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22 Jul

Chemotherapy-Induced Peripheral Neuropathy

Chemotherapy-Induced Peripheral Neuropathy
Timothy J Brown, MD; Ramy Sedhom, MD; Arjun Gupta, MD
Article Information
JAMA Oncol. 2019;5(5):750. doi:10.1001/jamaoncol.2018.6771

Peripheral neuropathy refers to symptoms arising from damage to peripheral nerves. These nerves carry sensation, control movements of the arms and legs, and control the bladder and bowel. Chemotherapy and other drugs used to treat cancer can cause peripheral neuropathy. This is termed chemotherapy-induced peripheral neuropathy (or CIPN).

What Increases the Risk of Developing CIPN?
Certain chemotherapy drugs are more likely to cause neuropathy. These include: platinum drugs, such as oxaliplatin; taxanes, such as docetaxel; vinca alkaloids, such as vincristine; and myeloma treatments, such as bortezomib.
Other chemotherapy drugs can also cause neuropathy. The risk of developing CIPN is higher with higher doses, multiple courses, and combination chemotherapy. Patients are more likely to develop CIPN if they are older or have diabetes, vitamin deficiencies, or preexisting peripheral neuropathy.
How Can I Reduce My Risk of Developing CIPN?
No medication or supplement has been shown to definitively prevent CIPN. Regular exercise, reducing alcohol use, and treating preexisting medical conditions (vitamin B12 deficiency) may reduce the risk of CIPN.
What Are the Symptoms and Complications of CIPN?
Depending on the nerves affected, symptoms include:

Tingling (“pins and needles”)
Pain, which may be severe and constant, may come and go, or may feel like burning
Decreased sensation (“legs feel like jelly”)
Increased sensitivity to touch, temperature, pressure, pain
Muscle weakness

Symptoms can appear hours to days after chemotherapy and may reduce in intensity with time. Commonly, symptoms occur weeks to months after chemotherapy. They can get worse with additional cycles of chemotherapy.
What Should I Do If I Develop Symptoms?
You should notify your care team. Symptoms are likely to worsen if not addressed. Your oncologist can diagnose CIPN based on symptoms and by examining you. Specialized testing is rarely needed.
I Have CIPN—What Now?
One should avoid injury by paying attention to home safety, such as by using handrails on stairs to prevent falls and potholders in the kitchen to avoid burns. Your oncologist may choose to discontinue or reduce the dose of a chemotherapy drug. Your oncologist may recommend over-the-counter pain medications, lidocaine patches, menthol creams, or a medication called duloxetine. Physical therapy, occupational therapy, and rehabilitation may be helpful to regain function. Studies are researching how novel therapies (biofeedback or scrambler therapy) can help. Improvements in function may be gradual. In some cases, nerve damage may be permanent.

Article Provided By: JAMA

If Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC 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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20 Jul

Scrambler Therapy for Treating Neuropathic Pain

Scrambler Therapy for Treating Neuropathic Pain
December 9, 2016
by Dr. Thomas Smith and Dr. Charles Loprinzi

What is neuropathic pain, from the non-expert oncologist’s point of view?
The way we think of it, pain is about the most protective instinct and impulse known to humans! If you touch a hot plate, you retract your hand even before you actually feel the pain. Then, the pain comes – very localized – such that you can plunge the hand into cold water. After that, usually the pain goes away and you can then blame your son-in-law for leaving the hot plate on. But sometimes, the pain signal gets stuck in the “on” position, even though your hand has healed. There has been some damage to the nerve endings, and they are continuing to send the “pain” impulse when it is not doing you any good. The pain pathways in the spinal cord and the brain actually get bigger and more active; neurologists call this “wind-up.”
Pain has come to the attention of most oncologists because we CAUSE it with chemotherapy agents; we call it chemotherapy induced peripheral neuropathy (CIPN).
For the unfortunate 40-70% of chemo patients who get CIPN, it can range from being a nuisance to being life-destroying. Our patients describe constant burning or pins-and-needles pain, with numbness and tingling. It starts in the longest nerves that go to the hands and feet first, then progresses upstream. For many people it is just an inconvenience, and goes away in between chemo cycles and abates after treatment. But for others it persists, for years.
Preventing or treating CIPN has been frustrating. We both were part of the American Society of Clinical Oncology panel that made national clinical practice guidelines for CIPN. There are no drugs proven to prevent it, and alpha-lipoic acid, Vitamin A, natural products, L-carnitine – things that help in other neuropathies – were no better than placebo. Only one drug is proven to help, duloxetine (Cymbalta), with a reduction in pain of about 1 point on a 10 point scale.
Of course, there are other neuropathic pains that oncologists know all too well. The pain from a pinched nerve leaving a collapsed or damaged vertebra, shooting down the leg. The pain after shingles, “post-herpetic neuropathy” that can last for years. The pain after chest surgery, or mastectomy, or radiation.

What is Scrambler Therapy, and How Does it Work?
Scrambler Therapy (marketed as Calmare™ therapy in the United States) is a new type of pain relief that uses a rapidly changing electrical impulse to send a “non-pain” signal along the same pain fibers that are sending the “pain” stimulus. We got interested in Scrambler Therapy because we thought it MIGHT help CIPN patients, and Scrambler Therapy appeared to be non-toxic. It had been cleared for safety by the FDA in 2009.
We were skeptical, but we did a trial of Scrambler Therapy. We treated 16 patients with refractory CIPN (present for at least 6 months, and refractory to medications); the group had a 60% reduction in their CIPN pain – in 10 days of treatment. Of the 16 patients we treated, essentially all reported some benefit, including 4 whose pain resolved to “0.” Function improved in most patients including less interference with walking and sleeping, for at least 3 months.
The setup is simple as shown in Figure 1 (Tom Smith’s legs). EKG electrodes are used to transmit the electrical impulses from a colored electrode to a black one, back and forth. The treatment is given for 30-45 minutes for up to 10 days in a row (excluding weekends). Our patients report a feeling like being bitten by electrical ants, or bee-stings. If the treatment is working, the sensation will change to a “hum” in the nerve and go to the ends of the nerve. We have to start above the painful area – remember, we are trying to replace the pain with a “non-pain” stimulus, and sometimes can work progressively down the legs and arms as pain relief occurs. A typical setup to treat “stocking and glove neuropathy”
Colleagues at Mayo Clinic were skeptical and repeated the study in a larger group of people with CIPN. Pachman, Loprinzi and colleagues at Mayo reported about a 50% reduction in pain, numbness and tingling lasting at least 3 months. Of note, there appeared to be a learning curve, with the later patients getting better and longer lasting pain relief.
We will be the first to note that Scrambler Therapy lacks the “Good Housekeeping Seal of Approval” of cancer treatments – the well-designed, large, high statistical power, randomized controlled trial. We are both doing randomized trials, comparing Scrambler Therapy to “sham” (electrodes in the wrong place” and to TENS (trans-cutaneous electrical stimulation).
That said, we are interested in treatments that might work and don’t cause side effects. A recent review of at least 20 scientific reports noted no harm in any trial, with most reporting a substantial relief of pain. The two randomized trials comparing “sham” to real Scrambler Therapy showed a 50% reduction in low back pain, and a 91% reduction in pain from failed back syndrome, post herpetic neuropathy, and spinal cord stenosis. In all the trials, pain relief – if it happened – was obvious in the first 3 days, continued to get better, and usually lasted several months. There are additional reports of Scrambler Therapy having success in cancer somatic pain including bone and visceral metastases, complex regional pain syndrome, pediatric cancer chest wall pain, and others (see list below). The US Military has 17 Scrambler Therapy machines for treating both wounded warriors and civilians.
Some types of pain for which Scrambler Therapy has been used
Pancreas and abdominal cancer pain
Chemotherapy induced peripheral neuropathy
Non cancer pain such as neuropathic back pain
Post-herpetic pain (shingles pain)
Bone metastases
Spinal cord stenosis
“Failed back syndrome” – after surgery, the back hurts worse
Complex regional pain syndrome
Post-mastectomy pain

Is Scrambler Therapy Related to Anything Similar?
Scrambler Therapy looks superficially likes TENS therapy. TENS applies similar electrodes on the skin and passes a pulse of electrical current between them. TENS is a completely different type of on-off current, and, classically, the effect wears off as soon as the electrodes are removed. When Scrambler Therapy works, it seems to reset or reboot the system for an extended period of time.
Spinal cord stimulation appears to have a same effect on pain that Scrambler Therapy appears to have. However, it involves putting electrodes on the spinal cord, and implantation of a pulse generator, similar to a pacemaker. It is also expensive – typically near $100,000 for a trial, then surgery and the equipment. It can last for years.

Is Scrambler Therapy Covered by Insurance?
Quick answer, no, not very well yet. They are waiting for more traditional evidence (unlike the U S Military!) Some places are doing it for free on the clinical trials listed on clinicaltrials.gov. There is a list of certified centers on the Calmare website. An increasing number of insurers are paying for Scrambler if the person and their doctor appeals with lots of evidence from the trials above.
The machines themselves are expensive ($105,000 was the last quote we got) but can be used for a new person each hour, and last for years. The electrodes cost $4-15 dollars per person for a course of treatment. A person with training can do the treatment supervised by a physician with knowledge of the nervous system.

What research needs to be done before Scrambler Therapy is proven effective, and reimbursed if it is?
We have been using Scrambler Therapy routinely at our centers, and believe there is benefit to some patients. At the same time, we are humbled by the many therapies that have shown promise in phase II trials only to be no better than placebo or sham in Phase III trials. We need bigger randomized trials, sponsored by the NIH or someone who is not trying to sell the machines.

Dr. Thomas Smith is the Director of Palliative Medicine, Harry J. Duffey Family Professor of Palliative Medicine, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
Dr. Charles Loprinzi is Regis Professor of Breast Cancer Research, Mayo Clinic

Article Provided By: foundationforpn

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

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17 Jul

Neuropathic Pain Management

Neuropathic pain is often described as a shooting or burning pain. It can go away on its own but is often chronic. Sometimes it is unrelenting and severe, and sometimes it comes and goes. It often is the result of nerve damage or a malfunctioning nervous system. The impact of nerve damage is a change in nerve function both at the site of the injury and areas around it.
One example of neuropathic pain is called phantom limb syndrome. This rare condition occurs when an arm or a leg has been removed because of illness or injury, but the brain still gets pain messages from the nerves that originally carried impulses from the missing limb. These nerves now misfire and cause pain.
Causes of Neuropathic Pain
Neuropathic pain often seems to have no obvious cause. But some common causes of neuropathic pain include:
Alcoholism
Amputation
Chemotherapy
Diabetes
Facial nerve problems
HIV infection or AIDS
Multiple myeloma
Multiple sclerosis
Nerve or spinal cord compression from herniated discs or from arthritis in the spine
Shingles
Spine surgery
Syphilis
Thyroid problems
Symptoms of Neuropathic Pain
Neuropathic pain symptoms may include:

Shooting and burning pain
Tingling and numbness

Diagnosing Neuropathic Pain
To diagnose neuropathic pain, a doctor will conduct an interview and physical exam. He or she may ask questions about how you would describe your pain, when the pain occurs, or whether anything specific triggers the pain. The doctor will also ask about your risk factors for neuropathic pain and may also request both blood and nerve tests.
Neuropathic Pain Treatment
Anticonvulsant and antidepressant drugs are often the first line of treatment. Some neuropathic pain studies suggest the use of non-steroidal anti-inflammatory drugs (NSAIDs), such as Aleve or Motrin, may ease pain. Some people may require a stronger painkiller. Be sure to discuss the pros and cons of the medicine you take with your doctor.

If another condition, such as diabetes, is involved, better management of that disorder may alleviate the pain. Effective management of the condition can also help prevent further nerve damage.
In cases that are difficult to treat, a pain specialist may use an invasive or implantable device to effectively manage the pain. Electrical stimulation of the nerves involved in neuropathic pain may significantly control the pain symptoms.
Other kinds of treatments can also help with neuropathic pain. Some of these include:
Physical therapy
Working with a counselor
Relaxation therapy
Massage therapy
Acupuncture
Unfortunately, neuropathic pain often responds poorly to standard pain treatments and occasionally may get worse instead of better over time. For some people, it can lead to serious disability. A multidisciplinary approach that combines therapies, however, can be a very effective way to provide relief from neuropathic pain.

WebMD Medical Reference Reviewed by Tyler Wheeler, MD on August 11, 2019

Article Provided By: Webmd

I Carolina Pain Scrambler Logo, Chronic Pain, Greenville, SC f 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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14 Jul

RSD

Reflex Sympathetic Dystrophy

Reflex sympathetic dystrophy (RSD) is a type of complex regional pain syndrome (CRPS). This condition occurs because of malfunctions in your sympathetic nervous system and immune system. RSD causes severe pain in one or more limbs that lasts months or longer.
In general, the condition develops after an injury or other medical condition. RSD can lead to many physical and emotional symptoms. A variety of treatments are available for RSD, and it’s important to get treated early to prevent worsening of your symptoms.

Symptoms
RSD occurs in the extremities. It most commonly affects the upper limbs, but it’s possible to get it in your lower limbs as well. Specifically, you may experience RSD in your:
hands
fingers
arms
shoulders
legs
hips
knees
Symptoms include:
stiffness
discomfort
pain or burning sensation
swelling
sensitivity to heat or cold
weakness
feeling warm to the touch
skin redness
skin paleness with a blue tone
tenderness
sweating around the affected area
changes to the skin in the affected area
muscle weakness
muscle spasms
muscle atrophy
joint pain and stiffness
nail and hair changes
Most symptoms begin at the site of the condition but may spread as RSD progresses. You may have symptoms on one side but notice them in your opposite limb as the condition worsens. Symptoms may begin as mild and then become more severe, interfering with your daily life.
Your mental health can also be affected with RSD. You may experience anxiety, depression, or post-traumatic stress disorder related to the condition.

Causes
RSD occurs when your sympathetic nervous system and immune system malfunction because of nerve damage. It affects up to 200,000 Americans annually. The damaged nerves misfire, sending your brain excessive signals of pain from the affected area.
According to the National Institute of Neurological Disorders and Stroke, 90 percent of people with CRPS can point to their medical history to determine what caused the condition. Many underlying conditions and factors can lead to RSD, including:
trauma, such as fractures, broken bones, or amputation
infection
soft tissue injuries such as burns and bruises
sprains
radiation therapy
cancer
surgery
paralysis of one side of the body
heart attack
emotional stress
nerve pressure
stroke
You may also experience RSD with no prior medical condition. Your doctor will try to determine the cause of the RSD if this is the case.

Factors that may put you at risk
You may be more susceptible to RSD if you:
are between the ages of 40 and 60 years
are a woman
have other inflammatory or autoimmune conditions

How it’s diagnosed
There isn’t a definitive test for RSD. Your doctor will need to take your medical history, conduct several tests, and perform a thorough physical examination. It’s important to diagnose the condition early to prevent it from getting worse, though diagnosis isn’t always straightforward. You may wait for many months or even longer before your doctor diagnoses RSD.
Tests your doctor may perform include:
bone scans
MRI scans
X-rays
sympathetic nervous system tests
skin temperature readings
Your doctor may check for other medical conditions before diagnosing RSD. These conditions are treated differently than RSD. They include:
arthritis
Lyme disease
muscle diseases
blood clots in your veins
small fiber polyneuropathies

Treatment
Early treatment is imperative to stop RSD from worsening or spreading. However, early treatment can be difficult if it takes time to diagnose the condition.
Treatments for RSD vary. Certain interventions and medications may help relieve and treat symptoms. You may also seek physical therapy and psychotherapy to reduce the effects of RSD. You may find that your condition improves dramatically with treatment, but some people have to learn how to manage their symptoms.
Medical procedures
Interventions for RSD include:
transcutaneous electrical nerve simulation
biofeedback
peripheral nerve blocks
spinal cord stimulation
pump implantation
sympathectomy, either chemical or surgical, which destroys some of your sympathetic nerves
deep brain stimulation
intrathecal (in the spine) drug pumps
electroacupuncture
Medication
A variety of medications are available for RSD, ranging from over-the-counter pain relievers and topical creams to prescription drugs from your doctor. These medications include:
anticonvulsants
antidepressants
beta-blockers
benzodiazepines
bisphosphonates
guanethidine
membrane stabilizers
muscle relaxers
nonsteroidal anti-inflammatory drugs
opioids
systemic steroids
topical anesthetics
vasodilators
Therapies
Physical therapy may help you rehabilitate the affected limb. This type of therapy will ensure that you continue to move the limb to retain its abilities. It also improves your blood flow and reduces symptoms related to circulation problems. Regular physical therapy may be needed to reduce symptoms.
Seeing a health professional for psychotherapy may also be necessary with RSD. You may develop a psychological condition from the chronic pain associated with the condition. Psychotherapy will help you manage your mental health.
You may also find that complementary alternative therapies like acupuncture or relaxation methods work for treating your RSD.

About prevention
While some research discusses the prevention of RSD for specific cases, there is no conclusive evidence that a person can avoid RSD completely.
People who’ve had a stroke should be mobilized soon afterward to avoid developing RSD. If you’re taking care of a loved one with a stroke, help them get up and walking around. This movement may also be useful to people who’ve had heart attacks.
Read more: What to expect when recovering from a stroke »
Taking daily vitamin C after a fracture may also decrease your chances of CRPS.
Outlook
RSD can result in a variety of outcomes. You may find that early intervention and treatment minimizes your symptoms and allows you to return to life as usual. On the other hand, your symptoms may get worse and may not be diagnosed in a timely fashion. In these cases, it’s necessary to learn how to best manage your symptoms for the fullest life possible.

Article Provided By: healthline

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

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3 Jul

Peripheral Neuropathy

There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis.
Peripheral neuropathy has many different causes. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.
The most common type of peripheral neuropathy is diabetic neuropathy, caused by a high sugar level and resulting in nerve fiber damage in your legs and feet.
Symptoms can range from tingling or numbness in a certain body part to more serious effects, such as burning pain or paralysis.

Peripheral neuropathy is a type of damage to the nervous system. Specifically, it is a problem with your peripheral nervous system. This is the network of nerves that sends information from your brain and spinal cord (central nervous system) to the rest of your body.
Peripheral Neuropathy Causes
Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents. Others develop it because of an injury or another disorder.
In many cases, a different type of problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes.
Peripheral Neuropathy Types
There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. To help doctors classify them, they are often broken down into the following categories:
Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.
Sensory neuropathy. Sensory nerves control what you feel, such as pain, temperature or a light touch. Sensory neuropathy affects these groups of nerves.
Autonomic nerve neuropathy. Autonomic nerves control functions that you are not conscious of, such as breathing and heartbeat. Damage to these nerves can be serious.
Combination neuropathies. You may have a mix of 2 or 3 of these other types of neuropathies, such as a sensory-motor neuropathy.
Peripheral Neuropathy Symptoms
The symptoms of peripheral neuropathy vary based on the type that you have and what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis.
Muscle weakness
Cramps
Muscle twitching
Loss of muscle and bone
Changes in skin, hair, or nails
Numbness
Loss of sensation or feeling in body parts
Loss of balance or other functions as a side effect of the loss of feeling in the legs, arms, or other body parts
Emotional disturbances
Sleep disruptions
Loss of pain or sensation that can put you at risk, such as not feeling an impending heart attack or limb pain
Inability to sweat properly, leading to heat intolerance
Loss of bladder control, leading to infection or incontinence
Dizziness, lightheadedness, or fainting because of a loss of control over blood pressure
Diarrhea, constipation, or incontinence related to nerve damage in the intestines or digestive tract
Trouble eating or swallowing
Life-threatening symptoms, such as difficulty breathing or irregular heartbeat
The symptoms of peripheral neuropathy may look like other conditions or medical problems. Always see your healthcare provider for a diagnosis.
Peripheral Neuropathy Diagnosis
The symptoms and body parts affected by peripheral neuropathy are so varied that it may be hard to make a diagnosis. If your healthcare provider suspects nerve damage, he or she will take an extensive medical history and do a number of neurological tests to determine the location and extent of your nerve damage. These may include:
Blood tests
Spinal fluid tests
Muscle strength tests
Tests of the ability to detect vibrations
Depending on what basic tests reveal, your healthcare provider may want to do more in-depth scanning and other tests to get a better look at your nerve damage. Tests may include:
CT scan
MRI scan
Electromyography (EMG) and nerve conduction studies
Nerve and skin biopsy
Peripheral Neuropathy Treatment
Usually a peripheral neuropathy can’t be cured, but you can do a lot of things to prevent it from getting worse. If an underlying condition like diabetes is at fault, your healthcare provider will treat that first and then treat the pain and other symptoms of neuropathy.
In some cases, over-the-counter pain relievers can help. Other times, prescription medicines are needed. Some of these medicines include mexiletine, a medicine developed to correct irregular heart rhythms; antiseizure drugs, such as gabapentin, phenytoin, and carbamazepine; and some classes of antidepressants, including tricyclics such as amitriptyline.
Lidocaine injections and patches may help with pain in other instances. And in extreme cases, surgery can be used to destroy nerves or repair injuries that are causing neuropathic pain and symptoms.
Peripheral Neuropathy Prevention
Lifestyle choices can play a role in preventing peripheral neuropathy. You can lessen your risk for many of these conditions by avoiding alcohol, correcting vitamin deficiencies, eating a healthy diet, losing weight, avoiding toxins, and exercising regularly. If you have kidney disease, diabetes, or other chronic health condition, it is important to work with your healthcare provider to control your condition, which may prevent or delay the onset of peripheral neuropathy.
Peripheral Neuropathy Management
Even if you already have some form of peripheral neuropathy, healthy lifestyle steps can help you feel your best and reduce the pain and symptoms related to the disorder. You’ll also want to quit smoking, not let injuries go untreated, and be meticulous about caring for your feet and treating wounds to avoid complications, such as the loss of a limb.
In some cases, non-prescription hand and foot braces can help you make up for muscle weakness. Orthotics can help you walk better. Relaxation techniques, such as yoga, may help ease emotional as well as physical symptoms.

Article Provided By: hopkinsmedicine

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18 Jun

Femoral Neuropathy

What is femoral neuropathy?

Femoral neuropathy, or femoral nerve dysfunction, occurs when you can’t move or feel part of your leg because of damaged nerves, specifically the femoral nerve. This can result from an injury, prolonged pressure on the nerve, or damage from disease. In most cases, this condition will go away without treatment. However, medications and physical therapy may be necessary if symptoms don’t improve.

What causes femoral neuropathy?

The femoral nerve is one of the largest nerves in your leg. It’s located near the groin and controls the muscles that help straighten your leg and move your hips. It also provides feeling in the lower part of your leg and the front of your thigh. Because of where it’s located, damage to the femoral nerve is uncommon relative to neuropathies caused by damage to other nerves. When the femoral nerve is damaged, it affects your ability to walk and may cause problems with sensation in your leg and foot. View the femoral nerve on this BodyMap of the femur.

Damage to the femoral nerve can be the result of:

a direct injury
a tumor or other growth blocking or trapping part of your nerve
prolonged pressure on the nerve, such as from prolonged immobilization
a pelvic fracture
radiation to the pelvis
hemorrhage or bleeding into the space behind the abdomen, which is called the retroperitoneal space
a catheter placed into the femoral artery, which is necessary for certain surgical procedures

Diabetes may cause femoral neuropathy. Diabetes can cause widespread nerve damage due to fluctuations in blood sugar and blood pressure. Nerve damage that affects your legs, feet, toes, hands, and arms is known as peripheral neuropathy. There is currently some debate about whether femoral neuropathy is truly a peripheral neuropathy or a form of diabetic amyotrophy.

According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), diabetes is the most common reason for peripheral neuropathy in people who’ve had diabetes for at least 25 years.

Signs of femoral neuropathy

This nerve condition can lead to difficulties moving around. Your leg or knee might feel weak, and you may be unable to put pressure on the affected leg.

You might also feel unusual sensations in your legs. They include:

numbness in any part of the leg (typically the front and inside of the thigh, but potentially all the way down to the feet)
tingling in any part of the leg
dull aching pain in the genital region
lower extremity muscle weakness
difficulty extending the knee due to quadriceps weakness
feeling like your leg or knee is going to give out (buckle) on you

How serious is it?

Prolonged pressure placed on the femoral nerve can prevent blood from flowing in the affected area. The decreased blood flow can result in tissue damage.

If your nerve damage is the result of an injury, it may be possible that your femoral vein or artery is also damaged. This could cause dangerous internal bleeding. The femoral artery is a very large artery that lies close to the femoral nerve. Trauma often damages both at the same time. Injury to the artery or bleeding from the artery can cause compression on the nerve.

Additionally, the femoral nerve provides sensation to a major portion of the leg. This loss of sensation can lead to injuries. Having weak leg muscles can make you more prone to falling. Falls are of particular concern in older adults because they can cause hip fractures, which are very serious injuries.

Diagnosing femoral neuropathy

Initial tests

To diagnose femoral neuropathy and its cause, your doctor will perform a comprehensive physical exam and ask questions about recent injuries or surgeries, as well as questions about your medical history.

To look for weakness, they will test specific muscles that receive sensation from the femoral nerve. Your doctor will probably check your knee reflexes and ask about changes in feeling in the front part of the thigh and the middle part of the leg. The goal of the evaluation is to determine whether the weakness involves only the femoral nerve or if other nerves also contribute.

Additional testing might include:

Nerve conduction

Nerve conduction checks the speed of electrical impulses in your nerves. An abnormal response, such as a slow time for electrical signals to travel through your nerves, usually indicates damage to the nerve in question.

Electromyography (EMG)

Electromyography (EMG) should be performed after the nerve conduction test to see how well your muscles and nerves are working. This test records the electrical activity present in your muscles when the nerves that lead to them are active. The EMG will determine whether the muscle responds appropriately to stimulation. Certain medical conditions cause muscles to fire on their own, which is an abnormality that an EMG can reveal. Because nerves stimulate and control your muscles, the test can identify problems with both muscles and nerves.

MRI and CT scans

An MRI scan can look for tumors, growths, or any other masses in the area of the femoral nerve that could cause compression on the nerve. MRI scans use radio waves and magnets to produce a detailed image of the part of your body that is being scanned.

A CT scan can also look for vascular or bone growths.

Treatment options

The first step in treating femoral neuropathy is dealing with the underlying condition or cause. If compression on the nerve is the cause, the goal will be to relieve the compression. Occasionally in mild injuries, such as mild compression or a stretch injury, the problem may resolve spontaneously. For people with diabetes, bringing blood sugar levels back to normal may alleviate nerve dysfunction. If your nerve doesn’t improve on its own, you’ll need treatment. This usually involves medications and physical therapy.

Medications

You might have corticosteroid injections in your leg to reduce inflammation and get rid of any swelling that occurs. Pain medications can help relieve any pain and discomfort. For neuropathic pain, your doctor may prescribe medications, such as gabapentin, pregabalin, or amitriptyline.

Therapy

Physical therapy can help build up the strength in your leg muscles again. A physical therapist will teach you exercises to strengthen and stretch your muscles. Undergoing physical therapy helps to reduce pain and promote mobility.

You might need to use an orthopedic device, such as a brace, to assist you with walking. Usually, a knee brace is helpful in preventing knee buckling.

Depending on how severe the nerve damage is and how much trouble you’re having moving around, you might also need occupational therapy. This type of therapy helps you learn to do regular tasks like bathing and other self-care activities. These are called “activities of daily living.” Your doctor might also recommend vocational counseling if your condition forces you to find another line of work.

Surgery

Your doctor might recommend surgery if you have a growth blocking your femoral nerve. Removing the growth will relieve the pressure on your nerve.

Long-term outlook after treatment

You might be able to heal fully after you treat the underlying condition. If the treatment isn’t successful or if the femoral nerve damage is severe, you might permanently lose feeling in that part of your leg or the ability to move it.

Tips to prevent nerve damage

You can lower your risk of femoral neuropathy caused by diabetes by keeping your blood sugar levels under control. This helps protect your nerves from damage caused by this disease. Preventive measures would be directed at each cause. Talk to your doctor for advice about what preventive measures would be the best for you.

Maintaining an active lifestyle helps to keep your leg muscles strong and improve stability.

Last medically reviewed on September 13, 2017

Article Provided ByHealthline

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12 Jun

Nerve Pain Therapy, Pain Therapy, Chronic Pain, Calmare Scrambler, Chronic Pain Therapy, Neuropathic Pain Therapy, Greenville SC

Sacroiliac Joint Dysfunction

https://www.cedars-sinai.edu/Patients/Health-Conditions/Sacroiliac-Joint-Dysfunction.aspx

Sacroiliac Joint Dysfunction

Dysfunction in the sacroiliac joint is thought to cause low back pain and/or leg pain. The leg pain can be particularly difficult and may feel similar to sciatica or pain caused by a lumbar disc herniation. The sacroiliac joint lies next to the bottom of the spine, below the lumbar spine and above the tailbone (coccyx). It connects the sacrum (the triangular bone at the bottom of the spine) with the pelvis (iliac crest).

The joint typically has the following characteristics:

Small and very strong, reinforced by strong ligaments that surround it
Does not have much motion
Transmits all the forces of the upper body to the pelvis (hips) and legs
Acts as a shock-absorbing structure

Symptoms

The most common symptoms for patients are lower back pain and the following sensations in the lower extremity: pain, numbness, tingling, weakness, pelvis/buttock pain, hip/groin pain, feeling of leg instability (buckling, giving way), disturbed sleep patterns, disturbed sitting patterns (unable to sit for long periods, sitting on one side), pain going from sitting to standing.

Causes and Risk Factors

While it is not clear how the pain is caused, it is thought that an alteration in the normal joint motion may be the culprit that causes sacroiliac pain. This source of pain can be caused by either:

Too much movement (hypermobility or instability): The pain is typically felt in the lower back and/or hip and may radiate into the groin area.

Too little movement (hypomobility or fixation): The pain is typically felt on one side of the lower back or buttocks and can radiate down the leg. The pain usually remains above the knee, but at times pain can extend to the ankle or foot. The pain is similar to sciatica — or pain that radiates down the sciatic nerve — and is caused by a radiculopathy.

Diagnosis

Accurately diagnosing sacroiliac joint dysfunction can be difficult because the symptoms mimic other common conditions, including other mechanical back pain conditions like facet syndrome and lumbar spine conditions including disc herniation and radiculopathy (pain along the sciatic nerve that radiates down the leg). A diagnosis is usually arrived at through physical examination (eliminating other causes) and/or an injection (utilized to block the pain).

Treatments

Treatments for sacroiliac joint dysfunction are usually conservative (meaning nonsurgical) and focus on trying to restore normal motion in the joint:

Ice, heat and rest.
Medications: acetaminophen, as well as anti-inflammatory medications (such as ibuprofen or naproxen) to reduce the swelling that is usually contributing to the patient’s pain.
Manual manipulation provided by a chiropractor, osteopathic doctor or other qualified health practitioner may help. This can be highly effective when the sacroiliac joint is fixated or “stuck.” It may be irritating if the sacroiliac joint is hypermobile. The manipulation is accomplished through a number of methods, including (but not limited to): side-posture manipulation, drop technique, blocking techniques and instrument-guided methods.
Supports or braces for when the sacroiliac joint is “hypermobile,” or too loose.
Controlled, gradual physical therapy may be helpful to strengthen the muscles around the sacroiliac joint and appropriately increase range of motion. In addition, any type of gentle, low-impact aerobic exercise will help increase the flow of blood to the area, which in turn stimulates a healing response. For severe pain, water therapy may be an option, as the water provides buoyancy for the body and reduces stress on the painful joint.
Sacroiliac joint injections.

When these treatments fail, surgery may be offered. In surgery, one or both of the sacroiliac joints may be fused with the goal of eliminating any abnormal motion.

Article Provided By: Cedars-Sinai

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29 May

Carpal Tunnel Pain

Carolina Pain Scrambler

Calmare Pain Scrambler, Chronic Pain, Neuropathic Pain, News Calmare Pain Scrambler, Carolina Pain Scrambler, Greenville, Neuropathic Pain, Scrambler Therapy, South Carolina

https://www.webmd.com/pain-management/carpal-tunnel/carpal-tunnel-syndrome#1

Carpal Tunnel Syndrome

Carpal tunnel syndrome, also called median nerve compression, is a condition that causes numbness, tingling, or weakness in your hand.It happens because of pressure on your median nerve, which runs the length of your arm, goes through a passage in your wrist called the carpal tunnel, and ends in your hand. The median controls the movement and feeling of your thumb and the movement of all your fingers except your pinky.

Carpal Tunnel Syndrome Symptoms

Symptoms of carpal tunnel include:

Burning, tingling, or itching numbness in your palm and thumb or your index and middle fingers
Weakness in your hand and trouble holding things
Shock-like feelings that move into your fingers
Tingling that moves up into your arm

You might first notice that your fingers “fall asleep” and become numb at night. It usually happens because of how you hold your hand while you sleep.

In the morning, you may wake up with numbness and tingling in your hands that may run all the way to your shoulder. During the day, your symptoms might flare up while you’re holding something with your wrist bent, like when you’re driving or reading a book.

Early on in the condition, shaking out your hands might help you feel better. But after some time, it may not make the numbness go away.

As carpal tunnel syndrome gets worse, you may have less grip strength because the muscles in your hand shrink. You’ll also have more pain and muscle cramping.

Your median nerve can’t work the way it should because of the irritation or pressure around it. This leads to:

Slower nerve impulses
Less feeling in your fingers
Less strength and coordination, especially the ability to use your thumb to pinch

Carpal Tunnel Syndrome Causes

Often, people don’t know what brought on their carpal tunnel syndrome. It can be due to:

Repetitive motions, like typing, or any wrist movements that you do over and over. This is especially true of things you do when your hands are lower than your wrists.
Conditions like hypothyroidism, obesity, rheumatoid arthritis, and diabetes
Pregnancy

Carpal Tunnel Syndrome Risk Factors

You might have a higher risk of getting carpal tunnel syndrome if you:

Are a woman. Women are three times more likely than men to get it. This might be because they tend to have smaller carpal tunnels.
Have a family member with small carpal tunnels
Have a job in which you make the same motions with your arm, hand, or wrist over and over, such as an assembly line worker, sewer or knitter, baker, cashier, hairstylist, or musician
Fracture or dislocate your wrist

Carpal Tunnel Syndrome Diagnosis and Tests

Your doctor may tap the palm side of your wrist, a test called Tinel sign, or fully flex your wrist with your arms extended. They might also do tests including:

Imaging tests. X-rays, ultrasounds, or MRI exams can let your doctor look at your bones and tissues.
Electromyogram. Your doctor puts a thin electrode into a muscle to measure its electrical activity.
Nerve conduction studies. Your doctor tapes electrodes to your skin to measure the signals in the nerves of your hand and arm.

Carpal Tunnel Syndrome Treatment

Your treatment will depend on your symptoms and how far your condition has progressed. You might need:

Lifestyle changes. If repetitive motion is causing your symptoms, take breaks more often or do a bit less of the activity that’s causing you pain.
Exercises. Stretching or strengthening moves can make you feel better. Nerve gliding exercises can help the nerve move better within your carpal tunnel.
Immobilization. Your doctor may tell you to wear a splint to keep your wrist from moving and to lessen pressure on your nerves. You may wear one at night to help get rid of that numbness or tingling feeling. This can help you sleep better and rest your median nerve.
Medication. Your doctor may give you anti-inflammatory drugs or steroid shots to curb swelling.
Surgery. If none of those treatments works, you might have an operation called carpal tunnel release that increases the size of the tunnel and eases the pressure on your nerve.

Carpal Tunnel Syndrome Complications

If you have carpal tunnel syndrome and don’t treat it, the symptoms can last a long time and get worse. They could also go away and then come back. When you get a diagnosis early, the condition is easier to treat. You can avoid permanent muscle damage and keep your hand working the way it should.

Carpal Tunnel Syndrome Prevention

To avoid carpal tunnel syndrome, try to:

Keep your wrists straight.
Use a splint or brace that helps keep your wrist in a neutral position.
Avoid flexing and extending your wrists over and over again.
Keep your hands warm.
Take breaks whenever you can.
Put your hands and wrists in the right position while you work.

Article Provided By: Webmd

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29 May

CRPS, Complex Regional Pain Syndrome, Chronic Pain, Pain Management, Carolina Pain Scrambler, Greenville South Carolina

Causes of CRPS

What is complex regional pain syndrome (CRPS)?

Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy syndrome (RSDS), is a type of chronic pain condition. It typically occurs after an injury or medical condition and affects one limb (arm, leg, hand or foot).

What are the causes of complex regional pain syndrome (CRPS)?

Though complex regional pain syndrome is not yet completely understood, it is believed that CRPS develops when the central or peripheral nervous system is damaged or malfunctions. When the nerves are damaged, they are not able to properly control blood flow, sensation and temperature in the affected area; this leads to the symptoms of CRPS, including pain and skin changes.

CRPS can be triggered by an injury or a medical condition. Triggers for CRPS include, but are not limited to, the following:

Sprain or strain
Soft tissue or nerve injury
Surgical injury
Heart attack
Stroke
Infection
Immobilization of a limb (such as using a splint or cast)

In addition to nerve damage, CRPS may also be caused by pain receptors in the injured part of the body becoming receptive to different nervous system messages. It may be caused by dysfunction between the central and peripheral nervous system.

The immune system may also play a role in the development of CRPS. After an injury, an immune response is triggered. This leads to inflammatory symptoms, such as redness and swelling in the affected area. In the case of CRPS, this immune system response may malfunction and continue after the original injury has healed.

It is likely that a combination of these different factors leads to the development of complex regional pain syndrome .

Article Provided By: PainScale

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27 May

Neuropathic Pain, Chronic Pain, Pain Relief, Pain Management, Carolina Pain Scrambler, Greenville South Carolina

How Does Neuropathic Pain Develop?

What is Neuropathic Pain?

If you are involved in an accident and an injury occurs, under normal circumstance, your nerves will send messages to the brain, signaling pain at the site of trauma. Neuropathic pain is coming directly from the nerves without the occurrence of trauma or accident. In other words, there is no reason the nerves should be sending pain signals.

How Does Neuropathic Pain Develop?

A damaged nerve may lead to dysfunction. Nerves can be damaged in a previous injury or surgery. As a result, the damaged nerve may send false signals of pain to the brain, despite there being no real cause of pain. In the case of a previous injury, the site of trauma may have completely healed but the central nervous system is still registering the site as a location of trauma.

Neuropathy Symptoms

There are several key symptoms associated with Neuropathy:

Normal movements become painful
Mobility is limited
May lead to a sedentary lifestyle
Pain will range from mild to severe
Pain may be experienced differently – For example: sharp, shock-like, shooting, etc
Numbness
Feeling of coldness
Tingling
Persistent numbness, tingling, or weakness
Sleeplessness
Insomnia

Neuropathic Pain Relief Treatments

First, your doctor will attempt to find the cause of the Neuropathy. Tests such as an MRI and Electromyography are conducted. If a cause is discovered, such as a herniated disc as the central cause of the pain, the appropriate measures are taken.

If no obvious cause is discovered, your doctor will focus on prescribing an effective pain relief method. The pain relief will depend on the individual and the severity of the neuropathy. Treatment options typically include medications, an active method of recovery such as physical therapy, and spinal cord stimulation for more complex cases.

Article Provided By: PainScale

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