nerve block will determine which areas of the body experience pain relief. For example, a lumbar sympathetic block treats pain that originates in the nerves of the lumbar area, or lower back.
Nerve blocks can also help people who experience pain after the installation of spinal hardware. This type of hardware may be surgically implanted to treat spinal stenosis, injuries, trauma, degeneration, or deformities. Clamps, screws, and bone grafts can all be used, but they can also cause pain. A hardware block is a nerve block injected near the hardware to relieve the pain it may be causing.
Sometimes, rather than the traditional injected nerve block, a continuous catheter nerve block is used. It involves a catheter inserted below the skin near the nerves. A small container of pain medication is attached to the catheter, which allows the medication to be delivered continuously to provide long-lasting pain relief.
In addition to providing pain relief, a nerve block injection can be used as a diagnostic tool.
The source of pain, especially chronic pain, can be difficult to diagnose. By extension, it can be difficult to successfully treat pain when the underlying condition isn’t clear. For this reason, nerve block injections are often utilized as diagnostic tools.
A nerve block injection is relatively low risk. As with any injection, there’s always a risk of infection, irritation, or bruising at the site. Additionally, there’s an extremely low risk that the nerve block injection will miss the nerve and instead hit an artery. However, as compared to other interventional pain management techniques, nerve blocks are very low-risk.
This makes nerve blocks a good choice to test a physician’s diagnosis. For example, if a person is experiencing acute headaches, the cause could be one of several underlying conditions, as noted in the Pain Doctor article on acute headaches:
“In fact, there are over 150 different classifications of headaches. Given this wide range of symptomatology, determining the cause of a headache can be somewhat difficult at times. Indeed, in some instances physicians are not able to clearly identify the precise cause of acute headache pain at all.”
However, if a nerve block injected into the occipital nerve relieves the headaches, it can confirm a diagnosis of occipital neuralgia. Then, if the pain returns after the nerve block has worn off, another nerve block injection can be applied. Alternatively, other treatment methods, such as radiofrequency ablation, can be utilized after the nerve block has worn off, with confidence that the correct nerves are being targeted.
Certainly most people have experienced a headache or a poor night’s sleep after a stressful day, but in fact it can do a lot more than this. Each person responds differently to stress, and different types have different effects.
There are three types of stress: acute, episodic acute, and chronic.
Acute stress is a burst that comes from a specific incident, like a fender-bender or a work deadline. The potential symptoms of acute stress are quite noticeable and include:
Emotional distress, including anxiety, depression, or anger
Muscular pain, such as jaw or back pain or tension headaches
Digestion issues, like constipation, diarrhea, flatulence, or heartburn
People who suffer from episodic acute stress experience frequent incidents of acute stress. For example, people who exhibit a fierce competitiveness over everyday activities might also experience frequent bouts of acute stress during those activities. “Worrywarts” who constantly see disaster or catastrophe around the corner might feel acute stress on a very regular basis. Symptoms of this include tension headaches, migraines, hypertension, or even heart disease.
Chronic stress comes from day-to-day trials. People in unhappy marriages, in caregiver positions, those in pain, or people in miserable jobs often suffer from chronic stress. It can accompany miserable situations with no apparent escape. Eventually it can convince individuals that there is no use searching for solutions to problems. Chronic stress is particularly dangerous because it’s so constant that it can easily be forgotten or become familiar.
Headaches, digestive issues, muscle aches, or irritability – all typically associated with acute types – are generally pretty clear. In addition to these common effects, people experiencing it might notice a few other things.
For instance, one study looked at seasonal allergies. It was found that while high levels of stress don’t cause allergies, they can lead to more allergy flare-ups. Therefore, stressed-out people suffering from hay fever might experience more days with more intense sneezing, stuffy or runny noses, or itchy eyes. The increased allergy symptoms might not occur on the same day as the stress, but the researchers found that people tended to experience increased allergy symptoms within days of their increased stress.
People with high levels of stress might also notice that those around them are also suffering from more stress. Scientists have found that stress is highly contagious, especially between partners in a relationships. As many as 40% of people experienced empathic stress when they witnessed their partner experiencing it. Even when the observed person was a stranger, 10% of people still experienced empathic stress.
The true danger of stress lies in its more subtle effects.
Acute stress causes a temporary spike in blood pressure. Studies have also shown that stress might have a longer-lasting effect on health. One recent study found that stress can cause older men to live shorter lives than their peers. Both significant life events, such as the death of a spouse or loss of a job, and everyday stressors, like traffic or a difficult job, impacted men’s health. It was also found that it’s not necessarily the everyday stressors that negatively impact health; it’s the individual’s perception of those as stressful that makes them harmful.
Also, while it’s well-known that a high-fat, high-sugar diet isn’t healthy, researchers at UC San Francisco have found that stress can make an unhealthy diet even unhealthier. Metabolic syndrome is a group of symptoms that occur together, including high blood sugar levels, extra body fat around the waist, increased blood pressure, and abnormal cholesterol levels. Women who were under stress experienced more symptoms of metabolic syndrome, even though women without it reported eating the same amounts of the same foods.
For people with a chronicpain condition, stress can also have an impact on pain levels.
Some types of pain are directly connected to stress levels. For example, someone who suffers from headaches after grinding his or her teeth will grind their teeth more while under stress. This can in turn worsen headaches. The connection between stress and pain goes deeper than this type of cycle, though.
A study recently published in the journal PAIN examined the body’s ability to tolerate pain while under acute psychological stress. Professor Ruth Defrin, of the Department of Physical Therapy at Tel Aviv University’s Sackler Faculty of Medicine, expected that stress might help the body modulate pain better, because of common stories about athletes taking no notice of injuries. However, the results were just the opposite. Acute stress does not affect pain threshold or pain tolerance, but it does increase pain intensification and decrease the body’s ability to inhibit pain.
This means that acute psychological stress might not affect a person when pain is first experienced or how long it can be tolerated. However, it may very well affect how intense the pain is perceived to be. Additionally, it was found that the altered intensity of pain was related to how stressed individuals were. The more acutely stressed out a person was, the more he or she experienced increased pain intensity.
Chronic stress, too, interferes with pain. 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.
Additionally, inflammation plays a role in overall health, as well as in pain. One study found that negative emotions (such as stress) can interfere with the part of the brain that regulates inflammation. In fact, the increased pro-inflammatory markers seen in people under stress may be why there are such strong links between it and heart disease; too much inflammation can increase the risk factors for heart disease, heart attack, and stroke. In individuals with chronic pain, which is often caused or worsened by inflammation, increased pro-inflammatory markers from stress are certainly not a good thing.
In a way, however, the tight connections between stress and pain can be viewed as a good thing. Just as increased stress can increase pain, decreased stress can decrease pain. By finding ways to lower stress, people can both improve their overall health and control their pain levels.
A herniated disc is one of the most painful, debilitating lower back pain conditions. The pain caused by herniated disc is different for each person who experiences it and can even change as the condition progresses. Because this condition can be unpredictable, a herniated disc treatment that works can also vary from person to person. Here’s how to treat a herniated disc.
The spine consists of 33 individual vertebrae, each stacked upon a fluid-filled sac that keeps the bones cushioned from rubbing against each other. This fluid-filled sac is called an intervertebral disc.
The spine consists of individual vertebrae with a spongy cushion separating each. The discs have a gel-like substance in them (like the gel in the insoles you put in your shoes or the gel in an eye mask) called nucleus pulposas. These oval discs help the spine be more flexible because each vertebra isn’t locked into another, and they also contribute to the spine’s flexibility.
When an intervertebral disc herniation occurs, the outer layer becomes weakened, allowing the nucleus pulposus to leak out. The cushion between the bones is gone, and the result can be very painful.
Over time and left untreated, disc herniation can cause permanent nerve damage.
A herniated disc can be caused by a number of different factors:
Time: The continued action and pressure of gravity as people age can begin to wear down the annulus fibrosis
Injury: If the spine is injured (i.e., as a result of a car accident or other trauma to the back), the intervertebral disc may be weakened and begin to leak
Improper use: A sudden, awkward movement such as lifting a heavy object improperly can cause a herniated disc
There are also several risk factors that increase the likelihood that a person will experience a herniated disc. These include:
Age: Because herniated discs can be caused by bone deterioration, older adults have a higher incidence.
Genetics: There is a potential hereditary connection to disc herniation.
Weight: Being overweight or underweight increases an individual’s risk for developing herniated disc.
Lifestyle: Smoking contributes to bone density loss and can increase the spine’s vulnerability to fracture, either from injury or wear-and-tear. Excess consumption of alcohol and prolonged use of steroids can also contribute.
Occupation: Occupations that feature repetitive motion and twisting or bending increase a person’s risk of a herniated disc.
Symptoms of a herniated disc are as varied as the condition itself, and vary from person to person. Herniated disc symptoms may include:
Pain: Pain location varies depending on which disc is herniated. A herniated disc in the lower back can produce pain in the buttocks, thigh, and calf (and possibly the foot). If the disc is herniated in the neck, pain may be shooting in the arm and shoulder area.
When your back is aching, especially along the spine, you may leap to the conclusion that you have a herniated or bulging disc. Many people use the words interchangeably, but there is a difference between the two conditions. How to treat a herniated disc may differ from how you treat a bulging one.
Bulging discs–sometimes also called slipped discs–are “contained.” This means that there are no tears in the disc itself, just that the disc is protruding out from between the vertebrae.
A herniated or ruptured disc has a tear or a rupture and is “uncontained.” The disc is not merely pushing out from between the vertebrae. It is torn, and some or all of the nucleus pulposas has leaked out. A herniated disc may be the second stage of a bulging disc. The vertebrae may have put so much pressure on the bulging disc that it ruptured.
Whichever condition you are suffering from, the result can be tingling, muscle weakness, pain that ranges from moderate to severe, and numbness. Always talk to your doctor to get an accurate diagnosis.
Poor posture, age, repetitive motion, injury due to strain, and normal wear and tear all contribute to herniated discs. Sometimes a herniated disc does not cause pain, but it can be addressed generally with a combination of pain treatments, either natural or prescribed.
What herniated disc treatment works varies widely depending on many different factors. These include:
For some patients, a course of over-the-counter non-steroidal anti-inflammatory drugs (nsaids) combined with targeted exercise and strengthening may be all that is necessary.
Any treatments are only started after your doctor has diagnosed the cause of your pain. Always work closely with them to explain all of your symptoms so they can make the most accurate diagnosis.
The Mayo Clinic has more information on the diagnostic tests for a herniated disc here.
Whether over-the-counter or prescribed, a herniated disc treatment generally begins with a period of anti-inflammatory drugs used to control pain and inflammation. For some patients, this is enough to allow them to begin exercise or other activities to heal the herniated disc.
Epidural steroid injections or nerve blocks may be recommended for those patients who find no relief with nsaids. These injections target the affected nerves directly. Steroid injections are anti-inflammatory and offer pain relief but have only been proven effective for approximately 50% of patients. Nerve blocks numb the nerve so that other treatments can begin.
The following video shows you what you can expect during an epidural steroid injection procedure. Overall, this is a safe and effective option for many people, especially while also undergoing physical therapy or chiropractic care.
Because a herniated disc can be the result of decreased space between the vertebrae, doctors may recommend chiropractic care to help lengthen the spine and physical therapy to strengthen the supporting muscles.
Physical therapists may design an exercise plan, offer manual therapy, apply hot and cold treatments, or administer electrical stimulation. In combination with pain-relieving therapies, physical therapy can go a long way towards rebuilding the muscles around the spine.
Surgery is an option that you should exercise only after you’ve attempted other treatments. If pain and numbness persists, a pain management specialist may recommend a surgical procedure called a discectomy. This procedure removes the herniated material that is pressing on the nerve and causing pain.
For more serious and unresponsive pain due to a herniated disc, your doctor may recommend removing the entire disc. This is a rare procedure that includes inserting metal hardware to connect the remaining vertebrae for stability.
If a patient experiences sudden loss of bowel or bladder control, this is considered a medical emergency that is often addressed with surgery. This condition can become very serious very quickly, and patients should go to the emergency room if this arises.
As with many lower back pain conditions, the best way to treat a herniated disc is to take steps to prevent it from occurring in the first place. There are ways to keep your lower back safe and healthy. Here’s how.
Regular exercise that focuses on strengthening the abdomen and lower back is the best way to prevent a herniated disc.
Rather than spending hours doing crunches, exercises that focus on the whole body are just as valuable. Swimming, balancing poses in yoga (including planks), and targeted exercises for the back are excellent ways to help strengthen the muscles that support the spine.
A well-balanced diet that includes plenty of calcium and vitamin D-rich foods helps maintain strong muscles to support the spine. A healthy diet also helps maintain an appropriate weight for your frame.
Among other things, smoking contributes to a loss of bone density that can contribute to spinal fractures and herniated discs. Quitting smoking is one of the best things you can do for your health, with benefits that start just 20 minutes after your last cigarette. It may be difficult, but there are many resources out there to help.
Pain is a complex phenomenon made up of physical, mental, and social components. At a basic level, the ability to perceive pain has helped people survive throughout the ages. Without feeling the uncomfortable sensation when you touch a stove, which causes you to remove your hand, the heat from the stove would end up causing far more damage to the cells in your hand, than it did before you felt the pain.
In essence, pain is the body’s way of letting you know something is wrong. However, it is when pain fails to subside, despite removing the initial cause, that it becomes pathologic, and known as chronic pain.
“The origins of chronic pain can be categorized into visceral (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).”
Chronic pain can have a wide range of causes and can be associated with a number of different disease processes, thus the ability to diagnose chronic pain syndromes has been a widely debated topic within the medical community for many years.
Earlier this year, the American Pain Society, released a framework that attempts to account for all of the various factors that encompass chronic pain syndromes: physical, pathological, neurobiological, psychological, and social. Broadly speaking, however, the origins of chronic pain can be categorized into visceral (internal organs), somatic (skin and deep tissue), and neurogenic (nerves).
The Institute of Medicine reports that common chronic pain affects approximately 100 million American adults at a cost of $560-635 billion in direct medical treatment cost and lost productivity. However, while the impact of chronic pain is wide-reaching across the population, its effect on the individual person is unique; there is variation in the source(s), severity, duration, response to treatment, and psychological impact from person to person.
Given the variety in the spectrum of chronic pain, it is no wonder why clinicians at times find difficulty in helping patients manage their chronic pain. This difficulty in management has contributed in part to the wide range of therapies that are used to treat chronic pain, such as aspirin, ibuprofen, and other drugs which are classified broadly as non-steroidal anti-inflammatory drugs (NSAIDs) and can be purchased over over the counter.
These medications may work well for short-term relief of mild to moderate pain, but they can create side effects such as ulcers and potentially damage the liver when used continuously, such as in a chronic pain scenario. It is for these reasons that most clinicians avoid relying on this type of medication for long-term pain relief.
A more powerful alternative to NSAIDs is the opiates, such as morphine, oxycodone, codeine, and hydromorphone. The drugs have been well described in the scientific literature, and work by affecting the body’s natural opioid receptors to prevent the nerves responsible for sending pain signals from firing.
These medications have the ability to provide tremendous pain relief and provide clinicians the opportunity to perform life-saving therapies which would otherwise be impossible (e.g. surgery). However, in the treatment of chronic pain, opioid therapy by itself can become problematic for patients – the body begins to develop a tolerance to these medications, thus the dose required in order to get symptomatic relief continues to increase over time.
Additionally, the side effects of taking opioids (sedation, nausea, constipation, and potential respiratory depression and death) make physicians reluctant to continue to raise dosages for patients out of fear of causing dependence. This fear is not ill-conceived either; in 2007, the US Substance and Mental Health Services Administration declared that the dependence on and abuse of pharmaceutical medications is the fastest growing form of problematic substance use in America.
Recently, the argument has been made that the growing rate of prescription drug abuse in the first decade of the 21 century, has been the foundation for the emerging heroin epidemic which characterizes this decade. Due to the issue of tolerance and dependence on opioids, many physicians, supplement the therapy with anti-depressants, muscle relaxants, and additional interventions when treating patients with chronic pain in an attempt to provide relief.
The use of cannabis to treat chronic pain has had a long history, with written references of its use dating back to around 2700 B.C.E. The first records in the nineteenth century were recorded by the Irish doctor William B. O’Shaughnessy, who described the use of cannabis in the treatment of cholera, rabies, tetanus, menstrual cramps, and delirium tremens.
In modern times, significant research has been done around cannabis therapy in the treatment of chronic pain with very promising results.
“Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine.” – Dr. Mark Rabe
“Medical cannabis is a very effective therapy for chronic pain patients because it affects people’s perception of pain, has the ability to mitigate the inflammatory process, and has been shown to affect voltage-gated sodium channels in nerves in a way similar to lidocaine,” reports Dr. Mark Rabe, Medical Director of Centric Wellness, am integrative holistic healthcare practice in San Diego CA and Chairman of the Scientific Advisory Board at Medical Marijuana Sciences, Inc.
The ability of cannabis therapy to help relieve chronic pain on multiple fronts rests squarely in the cannabinoid receptors – cannabinoid receptor type-1 (CB1) and type-2 (CB2). Studies have shown that CB1 receptors are located all over the body, however, they have a particularly high concentration in the central nervous system in areas that control pain perception. CB2 receptors, on the other hand, are primarily located in areas of the body that control immune function, such as the spleen, white blood cells, and tonsils.
The fact that these receptors are found in the two major body systems responsible for producing the sensation of pain, the immune system and the nervous system is what gives cannabis its therapeutic relevance in the chronic pain space. Additionally, and importantly, there is a lack of cannabinoid receptors in the brainstem region, the area of the brain responsible for controlling breathing, thus the dangerous side effect of respiratory depression found with high dose opioid use is not a factor in cannabis therapy.
In practical application, cannabis therapy can be used in conjunction with other chronic pain therapies. In his clinical practice, Dr. Rabe reports, “We have many patients who come in on higher doses of opioid medications. Through using cannabis, in conjunction with other therapies, they are able to lower their daily opioid requirement.”
Numerous studies support these findings, including a 2011 study published in the Journal of Clinical Pharmacology and Therapeutics which showed that vaporizing cannabis increased the patient-reported analgesic effect of opioids, without altering plasma opioid levels. Moreover, there is an emerging body of research whose findings suggest cannabis can be used as an effective substitution therapy for patients with opiate abuse issues.
Overall, we are just at the beginning of our understanding of the possible therapeutic benefits associated with cannabis in the treatment of chronic pain. In addition to the wide range of possibilities in targeting CB1 and CB2 receptors, scientists are beginning to look at targets within the body’s endocannabinoid metabolic life cycle for potential opportunities for therapeutic intervention. Given the growing need for clinicians to transition away from an opiate–dependent treatment protocol for chronic pain, hopefully, these breakthroughs happen sooner rather than later. Naturally, the relaxation of government prohibition would go a long way towards supporting these efforts.
