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Does Neuropathy from Chemo Go Away?

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Does Neuropathy from Chemo Go Away?

What is peripheral neuropathy?

Peripheral neuropathy is a blanket term for pain and discomfort and other symptoms that result from damage to peripheral nerves, which are the nerves that extend away from the brain and spinal cord.

The peripheral nervous system carries signals from the brain and spinal cord to the rest of your body, and then returns nerve signals from the periphery to be received by the spinal cord and brain. Any problems along the way can affect the skin, muscles, and joints of your hands, feet, and other parts of the body.

Many things can cause neuropathy, including certain chemotherapy drugs. Damage to peripheral nerves by these drugs is called chemotherapy-induced peripheral neuropathy, abbreviated as CIPN.

CIPN isn’t uncommon. Of people with cancer who are treated with chemotherapy, about 30 to 40 percent develop CIPN. It’s one of the reasons that some stop cancer treatment early.

What are the symptoms of CIPN?

CIPN generally affects both sides of your body the same way. Symptoms are likely to begin in your toes but can move to your feet, legs, hands, and arms. Symptoms range from mild to severe. Some of the more common symptoms are:

  • tingling or pins-and-needles sensation
  • sharp, stabbing pain
  • burning or shock-like sensations
  • loss of sensation or complete numbness
  • trouble with small motor skills such as writing, texting, and buttoning
  • gripping problems (dropping things)
  • clumsiness
  • weakness

You might also experience:

  • oversensitivity to touch
  • balance and coordination problems, which can lead to stumbling or falling when walking
  • differences in your sensitivity to temperature, making it harder to gauge heat and cold
  • reduced reflexes
  • swallowing difficulties
  • jaw pain
  • hearing loss
  • constipation
  • trouble urinating

Severe peripheral neuropathy can lead to serious health problems such as:

  • changes to blood pressure
  • changes to heart rate
  • breathing difficulties
  • injury due to falling
  • paralysis
  • organ failure
What causes CIPN?

Chemotherapy drugs are systemic treatments — that is, they affect your entire body. These powerful medications can take a toll, and some can damage your peripheral nervous system.

It’s hard to say exactly what causes CIPN since each chemotherapy drug is different, as is each person who receives treatment.

Some of the chemotherapy drugs associated with CIPN are:

  • nanoparticle albumin bound-paclitaxel (Abraxane)
  • bortezomib (Velcade)
  • cabazitaxel (Jevtana)
  • carboplatin (Paraplatin)
  • carfilzomib (Kyprolis)
  • cisplatin (Platinol)
  • docetaxel (Taxotere)
  • eribulin (Halaven)
  • etoposide (VP-16)
  • ixabepilone (Ixempra)
  • lenalidomide (Revlimid)
  • oxaliplatin (Eloxatin)
  • paclitaxel (Taxol)
  • pomalidomide (Pomalyst)
  • thalidomide (Thalomid)
  • vinblastine (Velban)
  • vincristine (Oncovin, Vincasar PFS)
  • vinorelbine (Navelbine)

Besides chemotherapy, peripheral neuropathy can be due to the cancer itself, such as when a tumor presses on a peripheral nerve.

Other cancer treatments such as surgery and radiation therapy can also lead to peripheral neuropathy. Even if you’re receiving chemotherapy, the neuropathy can be caused or aggravated by other conditions such as:

  • alcohol use disorder
  • autoimmune disorders
  • diabetes mellitus
  • HIV
  • infections that lead to nerve damage
  • poor peripheral blood circulation
  • shingles
  • spinal cord injury
  • vitamin B deficiency
How long does it last?

Symptoms can appear as soon as chemotherapy begins. Symptoms tend to get worse as the chemotherapy regimen progresses.

It’s a temporary problem for some, lasting only a few days or weeks.

For others, it can last for months or years and can even become a lifelong problem. This may be more likely if you have other medical conditions that cause neuropathy or take other prescription drugs that cause it.

How is CIPN treated?

Once your oncologist (a doctor who specializes in cancer treatment) determines that your peripheral neuropathy is caused by chemotherapy, they will monitor your treatment to see if symptoms are worsening. In the meantime, symptoms can be treated with:

  • steroids to reduce inflammation
  • topical numbing medicines
  • antiseizure medications, which can help relieve nerve pain
  • prescription-strength pain relievers such as narcotics (opioids)
  • antidepressants
  • electrical nerve stimulation
  • occupational and physical therapy

If symptoms continue, your doctor may decide to:

  • lower the dose of your chemotherapy drug
  • switch to a different chemotherapy drug
  • delay chemotherapy until symptoms improve
  • stop chemotherapy
Managing symptoms

It’s very important to work with your doctor to prevent neuropathy from getting worse. In addition, there are a few other things you can do, such as:

  • relaxation therapy, guided imagery, or breathing exercises
  • massage therapy
  • acupuncture
  • biofeedback

Pain, numbness, or strange sensations can make it difficult to work with your hands, so you should be extra careful with sharp objects. Wear gloves for yardwork or when working with tools.

If symptoms involve your feet or legs, walk slowly and carefully. Use handrails and grab bars when available and put no-slip mats in your shower or tub. Remove loose area rugs, electrical cords, and other tripping hazards in your home.

Wear shoes indoors and out to protect your feet. And if you have severe numbness in your feet, be sure to inspect them every day for cuts, injuries, and infection that you can’t feel.

Temperature sensitivity can also be a problem.

Make sure your water heater is set to a safe level, and check the temperature of the water before getting in the shower or bath.

Check the air temperature before going outside in winter. Even though you might not feel the cold, gloves and warm socks can help protect your feet and hands from frostbite.

If you find it helps to relieve your peripheral neuropathy symptoms, you can apply an ice pack on your hands or feet, but only for less than 10 minutes at a time with at least 10 minutes of breaktime between each repeat application.

Here are a few additional tips:

  • Don’t wear tight clothes or shoes that interfere with circulation.
  • Avoid alcoholic beverages.
  • Take all your medications as directed.
  • Get plenty of rest while in treatment.
  • Follow your doctor’s recommendations for diet and exercise.
  • Keep your oncologist informed about new or worsening symptoms.

Currently, there’s no scientifically proven way to prevent neuropathy caused by chemotherapy. And there’s no way to know in advance who’ll develop it and who won’t.

Some research, such as this 2015 studyTrusted Source and this 2017 studyTrusted Source, suggests that taking glutathione, calcium, magnesium, or certain antidepressant or antiseizure drugs might help mitigate the risk for certain people. However, the research is limited, weak, or shows mixed results at best.

Before starting chemotherapy, tell your oncologist about other health conditions, such as diabetes mellitus, that could lead to peripheral neuropathy. This can help them choose the best chemotherapy drug for you.

Your oncologist may try to lessen the risk by prescribing lower doses of chemotherapy drugs over a longer period of time. If symptoms start, it may be appropriate to stop chemotherapy and restart when symptoms improve. It’s something that must be decided on a case-by-case basis.

While mild symptoms may resolve within a short time frame, more severe cases can linger for months or years. It can even become permanent. That’s why it’s so important to keep your oncologist informed about all your symptoms and side effects.

Addressing CIPN early may help ease symptoms and prevent it from getting worse.

Last medically reviewed on January 24, 2019

 

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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Sciatica

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Sciatica

Sciatica refers to pain that radiates along the path of the sciatic nerve, which branches from your lower back through your hips and buttocks and down each leg. Typically, sciatica affects only one side of your body.

Sciatica most commonly occurs when a herniated disk, bone spur on the spine or narrowing of the spine (spinal stenosis) compresses part of the nerve. This causes inflammation, pain and often some numbness in the affected leg.

Although the pain associated with sciatica can be severe, most cases resolve with non-operative treatments in a few weeks. People who have severe sciatica that’s associated with significant leg weakness or bowel or bladder changes might be candidates for surgery.

Symptoms

Pain that radiates from your lower (lumbar) spine to your buttock and down the back of your leg is the hallmark of sciatica. You might feel the discomfort almost anywhere along the nerve pathway, but it’s especially likely to follow a path from your low back to your buttock and the back of your thigh and calf.

The pain can vary widely, from a mild ache to a sharp, burning sensation or excruciating pain. Sometimes it can feel like a jolt or electric shock. It can be worse when you cough or sneeze, and prolonged sitting can aggravate symptoms. Usually only one side of your body is affected.

Some people also have numbness, tingling or muscle weakness in the affected leg or foot. You might have pain in one part of your leg and numbness in another part.

When to see a doctor

Mild sciatica usually goes away over time. Call your doctor if self-care measures fail to ease your symptoms or if your pain lasts longer than a week, is severe or becomes progressively worse. Get immediate medical care if:

  • You have sudden, severe pain in your low back or leg and numbness or muscle weakness in your leg
  • The pain follows a violent injury, such as a traffic accident
  • You have trouble controlling your bowels or bladder

Causes

Sciatica occurs when the sciatic nerve becomes pinched, usually by a herniated disk in your spine or by an overgrowth of bone (bone spur) on your vertebrae. More rarely, the nerve can be compressed by a tumor or damaged by a disease such as diabetes.

Risk factors

Risk factors for sciatica include:

  • Age. Age-related changes in the spine, such as herniated disks and bone spurs, are the most common causes of sciatica.
  • Obesity. By increasing the stress on your spine, excess body weight can contribute to the spinal changes that trigger sciatica.
  • Occupation. A job that requires you to twist your back, carry heavy loads or drive a motor vehicle for long periods might play a role in sciatica, but there’s no conclusive evidence of this link.
  • Prolonged sitting. People who sit for prolonged periods or have a sedentary lifestyle are more likely to develop sciatica than active people are.
  • Diabetes. This condition, which affects the way your body uses blood sugar, increases your risk of nerve damage.

Complications

Although most people recover fully from sciatica, often without treatment, sciatica can potentially cause permanent nerve damage. Seek immediate medical attention if you have:

  • Loss of feeling in the affected leg
  • Weakness in the affected leg
  • Loss of bowel or bladder function

Prevention

It’s not always possible to prevent sciatica, and the condition may recur. The following can play a key role in protecting your back:

  • Exercise regularly. To keep your back strong, pay special attention to your core muscles — the muscles in your abdomen and lower back that are essential for proper posture and alignment. Ask your doctor to recommend specific activities.
  • Maintain proper posture when you sit. Choose a seat with good lower back support, armrests and a swivel base. Consider placing a pillow or rolled towel in the small of your back to maintain its normal curve. Keep your knees and hips level.
  • Use good body mechanics. If you stand for long periods, rest one foot on a stool or small box from time to time. When you lift something heavy, let your lower extremities do the work. Move straight up and down. Keep your back straight and bend only at the knees. Hold the load close to your body. Avoid lifting and twisting simultaneously. Find a lifting partner if the object is heavy or awkward.

 

Diagnosis

During the physical exam, your doctor may check your muscle strength and reflexes. For example, you may be asked to walk on your toes or heels, rise from a squatting position and, while lying on your back, lift your legs one at a time. Pain that results from sciatica will usually worsen during these activities.

Imaging tests

Many people have herniated disks or bone spurs that will show up on X-rays and other imaging tests but have no symptoms. So doctors don’t typically order these tests unless your pain is severe, or it doesn’t improve within a few weeks.

  • X-ray. An X-ray of your spine may reveal an overgrowth of bone (bone spur) that may be pressing on a nerve.
  • MRI. This procedure uses a powerful magnet and radio waves to produce cross-sectional images of your back. An MRI produces detailed images of bone and soft tissues such as herniated disks. During the test, you lie on a table that moves into the MRI machine.
  • CT scan. When a CT is used to image the spine, you may have a contrast dye injected into your spinal canal before the X-rays are taken — a procedure called a CT myelogram. The dye then circulates around your spinal cord and spinal nerves, which appear white on the scan.
  • Electromyography (EMG). This test measures the electrical impulses produced by the nerves and the responses of your muscles. This test can confirm nerve compression caused by herniated disks or narrowing of your spinal canal (spinal stenosis).
  • Treatment

If your pain doesn’t improve with self-care measures, your doctor might suggest some of the following treatments.

Medications

The types of drugs that might be prescribed for sciatica pain include:

  • Anti-inflammatories
  • Muscle relaxants
  • Narcotics
  • Tricyclic antidepressants
  • Anti-seizure medications

Physical therapy

Once your acute pain improves, your doctor or a physical therapist can design a rehabilitation program to help you prevent future injuries. This typically includes exercises to correct your posture, strengthen the muscles supporting your back and improve your flexibility.

Steroid injections

In some cases, your doctor might recommend injection of a corticosteroid medication into the area around the involved nerve root. Corticosteroids help reduce pain by suppressing inflammation around the irritated nerve. The effects usually wear off in a few months. The number of steroid injections you can receive is limited because the risk of serious side effects increases when the injections occur too frequently.

Surgery

This option is usually reserved for when the compressed nerve causes significant weakness, loss of bowel or bladder control, or when you have pain that progressively worsens or doesn’t improve with other therapies. Surgeons can remove the bone spur or the portion of the herniated disk that’s pressing on the pinched nerve.

 

Lifestyle and home remedies

For most people, sciatica responds to self-care measures. Although resting for a day or so may provide some relief, prolonged inactivity will make your signs and symptoms worse.

Other self-care treatments that might help include:

  • Cold packs. Initially, you might get relief from a cold pack placed on the painful area for up to 20 minutes several times a day. Use an ice pack or a package of frozen peas wrapped in a clean towel.
  • Hot packs. After two to three days, apply heat to the areas that hurt. Use hot packs, a heat lamp or a heating pad on the lowest setting. If you continue to have pain, try alternating warm and cold packs.
  • Stretching. Stretching exercises for your low back can help you feel better and might help relieve nerve root compression. Avoid jerking, bouncing or twisting during the stretch, and try to hold the stretch for at least 30 seconds.
  • Over-the-counter medications. Pain relievers such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve) are sometimes helpful for sciatica.

Alternative medicine

Alternative therapies commonly used for low back pain include:

  • Acupuncture. In acupuncture, the practitioner inserts hair-thin needles into your skin at specific points on your body. Some studies have suggested that acupuncture can help back pain, while others have found no benefit. If you decide to try acupuncture, choose a licensed practitioner to ensure that he or she has had extensive training.
  • Chiropractic. Spinal adjustment (manipulation) is one form of therapy chiropractors use to treat restricted spinal mobility. The goal is to restore spinal movement and, as a result, improve function and decrease pain. Spinal manipulation appears to be as effective and safe as standard treatments for low back pain, but might not be appropriate for radiating pain.

Article Provided By: mayoclinic
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Postherpetic Neuralgia

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Postherpetic Neuralgia

 

Postherpetic neuralgia is a painful condition that affects your nerves and skin. It’s a complication of herpes zoster, commonly called shingles.

Shingles is a painful, blistering skin rash caused by a reactivation of the varicella-zoster virus.

People usually contract this virus in childhood or adolescence as chickenpox. The virus can remain dormant in the body’s nerve cells after childhood and reactivate decades later.

When the pain caused by shingles doesn’t go away after the rash and blisters clear up, the condition is called postherpetic neuralgia.

Postherpetic neuralgia is the most common shingles complication. It occurs when a shingles outbreak damages the nerves.

The damaged nerves can’t send messages from the skin to the brain, and the messages become confused. This results in chronic, severe pain that can last for months.

According to a 2017 review, about 20 percent of people who get shingles also develop postherpetic neuralgia. Additionally, this condition is more likely to occur in people over the age of 50.

What are the symptoms of postherpetic neuralgia?

Shingles typically causes a painful, blistering rash. Postherpetic neuralgia is a complication that only occurs in people who have already had shingles.

Common signs and symptoms of postherpetic neuralgia include:

  • severe pain that continues for more than 1 to 3 months in the same place that the shingles occurred, even after the rash goes away
  • burning sensation on the skin, even from the slightest pressure
  • sensitivity to touch or temperature changes
What are the risk factors for postherpetic neuralgia?

Age is a major risk factor for getting both shingles and postherpetic neuralgia. Risk begins to increase at age 50 and rises exponentially the older you get.

People who have acute pain and severe rash during shingles also have a higher risk for developing postherpetic neuralgia.

People with lowered immunity due to conditions like HIV or Hodgkin’s lymphoma have an increased risk for developing shingles. The risk of shingles is 20 to 100 greater in this group.

How is postherpetic neuralgia diagnosed and treated?

Most of the time, your doctor is able to make a diagnosis of postherpetic neuralgia based on how long you’ve experienced pain following shingles. Tests are unnecessary in confirming a diagnosis.

Treatment for postherpetic neuralgia aims to manage and reduce the pain until the condition goes away.

How can postherpetic neuralgia be prevented?

Two doses of a herpes zoster vaccine called Shingrix reduce the risk of shingles by more than 90 percentTrusted Source. The vaccine also protects against postherpetic neuralgia.

The Centers for Disease Control and Prevention (CDC)Trusted Source recommends healthy people ages 50 and up get the Shingrix vaccine.

Postherpetic neuralgia is treatable and preventable. Most cases disappear in 1 to 2 months. In rare cases, it can last longer than a year.

If you’re older than 50, it’s wise to get vaccinated against shingles and postherpetic neuralgia.

If you do develop postherpetic neuralgia, you have many treatment options to manage the pain. Talk with your doctor to find the best treatment for you.

Article Provided By: healthline
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The Common Symptoms of Neuralgia

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The Common Symptoms of Neuralgia

By

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, 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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Neuralgia

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Neuralgia

Neuralgia is a stabbing, burning, and often severe pain due to an irritated or damaged nerve. The nerve may be anywhere in the body, and the damage may be caused by several things, including:

  • aging
  • diseases such as diabetes or multiple sclerosis
  • an infection, such as shingles

Treatment for the pain of neuralgia depends on the cause.

Types of neuralgia

Postherpetic neuralgia

This type of neuralgia occurs as a complication of shingles and may be anywhere on the body. Shingles is a viral infection characterized by a painful rash and blisters. Neuralgia can occur wherever the outbreak of shingles was. The pain can be mild or severe and persistent or intermittent. It can also last for months or years. In some cases, the pain may occur before the rash. It will always occur along the path of a nerve, so it’s usually isolated to one side of the body.

Trigeminal neuralgia

This type of neuralgia is associated with pain from the trigeminal nerve, which travels from the brain and branches to different parts of the face. The pain can be caused by a blood vessel pressing down on the nerve where it meets with the brainstem. It can also be caused by multiple sclerosis, injury to the nerve, or other causes.

Trigeminal neuralgia causes severe, recurrent pain in the face, usually on one side. It’s most common in people who are older than 50 years.

Glossopharyngeal neuralgia

Pain from the glossopharyngeal nerve, which is in the throat, is not very common. This type of neuralgia produces pain in the neck and throat.

Causes of neuralgia

The cause of some types of nerve pain is not completely understood. You may feel nerve pain from damage or injury to a nerve, pressure on a nerve, or changes in the way the nerves function. The cause may also be unknown.

Infection

An infection can affect your nerves. For example, the cause of postherpetic neuralgia is shingles, an infection caused by the chickenpox virus. The likelihood of having this infection increases with age. An infection in a specific part of the body may also affect a nearby nerve. For example, if you have an infection in a tooth, it may affect the nerve and cause pain.

Multiple sclerosis

Multiple sclerosis (MS) is a disease caused by the deterioration of myelin, the covering of nerves. Trigeminal neuralgia may occur in someone with MS.

Pressure on nerves

Pressure or compression of nerves may cause neuralgia. The pressure may come from a:

  • bone
  • ligament
  • blood vessel
  • tumor

The pressure of a swollen blood vessel is a common cause of trigeminal neuralgia.

Diabetes

Many people with diabetes have problems with their nerves, including neuralgia. The excess glucose in the bloodstream may damage nerves. This damage is most common in the hands, arms, feet, and legs.

Less common causes

If the cause of neuralgia isn’t infection, MS, diabetes, or pressure on the nerves, it may be from one of many less-common factors. These include:

  • chronic kidney disease
  • medications prescribed for cancer
  • fluoroquinolone antibiotics, used to treat some infections
  • trauma, such as from surgery
  • chemical irritation
When to seek medical help

The pain of neuralgia is usually severe and sometimes debilitating. If you have it, you should see your doctor as soon as possible.

You should also see your doctor if you suspect you have shingles. Besides neuralgia, shingles also causes a red, blistering rash. It’s usually on the back or the abdomen, but it may also be on the neck and face. Shingles should be treated as soon as possible to prevent complications. These can include postherpetic neuralgia, which can cause debilitating and lifelong pain.

What to expect at a doctor’s appointment

When you see your doctor for neuralgia, you can expect to be asked a series of questions about your symptoms. Your doctor will want you to describe the pain and to tell them how long the pain has been a problem. You will also need to inform them of any medications you take and any other medical issues you have. This is because neuralgia may be a symptom of another disorder, such as diabetes, MS, or shingles.

Your doctor will also perform a physical exam to pinpoint the location of the pain and the nerve that’s causing it, if possible. You may also need to have a dental exam. For example, if the pain is in your face, your doctor may want to rule out other possible dental causes, such as an abscess.

To find an underlying cause of your pain, your doctor may order certain tests. You may need to have blood drawn to check your blood sugar levels and kidney function. A magnetic resonance imaging (MRI) test can help your doctor determine if you have MS. A nerve conduction velocity test can determine nerve damage. It shows how fast signals are moving through your nerves.

Treatment of neuralgia

If your doctor can pinpoint the cause of your neuralgia, your treatment will focus on treating the underlying cause. If the cause is not found, treatment will focus on relieving your pain.

Potential treatments may include:

  • surgery to relieve the pressure on the nerve
  • better control of blood sugar levels in people with diabetes-caused neuralgia
  • physical therapy
  • nerve block, which is an injection directed at a particular nerve or nerve group and that is intended to “turn off” pain signals and reduce inflammation
  • medications to relieve the pain

Medications prescribed may include:

  • antidepressants such as amitriptyline or nortriptyline, which are effective in treating nerve pain
  • antiseizure medications such as carbamazepine, which is effective for trigeminal neuralgia
  • short-term narcotic pain medications, such as codeine
  • topical creams with capsaicin

There is no cure for neuralgia, but treatment can help improve your symptoms. Some types of neuralgia improve over time. More research is being done to develop better treatments for neuralgia.

 

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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Peripheral Neuropathy

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Peripheral neuropathy

Peripheral neuropathy, a result of damage to the nerves outside of the brain and spinal cord (peripheral nerves), often causes weakness, numbness and pain, usually in your hands and feet. It can also affect other areas of your body.
Your peripheral nervous system sends information from your brain and spinal cord (central nervous system) to the rest of your body. The peripheral nerves also send sensory information to the central nervous system.

Peripheral neuropathy can result from traumatic injuries, infections, metabolic problems, inherited causes and exposure to toxins. One of the most common causes is diabetes.
People with peripheral neuropathy generally describe the pain as stabbing, burning or tingling. In many cases, symptoms improve, especially if caused by a treatable condition. Medications can reduce the pain of peripheral neuropathy.

Symptoms
Every nerve in your peripheral system has a specific function, so symptoms depend on the type of nerves affected. Nerves are classified into:
Sensory nerves that receive sensation, such as temperature, pain, vibration or touch, from the skin
Motor nerves that control muscle movement
Autonomic nerves that control functions such as blood pressure, heart rate, digestion and bladder
Signs and symptoms of peripheral neuropathy might include:
Gradual onset of numbness, prickling or tingling in your feet or hands, which can spread upward into your legs and arms
Sharp, jabbing, throbbing or burning pain
Extreme sensitivity to touch
Pain during activities that shouldn’t cause pain, such as pain in your feet when putting weight on them or when they’re under a blanket
Lack of coordination and falling
Muscle weakness
Feeling as if you’re wearing gloves or socks when you’re not
Paralysis if motor nerves are affected
If autonomic nerves are affected, signs and symptoms might include:
Heat intolerance
Excessive sweating or not being able to sweat
Bowel, bladder or digestive problems
Changes in blood pressure, causing dizziness or lightheadedness
Peripheral neuropathy can affect one nerve (mononeuropathy), two or more nerves in different areas (multiple mononeuropathy) or many nerves (polyneuropathy). Carpal tunnel syndrome is an example of mononeuropathy. Most people with peripheral neuropathy have polyneuropathy.
When to see a doctor
Seek medical care right away if you notice unusual tingling, weakness or pain in your hands or feet. Early diagnosis and treatment offer the best chance for controlling your symptoms and preventing further damage to your peripheral nerves.

Not a single disease, peripheral neuropathy is nerve damage caused by a number of conditions. Health conditions that can cause peripheral neuropathy include:
Autoimmune diseases. These include Sjogren’s syndrome, lupus, rheumatoid arthritis, Guillain-Barre syndrome, chronic inflammatory demyelinating polyneuropathy and vasculitis.
Diabetes. More than half the people with diabetes develop some type of neuropathy.
Infections. These include certain viral or bacterial infections, including Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, leprosy, diphtheria, and HIV.
Inherited disorders. Disorders such as Charcot-Marie-Tooth disease are hereditary types of neuropathy.
Tumors. Growths, cancerous (malignant) and noncancerous (benign), can develop on the nerves or press nerves. Also, polyneuropathy can arise as a result of some cancers related to the body’s immune response. These are a form of a degenerative disorder called paraneoplastic syndrome.
Bone marrow disorders. These include an abnormal protein in the blood (monoclonal gammopathies), a form of bone cancer (myeloma), lymphoma and the rare disease amyloidosis.
Other diseases. These include kidney disease, liver disease, connective tissue disorders and an underactive thyroid (hypothyroidism).
Other causes of neuropathies include:
Alcoholism. Poor dietary choices made by people with alcoholism can lead to vitamin deficiencies.
Exposure to poisons. Toxic substances include industrial chemicals and heavy metals such as lead and mercury.
Medications. Certain medications, especially those used to treat cancer (chemotherapy), can cause peripheral neuropathy.
Trauma or pressure on the nerve. Traumas, such as from motor vehicle accidents, falls or sports injuries, can sever or damage peripheral nerves. Nerve pressure can result from having a cast or using crutches or repeating a motion such as typing many times.
Vitamin deficiencies. B vitamins — including B-1, B-6 and B-12 — vitamin E and niacin are crucial to nerve health.
In a number of cases, no cause can be identified (idiopathic).
More Information
Peripheral neuropathy care at Mayo Clinic
Hypothyroidism: Can it cause peripheral neuropathy?
Risk factors
Peripheral neuropathy risk factors include:
Diabetes, especially if your sugar levels are poorly controlled
Alcohol abuse
Vitamin deficiencies, particularly B vitamins
Infections, such as Lyme disease, shingles, Epstein-Barr virus, hepatitis B and C, and HIV
Autoimmune diseases, such as rheumatoid arthritis and lupus, in which your immune system attacks your own tissues
Kidney, liver or thyroid disorders
Exposure to toxins
Repetitive motion, such as those performed for certain jobs
Family history of neuropathy
Complications
Complications of peripheral neuropathy can include:
Burns and skin trauma. You might not feel temperature changes or pain on parts of your body that are numb.
Infection. Your feet and other areas lacking sensation can become injured without your knowing. Check these areas regularly and treat minor injuries before they become infected, especially if you have diabetes.
Falls. Weakness and loss of sensation may be associated with lack of balance and falling.
Prevention
Manage underlying conditions
The best way to prevent peripheral neuropathy is to manage medical conditions that put you at risk, such as diabetes, alcoholism or rheumatoid arthritis.
Make healthy lifestyle choices
These habits support your nerve health:
Eat a diet rich in fruits, vegetables, whole grains and lean protein to keep nerves healthy. Protect against vitamin B-12 deficiency by eating meats, fish, eggs, low-fat dairy foods and fortified cereals. If you’re vegetarian or vegan, fortified cereals are a good source of vitamin B-12, but talk to your doctor about B-12 supplements.
Exercise regularly. With your doctor’s OK, try to get at least 30 minutes to one hour of exercise at least three times a week.
Avoid factors that may cause nerve damage, including repetitive motions, cramped positions that put pressure on nerves, exposure to toxic chemicals, smoking and overindulging in alcohol.

By Mayo Clinic Staff

Article Provided By: mayoclinic
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Mayo Clinic Researchers Test Scrambler Therapy For Pain

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Mayo Clinic researchers test scrambler therapy for pain

Scrambler therapy is a pain management approach that uses a machine to block the transmission of pain signals by providing non-pain information to nerve fibers that have been receiving pain messages.
The first study on scrambler therapy was published in 2003 by a team of researchers led by Giuseppe Marineo, professor in delta research and development at University of Rome Tor Vergata in Italy. He and colleagues reported that scrambler therapy was effective at reducing pain symptoms in patients with severe, drug-resistant pain from terminal cancer.

 

Charles L. Loprinzi

The Calmare scrambler therapy device has since received FDA clearance in the United States for use in patients experiencing pain from cancer and chemotherapy, pain as a result of chronic diseases such as diabetes, multiple sclerosis and arthritis, back and neck pain, failed back surgery syndrome, and phantom limb pain among others.
HemOnc Today asked Charles L. Loprinzi, MD, Regis professor of breast cancer research at Mayo Clinic in Rochester, Minnesota, about the safety and efficacy of scrambler therapy, as well as his ongoing research efforts.
Question: Can you describe scrambler therapy and how it came about?
Answer: Scrambler therapy is an electro-cutaneous treatment. Although people may think of it as being similar to transcutaneous electrical nerve stimulation (TENS) therapy, scrambler therapy is felt to work through a different mechanism. TENS is thought to work through the gateway theory of pain relief, whereby normal touch sensations blocks pain sensations. Scrambler therapy, on the other hand, is proposed to provide normal-self, non-pain electrical information via nerves that have been transmitting chronic pain information. Through a process termed plasticity, this is able to retrain the brain so that it does not ascribe pain to the chronic pain area. Scrambler therapy consists of a machine, which looks somewhat like an electrocardiogram machine. Leads are placed on patients, around the areas of chronic pain. Scrambled electrical signals are then sent to the brain that perceives them as normal, non-pain signals. Via this process, the brain is retrained to think that there really is not pain in the area that is being treated.
Q: How and when did you become involved with this treatment approach?
A: I was introduced to scrambler therapy in 2010 by Thomas J. Smith, MD, now at Johns Hopkins University, who had heard about scrambler therapy and decided to try it in patients with chemotherapy-induced peripheral neuropathy (CIPN). He subsequently published a pilot trial that supported that scrambler therapy was an effective approach for treating established CIPN. After some internal debate as to whether I should look further into this treatment approach, which sounded quite strange to me, I did agree to study it. Having now treated more than 200 patients at Mayo, we published a paper on the use of this treatment for chemotherapy neuropathy, which concurred with Dr. Smith’s report, further supporting that this therapy was helpful for CIPN.
Q: What other published data support the value of scrambler therapy?
A: I am aware of 19 published reports regarding scrambler therapy, involving more than 800 patients. Seventeen of these are published manuscripts, whereas two are only published as meeting abstracts. These reports include clinical practice summaries, prospective non-randomized clinical trials and randomized controlled trials, including two trials that sought to double blind patients and investigators. The authors of 18 of the 19 reports concluded that scrambler therapy was a beneficial treatment approach, whereas one report — published only as a meeting abstract and only involving 14 patients — concluded that this was not an effective treatment. Of note, one relatively large randomized trial, with a non-blinded control arm consisting of optimizing medical management of pain, reported substantially more benefit from scrambler therapy than was observed in the control arm. Additionally, a relatively small placebo-controlled, patient-blinded trial reported a statistically significantly beneficial effect for scrambler therapy in a small number of patients with chronic low back pain. Thus, there are substantial data that support the value of scrambler therapy. Having said this, I readily admit that scrambler therapy has not yet been clearly proven to be beneficial. Ideally, additional randomized clinical trials will be reported to provide for more substantial clinical data regarding the true value of scrambler therapy. Dr. Smith is conducting one trial at Johns Hopkins and we, at Mayo, are gearing up for another one. This all takes time, energy and funds.
Q: Can you briefly discuss the findings from the clinical study you reported regarding the use of scrambler therapy in patients with established CIPN?
A: When we received the scrambler therapy machine, we decided to treat patients on a clinical trial as opposed to just using it for routine clinical practice. For this, we developed an open-label clinical trial to document our results and to learn how to provide this therapy. Prior to treating patients on this trial, we went to Rome for training. We then treated patients on this clinical trial, who had chronic pain or neuropathy with a pain and/or tingling score of at least 4 out of 10. In order to report data on a series of these patients, we took the first 37 patients who entered on this clinical trial who had CIPN as their designated clinical problem. We prospectively collected patient-reported outcome data on each of 10 days of treatment and then weekly for 10 weeks following that. Results, reported in Supportive Care in Cancer, illustrated that, during the treatment days, there was approximately a 50% reduction from baseline for pain, tingling and numbness scores. When we then followed the patients weekly, after the 10 days of therapy, the benefit, on the whole, persisted.
Q: Can you describe the treatment process and when beneficial results appear?
A: The area of pain/neuropathy is first defined and a set of leads is placed in normal sensation skin sites, close to the area of pain/neuropathy. The electrodes are then turned on with a gradual increase in intensity to a point where the patient is able to feel sensations, short of pain. When successful, the patient reports that the buzzing sensation has replaced an area of pain/neuropathy. This generally occurs within a minute or two. At times, electrodes need to be moved to obtain this sort of success. Sometimes, several sets of electrodes are needed to cover the area of discomfort. The scrambler machine stays on for about 30 minutes following successful electrode placements. The electricity is then turned off and the patient commonly reports that the pain/tingling is still markedly improved. After one treatment, the benefit is often relatively short-lived, lasting for minutes to hours. With repetitive days of treatment (standardly up to 10 treatments, although stopped earlier if the problem goes away completely and lasts overnight), the period of benefit increases until it lasts for a couple days. The benefit largely persists for weeks to months. Some patients relapse and can be successfully retreated, oftentimes only needing an additional few doses.
Q: Is this therapy routinely offered at Mayo Clinic?
A: Mayo recently began offering scrambler therapy as part of clinical practice. As with many new practice approaches, there are many questions that arise: How effective is the therapy? Who should be treated and for which conditions? How well is this approach covered by different insurance carriers? Admittedly, we do not have ideal answers for these and many other questions, but we are cautiously proceeding forward. There is considerable demand for scrambler therapy along with concerns that efficacy has not been proven and that the reported results from it sound too good to be true. But, these concerns are not too surprising, as there is often a wariness when a new therapy is initiated.
Q: Is this therapy routinely offered at places other than Mayo Clinic?
A: Yes, it is available at other select places. I understand there are more than 30 institutions in Italy and even more institutions in South Korea that provide scrambler therapy as a part of clinical practice. Multiple United States military institutions also offer scrambler therapy. In the United States, I estimate that there are between 15 and 30 sites that are actively offering this treatment. It should be noted that there is a learning curve in terms of making this therapy work. For example, in our paper where we looked at CIPN, even though we had reasonably good experience which included visiting the inventor in Rome and being trained by him, we did a whole lot better with the later patients we treated than we did the first 25% we treated.
Q: What type of feedback have you received on the therapy?
A: There are patient testimonials, which can be found on the Internet, whereby patients swear by this therapy. In line with this, I have seen some phenomenal results in patients. We have clinical trial data that asked patients, daily while they were receiving 2 weeks of outpatient therapy and then weekly for 10 weeks of follow-up, whether they would recommend this treatment to others. Approximately 80% of the replies noted that they would recommend it, 1% said that they would not and the rest said that they were unsure. There, admittedly, are some people who say this therapy did not work for them.
Q: How much of an issue is cost?
A: There are the issues regarding the cost of the machine, the cost of training and whether insurance companies cover this therapy. There are some insurance companies that cover the therapy, having realized that it is a lot cheaper than alternative therapies that might be employed for the same patient problem. This is certainly an evolving process. The cost can run anywhere between $200 and $500 per session, and up to 10 sessions may be recommended. This is less expensive than some other procedures and therapies employed for chronic pain, such as spinal cord stimulators. There are some patients who choose to pay for the treatments on their own, if not covered by insurance.
Q: Are there any side effects associated with this therapy? Do they outweigh the benefit, in your opinion?
A: There have not been many documented side effects with this therapy. People feel a buzzing sensation when the machine is working and sometimes this can be uncomfortable. If pain happens during the procedure, the signal intensity should be turned down and/or off. At times the electrode leads can be moved to an alternative site, sometimes by just a couple centimeters. Occasionally, patients may develop some skin irritation or bruising under the sites of the leads. There have been some patients who report more pain in the day or days following the treatment, but it is not apparent that this is more than the normal process of a waxing and waning of the baseline pain. Overall, the reports in the literature have been largely free of side effects.
Q: Is there anything else you would like to add?
A: Although if I consider myself to be a fairly conservative clinician and have not been shy about publishing negative results from many clinical trials, I do believe that scrambler therapy works. This contention is based on the knowledge that the majority of the reports in the literature are positive an also the personal experience I have observed in many patients, including seeing dramatic reductions of symptoms in some patients that did not derive similar benefit from previous treatment approaches. – by Jennifer Southal

Article Provided By:healio.com
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Trigeminal Neuralgia

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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
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Failed Back and Failed Fusion Syndrome

Calmare Pain Scrambler, Carolina Pain Scrambler, Chemotherapy-Induced Peripheral Neuropathy, Chronic Back Pain, Chronic Pain, Complex Regional Pain Syndrome, CRPS, Nerve Pain, Neuropathic Pain, News, Sciatica, Therapy , , , , , , , , , , ,

Failed Back and Failed Fusion Syndrome

After any spine surgery, a percentage of patients may still experience pain. This is called failed back or failed fusion syndrome, which is characterized by intractable pain and an inability to return to normal activities. Surgery may be able to fix the condition but not eliminate the pain.

Symptoms
The main symptom is pain following back surgery. Additionally, the patient’s ability to complete activities of daily living may be altered.

Causes and Risk Factors
Smoking
Formation of scar tissue
Recurring or persistent disc disease at adjacent levels
Continued pressure from spinal stenosis
Instability or abnormal movement
Pseudoarthrosis or failure of the fusion
Nerve damage within the nerve, arachnoiditis

Diagnosis
A diagnosis will be based on the patient’s symptoms and medical history.
Additional tests that may be useful include:
Magnetic resonance imaging (MRI)
Computed tomography (CT scans)

Treatment
Treatment of these conditions, once they have occurred, will vary depending on the nature of the condition and what caused prior surgery to fail.
Some patients fail to improve even after the best surgical intervention. In spite of careful diagnosis and a successful operation, patients may continue to experience pain or limitations in performing daily activities. This continuation of symptoms is known as “failed back syndrome.” A spinal fusion occurs after the surgeon creates the conditions for the bones of the spine to unite into an immobile block. The union of the fusion mass occurs over time. When the time for healing is extended or the fusion fails to unite, this is a called a “failed fusion” or pseudoarthrosis.

Article Provided By: cedars-sinai
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Carpal Tunnel Syndrome

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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
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