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18 Aug

Postherpetic Neuralgia

Postherpetic neuralgia

Postherpetic neuralgia (post-hur-PET-ik noo-RAL-juh) is the most common complication of shingles. The condition affects nerve fibers and skin, causing burning pain that lasts long after the rash and blisters of shingles disappear.

The chickenpox (herpes zoster) virus causes shingles. The risk of postherpetic neuralgia increases with age, primarily affecting people older than 60. There’s no cure, but treatments can ease symptoms. For most people, postherpetic neuralgia improves over time.

Symptoms

The signs and symptoms of postherpetic neuralgia are generally limited to the area of your skin where the shingles outbreak first occurred — most commonly in a band around your trunk, usually on one side of your body.

Signs and symptoms might include:

Pain that lasts three months or longer after the shingles rash has healed. The associated pain has been described as burning, sharp and jabbing, or deep and aching.
Sensitivity to light touch. People with the condition often can’t bear even the touch of clothing on the affected skin (allodynia).
Itching and numbness. Less commonly, postherpetic neuralgia can produce an itchy feeling or numbness.

When to see a doctor

See a doctor at the first sign of shingles. Often the pain starts before you notice a rash. Your risk of developing postherpetic neuralgia is lessened if you begin taking antiviral medications within 72 hours of developing the shingles rash.

Causes

Once you’ve had chickenpox, the virus remains in your body for the rest of your life. As you age or if your immune system is suppressed, such as from medications or chemotherapy, the virus can reactivate, causing shingles.

Postherpetic neuralgia occurs if your nerve fibers are damaged during an outbreak of shingles. Damaged fibers can’t send messages from your skin to your brain as they normally do. Instead, the messages become confused and exaggerated, causing chronic, often excruciating pain that can last months — or even years.

Risk factors

When you have shingles, you might be at greater risk of developing postherpetic neuralgia as a result of:

Age. You’re older than 50.
Severity of shingles. You had a severe rash and severe pain.
Other illness. You have a chronic disease, such as diabetes.
Shingles location. You had shingles on your face or torso.
Your shingles antiviral treatment was delayed for more than 72 hours after your rash appeared.

Complications

Depending on how long postherpetic neuralgia lasts and how painful it is, people with the condition can develop other symptoms that are common with chronic pain such as:

Depression
Fatigue
Difficulty sleeping
Lack of appetite
Difficulty concentrating

Prevention

The Centers for Disease Control and Prevention (CDC) recommends that adults 50 and older get a Shingrix vaccine to prevent shingles, even if they’ve had shingles or the older vaccine Zostavax. Shingrix is given in two doses, two to six months apart.

The CDC says two doses of Shingrix is more than 90 percent effective in preventing shingles and postherpetic neuralgia. Shingrix is preferred over Zostavax. The effectiveness may be sustained for a longer period of time than Zostavax. Zostavax may still be used sometimes for healthy adults age 60 and older who aren’t allergic to Zostavax and who don’t take immune-suppressing medications.

By Mayo Clinic Staff

Article Provided By: mayo clinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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10 Aug

The Lowdown on Living with Neuropathy

May 7 to 13 is National Neuropathy Awareness Week. The week highlights the national effort to educate the public on neuropathy’s causes, treatments, and prevention strategies. If you or someone you care for is living with neuropathy, the week presents an excellent opportunity to learn more about this condition and help others.

What Is Neuropathy?

Approximately 20 million Americans are living with peripheral neuropathy. While the term “neuropathy” simply means “nerve damage,” peripheral neuropathy is the impairment of the nerves in the body’s outer extremities — such as the hands and feet. While the explanation for an individual’s neuropathy is sometimes unknown, a wide range of factors can cause it. Here are some causes of this chronic neurological disease.

Trauma from injury and repetitive stress is the most common cause, and medical treatments, like certain types of chemotherapy and surgeries, can damage nerves.
Nearly 70 percent of people with diabetes live with some level of neuropathy.
Inflammation from autoimmune diseases like lupus and rheumatoid arthritis can destroy nerve fibers.
The majority of people on dialysis for kidney disease develop neuropathy because excess toxic chemicals accumulate and damage nerves.
Infections, both bacterial and viral, are a major cause of neuropathy.
Heavy drinking can cause irreversible nerve damage.

Diagnosing Neuropathy

Symptoms of neuropathy depend on the type of nerve damaged. Associated with muscle weakness, motor nerve damage symptoms include decreased reflexes, twitching, and cramping. Sensory nerve damage leads to loss of sensation and is a leading cause of falls among older adults. It also causes difficult-to-treat neuropathic pain. Common symptoms of neuropathy include:

Tingling, burning, or numb sensations
Hypersensitive to touch
Stabbing or shooting pains
Muscle cramps and loss of muscle mass
Dizziness and balance issues
Weakness

To diagnose neuropathy, health care professionals begin with a physical and neurological exam, and gather your medical history. They may order any number of tests and screenings to expand their search or confirm suspicions. Tests might include skin and nerve biopsies and magnetic resonance imaging (MRI) scans. Nerve conduction velocity tests — used to determine damage to large nerve fibers — and those that measure muscles’ electrical activity help pinpoint neuropathy’s physical effects.

Treating Neuropathy

The good news for those living with neuropathy is that it is sometimes reversible. Peripheral nerves do regenerate. Simply by addressing contributing causes such as underlying infections, exposure to toxins, or vitamin and hormonal deficiencies, neuropathy symptoms frequently resolve themselves.

In most cases, however, neuropathy is not curable, and the focus for treatment is managing symptoms. Assistive devices, pain management, and physical therapy make a tremendous difference for those living with neuropathy. Technologies — from specialized footwear to electrical nerve stimulation devices — offer hope for the future.

Preventing Neuropathy

Whether you have to quit smoking, control blood sugar levels, avoid alcohol, or implement aggressive self-care, you can likely manage symptoms and stall neuropathy’s progression. Some people even make changes to their routine to greatly reduce their risk of ever acquiring it. Eating a healthy diet, exercising regularly, and avoiding bad habits are major steps in that direction.

Help make National Neuropathy Awareness Week a success by becoming a part of the effort. Learn what you can and share your experiences. If you’re living with neuropathy or caring for someone who is, know that your voice matters.

Article Provided By: dignityhealth

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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4 Aug

Neuropathy and COVID-19, What You Should Know

COVID-19 has been dominating the news and has been a constant worry for people with preexisting conditions. If you’re one of these people and are living with neuropathy, the best thing you can do is to arm yourself with the best information available.

At US Neuropathy Centers, our team of experienced doctors is dedicated not only to treating your neuropathy but helping you safely manage and navigate your way through the COVID-19 crisis.

Neuropathy basics

To understand COVID-19’s effect on neuropathy, you need to understand the condition itself. Here’s some information we put together on the basics of neuropathy.

Your body is made up of many complex systems including your central nervous system. The nervous system consists of your brain, your spine, and a network of nerves called peripheral nerves.

These nerves extend into the other areas of your body, controlling movement and carrying information between your brain and muscles.

Neuropathy, often known as peripheral neuropathy because it affects the peripheral nerves outside your spine and brain, refers to weakened or damaged nerves. There are many reasons you may be experiencing peripheral neuropathy.

For example, chemotherapy treatment, diseases like HIV and shingles, some autoimmune diseases, and exposure to certain toxins can result in loss of sensation. But the most common cause of neuropathy is diabetes.

The nerve damage leaves you with numbness or tingling in your affected extremities. You may even completely lose sensation and reflexes. Managing these symptoms and monitoring your condition is especially important in the middle of the pandemic.

Neuropathy and COVID-19

While there’s no direct link between neuropathy and COVID-19, there are certain circumstances that put you at risk for contracting the virus and experiencing worsened symptoms. Here are a few things you should know about living with neuropathy during this pandemic:

Be aware of your condition

Neuropathy typically indicates the presence of an underlying condition. Diabetes, autoimmune diseases, cancer, and other infections are all causes of neuropathy and all reasons to be extra vigilant with COVID-19 spreading.

Because your immune system is compromised, you’re at a much higher risk of contracting the virus. We recommend that you observe social distancing guidelines and possibly quarantine yourself to prevent the risk of infection.

Know the risk

Because your extremities have lost most or all of their sensation, you might not be aware that you’ve injured yourself and developed an infection.

For example, if you have diabetic neuropathy, it’s now even more important that you control your blood sugar and constantly monitor your feet for signs of ulcers and infections.

If you suffer from neuropathy caused by an autoimmune disease and need regular blood infusions, be aware that most blood donors have not been tested for COVID-19 antibodies. If you’re aware of the risks related to your neuropathy, you can adjust and protect yourself.

Contracting COVID-19

If you do become infected with the virus, you’re not likely to experience any new damage to your cells, but you may have flare-ups of your neuropathic symptoms.

The flu-like effects of COVID-19 may exacerbate the tingling and numbness you normally feel. While this may be uncomfortable, it’s no need to panic. Follow your doctor’s care orders closely until the infection runs its course.

Article Provided By: usneuropathycenters
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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26 Jul

How do I Exercise with Neuropathy?

Water aerobics is an exercise performed in a pool.

To exercise with neuropathy, or nerve damage, you should aim for a moderate workout schedule rather than overdoing it. It’s important to have regular exercise sessions though, because it may lessen the extent or intensity of neuropathy over time. In general, exercises that don’t put a lot of pressure on the skeleton, especially the feet, are good for people with neuropathy.

Exercising in the water puts little stress on the joints and bones, and may be recommended for those with neuropathy.

Running, jogging, hiking, walking and step aerobics may be too much when exercising with nerve damage. If you have moderate to severe neuropathy in the feet or legs, overdoing or even moderately doing these activities may cause foot ulcers or joint damage. If the feet or legs aren’t swollen, sore or have a “pins and needles” feeling, then a limited amount of these types of exercises may be able to be done.

Running, jogging, hiking, and walking may be too much when exercising with nerve damage.

Aqua aerobics in the shallow end of a swimming pool may be fine in moderation, as the water helps cushion the feet and joints. However, as there is still contact with the feet on the pool floor, deep water aerobics can offer even more cushioning exercises. Swimming is often an excellent physical activity for those who exercise with neuropathy. Since it involves whole body movement, swimming can provide overall toning as well as cardiovascular benefits when done at a brisk pace.

While regular exercise is especially important for diabetics with neuropathy, as it can help lower blood sugar, proper fitting shoes and checks of the feet after workouts is important. Yoga can be an extremely beneficial exercise with neuropathy, as it’s gentle on the body, but if it’s done in bare feet, diabetics must be sure to take caution in not getting any scrapes or even a tiny pebble on either foot. Something as minor as a scratch on the foot may go unnoticed by those with neuropathy, as their feet are typically numb. If untreated, a foot infection may become so severe that amputation is necessary.

Individuals suffering from neuropathy may not notice scratches on their feet.

If you begin the type of exercise that best suits your degree of neuropathy, you should aim for about 30 minutes three to five times a week, depending on your fitness level and physician’s recommendations. In addition to water exercises, cycling may be another activity that you find you can do with neuropathy. It’s important to begin any type of exercise with neuropathy slowly and build up your time spent on it gradually.

Article Provided By: thehealthboard

Olympic Photo by Alex Smith on Unsplash

If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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7 Jul

What Is Nerve Pain (and How Does It Differ From Other Kinds of Pain?)

“Can you describe your pain?” This will likely be one of the first questions your doctor asks if you complain of chronic pain. Unless there’s an obvious reason for pain, your doctor needs a lot of information to identify the underlying cause. This includes the location, type, intensity and frequency of pain. The doctor is partly trying to determine whether the pain is nociceptive or neuropathic (also called nerve pain), or possibly both.

“This can be tricky because all pain is experienced through the nerves,” says sports medicine specialist Dominic King, DO. Damage to bodily tissues, such as muscles, tendons, ligaments or the capsules around joints, causes nociceptive pain. Nerve receptors adjacent to the damaged tissue, called nociceptors, transmit a pain signal to the brain. This type of pain tends to feel sharp, achy, dull or throbbing.

Understanding ‘electric pain’

If you’re experiencing something that feels more like burning, stabbing, or shooting pain ― especially if there also is numbness or tingling ― it’s likely to be neuropathic pain. This means there is direct damage or irritation to a nerve. “It can cause a lightning strike type of electric pain,” says Dr. King.

Nerve pain can arise from a variety of causes, including diabetes, infections (such as shingles), multiple sclerosis, the effects of chemotherapy or trauma. When it comes to orthopeadic issues, nerve pain often stems from a nerve being pinched by nearby bones, ligaments and other structures.

For example, a herniated disk in the spine or a narrowing of the spinal canal (stenosis) can press on a nerve as it leaves the spinal canal. This can cause pain along the path of the nerve. When nerves that originate in the lower spine are affected, symptoms might be felt in the buttocks or down a leg. If the compressed nerve is in the upper spine, the pain and other symptoms can shoot down the arm. Numbness or tingling may also occur because the brain is not receiving a consistent signal due to the compression.

Another common cause of nerve pain is carpal tunnel syndrome. A nerve and several tendons travel through a passageway in the wrist (the carpal tunnel) to the hand. Inflammation in the tunnel can press on the nerve, causing numbness and tingling in the thumb and fingers.

How is the cause of nerve pain found?

“There are so many orthopaedic conditions that overlap between pain stemming from problems with tendons, muscles, joints and nerves that you need a very discerning physician to do a good physical exam to figure out the cause,” says Dr. King. “I make my determination based on when the patient experiences pain, where the pain is located and what the pain feels like.”

Pain related to joints, such as from arthritis, will feel more like stiffness when going from sitting to standing. With tendon pain, it will feel sore when you push on the affected area. “Nerve pain is more of a burning, fiery pain,” says Dr. King. And it tends to come and go.

“Nerve pain typically gets worse with more and more use and can be associated with numbness,” says Dr. King.

Ultimately, getting the right treatment depends on getting the right diagnosis. For many bone and joint conditions, nondrug treatment will be tried first. Sometimes pain medication is needed. However, neuropathic pain does not respond to drugs commonly used for nociceptive pain, such as nonsteroidal anti-inflammatory drugs.

This article originally appeared in Cleveland Clinic Arthritis Advisor.

Article Provided By: clevelandclinic

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14 Jun

Managing & Coping with Neuropathy

What predicts depression and anxiety among people with PN? Not necessarily the severity of the PN symptoms! The predictors are the psychological variables (i.e.: How do you feel? Hopeless, optimistic, anxious, etc.); social variables (i.e.: Are you active? Do you have support?) All of these variables can be changed!

Dwelling on what might have been if you were not diagnosed, self-pitying, ruminating about better times, and think of yourself primarily as a “PN patient” does not provide the escape from stress of the illness. These coping strategies are ineffective and can make your neuropathy symptoms worse.

Below are effective Self-Care and Coping Skills:

Managing Peripheral Neuropathy

The following suggestions can help you manage peripheral neuropathy:

Take care of your feet, especially if you have diabetes. Check your feet daily for signs of blisters, cuts or calluses. Tight shoes and socks can worsen pain and tingling and may lead to sores that won’t heal. Wear soft, loose cotton socks and padded shoes. You can use a semicircular hoop, which is available in medical supply stores, to keep bed covers off hot or sensitive feet.

Quit smoking. Cigarette smoking can affect circulation, increasing the risk of foot problems and possibly amputation.

Eat healthy meals. If you’re at high risk of neuropathy or have a chronic medical condition, healthy eating is especially important. Emphasize low-fat meats and dairy products and include lots of fruits, vegetables and whole grains in your diet. Drink alcohol in moderation.

Massage. Massage your hands and feet, or have someone massage them for you. Massage helps improve circulation, stimulates nerves and may temporarily relieve pain.

Avoid prolonged pressure. Don’t keep your knees crossed or lean on your elbows for long periods of time. Doing so may cause new nerve damage.

Skills for Coping With Peripheral Neuropathy

Living with chronic pain or disability presents daily challenges. Some of these suggestions may make it easier for you to cope:

Set priorities. Decide which tasks you need to do on a given day, such as paying bills or shopping for groceries, and which can wait until another time. Stay active, but don’t overdo.

Acceptance & Acknowledgement. Accept and acknowledge the negative aspects of the illness, but then move forward to become more positive to find what works best for you.

Find the positive aspects of the disorder. Of course you are thinking there is nothing positive about PN. Perhaps your outlook can help increase empathy, encourage you to maintain a balanced schedule or maintaining a healthier lifestyle.

Get out of the house. When you have severe pain, it’s natural to want to be alone. But this only makes it easier to focus on your pain. Instead, visit a friend, go to a movie or take a walk.

Get moving. Develop an exercise program that works for you to maintain your optimum fitness. It gives you something you can control, and provides so many benefits to your physical and emotional well-being.

Seek and accept support. It isn’t a sign of weakness to ask for or accept help when you need it. In addition to support from family and friends, consider joining a chronic pain support group. Although support groups aren’t for everyone, they can be good places to hear about coping techniques or treatments that have worked for others. You’ll also meet people who understand what you’re going through. To find a support group in your community, check with your doctor, a nurse or the county health department.

Prepare for challenging situations. If something especially stressful is coming up in your life, such as a move or a new job, knowing what you have to do ahead of time can help you cope.

Talk to a counselor or therapist. Insomnia, depression and impotence are possible complications of peripheral neuropathy. If you experience any of these, you may find it helpful to talk to a counselor or therapist in addition to your primary care doctor. There are treatments that can help.

How to Sleep With Neuropathy

Sleep is an essential part of living—sleep helps us avoid major health problems and it is essential to our mental and physical performance. It affects our mood and stress and anxiety levels. Unfortunately, sleep disturbance or insomnia is often a side effect of neuropathy pain. It is a common complaint among people with living with chronic pain.

It’s no surprise that about 70 percent of pain patients, including those suffering from PN, back pain, headaches, arthritis and fibromyalgia, report they have trouble sleeping according to the Journal of Pain Medicine.

Pain can interfere with sleep due to a combination of issues. The list includes discomfort, reduced activity levels, anxiety, worry, depression and use of medications such as codeine that relieve pain but disturb sleep.

Most experts recommend a range of seven to nine hours of sleep per night for adults, regardless of age or gender. This may seem impossible to people with chronic pain, but there are steps you can take to improve your sleep, which may lead to less pain and lower levels of depression and anxiety. First, talk with your doctor to see if there are medications that may lessen your sleep disturbance. You should also check with your doctor to make sure your current medications aren’t causing some of your sleep disturbance.

Beyond medication, there are several things you can do yourself to improve your sleep. Here are some methods to try and help you fall asleep more quickly, help you sleep more deeply, help you stay asleep, and ultimately help keep you healthy.

Following are tips for improving your sleep:

Reduce your caffeine intake, especially in the afternoons
Quit smoking
Limit and/or omit alcohol consumption
Limit naps to less than one hour, preferably less
Don’t stay in bed too long—spending time in bed without sleeping leads to more shallow sleep
Adhere to a regular daily schedule including going to bed and getting up at the same time
Maintain a regular exercise program. Be sure to complete exercise several hours before bedtime
Make sure your bed is comfortable. You should have enough room to stretch and turn comfortably. Experiment with different levels of mattress firmness, foam or egg crate toppers, and pillows that provide more support
Keep your room cool. The temperature of your bedroom also affects sleep. Most people sleep best in a slightly cool room (around 65° F or 18° C) with adequate ventilation. A bedroom that is too hot or too cold can interfere with quality sleep.
Turn off your TV and Computer, many people use the television to fall asleep or relax at the end of the day. Not only does the light suppress melatonin production, but television can actually stimulate the mind, rather than relaxing it.
Don’t watch the clock – turn your alarm clock around so that it is not facing you
Keep a note pad and pencil by your bed to write down any thoughts that may wake you up at night so you can put them to rest
Refrain from taking a hot bath or shower right before bed; the body needs to cool a degree before getting into deep sleep
Try listening to relaxing soft music or audio books instead, or practicing relaxation exercises.

Visualizing a peaceful, restful place. Close your eyes and imagine a place or activity that is calming and peaceful for you. Concentrate on how relaxed this place or activity makes you feel.

Some patients find comfort from a pillow between their legs that keeps their knees from touching. And there’s an added benefit: A pillow between your legs at night will prevent your upper leg from pulling your spine out of alignment and reduces stress on your hips and lower back.

It may take three to four weeks of trying these techniques before you begin to see an improvement in your sleep. During the first two weeks, your sleep may actually worsen before it improves, but improved sleep may lead to less pain intensity and improved mood.

Article Provided By: foundationforPN

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26 Apr

The Common Symptoms of Neuralgia

Erica Jacques

Medically reviewed by

Scott Zashin, MD

on July 05, 2020

Neuralgia is nerve pain that may be caused by many different things, including nerve damage, nerve irritation, infection, or other diseases. It is caused by irritation or damage to a nerve and is a sharp and very intense pain that follows the path of the nerve.

Neuralgia is also sometimes called neuropathy, neuropathic pain, or neurogenic pain. It is most common in older adults but can affect people of all ages.

The nerves of the lower body — MedicalRF.com / Getty Images

Symptoms

How can you tell if the pain you are experiencing is neuralgia or some other type of pain? Neuralgia is typically more severe and has some distinct symptoms:

Increased sensitivity: The skin along the path of the damaged nerve will be very sensitive, and any touch or pressure, even gentle, is painful.
Sharp or stabbing pain: Pain will occur along the path or the damaged nerve and will be felt in the same location each time. It often comes and goes but can also be constant and burning and may feel more intense when you move that area of your body.
Weakness: Muscles supplied by the damaged nerve may feel very weak or become completely paralyzed.

Types

Certain painful conditions are classified as neuralgia because they are caused by nerve damage and lead to nerve pain. You can also experience neuralgia as a side effect of surgery. The pain can range in severity based on the extent of nerve damage and what nerves are affected.

Some common types of neuralgia include:

Treatment

Unfortunately, treating neuralgia is not an easy task and treatment will vary depending on the cause, location, and severity of your pain. The first step your doctor will likely take will be to identify the cause of the nerve problem and work to reverse or control it. He or she will also likely recommend pain medications to control your symptoms, including:1

Antidepressant medications
Antiseizure medications
Over-the-counter pain medications, such as aspirin, acetaminophen or ibuprofen
Narcotic analgesics for short-term pain
Lidocaine patch
Capsaicin or lidocaine medicated skin creams

Other treatment options may include anesthetic shots, nerve blocks, physical therapy, surgery, nerve ablation, or complementary and alternative therapies. Talk to your doctor to discover the source of your pain and find out what treatments may work for you.

Article Provided By:verywellhealth
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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1 Apr

Trigeminal Neuralgia

Trigeminal Neuralgia
Trigeminal neuralgia (TN), also known as tic douloureux, is sometimes described as the most excruciating pain known to humanity. The pain typically involves the lower face and jaw, although sometimes it affects the area around the nose and above the eye. This intense, stabbing, electric shock-like pain is caused by irritation of the trigeminal nerve, which sends branches to the forehead, cheek and lower jaw. It usually is limited to one side of the face. The pain can be triggered by an action as routine and minor as brushing your teeth, eating or the wind. Attacks may begin mild and short, but if left untreated, trigeminal neuralgia can progressively worsen.

Although trigeminal neuralgia cannot always be cured, there are treatments available to alleviate the debilitating pain. Normally, anticonvulsive medications are the first treatment choice. Surgery can be an effective option for those who become unresponsive to medications or for those who suffer serious side effects from the medications.
The Trigeminal Nerve
The trigeminal nerve is one set of the cranial nerves in the head. It is the nerve responsible for providing sensation to the face. One trigeminal nerve runs to the right side of the head, while the other runs to the left. Each of these nerves has three distinct branches. “Trigeminal” derives from the Latin word “tria,” which means three, and “geminus,” which means twin. After the trigeminal nerve leaves the brain and travels inside the skull, it divides into three smaller branches, controlling sensations throughout the face:
Ophthalmic Nerve (V1): The first branch controls sensation in a person’s eye, upper eyelid and forehead.
Maxillary Nerve (V2): The second branch controls sensation in the lower eyelid, cheek, nostril, upper lip and upper gum.
Mandibular Nerve (V3): The third branch controls sensations in the jaw, lower lip, lower gum and some of the muscles used for chewing.
Prevalence and Incidence
It is reported that 150,000 people are diagnosed with trigeminal neuralgia (TN) every year. While the disorder can occur at any age, it is most common in people over the age of 50. The National Institute of Neurological Disorders and Stroke (NINDS) notes that TN is twice as common in women than in men. A form of TN is associated with multiple sclerosis (MS).
Causes
There are two types of TN — primary and secondary. The exact cause of TN is still unknown, but the pain associated with it represents an irritation of the nerve. Primary trigeminal neuralgia has been linked to the compression of the nerve, typically in the base of the head where the brain meets the spinal cord. This is usually due to contact between a healthy artery or vein and the trigeminal nerve at the base of the brain. This places pressure on the nerve as it enters the brain and causes the nerve to misfire. Secondary TN is caused by pressure on the nerve from a tumor, MS, a cyst, facial injury or another medical condition that damages the myelin sheaths.
Symptoms
Most patients report that their pain begins spontaneously and seemingly out of nowhere. Other patients say their pain follows a car accident, a blow to the face or dental work. In the cases of dental work, it is more likely that the disorder was already developing and then caused the initial symptoms to be triggered. Pain often is first experienced along the upper or lower jaw, so many patients assume they have a dental abscess. Some patients see their dentists and actually have a root canal performed, which inevitably brings no relief. When the pain persists, patients realize the problem is not dental-related.
The pain of TN is defined as either type 1 (TN1) or type 2 (TN2). TN1 is characterized by intensely sharp, throbbing, sporadic, burning or shock-like pain around the eyes, lips, nose, jaw, forehead and scalp. TN1 can get worse resulting in more pain spells that last longer. TN2 pain often is present as a constant, burning, aching and may also have stabbing less intense than TN1.
TN tends to run in cycles. Patients often suffer long stretches of frequent attacks, followed by weeks, months or even years of little or no pain. The usual pattern, however, is for the attacks to intensify over time with shorter pain-free periods. Some patients suffer less than one attack a day, while others experience a dozen or more every hour. The pain typically begins with a sensation of electrical shocks that culminates in an excruciating stabbing pain within less than 20 seconds. The pain often leaves patients with uncontrollable facial twitching, which is why the disorder is also known as tic douloureux.
Pain can be focused in one spot or it can spread throughout the face. Typically, it is only on one side of the face; however, in rare occasions and sometimes when associated with multiple sclerosis, patients may feel pain in both sides of their face. Pain areas include the cheeks, jaw, teeth, gums, lips, eyes and forehead.
Attacks of TN may be triggered by the following:
Touching the skin lightly
Washing
Shaving
Brushing teeth
Blowing the nose
Drinking hot or cold beverages
Encountering a light breeze
Applying makeup
Smiling
Talking
The symptoms of several pain disorders are similar to those of trigeminal neuralgia. The most common mimicker of TN is trigeminal neuropathic pain (TNP). TNP results from an injury or damage to the trigeminal nerve. TNP pain is generally described as being constant, dull and burning. Attacks of sharp pain can also occur, commonly triggered by touch. Additional mimickers include:
Temporal tendinitis
Ernest syndrome (injury of the stylomandibular ligament
Occipital neuralgia
Cluster headaches/ migraines
Giant cell arteritis
Dental pain
Post-herpetic neuralgia
Glossopharyngeal neuralgia
Sinus infection
Ear infection
Temporomandibular joint syndrome (TMJ)
Diagnosis
TN can be very difficult to diagnose, because there are no specific diagnostic tests and symptoms are very similar to other facial pain disorders. Therefore, it is important to seek medical care when feeling unusual, sharp pain around the eyes, lips, nose, jaw, forehead and scalp, especially if you have not had dental or other facial surgery recently. The patient should begin by addressing the problem with their primary care physician. They may refer the patient to a specialist later.
Testing

Magnetic resonance imaging (MRI) can detect if a tumor or MS is affecting the trigeminal nerve. A high-resolution, thin-slice or three-dimensional MRI can reveal if there is compression caused by a blood vessel. Newer scanning techniques can show if a vessel is pressing on the nerve and may even show the degree of compression. Compression due to veins is not as easily identified on these scans. Tests can help rule out other causes of facial disorders. TN usually is diagnosed based on the description of the symptoms provided by the patient, detailed patient history and clinical evaluation. There are no specific diagnostic tests for TN, so physicians must rely heavily on symptoms and history. Physicians base their diagnosis on the type pain (sudden, quick and shock-like), the location of the pain and things that trigger the pain. Physical and neurological examinations may also be done in which the doctor will touch and examine parts of your face to better understand where the pain is located.
Treatment
Non-Surgical Treatments
There are several effective ways to alleviate the pain, including a variety of medications. Medications are generally started at low doses and increased gradually based on patient’s response to the drug.
Carbamazepine, an anticonvulsant drug, is the most common medication that doctors use to treat TN. In the early stages of the disease, carbamazepine controls pain for most people. When a patient shows no relief from this medication, a physician has cause to doubt whether TN is present. However, the effectiveness of carbamazepine decreases over time. Possible side effects include dizziness, double vision, drowsiness and nausea.
Gabapentin, an anticonvulsant drug, which is most commonly used to treat epilepsy or migraines can also treat TN. Side effects of this drug are minor and include dizziness and/or drowsiness which go away on their own.
Oxcarbazepine, a newer medication, has been used more recently as the first line of treatment. It is structurally related to carbamazepine and may be preferred, because it generally has fewer side effects. Possible side effects include dizziness and double vision.
Other medications include: baclofen, amitriptyline, nortriptyline, pregabalin, phenytoin, valproic acid, clonazepam, sodium valporate, lamotrigine, topiramate, phenytoin and opioids.
There are drawbacks to these medications, other than side effects. Some patients may need relatively high doses to alleviate the pain, and the side effects can become more pronounced at higher doses. Anticonvulsant drugs may lose their effectiveness over time. Some patients may need a higher dose to reduce the pain or a second anticonvulsant, which can lead to adverse drug reactions. Many of these drugs can have a toxic effect on some patients, particularly people with a history of bone marrow suppression and kidney and liver toxicity. These patients must have their blood monitored to ensure their safety.
Surgery
If medications have proven ineffective in treating TN, several surgical procedures may help control the pain. Surgical treatment is divided into two categories: 1) open cranial surgery or 2) lesioning procedures. In general, open surgery is performed for patients found to have pressure on the trigeminal nerve from a nearby blood vessel, which can be diagnosed with imaging of the brain, such as a special MRI. This surgery is thought to take away the underlying problem causing the TN. In contrast, lesioning procedures include interventions that injure the trigeminal nerve on purpose, in order to prevent the nerve from delivering pain to the face. The effects of lesioning may be shorter lasting and in some keys may result in numbness to the face.
Open Surgery
Microvascular decompression involves microsurgical exposure of the trigeminal nerve root, identification of a blood vessel that may be compressing the nerve and gentle movement of the blood vessel away from the point of compression. Decompression may reduce sensitivity and allow the trigeminal nerve to recover and return to a more normal, pain-free condition. While this generally is the most effective surgery, it also is the most invasive, because it requires opening the skull through a craniotomy. There is a small risk of decreased hearing, facial weakness, facial numbness, double vision, stroke or death.
Lesioning Procedures
Percutaneous radiofrequency rhizotomy treats TN through the use of electrocoagulation (heat). It can relieve nerve pain by destroying the part of the nerve that causes pain and suppressing the pain signal to the brain. The surgeon passes a hollow needle through the cheek into the trigeminal nerve. A heating current, which is passed through an electrode, destroys some of the nerve fibers.
Percutaneous balloon compression utilizes a needle that is passed through the cheek to the trigeminal nerve. The neurosurgeon places a balloon in the trigeminal nerve through a catheter. The balloon is inflated where fibers produce pain. The balloon compresses the nerve, injuring the pain-causing fibers, and is then removed.
Percutaneous glycerol rhizotomy utilizes glycerol injected through a needle into the area where the nerve divides into three main branches. The goal is to damage the nerve selectively in order to interfere with the transmission of the pain signals to the brain.
Stereotactic radiosurgery (through such procedures as Gamma Knife, Cyberknife, Linear Accelerator (LINAC) delivers a single highly concentrated dose of ionizing radiation to a small, precise target at the trigeminal nerve root. This treatment is noninvasive and avoids many of the risks and complications of open surgery and other treatments. Over a period of time and as a result of radiation exposure, the slow formation of a lesion in the nerve interrupts transmission of pain signals to the brain.
Overall, the benefits of surgery or lesioning techniques should always be weighed carefully against its risks. Although a large percentage of TN patients report pain relief after procedures, there is no guarantee that they will help every individual.
Neuromodulation
For patients with TNP, another surgical procedure can be done that includes placement of one or more electrodes in the soft tissue near the nerves, under the skull on the covering of the brain and sometimes deeper into the brain, to deliver electrical stimulation to the part of the brain responsible for sensation of the face. In peripheral nerve stimulation, the leads are placed under the skin on branches of the trigeminal nerve. In motor cortex stimulation (MCS), the area which innervates the face is stimulated. In deep brain stimulation (DBS), regions that affect sensation pathways to the face may be stimulated.
How to Prepare for a Neurosurgical Appointment
Write down symptoms. This should include: What the pain feels like (for example, is it sharp, shooting, aching, burning or other), where exactly the pain is located (lower jaw, cheek, eye/forehead), if it is accompanied by other symptoms (headache, numbness, facial spasms), duration of pain (weeks, months, years), pain-free intervals (longest period of time without pain or in between episodes), severity of pain (0=no pain, 10=worst pain)
Note any triggers of pain (e.g. brushing teeth, touching face, cold air)
Make a list of medications and surgeries related to the face pain (prior medications, did they work, were there side effects), current medications (duration and dose)
Write down questions in advance
Understand that the diagnosis and treatment process for TN is not simple. Having realistic expectations can greatly improve overall outcomes.
Follow-up
Patients should follow-up with their primary care providers and specialists regularly to maintain their treatment. Typically, neuromodulation surgical patients are asked to return to the clinic every few months in the year following the surgery. During these visits, they may adjust the stimulation settings and assess the patient’s recovery from surgery. Routinely following-up with a doctor ensures that the care is correct and effective. Patients who undergo any form of neurostimulation surgery will also follow-up with a device representative who will adjust the device settings and parameters as needed alongside their doctors.

Article Provided By: aans.org
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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23 Mar

Carpal Tunnel Syndrome

Carpal tunnel syndrome

Carpal tunnel syndrome is caused by pressure on the median nerve. The carpal tunnel is a narrow passageway surrounded by bones and ligaments on the palm side of your hand. When the median nerve is compressed, the symptoms can include numbness, tingling and weakness in the hand and arm.

The anatomy of your wrist, health problems and possibly repetitive hand motions can contribute to carpal tunnel syndrome.
Proper treatment usually relieves the tingling and numbness and restores wrist and hand function.

Symptoms
Carpal tunnel syndrome symptoms usually start gradually and include:
Tingling or numbness. You may notice tingling and numbness in your fingers or hand. Usually the thumb and index, middle or ring fingers are affected, but not your little finger. You might feel a sensation like an electric shock in these fingers.
The sensation may travel from your wrist up your arm. These symptoms often occur while holding a steering wheel, phone or newspaper, or may wake you from sleep.
Many people “shake out” their hands to try to relieve their symptoms. The numb feeling may become constant over time.
Weakness. You may experience weakness in your hand and drop objects. This may be due to the numbness in your hand or weakness of the thumb’s pinching muscles, which are also controlled by the median nerve.
When to see a doctor
See your doctor if you have signs and symptoms of carpal tunnel syndrome that interfere with your normal activities and sleep patterns. Permanent nerve and muscle damage can occur without treatment.

Causes
Carpal tunnel syndrome is caused by pressure on the median nerve.
The median nerve runs from your forearm through a passageway in your wrist (carpal tunnel) to your hand. It provides sensation to the palm side of your thumb and fingers, except the little finger. It also provides nerve signals to move the muscles around the base of your thumb (motor function).
Anything that squeezes or irritates the median nerve in the carpal tunnel space may lead to carpal tunnel syndrome. A wrist fracture can narrow the carpal tunnel and irritate the nerve, as can the swelling and inflammation caused by rheumatoid arthritis.
Many times, there is no single cause of carpal tunnel syndrome. It may be that a combination of risk factors contributes to the development of the condition.
Risk factors
A number of factors have been associated with carpal tunnel syndrome. Although they may not directly cause carpal tunnel syndrome, they may increase the risk of irritation or damage to the median nerve. These include:
Anatomic factors. A wrist fracture or dislocation, or arthritis that deforms the small bones in the wrist, can alter the space within the carpal tunnel and put pressure on the median nerve.
People who have smaller carpal tunnels may be more likely to have carpal tunnel syndrome. Carpal tunnel syndrome is generally more common in women. This may be because the carpal tunnel area is relatively smaller in women than in men.
Women who have carpal tunnel syndrome may also have smaller carpal tunnels than women who don’t have the condition.
Nerve-damaging conditions. Some chronic illnesses, such as diabetes, increase your risk of nerve damage, including damage to your median nerve.
Inflammatory conditions. Rheumatoid arthritis and other conditions that have an inflammatory component can affect the lining around the tendons in your wrist and put pressure on your median nerve.
Medications. Some studies have shown a link between carpal tunnel syndrome and the use of anastrozole (Arimidex), a drug used to treat breast cancer.
Obesity. Being obese is a risk factor for carpal tunnel syndrome.
Body fluid changes. Fluid retention may increase the pressure within your carpal tunnel, irritating the median nerve. This is common during pregnancy and menopause. Carpal tunnel syndrome associated with pregnancy generally gets better on its own after pregnancy.
Other medical conditions. Certain conditions, such as menopause, thyroid disorders, kidney failure and lymphedema, may increase your chances of carpal tunnel syndrome.
Workplace factors. Working with vibrating tools or on an assembly line that requires prolonged or repetitive flexing of the wrist may create harmful pressure on the median nerve or worsen existing nerve damage, especially if the work is done in a cold environment.
However, the scientific evidence is conflicting and these factors haven’t been established work as direct causes of carpal tunnel syndrome.
Several studies have evaluated whether there is an association between computer use and carpal tunnel syndrome. Some evidence suggests that it is mouse use, and not the use of a keyboard, that may be the problem. However, there has not been enough quality and consistent evidence to support extensive computer use as a risk factor for carpal tunnel syndrome, although it may cause a different form of hand pain.
Prevention
There are no proven strategies to prevent carpal tunnel syndrome, but you can minimize stress on your hands and wrists with these methods:
Reduce your force and relax your grip. If your work involves a cash register or keyboard, for instance, hit the keys softly. For prolonged handwriting, use a big pen with an oversized, soft grip adapter and free-flowing ink.
Take short, frequent breaks. Gently stretch and bend hands and wrists periodically. Alternate tasks when possible. This is especially important if you use equipment that vibrates or that requires you to exert a great amount of force. Even a few minutes each hour can make a difference.
Watch your form. Avoid bending your wrist all the way up or down. A relaxed middle position is best. Keep your keyboard at elbow height or slightly lower.
Improve your posture. Incorrect posture rolls shoulders forward, shortening your neck and shoulder muscles and compressing nerves in your neck. This can affect your wrists, fingers and hands, and can cause neck pain.
Change your computer mouse. Make sure that your computer mouse is comfortable and doesn’t strain your wrist.
Keep your hands warm. You’re more likely to develop hand pain and stiffness if you work in a cold environment. If you can’t control the temperature at work, put on fingerless gloves that keep your hands and wrists warm.

Article Provided By: mayoclinic.org
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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4 Mar

How Pets Can Help Your Chronic Pain Symptoms

By Jeanne Faulkner
Reviewed by QualityHealth’s Medical Advisory Board

Pet owners love their companions for a variety of reasons. But can having a pet relieve your chronic pain? In fact, studies have found that, yes, pets can help relieve many of the symptoms associated with chronic pain conditions and help patients live better lives. Here are five ways that pets can help patients with chronic pain:
1. Provide distraction. It’s hard to focus on pain when you’re watching a kitten chase her tail or when a dog is cuddled up next to you. Animals give patients opportunities to enjoy life through simple moments and events, like throwing your dog a ball, playing with your cat or listening to your bird sing. Plus, being a responsible pet owner requires that you feed, water, walk, care for and clean up after your animal, which gives you something to focus on outside of your diagnosis.
2. Increase activity. Even if all you do is walk to the pantry to open a can, owning a pet makes you get up and move. Dogs are particularly effective pets for bumping up your physical activity level because they require walking and demand playful interaction. Cats, on the other hand, are more independent, which might provide a better pet-match for patients with mobility issues.
3. Improve your mood. Studies show that the very act of petting an animal reduces anxiety, symptoms of depression, and stress. Pets provide companionship, opportunities to connect with others and reduce feelings of isolation. What’s more, dogs are effective at sensing and absorbing people’s moods. Often they’re used in hospitals, schools, and other care facilities to provide therapy and personal services. That’s not just a benefit for dog owners, however. Cats, horses, birds, chickens, and other animals can provide companionship and services that help people experience a better sense of wellbeing.
4. Improve your heart health. According to the American Pain Foundation, pet owners who suffer heart attacks have higher one-year survival rates than patients who are not pet owners. Animal owners also have lower triglyceride and cholesterol levels, fewer minor health problems such as headaches and injuries, and are able to cope better with stressful life events. Petting a dog has been proven to reduce blood pressure dramatically in some patients.
5. Provide unconditional love. Animals don’t care what you look like, how much you complain, or how exhausted you are. They love you regardless of the circumstances. Through their eyes, you’re perfect. Their inexhaustible patience and ability to stay present in the moment provides their owners valuable lessons in how to be better humans.
Want to Reap the Benefits of Owning a Pet?
Contact a veterinarian and find out what types of pets would work for your home, family and health condition. Visit the Humane Society or local animal shelter and consider adopting an animal that needs you as much as you need him. If owning your own pet doesn’t work for you, contact the Delta Society and find out about pet therapy dogs in your area.

Article Provided By: qualityhealth
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC If you would like to discuss what Carolina Pain Scrambler do to help relieve your chronic pain symptoms or receive more information on our treatment process, please do not hesitate to call us at 864-520-5011 or you can email us at info@carolinapainscrambler.com

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