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Complex Regional Pain Syndrome

 

What is complex regional pain syndrome?
Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury. CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems. The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area.
CRPS is divided into two types: CRPS-I and CRPS-II. Individuals without a confirmed nerve injury are classified as having CRPS-I (previously known as reflex sympathetic dystrophy syndrome). CRPS-II (previously known as causalgia) is when there is an associated, confirmed nerve injury. As some research has identified evidence of nerve injury in CRPS-I, it is unclear if this disorders will always be divided into two types. Nonetheless, the treatment is similar.
CRPS symptoms vary in severity and duration, although some cases are mild and eventually go away. In more severe cases, individuals may not recover and may have long-term disability.

Who can get CRPS?
Although it is more common in women, CRPS can occur in anyone at any age, with a peak at age 40. CRPS is rare in the elderly. Very few children under age 10 and almost no children under age 5 are affected.

What are the symptoms of CRPS?
The key symptom is prolonged severe pain that may be constant. It has been described as “burning,” “pins and needles” sensation, or as if someone were squeezing the affected limb. The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or toe. In rare cases, pain can sometimes even travel to the opposite extremity. There is often increased sensitivity in the affected area, known as allodynia, in which normal contact with the skin is experienced as very painful.
People with CRPS also experience changes in skin temperature, skin color, or swelling of the affected limb. This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature. As a result, an affected arm or leg may feel warmer or cooler compared to the opposite limb. The skin on the affected limb may change color, becoming blotchy, blue, purple, pale, or red.
Other common features of CRPS include:
changes in skin texture on the affected area; it may appear shiny and thin
abnormal sweating pattern in the affected area or surrounding areas
changes in nail and hair growth patterns
stiffness in affected joints
problems coordinating muscle movement, with decreased ability to move the affected body part
abnormal movement in the affected limb, most often fixed abnormal posture (called dystonia) but also tremors in or jerking of the limb.

What causes CRPS?
It is unclear why some individuals develop CRPS while others with similar trauma do not. In more than 90 percent of cases, the condition is triggered by a clear history of trauma or injury. The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), surgery, or even minor medical procedures such as needle stick. CRPS represents an abnormal response that magnifies the effects of the injury. Some people respond excessively to a trigger that causes no problem for other people, such as what is observed in people who have food allergies.
Peripheral nerve abnormalities found in individuals with CRPS usually involve the small unmyelinated and thinly myelinated sensory nerve fibers (axons) that carry pain messages and signals to blood vessels. (Myelin is a mixture of proteins and fat-like substances that surround and insulate some nerve fibers.) Because small fibers in the nerves communicate with blood vessels, injuries to the fibers may trigger the many different symptoms of CRPS. Molecules secreted from the ends of hyperactive small nerve fibers are thought to contribute to inflammation and blood vessel abnormalities. These peripheral nerve abnormalities trigger abnormal neurological function in the spinal cord and brain.
Blood vessels in the affected limb may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin. The dilation and constriction of small blood vessels is controlled by small nerve fiber axons as well as chemical messengers in the blood. The underlying muscles and deeper tissues can become starved of oxygen and nutrients, which causes muscle and joint pain as well as damage. The blood vessels may over-constrict (clamp down), causing old, white, or bluish skin.
CRPS also affects the immune system. High levels of inflammatory chemicals (cytokines) have been found in the tissues of people with CRPS. These contribute to the redness, swelling, and warmth reported by many patients. CRPS is more common in individuals with other inflammatory and autoimmune conditions such as asthma.
Limited data suggest that CRPS also may be influenced by genetics. Rare family clusters of CRPS have been reported. Familial CRPS may be more severe with earlier onset, greater dystonia, and more than one limb being affected.
Occasionally CRPS develops without any known injury. In these cases, an infection, a blood vessel problem, or entrapment of the nerves may have caused an internal injury. A physician will perform a thorough examination in order to identify a cause.
In many cases, CRPS results from a variety of causes. In such instances, treatments are directed at all of the contributing factors.

How is CRPS diagnosed?
Currently there is no specific test that can confirm CRPS. Its diagnosis is based on a person’s medical history, and signs and symptoms that match the definition. Since other conditions can cause similar symptoms, careful examination is important. As most people improve gradually over time, the diagnosis may be more difficult later in the course of the disorder.
Testing also may be used to help rule out other conditions, such as arthritis, Lyme disease, generalized muscle diseases, a clotted vein, or small fiber polyneuropathies, because these require different treatment. The distinguishing feature of CRPS is that of an injury to the affected area. Such individuals should be carefully assessed so that an alternative treatable disorder is not overlooked.
Magnetic resonance imaging or triple-phase bone scans may be requested to help confirm a diagnosis. While CRPS is often associated with excess bone resorption, a process in which certain cells break down the bone and release calcium into the blood, this finding may be observed in other illnesses as well.

What is the prognosis?
The outcome of CRPS is highly variable. Younger persons, children, and teenagers tend to have better outcomes. While older people can have good outcomes, there are some individuals who experience severe pain and disability despite treatment. Anecdotal evidence suggests early treatment, particularly rehabilitation, is helpful in limiting the disorder, a concept that has not yet been proven in clinical studies. More research is needed to understand the causes of CRPS, how it progresses, and the role of early treatment.

How is CRPS treated?
The following therapies are often used:
Rehabilitation and physical therapy. An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms. Additionally, exercise can help improve the affected limb’s flexibility, strength, and function. Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain. Occupational therapy can help the individual learn new ways to work and perform daily tasks.
Psychotherapy. CRPS and other painful and disabling conditions often are associated with profound psychological symptoms for affected individuals and their families. People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult. Treating these secondary conditions is important for helping people cope and recover from CRPS.
Medications. Several different classes of medication have been reported to be effective for CRPS, particularly when used early in the course of the disease. However, no drug is approved by the U.S. Food and Drug Administration specifically for CRPS, and no single drug or combination of drugs is guaranteed to be effective in every person. Drugs to treat CRPS include:
bisphosphonates, such as high dose alendronate or intravenous pamidronate
non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen, and naproxen
corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
botulinum toxin injections
opioids such as oxycodone, morphine, hydrocodone, and fentanyl. These drugs must be prescribed and monitored under close supervision of a physician, as these drugs may be addictive.
N-methyl-D-aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine, and
topical local anesthetic creams and patches such as lidocaine.
All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.
Sympathetic nerve block. Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit. Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.
Surgical sympathectomy. The use of this operation that destroys some of the nerves is controversial. Some experts think it is unwarranted and makes CRPS worse, whereas others report a favorable outcome. Sympathectomy should be used only in individuals whose pain is dramatically relieved (although temporarily) by sympathetic nerve blocks.
Spinal cord stimulation. Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area. Electrodes may be placed temporarily for a few days in order to assess whether stimulation is likely to be helpful. Minor surgery is required to implant all the parts of the stimulator, battery, and electrodes under the skin on the torso. Once implanted, the stimulator can be turned on and off, and adjusted using an external controller. Approximately 25 percent of individuals develop equipment problems that may require additional surgeries.
Other types of neural stimulation. Neurostimulation can be delivered at other locations along the pain pathway, not only at the spinal cord. These include near injured nerves (peripheral nerve stimulators), outside the membranes of the brain (motor cortex stimulation with dural electrodes), and within the parts of the brain that control pain (deep brain stimulation). A recent option involves the use of magnetic currents applied externally to the brain (known as repetitive Transcranial Magnetic Stimulation, or rTMS). A similar method that uses transcranial direct electrical stimulation is also being investigated. These stimulation methods have the advantage of being non-invasive, with the disadvantage that repeated treatment sessions are needed.
Intrathecal drug pumps. These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids, local anesthetic agents, clonidine, and baclofen. The advantage is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness. There are no studies that show benefit specifically for CRPS.
Emerging treatments for CRPS include:
Intravenous immunoglobulin (IVIG). Researchers in Great Britain report low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments. Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.
Ketamine. Investigators are using low doses of ketamine—a strong anesthetic—given intravenously for several days to either reduce substantially or eliminate the chronic pain of CRPS. In certain clinical settings, ketamine has been shown to be useful in treating pain that does not respond well to other treatments.
Graded Motor imagery. Several studies have demonstrated the benefits of graded motor imagery therapy for CRPS pain. Individuals do mental exercises including identifying left and right painful body parts while looking into a mirror and visualizing moving those painful body parts without actually moving them.
Several alternative therapies have been used to treat other painful conditions. Options include behavior modification, acupuncture, relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy), and chiropractic treatment.

What research is currently being done on CRPS?
The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. The NINDS is part of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.
NINDS-supported scientists are studying new approaches to treat CRPS and to intervene more aggressively to limit the symptoms and disability associated with the syndrome. Other NIH institutes also support research on CRPS and other painful conditions.
Previous research has shown that CRPS-related inflammation is caused by the body’s own immune response. Researchers hope to better understand how CRPS develops by studying immune system activation and peripheral nerve signaling using an animal model of the disorder. The animal model was developed to mimic certain CRPS-like features following fracture or limb surgery, by activating certain molecules involved in the immune system process.
Limb trauma, such as a fracture, followed by immobilization in a cast, is the most common cause of CRPS. By studying an animal model, researchers hope to better understand the neuroinflammatory basis of CRPS in order to identify the relevant inflammatory signaling pathways that lead to the development of post-traumatic CRPS. They also will examine inflammatory effects of cast immobilization and exercise on the development of pain behaviors and CRPS symptoms.
Peripheral nerve injury and subsequent regeneration often lead to a variety of sensory changes. Researchers hope to identify specific cellular and molecular changes in sensory neurons following peripheral nerve injury to better understand the processes that underlie neuroplasticity (the brain’s ability to reorganize or form new nerve connections and pathways following injury or death of nerve cells). Identifying these mechanisms could provide targets for new drug therapies that could improve recovery following regeneration.
Children and adolescents with CRPS generally have a better prognosis than adults, which may provide insights into mechanisms that can prevent chronic pain. Scientists are studying children with CRPS given that their brains are more adaptable through a mechanism known as neuroplasticity. Scientists hope to use these discoveries in order to develop more effective therapies for CRPS.
NINDS-funded scientists continue to investigate how inflammation and the release of adenosine triphosphate (ATP) may induce abnormal connections and signaling between sympathetic and sensory nerve cells in chronic pain conditions such as CRPS. (ATP is a molecule involved with energy production within cells that can also act as a neurotransmitter. Neurotransmitters are chemicals used by nervous system cells to communicate with one another.) A better understanding of changes in nerve connections following peripheral nerve injury may offer greater insight to pain and lead to new treatments.

Article Provided By: ninds
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Responding to Weather Changes When Caring for Neuropathy Patients

Responding to Weather Changes When Caring for Neuropathy Patients

September 11, 2019 by Ezekiel Lim In Columns, Rumination and Response – a Column by Ezekiel Lim.

Patients with familial amyloid polyneuropathy may find that changes in seasons increase discomfort. Colder temperatures require layers of clothing that may bother someone with peripheral neuropathy symptoms. A change to hotter temperatures may cause increased discomfort to someone already experiencing burning sensations due to nerve damage.
Caregivers can take steps to help manage the impact of weather changes on neuropathy patients.

Cold weather and neuropathy
Patients with peripheral neuropathy symptoms experience a slowing of blood flow to nerve endings, causing numbness and tingling. Colder temperatures may make it difficult for patients to measure their bodies’ response to the climate.
My family lives in an area known for weather extremes. When spending time with my mother-in-law during the winter months, it is important for us not only to make sure she has adequate layers of clothing, but also to know when the bundled clothing is causing her discomfort.
Following are some tips for caregivers who are managing the daily care of a loved one during a change to colder weather:

Make sure the patient is wearing warm, comfortable clothing that isn’t too heavy.
Protect the patient’s hands and feet with warm gloves and neuropathy socks.
Massage areas where circulation may be lacking.
Limit the time spent outside in the cold.
Limit caffeine and alcohol intake as they may respectively narrow blood cells and cause vitamin deficiency.
Managing symptoms in heat
Hotter temperatures may exacerbate the tingling and burning sensations that neuropathy patients experience. During a transition from cold winters to mild or hot months, caregivers must gauge their loved one’s peripheral symptoms. Just as in winter months, patients may have difficulty measuring their bodily responses to temperature.
For caregivers managing responses to hotter temperatures, following are some tips for ensuring patient comfort:
Keep time spent outside to a minimum and, if needed, stay indoors all day.
Make sure air conditioning is adjusted to a comfortable level to avoid interacting with symptoms of numbness.
Make sure your loved one is adequately fed and hydrated.
Understand the patient’s comfort level and make sure they are wearing lighter layers of clothing.
Try using topical treatments and cooling products when the patient begins to feel too hot.
The pain caused by humidity and summer heat may cause increased discomfort in those suffering from peripheral neuropathy symptoms. By ensuring the patient has a comfortable indoor environment, the change in temperature will not exacerbate chronic pain.

***
Note: FAP News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of FAP News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to familial amyloid polyneuropathy.

Article Provided By: fapnewstoday

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Exercises for Peripheral Neuropathy

Exercises for Peripheral Neuropathy

Alternative treatments for peripheral neuropathy
About 20 million people across the country live with a form of peripheral neuropathy. Peripheral neuropathy is nerve damage disorder that typically causes pain in your hands and feet. Other common symptoms of this disorder include:
muscle weakness
numbness
tingling
poor balance
inability to feel pain or temperature
Treatment options typically focus on pain relief and treating the underlying cause. However, studies show that exercise can effectively preserve nerve function and promote nerve regeneration.
Exercise techniques for peripheral neuropathy
There are three main types of exercises ideal for people with peripheral neuropathy: aerobic, balance, and stretching.
Before you start exercises, warm up your muscles with dynamic stretching like arm circles. This promotes flexibility and increases blood flow. It will boost your energy, too, and activate your nerve signals.
Aerobic exercises
Aerobic exercises move large muscles and cause you to breathe deeply. This increases blood flow and releases endorphins that act as the body’s natural painkillers.
Best practices for aerobic exercising include routine activity for about 30 minutes a day, at least three days a week. If you’re just starting out, try exercising for 10 minutes a day to start.
Some examples of aerobic exercises are:
brisk walking
swimming
bicycling
Balance training
Peripheral neuropathy can leave your muscles and joints feeling stiff and sometimes weak. Balance training can build your strength and reduce feelings of tightness. Improved balance also prevents falls.
Beginning balance training exercises include leg and calf raises.
Side leg raise
Using a chair or counter, steady your balance with one hand.
Stand straight with feet slightly apart.
Slowly lift one leg to the side and hold for 5–10 seconds.
Lower your leg at the same pace.
Repeat with the other leg.
As you improve balance, try this exercise without holding onto the counter.
Calf raise
Using a chair or counter, steady your balance.
Lift the heels of both feet off the ground so you’re standing on your toes.
Slowly lower yourself down.
Repeat for 10–15 reps.
Stretching exercises
Stretching increases your flexibility and warms up your body for other physical activity. Routine stretching can also reduce your risk of developing an injury while exercising. Common techniques are calf stretches and seated hamstring stretches.
Calf stretch
Place one leg behind you with your toe pointing forward.
Take a step forward with the opposite foot and slightly bend the knee.
Lean forward with the front leg while keeping the heel on your back leg planted on the floor.
Hold this stretch for 15 seconds.
Repeat three times per leg.
Seated hamstring stretch
Sit on the edge of a chair.
Extend one leg in front of you with your toe pointed upward.
Bend the opposite knee with your foot flat on the floor.
Position your chest over your straight leg, and straighten your back until you feel a muscle stretch.
Hold this position for 15 – 20 seconds.
Repeat three times per leg.

Outlook
Exercise can reduce pain symptoms from peripheral neuropathy. Be sure to stretch after any workout to increase your flexibility and reduce pain from muscle tightness.
Mild pain is normal after stretching and regular activity. However, if your pain worsens or if you develop joint swelling, visit your doctor.

Article Provided By: healthline
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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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

Shingles affects the nerves

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: Mayoclinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Is Walking Good for Neuropathy?

Is Walking Good for Neuropathy?

Neuropathy is one of the most common chronic medical conditions in society. This is a serious medical condition that impacts countless people across the country, making it hard for them to go about their daily routines.
If you suffer from neuropathy, one of your most common questions is probably is whether or not walking can help you. The good news is that walking can be an effective part of your comprehensive neuropathy treatment program.
In this article, we’ll talk about the health effects of neuropathy on your walking and how to exercise without pain or discomfort.
Let’s get to it…

Is Walking Good for Neuropathy?
Yes! Walking is definitely good for the treatment of neuropathy. If you have neuropathy, you should make sure they work with a medical team to address all aspects of your specific form of neuropathy; however, there is a good chance that walking will be recommended to you.

All that said, when it comes to walking with neuropathy, there are a few additional points you should keep in mind.
If you suffer from neuropathy, there is a problem with the nerves in the body. Specifically, peripheral neuropathy is one of the most common forms. There are nerves that innervate your arms, legs, fingers, and toes. These nerves carry motor signals from your brain to your limbs. Then, different nerves carry information regarding temperature, pain, and pressure back to your brain for interpretation.
If there is a problem with your nerves, you could feel numbness, tingling, or even pain in certain parts of your body. Exercise, such as walking, can help you manage neuropathy.
First, regular physical activity, such as walking, can help you improve the circulation of blood throughout your body. This will strengthen your tissues, including those at the site of your neuropathy. When your ligaments, tendons, and nerves have access to more oxygen and nutrients, this can improve their function. As a result, exercise can improve the function of your nerves, helping you control many of the symptoms of neuropathy.
In addition, walking is effective for neuropathy because it can prevent the development of further complications. One of the most common causes of neuropathy is diabetes. Elevated levels of blood glucose can damage the nerves throughout your body, making peripheral neuropathy worse. In order to prevent this, you need to take steps to control your blood glucose. Exercise, such as walking, will help you do exactly that. When you take steps to keep your blood glucose levels under control, you can prevent the development of many of the complications of neuropathy.
If you have neuropathy, you are probably used to feeling some form of discomfort, particularly in your legs. Exercise might be the furthest thing from your mind. This is understandable and that is okay; however, you also need to take steps to overcome this hurdle. Walking regularly is a great first step. It is important for you to know how to walk safely if you summer from neuropathy.
How to Walk Safely with Neuropathy
Walking is a great way to control the symptoms of neuropathy while also preventing some serious complications. If you are trying to come up with a walking routine for neuropathy, there are a few important steps you need to follow.
1. Talk with Your Doctor First
If you have neuropathy, you probably go to the doctor on a regular basis. During your next visit, you need to speak with your doctor about an exercise routine. People with most forms of neuropathy will be able to walk effectively; however, every form of neuropathy is different.

For example, if you suffer from numbness in your ankle, you might not realize that you have sprained your ankle while walking. You need to speak with your doctor to figure out if you need to make any adjustments in how you walk to exercise safely with neuropathy.

2. Invest in the Right Equipment
If you have neuropathy, you need to invest in the right shoes to help you walk safely. You might have numbness or tingling in certain parts of your body, so you need to ensure that your shoes will protect you against injuring these specific locations.
For example, Orthofeet’s Stretchable for women provide anatomic orthotic insoles along with ergonomic soles that provide added protection for your feet, guarding against sprains, strains, and pressure injuries.

3. Start Slowly
It is important for everyone with neuropathy to start the exercise routine slowly. Being by walking at a slow tempo. Make sure that you preserve your sensation throughout all parts of your foot.
If you feel like you cannot feet certain parts of your foot (more than usual), then check to see if your shoes have been tied too tightly. This could be cutting off circulation to certain parts of your foot. In this case, loosen them and continue walking. Be sure to monitor your feet for the development of blisters as well. If you suffer from numbness or tingling, this might go unnoticed.
4. Increase Your Walking Gradually
Of course, you want to get to the point where your walking routine qualifies as exercise. In order for this to happen, you need to reach the point of cardio walking. In cardio walking, your heart rate must be sustained at between 50 and 70 percent of your maximum heart rate.
You can calculate your maximum heart rate by taking 220 and subtracting your age in years. If you are 60 years old, your maximum heart rate is 220 – 60 which is 160. Then, 50 to 70 percent of this number is 80 to 112. If you are 60 years old, keeping your heart rate between these two numbers will provide you with the cardiovascular benefits of walking that you need.
Finally, there are a few other strategies that you can follow to remain comfortable while walking with neuropathy. First, always stretch before you start walking. This will get your blood flowing, making it less likely that you might experience numbness or tingling while exercising.

Next, try to walk on flat ground as much as possible. This will prevent your calf muscles from getting tight, which might constrict the blood flow to your ankles and feet. Finally, remember to use ice and heat after walking to help your body recover appropriately. The goal is to come up with a regular walking routine. Therefore, the recovery process is important for those who suffer from neuropathy.
Final Thoughts on Walking with Neuropathy
These are a few of the most important points that you need to keep in mind if you would like to come up with a walking routine for neuropathy. Walking is a great way to not only treat neuropathy but also prevent other complications from developing down the road. Therefore, follow the steps above to come up with your own walking routine for neuropathy. This can drastically improve your quality of life, helping you preserve the function of the nerves throughout your body.

 

Article Provided By: Developgoodhabits
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Cold Feet

By Shawn Bishop

Cold Feet That Aren’t Cold to the Touch May Indicate Neurologic Problem
April 1, 2011
Dear Mayo Clinic:
Lately my feet always seem cold but are not cold to the touch. Could this be an early symptom of something to come?
Answer:
Pinpointing the exact source of this symptom requires a physical exam and diagnostic tests. But when feet feel cold but are not cold to the touch, a possible cause is a neurologic problem, such as peripheral neuropathy.
Of course, feet can get cold for many reasons. The most obvious is a cold environment, along with a lack of proper shoes or socks. Frequent or constant sweating (hyperhidrosis) can also make feet feel cold, especially when evaporation cools the feet quickly. This can often be caused by nervousness, literally “getting cold feet.” Lack of adequate blood flow to the feet through the arteries can also make the feet cold. But in all these situations, the feet feel cold to the touch.
Often the sensation of cold feet is benign and there is no serious underlying cause. However, experiencing the sensation of cold feet that don’t feel cold to the touch may be a sign of a nerve problem. For example, peripheral neuropathy can cause this symptom. Peripheral neuropathy occurs as a result of nerve damage caused by injury or an underlying medical disorder. Diabetes is one of the most common causes of peripheral neuropathy, but the condition may also result from vitamin deficiencies, metabolic problems, liver or kidney diseases, infections, or exposure to toxins. The condition can also be inherited. Sometimes the cause of peripheral neuropathy is never found.
The peripheral nerves are all of the nerves in the body that are outside of the brain and spinal cord (central nervous system). Peripheral neuropathy frequently begins in the body’s longest nerves, which reach to the toes. So symptoms often appear in the feet first and then the lower legs. Other potential symptoms caused by peripheral neuropathy include numbness; a tingling, burning or prickling feeling in the feet and legs that may spread to the hands and arms; sharp or burning pain; and sensitivity to touch. As peripheral neuropathy progresses, loss of feeling, lack of coordination, and muscle weakness may develop.
You should see your doctor to have your situation evaluated. If your doctor suspects peripheral neuropathy or other nerve damage, a variety of tests may be used to uncover the underlying source of the problem. To help in the diagnosis, your doctor will likely talk with you about your medical history and perform a physical and neurological exam that may include checking your reflexes, muscle strength and tone, ability to feel certain sensations, and posture and coordination.
In addition, blood tests may be used to check vitamin levels, thyroid function, blood sugar levels, liver function and kidney function, as all these can affect your nerves. Your doctor also may suggest electrophysiologic testing known as electromyography (EMG) and nerve conduction studies (NCS). These tests measure the electrical signals in the peripheral nerves and how well the nerves transfer signals to your muscles.
In some cases, a nerve biopsy — a procedure in which a small portion of a sensory nerve near the ankle is removed and examined for abnormalities — and imaging tests, such as an MRI or CT scan, may also be needed to help determine the cause of nerve damage.
It’s important to have your situation assessed by your doctor soon. If peripheral neuropathy is the source of the problem, and the cold sensation in your feet is the only symptom, you may be in the early stages of the disorder. In that case, finding and treating the underlying cause of the nerve damage may be all that’s necessary. Nerve damage that progresses can lead to pain and other symptoms which can be more difficult to successfully treat.
— John Jones, M.D., Vascular Center, Mayo Clinic, Rochester, Minn.

Article Provided By: Mayoclinic
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Peripheral Neuropathy

Neuropathy (Peripheral Neuropathy)

Diabetes is a leading cause of neuropathy in the United States, although there are many other causes too. Some cases of neuropathy can be easily treated and sometimes cured. If neuropathy can’t be cured, treatment is aimed at controlling and managing symptoms and preventing further nerve damage.

Your peripheral nervous system is made up of the nerves outside your central nervous system. Sensory nerves carry messages to your brain. Motor nerves carry messages to your muscles.
What is neuropathy?
Neuropathy is damage or dysfunction of one or more nerves that typically results in numbness, tingling, muscle weakness and pain in the affected area. Neuropathies frequently start in your hands and feet, but other parts of your body can be affected too.
Neuropathy, often called peripheral neuropathy, indicates a problem within the peripheral nervous system. Your peripheral nervous system is the network of nerves outside your brain and spinal cord. Your brain and spinal cord make up your central nervous system. Think of the two systems working together this way: Your central nervous system is the central station. It is the control center, the hub from which all trains come and go. Your peripheral nervous system are the tracks that connect to the central station. The tracks (the network of nerves) allow the trains (information signals) to travel to and from the central station (your brain and spinal cord).
Neuropathy results when nerve cells, called neurons, are damaged or destroyed. This disrupts the way the neurons communicate with each other and with the brain. Neuropathy can affect one nerve (mononeuropathy) or nerve type, a combination of nerves in a limited area (multifocal neuropathy) or many peripheral nerves throughout the body (polyneuropathy).

What types of peripheral nerves are there and what do they do?
The peripheral nervous system is made up of three types of nerves, each with an important role in keeping your body healthy and functioning properly.
Sensory nerves carry messages from your five senses (sight, hearing, smell, taste, touch) through your spinal cord to your brain. For example, a sensory nerve would communicate to your brain information about objects you hold in your hand, like pain, temperature, and texture.
Motor nerves travel in the opposite direction of sensory nerves. They carry messages from your brain to your muscles. They tell your muscles how and when to contract to produce movement. For example, to move your hand away from something hot.
Autonomic nerves are responsible for body functions that occur outside of your direct control, such as breathing, digestion, heart rate, blood pressure, sweating, bladder control and sexual arousal. The autonomic nerves are constantly monitoring and responding to external stresses and bodily needs. For instance, when you exercise, your body temperatures increases. The autonomic nervous system triggers sweating to prevent your body’s temperature from rising too high.
The type of symptoms you feel depend on the type of nerve that is damaged.
What does neuropathy feel like?
If you have neuropathy, the most commonly described feelings are sensations of numbness, tingling (“pins and needles”), and weakness in the area of the body affected. Other sensations include sharp, lightening-like pain; or a burning, throbbing or stabbing pain.
How common is neuropathy? Who gets neuropathy?
Neuropathy is very common. It is estimated that about 25% to 30% of Americans will be affected by neuropathy. The condition affects people of all ages; however, older people are at increased risk. About 8% of adults over 65 years of age report some degree of neuropathy. Other than age, in the United States some of the more common risk factors for neuropathy include diabetes, metabolic syndrome (high blood pressure, high cholesterol, obesity, diabetes), and heavy alcohol use. People in certain professions, such as those that require repetitive motions, have a greater chance of developing mononeuropathies from trauma or compression of nerves.
Among other commonly cited statistics, neuropathy is present in:
60% to 70% of people with diabetes.
30% to 40% of people who receive chemotherapy to treat cancer.
30% of people who have human immunodeficiency virus (HIV).
How quickly does neuropathy develop?
Some peripheral neuropathies develop slowly – over months to years – while others develop more rapidly and continue to get worse. There are over 100 types of neuropathies and each type can develop differently. The way your condition progresses and how quickly your symptoms start can vary greatly depending on the type of nerve or nerves damaged, and the underlying cause of the condition.

There are many causes of neuropathy. Diabetes is the number one cause in the United States. Other common causes include trauma, chemotherapy, alcoholism and autoimmune diseases.
What causes neuropathy?
Neuropathy is not caused by a single disease. Many conditions and events that impact health can cause neuropathy, including:
Diabetes: This is a leading cause of neuropathy in the United States. Some 60% to 70% of people with diabetes experience neuropathy. Diabetes is the most common cause of small fiber neuropathy, a condition that causes painful burning sensations in the hands and feet.
Trauma: Injuries from falls, car accidents, fractures or sports activities can result in neuropathy. Compression of the nerves due to repetitive stress or narrowing of the space through which nerves run are other causes.
Autoimmune disorders and infections: Guillain-Barré syndrome, lupus, rheumatoid arthritis, Sjogren’s syndrome and chronic inflammatory demyelinating polyneuropathy are autoimmune disorders that can cause neuropathy. Infections including chickenpox, shingles, human immunodeficiency virus (HIV), herpes, syphilis, Lyme disease, leprosy, West Nile virus, Epstein-Barr virus and hepatitis C can also cause neuropathy.
Other health conditions: Neuropathy can result from kidney disorders, liver disorders, hypothyroidism, tumors (cancer-causing or benign) that press on nerves or invade their space, myeloma, lymphoma and monoclonal gammopathy.
Medications and poisons: Some antibiotics, some anti-seizures medications and some HIV medications among others can cause neuropathy. Some treatments, including cancer chemotherapy and radiation, can damage peripheral nerves. Exposure to toxic substances such as heavy metals (including lead and mercury) and industrial chemicals, especially solvents, can also affect nerve function.
Vascular disorders: Neuropathy can occur when blood flow to the arms and legs is decreased or slowed by inflammation, blood clots, or other blood vessel disorders. Decreased blood flow deprives the nerve cells of oxygen, causing nerve damage or nerve cell death. Vascular problems can be caused by vasculitis, smoking and diabetes.
Abnormal vitamin levels and alcoholism: Proper levels of vitamins E, B1, B6, B12, and niacin are important for healthy nerve function. Chronic alcoholism, which typically results in lack of a well-rounded diet, robs the body of thiamine and other essential nutrients needed for nerve function. Alcohol may also be directly toxic to peripheral nerves.
Inherited disorders: Charcot-Marie-Tooth (CMT) disease is the most common hereditary neuropathy. CMT causes weakness in the foot and lower leg muscles and can also affect the muscles in the hands. Familial amyloidosis, Fabry disease and metachromatic leukodystrophy are other examples of inherited disorders that can cause neuropathy.
No known cause: Some cases of neuropathy have no known cause.
What are the symptoms of neuropathy?
Symptoms of neuropathy vary depending on the type and location of the nerves involved. Symptoms can appear suddenly, which is called acute neuropathy, or develop slowly over time, called chronic neuropathy.
Common signs and symptoms of neuropathy include:
Tingling (“pins and needles”) or numbness, especially in the hands and feet. Sensations can spread to the arms and legs.
Sharp, burning, throbbing, stabbing or electric-like pain.
Changes in sensation. Severe pain, especially at night. Inability to feel pain, pressure, temperature or touch. Extreme sensitivity to touch.
Falling, loss of coordination.
Not being able to feel things in your feet and hands – feeling like you’re wearing socks or gloves when you’re not.
Muscle weakness, difficulty walking or moving your arms or legs.
Muscle twitching, cramps and/or spasms.
Inability to move a part of the body (paralysis). Loss of muscle control, loss of muscle tone or dropping things out of your hand.
Low blood pressure or abnormal heart rate, which causes dizziness when standing up, fainting or lightheadedness.
Sweating too much or not enough in relation to the temperature or degree or exertion.
Problems with bladder (urination), digestion (including bloating, nausea/vomiting) and bowels (including diarrhea, constipation).
Sexual function problems.
Weight loss (unintentional).

Neuropathy (Peripheral Neuropathy): Diagnosis and Tests

Common symptoms of neuropathy include numbness and tingling, frequent falls, muscle weakness and difficulty walking, and low blood pressure.
How is neuropathy diagnosed?
History and physical exam: First, your doctor will conduct a thorough history and physical exam. You doctor will review your symptoms and ask questions including your current and past medications, exposure to toxic substances, your history of trauma, your line of work or social habits (looking for repetitive motions), family history of diseases of the nervous system, your diet and alcohol use.

Neurologic exam: During a neurologic exam, your doctor will check your reflexes, your coordination and balance, your muscle strength and tone, and your ability to feel sensations (such as light touch or cold).
Blood work and imaging tests: Your doctor may also order blood work and imaging tests. Blood work can reveal vitamin and mineral imbalances, electrolyte imbalances (indicator of kidney problems, diabetes, other health issues), thyroid problems, toxic substances, antibodies to certain viruses or autoimmune diseases. Magnetic resonance imaging (MRI) can detect tumors, pinched nerves and nerve compression.
Genetic testing: A genetic test may be ordered if your doctor suspects a genetic condition is causing your neuropathy.
Electrodiagnostic assessment (EDX): Your doctor might send you to a nerve specialist for an EDX to find the location and degree of nerve damage. EDX includes two tests:
Nerve conduction study (NCS): During this test, small patches – called electrodes – are placed on the skin over nerves and muscles on different parts of your body, usually your arms or legs. A brief pulse of electricity is applied to the patch over a nerve to be studied. The test measures the size of the response and how quickly the nerve is carrying the electrical signal. Both motor and sensory nerves can be studied in this way.
Needle electromyography (EMG): An EMG can determine the health of a muscle, and determine if there is any disconnection between the nerve and muscle by measuring the electrical activity within the muscle while it is in use. During an EMG, a very thin needle electrode is inserted through the skin into the muscle. The muscle is then used for a specific movement and the electrical activity of the muscle is recorded on a graph called an electromyogram.
Tissue biopsies: In some cases, a nerve, muscle or skin biopsy is needed to confirm the diagnosis. During a biopsy, a small sample of your tissue is removed for examination under a microscope.
Other tests: Other tests include a test to measure your body’s ability to sweat (called a QSART test) and other tests to check the sensitivity of your senses (touch, heat/cold, pain, vibration).

Neuropathy (Peripheral Neuropathy): Management and Treatment

How is neuropathy treated?
Treatment begins by identifying and treating any underlying medical problem, such as diabetes or infections.

Some cases of neuropathy can be easily treated and sometimes cured. Not all neuropathies can be cured, however. In these cases, treatment is aimed at controlling and managing symptoms and preventing further nerve damage. Treatment options include the following:
Medicines can be used to control pain. A number of different medications contain chemicals that help control pain by adjusting pain signaling pathways within the central and peripheral nervous system. These medications include:
Antidepressants such as duloxetine or nortripyline.
Antiseizure medicines such as gabapentin (Neurontin®, Gralise®) and pregabalin (Lyrica®).
Topical (on the skin) patches and creams containing lidocaine (Lidoderm®, Xylocaine®) or capsaicin (Capsin®, Zostrix®).
Narcotic medications are not usually used for neuropathy pain due to limited evidence that they are helpful for this condition.
Physical therapy uses a combination of focused exercise, massage and other treatments to help you increase your strength, balance and range of motion.
Occupational therapy can help you cope with the pain and loss of function, and teach you skills to make up for that loss.
Surgery is available for patients with compression-related neuropathy caused by such things as herniated disc in back or neck, tumors, infections, or nerve entrapment disorders, such as carpal tunnel syndrome.
Mechanical aids, such as braces and specially designed shoes, casts and splints can help reduce pain by providing support or keeping the affected nerves in proper alignment.
Proper nutrition involves eating a healthier diet and making sure to get the right balance of vitamins and other nutrients.
Adopting healthy living habits, including exercising to improve muscle strength, quitting smoking, maintaining a healthy weight, and limiting alcohol intake.
Other treatments
Transcutaneous electrical nerve stimulation (TENS): This treatment involves placing electrodes on the skin at or near the nerves causing your pain. A gentle, low-level electrical current is delivered through the electrodes to your skin. Treatment schedule (how many minutes and how often) is determined by your therapist. The goal of TENS therapy is to disrupt pain signals so they don’t reach the brain
Immune suppressing or immune modulating treatments: Various treatments are used for individuals whose neuropathy is due to an autoimmune disease. These include oral medications, IV infusion treatments, or even procedures like plasmapheresis where antibodies and other immune system cells are removed from your blood and the blood is then returned to your body. The goal of these therapies is to stop the immune system from attacking the nerves.
Complementary treatments: Acupuncture, massage, alpha-lipoic acid, herbal products, meditation/yoga, behavioral therapy and psychotherapy are other methods that could be tried to help relieve neuropathic pain. Ask your doctor if any of these therapies might be helpful for treating the cause of your neuropathy.

Neuropathy (Peripheral Neuropathy): Prevention

Can neuropathy be prevented?
You can reduce your risk of neuropathy by treating existing medical problems and adopting healthy living habits. Here are some tips:
Manage your diabetes: If you have diabetes, keep your blood glucose level within the range recommended by your doctor.
Take care of your feet: If you have diabetes or poor blood flow, it’s important to check your feet every day. Look for sores, blisters, redness, calluses, or dry or cracking skin. Keep your toenails clipped (clip straight across the nail); apply lotion to clean, dry feet; and wear closed-toe, well-fitting shoes. Protect your feet from heat and cold. Don’t walk barefoot.
Declutter your floors. Keep your floors free of items that could cause you to trip and fall. Make sure all electrical cords are tucked away along the baseboards of walls and rooms are well lit.
Stop smoking: Smoking constricts blood vessels that supply nutrients to nerves. Without proper nutrition, neuropathy symptoms can worsen.
Maintain a healthy lifestyle: Eat a balanced diet, stay within your ideal weight range, exercise several times a week and keep alcoholic drinks to a minimum. These healthy living tips keep your muscles strong and supply your nerves with the oxygen and nutrients they need to remain healthy.
Review your medications: Talk with your doctor or pharmacist about all the medications and over-the-counter products you take. Ask if any are known to cause or worsen neuropathy. If so, ask if a different medication can be tried.

Neuropathy (Peripheral Neuropathy): Outlook / Prognosis

Can neuropathy be stopped?
Your long-term outcome depends on what is causing your neuropathy. If your neuropathy is caused by a treatable condition, managing the condition might result in stopping the neuropathy or preventing it from getting worse. If the underlying cause of the neuropathy can’t be treated, then the goal is to manage the symptoms of neuropathy and improve your quality of life.
Neuropathy rarely leads to death if the cause is determined and controlled. The sooner the diagnosis is made and treatment is started, the greater the chance that nerve damage can be slowed or repaired. Recovery, if it’s possible, usually takes a very long time — from months to even years. Some people live with a degree of neuropathy for the rest of their lives.

Can neuropathy be reversed?
If the underlying cause of the neuropathy can be treated and cured (such as neuropathy caused by a vitamin deficiency), it’s possible that the neuropathy can be reversed too. However, frequently by the time individuals are diagnosed with a neuropathy, there is some degree of permanent damage that can’t be fixed.
Even though this is the general belief of today, it’s not the hope of tomorrow. Nerve damage may be reversible someday. Researchers are already seeing positive results – the regrowth of nerve fibers – in a drug study in mice with diabetes. Ongoing research combined with living a healthy lifestyle so the body can repair itself will likely be needed. Stay tuned.

Neuropathy (Peripheral Neuropathy): Living With

Can neuropathy lead to amputation?
Yes, neuropathy – especially diabetic neuropathy – can lead to limb amputation. Each year about 86,000 Americans with diabetes lose a limb. The sequence of events leading up to amputation is typically this: the high glucose levels seen in diabetes cause nerve damage. The nerve damage reduces sensation in the limbs (usually the feet), which can lead to unnoticed injuries turning into skin ulcers or infections. Reduced blood flow to the feet, another effect of diabetes, prevents the wound from healing properly. The wounds cause the tissue in the foot or leg to break down, requiring amputation.
You can, however, reduce your chance of an amputation by keeping your diabetes under control and carefully caring for your skin and feet.

What should I do if I think I have neuropathy?
See your healthcare provider immediately as soon as you notice symptoms. Neuropathy can also be a symptom of a serious disorder. If left untreated, peripheral neuropathy can lead to permanent nerve damage.

Article Provided By: ClevelandClinic
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Pinched Nerve In Shoulder

What happens with a pinched nerve in the shoulder?

A pinched nerve in the shoulder occurs when a nearby structure irritates or presses on a nerve coming from the neck. This can lead to shoulder pain and numbness of the arm and hand.
Doctors may also refer to a pinched nerve in the shoulder arising from the neck as cervical radiculopathy.
An acute injury or changes to the body over time can cause a pinched nerve in the shoulder. This article will identify common symptoms, causes, and treatments for the condition.
Signs and symptoms

Disk degeneration or herniation can cause a pinched nerve in the shoulder.
A pinched nerve in the shoulder will typically cause pain, numbness, or discomfort in the shoulder region.
A person may also have other symptoms, which include:

changes in feeling on the same side as the shoulder that hurts
muscle weakness in the arm, hand, or shoulder
neck pain, especially when turning the head from side to side
numbness and tingling in the fingers or hand
Causes
A pinched nerve in the shoulder occurs when material, such as bone, disk protrusions, or swollen tissue, puts pressure on the nerves extending from the spinal column toward the neck and shoulder.
The spinal column consists of 24 bones called vertebrae that sit atop each other with protective, cushion-like disks between each one.
Doctors divide the spinal column into three regions based on the area of the body and the appearance of the spinal bones. These include:
Cervical spine: Consisting of the first seven vertebrae.
Thoracic spine: Made up of the middle 12 vertebrae.
Lumbar spine: Consisting of the last five vertebrae.
A pinched nerve in the shoulder affects the cervical spine specifically. Extending from the cervical spine are nerves that transmit signals to and from the brain to other areas of the body.
Some common causes of a pinched nerve in the shoulder include:
Disk degeneration: Over time, the gel-like disks between the cervical vertebrae can start to wear down. As a result, the bones can get closer together and potentially rub against each other and the nerves. Sometimes, a person will develop bony growths on their vertebrae called bone spurs. These can also press on shoulder nerves.
Herniated disk: Sometimes a disk can stick out and press on nerves where they exit the spinal column. A person will tend to notice this pain more with activities, such as twisting, bending, or lifting.
Acute injury: A person can experience an injury, such as from a car accident or sports activity, that causes a herniated disk or tissue inflammation in the body that presses on the nerves.
A doctor can usually identify the cause of a pinched nerve in the shoulder by taking a medical history, doing a physical exam, and requesting imaging studies.

 

How does a doctor diagnose shoulder pain?

A doctor can use an X-ray to diagnose a pinched nerve.
Doctors will start to diagnose a person’s shoulder pain by taking a history and doing a physical examination.
They will ask a person about the symptoms they are experiencing, such as when they first noticed these, and what makes them worse or better. A doctor will also examine the shoulder, neck, and surrounding areas to try to identify any noticeable problems.
A doctor will often order further tests to confirm a diagnosis or rule out other causes. Examples of these tests include:
X-ray or computed tomography (CT) scan: These tests provide details of spinal bones to help identify changes to the bones that may be pressing on a nerve.
Magnetic resonance imaging (MRI): This test provides greater detail of soft tissue and nerves that a CT scan or X-ray cannot.
Electrodiagnostic studies: These tests use special needles that send electrical signals to different areas of the neck and shoulder. They can test the nerve functions in the body to work out where one is compressed.
These tests can help a doctor identify a pinched nerve in the shoulder or another condition that may also cause shoulder pain. Examples of other conditions include:
a tendon tear
arthritis or inflammation of the joints
bursitis or inflammation of the fluid-filled sacs that cushion the joints
shoulder fracture

Treatment options
Most people with a pinched nerve in the shoulder will get better over time and do not require any treatment.
When necessary to make treatment recommendations, a doctor will consider:
what is causing the pinched nerve
how severe the pain is
how the pinched nerve affects daily activities
A doctor will usually recommend nonsurgical treatments first. If a person’s pain does not respond to these treatments or gets worse, the doctor may then recommend surgery.
Nonsurgical treatments for a pinched nerve include:
taking nonsteroidal anti-inflammatory drugs, such as ibuprofen or naproxen
taking oral corticosteroids to relieve inflammation
injecting corticosteroids to reduce swelling and inflammation
wearing a soft, cervical collar to limit movement in the neck to allow the nerves to heal
undertaking physical therapy and exercises to reduce stiffness and improve range of motion
taking pain-relieving medication for a short time to reduce the most immediate effects of shoulder pain
Sometimes pain due to a pinched nerve in the shoulder will come and go. But if a person’s pain is the result of degenerative changes, their pain may worsen with time.
If the above treatments no longer relieve pain, a doctor may recommend surgery. Types of surgery can include:
Anterior cervical discectomy and fusion (ACDF): In this procedure, a surgeon accesses the neck bones from the front of the neck. They will remove the area of disk or bone that is causing pain before fusing areas of the spine together to reduce pain.
Artificial disk replacement: This procedure involves replacing a diseased or damaged disk with an artificial one made from metal, plastic, or a combination of both. As with an ACDF, a surgeon will access the spinal column from the front of the neck.
Posterior cervical laminoforaminotomy: This procedure involves making a 1- to 2-inch cut on the back of the neck and removing portions of the spine that may be pressing on the nerves in the back.
Decompression of the suprascapular nerve: This means the surgeon tries to free up the nerve in the region of the scapular notch if this nerve is compressed.
The surgical approach will depend on a person’s symptoms and what area of the spine or tissue is pressing on the nerves.

Managing a pinched nerve in the shoulder

An ice pack can help to manage intense symptoms of a pinched nerve.
The pain from a pinched nerve in the shoulder often comes and goes. When a person is experiencing intense symptoms, they may wish to try the following:
Apply cloth-covered ice packs to the neck and shoulder blade area over a period of up to 48 hours after the pain began. After this time, they can use warm, moist heat to relieve pain.
Sleep with a pillow designed to support the neck. These pillows are available to purchase online.
Take anti-inflammatory or pain-relieving medications.
When a person’s symptoms start to get better, they may want to try doing the following to help prevent further episodes of pain:
Focusing on proper postures when sleeping and sitting at a desk. People can use devices, such as a hands-free phone, to avoid having to strain or move the neck repetitively. Adjusting chair and keyboard height may also reduce strain on the back.
Engaging in regular exercise to reduce stiffness and help maintain a healthy weight.
Having massages that can boost circulation to inflamed areas, which can aid healing. Massages can also relieve muscle tension.
A physical or occupational therapist can be helpful in recommending exercises and giving advice on how to improve posture at home and at work.

Outlook
A pinched nerve in the shoulder can be a painful problem that can lead to weakness, tingling, and numbness in the hand and arm.
Over-the-counter measures can usually help to reduce symptoms. If these methods do not work, surgical options are available.
People should always talk to their doctor when they have shoulder pain that lasts beyond a few days.

Last medically reviewed on January 14, 2020

Article Provided By: Medicalnewstoday
Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Tarsal Tunnel Syndrome

Recognizing and Treating Tarsal Tunnel Syndrome

What is tarsal tunnel syndrome?
Tarsal tunnel syndrome is a condition caused by repeated pressure that results in damage on the posterior tibial nerve. Your tibial nerve branches off of the sciatic nerve and is found near your ankle.
The tibial nerve runs through the tarsal tunnel, which is a narrow passageway inside your ankle that is bound by bone and soft tissue. Damage of the tibial nerve typically occurs when the nerve is compressed as a result of consistent pressure.

What are the symptoms of tarsal tunnel syndrome?
People with tarsal tunnel syndrome may experience pain, numbness, or tingling. This pain can be felt anywhere along the tibial nerve, but it’s also common to feel pain in the sole of the foot or inside the ankle. This can feel like:
sharp, shooting pains
pins and needles
an electric shock
a burning sensation
Symptoms vary greatly depending on each individual. Some people experience symptoms that progress gradually, and some experience symptoms that begin very suddenly.
Pain and other symptoms are often aggravated by physical activity. But if the condition is long-standing, some people even experience pain or tingling at night or when resting.
What causes tarsal tunnel syndrome?
Tarsal tunnel syndrome results from compression of the tibial nerve, and it’s often caused by other conditions.
Causes can include:
severely flat feet, because flattened feet can stretch the tibial nerve
benign bony growths in the tarsal tunnel
varicose veins in the membrane surrounding the tibial nerve, which cause compression on the nerve
inflammation from arthritis
lesions and masses like tumors or lipomas near the tibial nerve
injuries or trauma, like an ankle sprain or fracture — inflammation and swelling from which lead to tarsal tunnel syndrome
diabetes, which makes the nerve more vulnerable to compression

 

How is tarsal tunnel syndrome diagnosed?
If you think you have tarsal tunnel syndrome, you should see your doctor so they can help you identify the cause and create a treatment plan so that the condition doesn’t get worse. Your general practitioner can refer you to an orthopedic surgeon or podiatrist.
At your appointment, your doctor will ask about the progression of your symptoms and about medical history like trauma to the area. They’ll examine your foot and ankle, looking for physical characteristics that could indicate tarsal tunnel syndrome. They’ll likely perform a Tinel’s test, which involves gently tapping the tibial nerve. If you experience a tingling sensation or pain as a result of that pressure, this indicates tarsal tunnel syndrome.
Your doctor may also order additional tests to look for an underlying cause, including an electromyography, which is a test that can detect nerve dysfunction. MRIs may also be ordered if your doctor suspects that a mass or bony growth could be causing the tarsal tunnel syndrome.

Can tarsal tunnel syndrome cause any complications?
If tarsal tunnel syndrome is left untreated, it can result in permanent and irreversible nerve damage. Because this nerve damage affects your foot, it could be painful or difficult to walk or resume normal activities.

How is tarsal tunnel syndrome treated?
Treating tarsal tunnel syndrome depends on your symptoms and the underlying cause of your pain.
At-home treatments
You can take anti-inflammatory medications (including nonsteroidal anti-inflammatory drugs) to reduce inflammation, which may alleviate compression of the nerve. Resting, icing, compression, and elevation, known as the RICE treatment, may also help reduce swelling and inflammation.
Doctor-prescribed treatments
Steroid injections may also be applied to the affected area to reduce swelling. In some cases, braces and splits may be used to immobilize the foot and limit movement that could compress the nerve. If you have naturally flat feet, you may want to have custom shoes made that support the arches of your feet.
Surgery
In severe, long-term cases, your doctor may recommend a surgery called the tarsal tunnel release. During this procedure, your surgeon will make an incision from behind your ankle down to the arch of your foot. They will release the ligament, relieving the nerve.
A minimally invasive surgery is also used by some surgeons, in which much smaller incisions are made inside your ankle. The surgeon uses tiny instruments to stretch out the ligament. Because there’s less trauma sustained by the tissues, the risk of complications and recovery time are both reduced.

Article Provided By: healthline

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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Hyperalgesia

Hyperalgesia: It Hurts Everywhere!!

Christina Lasich, MD
Health Professional
March 2, 2013

Imagine if a paper cut felt like a red, hot poker stabbed you. Imagine if a small bruise felt like a sledge hammer hit you. If you are able to imagine these examples or maybe have even felt this way, then you know what it is like to have hyperalgesia. This term means that the tissue involved has an increased sensitivity to painful stimuli. The small hurts hurt even worse. The minor injuries feel ten times worse. And it seems to hurt everywhere.

Where does hyperalgesia come from? And why does it happen? Increased sensitivity to pain can occur in damaged or undamaged tissue. Remember, pain does not necessarily mean that something is damaged. But pain does mean that the brain is interpreting signals from the body that seem threatening. Sometimes those signals are amplified because of the superactivation of the pain pathways. And sometimes those signals are amplified because of the suppression natural pain-relieving pathways in the body. Whether you have over-activity of pain pathways or suppression of pain-relieving pathways or both, all these roads can lead to an increased sensitivity to pain.

A classic example of hyperalgesia is felt when someone is experiencing opioid withdrawals. The sudden discontinuation of pain medications leaves a person with a non-functioning natural-pain relieving system while at the same time, the pain pathways deep within the nervous system become extremely active. This perfect storm of hyperalgesia causes a person to feel achy and sensitive everywhere. (1)

 

Another example of an increased sensitivity to pain is getting more and more notoriety because of the overuse of short-acting opioid medications for the treatment of chronic pain. This condition is called opioid-induced hyperalgesia. Pain medication can cause more pain if the user is experiencing a frequent cycle of withdrawals. As already mentioned, opioid withdrawals are well known to cause hyperalgesia. Furthermore, the frequent cycle of withdrawals sensitizes the nervous system. (2)

Nervous system sensitization is probably the most common reason for someone to experience an increased sensitivity to pain. Common conditions like fibromyalgia, headaches and sciatica are all conditions that typically have a component of hyperalgesia associated with that experience. Furthermore, each of those conditions is also related to a nervous system that has been altered in some way to be overactive and wound-up. The nervous system is your alarm system. When your alarm system overreacts to painful stimuli, all the little hurts feel HUGE.

And that might be the reason why you hurt everywhere. Hyperalgesia is not only an increased sensitivity to pain; it is also an indicator that someone’s alarm system might be dysfunctional because of the sudden withdrawal of medications, the overuse of medications or the sensitization of the nervous system. The hyperalgesia process can be reversed. It’s a matter of resetting the alarm. Allowing the body’s natural pain-relieving system to turn back on, eliminating the frequent cycles of withdrawals and desensitizing the nervous system are all ways to treat the increased sensitivity to pain. Unfortunately, resetting your alarm system is easier said than done.

Pain. 2013 Jan 11. pii: S0304-3959(13)00011-0

Cephalalgia. 2013 Jan;33(1):52-64

 

Article Provided By: Healthcentral

Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SCIf 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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