Pain

 Pain is common health problem. Pain afflicts one out of every two to three people in the United States and around the world at any given time. Chronic pain and acute pain are major sources of mental and physical disabilities which generally go undiagnosed and do not receive adequate attention.  Pain sufferers continue to live in an enigma, and their lives becomes an endless misery.

ARE YOU A PAIN SUFFERER?

Do you suffer from agonizing pain ?

Do you have sleepless nights ?

Are you physically and emotionally distressed?

Is your life at a standstill because of pain ?

Are you taking excessive pain medication ?

Have you undergone multiple treatments ?

Are you financially stressed out ?

Are you missing out on life ?

Were you ever told that your pain is unreal or all in your head ?

Are you on a never ending Merry-Go-Round in search of pain relief ?

If you have to answer 'Yes' to any of these questions,  then this is the time to look at your pain from a new and better angle. In order to accomplish that, it is important that you understand the definition of pain.

 DEFINITION OF PAIN  

     According to the new Taxonomy on Pain, the most complete definition of Pain is as follows:

" Pain is an unpleasant, emotional and sensory experience associated with actual or potential tissue damage . "

     According to this scientific definition of pain, pain is a multidimensional and a complex process; that is, pain is a process which can affect the individual physically, emotionally, psychologically, socially, occupationally and in many other ways. This establishes a new frame of reference which allows the pain specialist to treat and the pain patient to be treated in an effective and appropriate manner. This treatment is best accomplished by the professional services of a Pain Specialist in an interdisciplinary setting.

THE CHRONIC PAIN PATIENT

 Being a sensation of discomfort, distress or even agony, pain can exert definite physical and mental effects. The lives of chronic pain sufferers change in too many ways for them to cope and deal with pain. Personality and attitude change many times, leaving behind a feeling of hopelessness and despair. Depression, irritability, loss of sleep, isolation and lack of activity makes life an endless misery. As a result, trying to deal with pain becomes the center of the patient's life. The patient gets into the habits of doctor shopping, drug dependence, multiple invasive and non-invasive procedures, until at last the patient finds himself running from place to place on a never ending merry-go-round.

TYPES OF PAIN

Our facility treats the following common pain disorders:

I discuss three common type of pain, myofascial pain ,back pain and neck pain.

What Is Myofascial Pain?

    Muscles make up the bulk of the human body  and are instrumental  in mobilizing, balancing and coordinating our  motions, both voluntary and involuntary.   Myofascial pain is pain produced by  stress or damage to muscle and fascia. Myofascial pain is often overlooked, yet it is the major cause of pain and dysfunction in the body.

The muscles and fascia suffer the most wear and tear; however, health care professionals tend  to focus on bones, discs or nerves. This bias must be changed.   I am a pain specialist, and considering the   prevalence of myofascial pain, its devastating effects on pain sufferers, and its toll on the economy, I consider it urgent to educate not only physicians and pain patients but the public as well.

     Myofascial pain is a relatively new term which describes pain of muscular and fascial origin.  A myofascial trigger point is a center of  pain within the muscle, a taut band of the muscle or fascia. The most common symptoms of myofascial pain  are referred pain. This referred pain is usually dull and aching, often deep, with intensity varying from mere discomfort to pain so severe that the patient cannot work or even rest.

      Pain can be localized to one part of the body or it can be generalized.  About two-thirds of patients state that they "hurt all over."   Myofascial pain is also  described as radiating, burning, shooting, pressing or nagging pain.

    The majority of patients evaluated in pain management programs have myofascial pain.  Yet  most physicians have received little or no training in this area, and hardly recognize it. This is unfortunate because in most cases the cause of the pain can be eliminated and the body can be restored to full function. The most significant finding in myofascial pain is the presence of multiple trigger points.

What Is a Trigger Point?

    A Myofascial Trigger Point (MTP.) is a focus of hyper-irritability in a muscle or its fascia that causes pain.  A myofascial trigger point  can be active or latent.

     An active trigger point produces pain even at rest,  and then again with any movement of the muscle that stretches it.  An active trigger point is always tender; it is present in a palpable band of muscle fibers.  It usually weakens the muscle, and produces a "twitch response" when palpated directly.

     A latent trigger point does not cause pain during normal daily activities but causes pain only when palpated. In addition it can limit the range of motion such as difficulty in bending.

   Patients who come to Pain Centers often ask, "I have been suffering from this pain for years now! Why wasn't I diagnosed with myofascial pain before? "

    The  answer to this question is that the job requires experts. Myofascial pain is best diagnosed by  physicians who are  well-versed in myofascial pain. A detailed history and thorough physical  examination, especially of the  muscles, for myofascial trigger points is essential.

Some Facts about Myofascial Pain.

       Routine x-rays, EMG or MRI Scan studies do not provide specific clues to myofascial pain.

       Pain caused by myofascial trigger points is aggravated by dry, cold or humid weather, overuse or over activity, stress, anxiety or depression.

       Poor sleep is also common with myofascial pain. In response to the question "Do you sleep well?", 66% of patients describe their sleep to be poor.  However, 80% of patients complain of "morning fatigue".  Poor sleep may be indicated by difficulty falling asleep, waking up frequently, light sleep, increased dreams and morning fatigue.

      Approximately 85% of patients with myofascial pain complain of "generalized tiredness".  Some patients describe this as exhaustion, tiredness, generalized weakness.  This fatigue is aggravated by physical activity and can cause significant dysfunction in daily activity.

     Pain caused by myofascial TPs can reveal itself to the physician in various ways.  The most common symptoms relate to the neck, shoulders, upper extremity, fascial area, low back and lower extremity.

     In one study of 164 patients done by Friction, et al, the pain was variously described as pressure (48%), dull (27%), throbbing (26%), sharp (18%), burning (26%), and heavy (14%).

    Myofascial pain can also manifest itself as ear pain, tinnitus, nausea, dizziness, tingling sensation, or headaches.

    Some patients with trigger points in the fascial muscles suffer the following symptoms. They are unable to chew, or to open the mouth wide, and their teeth are sensitive to temperature.  They may have been diagnosed as TMJ, whereas the pain might be coming from trigger points in the fascial and neck muscles.

     The neck muscles are a frequent and vastly overlooked cause of headaches.  Patients are diagnosed with "migraine headaches" and treated unsuccessfully with a long list of pain medication or migraine medications.  Frequently, careful examination reveals that the patient's pain originates from trigger points in the neck muscles.

     The most important part of the treatment is to make the patient understand that the pain he is suffering is not from a pinched nerve or arthritic joint.  It is not coming from inflamed tendons or bursae, but is arising from his muscles.  More important is to re-assure patients that trigger point pain can be relieved by specific treatments.

     The treatment involves multi-modality treatments. These treatments may begin by identifying the factors which perpetuate and complement the pain. Then the pain physician may continue with trigger point injections, nerve blocks, and non-narcotic pain medication. Of course, since the problem involves every aspect of the patient's life, the pain physician will treat the patients' entire body by treating sleep disturbance, and then by assisting in neuromuscular conditioning and physical rehabilitation to increase strength,  flexibility of muscles, and endurance. Finally, the psychic parts of the problem may be addressed; secondary depression is alleviated and cognition is improved by meditation, while stress and anxiety are treated with supportive psychotherapy.

Back Pain                             

The spinal column is one of the most vital parts of the human body, supporting our trunks and making all of our movements possible. When the spine is injured and its function is impaired the consequences can be painful and even disabling. According to estimates, 80 percent of Americans will experience low back pain at least once in their lifetime. A small number of patients will develop chronic or degenerative spinal disorders that can be disabling.

Men and women are equally affected by lower back pain, and most back pain occurs between the ages of 25 and 60. However, no age is completely immune. Approximately 12% to 26% of children and adolescents suffer from low back pain. Fortunately most low back pain is acute, and will resolve itself in three days to six weeks with or without treatment. If pain and symptoms persist for longer than 3 months to a year, the condition is considered chronic.

Causes

Low back pain can often be attributed to complex origins and symptoms, and it does not discriminate. It can originate from identified muscle trauma, or an unknown non-traumatic event. Low back pain can also begin in other regions of the body and eventually attack the muscles or other structures in the lower back. Sometimes low back pain can even begin in the nerves or nervous system. Other origins for low back pain are postneural difficulties, congenital disorders, trauma, infections, degenerative disorders, inflammatory diseases, circulatory disorders or any of other 30 additional causes.

It is often difficult for physicians to pinpoint the exact cause of a patient's low back pain, because of the complex composition of the human spine. Bone, discs, muscles, ligaments, tendons and various other tissues are arranged like a three-dimensional puzzle to make up the spine. The complex make up can easily mask the exact cause of low back pain.

Symptoms

Low back pain is the most prevalent cause of disability in people under age 45, and of the $27 billion spent on all musculoskeletal trauma $16 billion is spent in the management of low back pain, more than half of that $16 billion being spent on surgical treatment.

If you have any of the following back pain symptoms, contact a doctor immediately:

Pain is worse when you cough or sneeze
 

Pain or numbness travels down one or both legs
 

Pain awakens you from sleep
 

You are finding it difficult to pass urine or have a bowel movement
 

Pain is accompanied by loss of control of urination or bowel movements

These important back pain symptoms could signal nerve damage or other serious medical problems. There are many other conditions that could be causing these problems, but an early and accurate diagnosis is vital for successful treatment.

Treatment option

The first order of business when it comes to lower back pain is to have an accurate diagnosis for your pain. Next, you should review treatment options. Most back pain can be managed conservatively, although some specific disorders require spine surgery. In most cases of back pain, patients will begin to notice relief within two weeks of starting treatment. Treatment options range from basic rest, ice or heat and gradually resuming activity to medication, exercise, physical therapy, chiropractic treatment, acupuncture and surgery. See your physician for recommendations for treatment of your specific back pain. Make sure to educate yourself on the cause of your back pain, and look into the pros and cons of available treatment options, so you and your doctor can choose what's best for you. The most important thing is for you to be in charge of your own treatment and recovery.

Neck Pain

Your neck has a hard job — holding up your head. Leaning into your computer or hunching over your workbench just makes its job more difficult.

Poor posture certainly contributes to neck pain. But the design of your neck also makes it vulnerable. All the interconnected structures that give your neck its incredible range of motion are subject to the wear-and-tear damage of arthritis and the "overstretching" injuries of whiplash.

Neck pain accompanied by a headache and fever could be a symptom of meningitis, an infection of the membranes that surround your brain. If your neck is so stiff that you can't touch your chin to your chest, you should seek immediate medical attention.

Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Neck muscles, particularly those in the back of your neck, become fatigued and eventually strained. When you overuse your neck muscles repeatedly, chronic pain can develop. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.

Arthritis. Just like all the other joints in your body, your neck joints tend to deteriorate with age.

Disk disorders. As you age, the cushioning disks between your vertebrae become dry, narrowing the spaces in your spinal column where the nerves come out. The disks in your neck also can herniate. This means the inner gelatinous material of a disk protrudes through the disk's tough covering. Nearby nerves can be irritated. Other tissues and bony growths also can press on your nerves as they exit your spinal cord, causing pain.

Injury. Rear-end collisions often result in whiplash injuries, which occur when the head is jerked forward and back, stretching the soft tissues of the neck beyond their limits.

Signs and symptoms

Your neck contains bones, joints, tendons, ligaments, muscles and nerves, any of which can hurt.  Neck pain also may come from regions near your neck, such as your jaw, head and shoulders. Conversely, problems in your neck can make other parts of your body hurt, such as your upper back, shoulders or arms.

If your nerves are involved in your neck pain, you may also feel numbness, tingling or weakness in your arms or legs.

Screening and diagnosis

Your doctor often will be able to diagnose the cause of your neck pain and recommend treatment just by asking questions about the type, location and onset of your pain.

In less clear-cut cases, your doctor may use imaging techniques such as X-rays, magnetic resonance imaging (MRI) or computerized tomography (CT) scans. These tests may show compression of nerve roots, narrowing of nerve root outlets, spinal cord problems and disk problems.

Electromyography (EMG), a test that evaluates the electrical activity in nerve and muscle, may help determine if there's nerve damage. And myelography, or X-ray imaging of the spinal cord after injection of a dye beneath its tough outer membrane, may be helpful in determining if a disk, bone or other growth is crowding the nerves or spinal cord.

When to seek medical advice

Muscle irritations are usually easy to self-diagnose. They typically come on after excessive activity, a period of overuse or prolonged postures that put excessive strain on your neck muscles. But they usually get better on their own within a few days to a couple of weeks. If the pain doesn't let up within a week or two, see your doctor.

Also see your doctor if the following signs and symptoms occur in conjunction with neck pain:

Severe pain from an injury. After head or neck trauma, such as whiplash or a blow to your head, see your doctor immediately. Severe pain over a bone might indicate a fracture or an injury to a ligament.

Shooting pain. Pain radiating to your shoulder, through your shoulder blades or down your arm, or numbness or tingling in your fingers, may indicate nerve irritation. Neck pain from nerve irritation can last from three to six months or longer. Because serious problems may occur after continued nerve irritation, see your doctor.

Loss of strength. Weakness in an arm or a leg, walking with a stiff leg, or shuffling your feet indicates the need for immediate evaluation.

Change in bladder or bowel habits. Any significant change, especially a sudden onset of incontinence, could indicate a neurological problem.

Treatment

Most neck pain responds well to home care. Neck injuries or strains often result in painful inflammation. You may want to try over-the-counter pain relievers that also combat inflammation, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve). Acetaminophen relieves pain but not inflammation.

Ice is another good way to reduce inflammation. Heat can help relax sore muscles, but it sometimes aggravates inflammation, so use it with caution. Apply heat or ice for 15 to 20 minutes, with a 40-minute rest between applications.

For pain that doesn't get better with simple home-care measures, your doctor may recommend:

Physical therapy. Heat, ice or similar treatments combined with an appropriate stretching and muscle strengthening program may enhance the structures that support your cervical spine. Such treatments are often all you need for neck pain.

Pain medications. Your doctor may prescribe stronger pain medicine than what you can get over-the-counter. Opioid analgesics are sometimes used briefly to treat acute neck pain. Muscle relaxants or tricyclic antidepressant medications also may be prescribed.

Traction. This therapy, under supervision of a medical professional and physical therapist, may provide relatively fast relief of some neck pain, especially pain related to nerve root irritation. Relief may last for hours or even days.

Transcutaneous electrical nerve stimulation (TENS). Electrodes placed on your skin near the painful areas deliver tiny electrical impulses that may relieve pain.

Corticosteroid medication. Although there is some evidence that corticosteroids are useful, research is inconclusive. These drugs may be administered orally or via injection into the space around the nerve roots.

Short-term immobilization. A soft cervical collar that supports your neck without taxing your muscles may help.

Surgery. Surgery is rarely needed for neck pain. It is used to relieve nerve root or spinal cord compression.

Prevention

Most neck pain is associated with poor posture. The goal is to keep your head centered over your spine, so gravity works with your neck instead of against it. Some simple changes in your daily routine may help.

Take frequent breaks if you drive long distances or work long hours at your computer. Keep your head back, over your spine, to reduce neck strain. Try to avoid gritting your teeth.

Adjust your desk, chair and computer so the monitor is at eye level. Knees should be slightly lower than hips. Use your chair's armrests.

Avoid tucking the phone between your ear and shoulder when you talk. If you use the phone a lot, get a headset.

Stretch frequently if you work at a desk. Shrug your shoulders up and down. Pull your shoulder blades together and then relax. Pull your shoulders down while leaning your head to each side to stretch your neck muscles.

Balance your base. Stretching the front chest wall muscles and strengthening the muscles around the shoulder blade and back of the shoulder can promote a balanced base of support for the neck.

Avoid sleeping on your stomach. This position puts stress on your neck. Choose a pillow that supports the natural curve of your neck.