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Failed Back Syndrome

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.org

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

 

 

 

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Postherpetic Neuralgia

Postherpetic Neuralgia

What Is Postherpetic Neuralgia?
Postherpetic neuralgia is a painful condition that affects your nerves and skin. It is a complication of herpes zoster, commonly called shingles.
Shingles is a painful, blistering skin rash caused by a reactivation of a virus called varicella-zoster, which people usually get in childhood or adolescence as chicken pox. The virus can remain dormant in your body’s nerve cells after childhood and can reactivate years 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 complication of shingles, and it occurs when a person’s nerves are damaged during a shingles outbreak. The damaged nerves can’t send messages from the skin to the brain and the messages become confused, resulting in chronic, severe pain that can last for months or years.
According to a study by the American Academy of Family Physicians, 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 60.
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 already have had shingles. Common signs and symptoms of postherpetic neuralgia include:
severe pain that continues for more than one to three 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 high risk factor for getting both shingles and postherpetic neuralgia. People over 60 have an increased risk, and people over 70 have an even higher risk.
Those who have acute pain and severe rash during shingles are also at a higher risk of developing postherpetic neuralgia.
People with lowered immunity due to disorders like HIV infection and Hodgkin’s lymphoma, a type of cancer, have an increased risk of developing shingles. A study by the American Academy of Family Physicians shows that the incidence of shingles is up to 15 times greater in patients with HIV than in those who don’t have the virus.

 

How Is Postherpetic Neuralgia Diagnosed and Treated?
Tests are unnecessary. Most of the time, your doctor will diagnose postherpetic neuralgia based on the duration of pain symptoms following shingles.
Treatment for postherpetic neuralgia aims to control and reduce pain until the condition goes away. Pain therapy may include the following treatments.
Analgesics
Painkillers are also known as analgesics. Common analgesics used for postherpetic neuralgia include:
capsaicin cream: an analgesic extracted from hot chili peppers
lidocaine patches, a numbing medicine
over-the-counter medications such as acetaminophen (Tylenol), or ibuprofen (Advil)
stronger prescription drugs, such as codeine, hydrocodone, or oxycodone
Tricyclic Antidepressants
Tricyclic antidepressants are normally prescribed to treat depression, but they are also effective in treating pain caused by postherpetic neuralgia. They often have side effects, like dry mouth and blurred vision. They do not act as quickly as other types of painkillers. Commonly used tricyclic antidepressants to treat postherpetic neuralgia include:
amitriptyline (Elavil)
desipramine (Norpramin)
imipramine (Tofranil)
nortriptyline (Pamelor)
Anticonvulsants
Anticonvulsants are normally used for seizures, however clinical studies have shown that lower doses can be effective in treating pain for postherpetic neuralgia as well. Commonly used anticonvulsants include
carbamazepine (Tegretol)
pregabalin (Lyrica)
gabapentin (Neurontin)
phenytoin (Dilantin)

How Can Postherpetic Neuralgia Be Prevented?
A herpes zoster vaccine called Zostavax reduces the risk of shingles by 50 percent, and also protects against postherpetic neuralgia. The Centers for Disease Control and Prevention (CDC)
Trusted Source
recommends that the vaccine be given to all adults over the age of 60, except for people with a weakened immune system. These people may be advised not to receive the vaccine because it contains a live virus.
The herpes zoster vaccine, Zostavax, is different from the chicken pox vaccine, Varivax, that is usually given to children. Zostavax has at least 14 times more live varicella viruses than Varivax. Zostavax can’t be used in children, and Varivax can’t be used to prevent herpes zoster.

Outlook
Painful, postherpetic neuralgia is treatable and preventable. Most cases disappear in one to two months, and rare cases last longer than a year.
If you’re over the age of 60, it’s wise to get vaccinated against it. If you do develop it, there are many analgesics and even antidepressants you can take to manage the pain. It may just take some time and patience.

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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Diabetic Neuropathy, Pain Relief, Peripheral Neuropathy, Pain Management, Nerve Pain Treatment, Carolina Pain Scrambler, Greenville South Carolina

Idiopathic Neuropathy

Idiopathic Neuropathy

What is idiopathic neuropathy?
Neuropathy is when nerve damage interferes with the functioning of the peripheral nervous system (PNS). When the cause can’t be determined, it’s called idiopathic neuropathy.
The PNS carries information from the central nervous system (CNS), or brain and spinal cord, to the rest of the body.
There are three kinds of nerves within the PNS. Sensory nerves relay messages from the senses to the brain. This allows sensations of temperature and touch. Motor nerves transmit signals from the brain to the muscles. This helps the brain control the muscles. Autonomic nerves control body functions like heart rate, breathing, and digestion.
Damage to nerve cells can affect how the PNS communicates with the rest of the body. Symptoms can include numbness, pain, and balance issues.
It’s called acute neuropathy when symptoms develop suddenly. Alternately, it’s called chronic neuropathy when symptoms start slowly and increase over time.
Diagnosis involves physical examination and review of medical history. Diagnostic testing may include blood tests, nerve testing, and imaging tests.
There is no cure for idiopathic neuropathy. Treatments including medication, physical therapy, and lifestyle modifications can help you function and feel better.
What are the symptoms of neuropathy?
Symptoms can be vague at onset and are similar to those of other conditions. Symptoms vary depending on which nerves are damaged.
Symptoms of sensory neuropathy may include:
numbness, tingling, and burning sensation, particularly in hands and feet
vague or strange sensations (paresthesias)
pain, or inability to feel pain, touch, or temperature
lack of coordination or loss of reflexes
Symptoms of motor neuropathy may include:
muscle weakness or loss of muscle control
trouble with balance and coordination
muscle twitching, cramping, or spasms
difficulty walking or moving limbs
Symptoms of autonomic neuropathy may include:
dizziness, or fainting
sweating abnormalities
nausea, vomiting, or diarrhea
abnormal heart rate or blood pressure
sexual dysfunction
Symptoms may progress quickly and then slowly get better over time in some forms of acute neuropathy. Some chronic neuropathies cause periods of relapse followed by periods of remission.
What are the causes of neuropathy?
Some conditions that cause neuropathy are hereditary. Other things that can cause it include:
injury or infection
nutritional or hormonal imbalances
chemotherapy or exposure to toxic substances
autoimmune diseases such as Lyme disease, lupus, and rheumatoid arthritis (RA)
systemic diseases like diabetes, kidney disorders, and certain cancers
vascular disorders
tumors
Approximately 30 percent of neuropathy cases are due to diabetes, according to the Cleveland Clinic. Between 30 and 40 percent of the remaining cases are idiopathic.

Who is at risk for neuropathy?
The National Institute of Neurological Disorders and Stroke estimates that approximately 20 million Americans have peripheral neuropathy. Anyone can develop neuropathy, but risk increases with age.

How is neuropathy diagnosed?
There is no one definitive test for neuropathy. Testing begins with a physical examination and a complete medical history. Tell your doctor about any symptoms you’re experiencing. Be sure to let them know about over-the-counter and prescription medications you’re taking. It’s also important to mention if you’ve been exposed to toxins on the job or at home.
Diagnostic testing may include:
blood work
urinalysis
nerve conduction studies (NCS)
electromyography (EMG)
skin, nerve, and muscle biopsies
Imaging tests may include a CT scan, X-rays, or magnetic resonance imaging (MRI).

How is neuropathy treated?
Peripheral neuropathy can cause permanent damage to nerves if untreated. Treatment will target the cause if it can be determined.
Treatment of idiopathic neuropathy revolves around symptom management. Options include over-the-counter and prescription medications, physical therapy, and occupational therapy.
Mobility aids can help you move around safely if you’re having trouble with balance or walking. These may include special shoes, braces, and canes.
Lifestyle choices can help to improve day-to-day functioning. It’s important to maintain a healthy weight through a balanced diet rich in vitamins and nutrients. It’s also important to get plenty of rest and exercise to tone and strengthen your muscles. Quitting smoking and keeping alcohol consumption to a minimum is healthy and may also help with your neuropathy.
Living with a chronic illness can lead to anxiety and stress. It can be helpful to talk with someone who lives with the same condition. Your doctor can refer you to a local neuropathy support group for additional support.

What is the long-term outlook for neuropathy?
The general prognosis for idiopathic neuropathy is good, even if your symptoms are permanent. There are many effective treatments available for keeping your symptoms in check and helping you lead a comfortable, happy life. Working with your doctor to treat any underlying condition you may have, along with your symptoms, is the ticket to your best outcome in the short and long term.

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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Knee Nerve Damage

What are the Symptoms of Knee Nerve Damage?

 

Patti Kate
Last Modified Date: July 03, 2020
There can be a number of different symptoms of knee nerve damage, but the most common include pain, numbness and tingling, and feelings of burning on or around the kneecap. Some people may also find that they have a hard time moving the joint, or they may feel stiffness or a dull ache when the leg bends in certain ways. Discoloration around the site of the damage is common, too, particularly if the nerve damage was caused by some sort of trauma. A number of different nerves run through the knees, but diagnosing damage can be somewhat tricky. Symptoms are often really similar to other joint problems, including cartilage damage and issues related to arthritis. In general, medical professionals recommend that anyone who suspects they may be suffering from knee nerve damage get evaluated and treated.

Numbness associated with knee nerve damage may radiate to the upper leg.
Nerve Damage Basics

The body’s nervous system is a complex series of chemical signals that course along the nerve pathways bringing messages about sensation and pain to and from the brain. Damage can happen almost anywhere, and is usually a result of injury or trauma. Nerves can get pinched, severed, or twisted, and moving joints like the knee provide many different opportunities for this sort of injury. Local nerves can be pinched or squeezed fairly easily between the bones and ligaments that together form the joint.

The pain associated with knee nerve damage may be alleviated with physical therapy.
Some damage is obvious right from the start. This isn’t always true, though, since the damage may not be immediate. Certain knee injuries build on themselves over time. A person may feel as though he or she has healed, but may not realize till later that that healing has actually compromised the nerve structure, for instance; or, a person may not even realize that there’s been an injury at all till certain signs of nerve damage begin appearing.

Knee nerve damage can make standing from a seated position painful or difficult.
Pain
Pain that seems to radiate out of the knee is one of the most common symptoms of localized nerve damage. This often comes in varying degrees, and can alternate between throbbing and mild, dull aching. Sometimes moving the leg or changing the knee’s position can alleviate pressure, but not always. A lot has to do with whether the nerve damage is accompanied by inflammation or swelling at the site, and how seriously the nerves were impacted.

Knee pain may be a sign of nerve damage.
Nerves are usually responsible for carrying signals to indicate pain, and when they’re damaged they can respond in exaggerated ways — in some cases transmitting signals of pain that are disproportionate with the extent of the actual injury. Pathways that have actually been severed, on the other hand, sometimes fail to transmit any signals of pain, even if it would otherwise be warranted.
Numbness and Burning
Anther major sign of knee nerve damage is numbness or a lack of sensitivity. Numbness may be localized in the knee, or it might radiate to the upper or lower leg. Some people also describe the discomfort as a prickly “pins and needles” sensation. Tingling tends to come and go, but is usually most common after periods of inactivity.
People who have suffered these sorts of injuries sometimes also describe a feeling of burning just below the skin. Some of this is just perception, but in certain cases there are actual local skin temperature fluctuations that go hand-in-hand with these sensations. The patient’s knee may feel warm to the touch, or in some cases colder than usual.
Restricted Movement
In many cases nerve damage can also restrict a person’s movement. Quick kicks, sharp bends, and other extreme or rapid movements may be delayed or too painful to perform. This is usually a result of muscle constrictions that happen in response to nerve signals indicating damage — which is to say, it isn’t caused directly by the nerves, but it is nonetheless closely related.
Patients with nerve damage to the knee may also experience weakness and immobility. This weakness may involve the knee or the entire leg. In some instances, the leg may buckle under and the patient may feel unsteady or lose his or her balance
Skin Discoloration
It’s also possible for the skin along the top or backside of the knee to become discolored. A bluish tinge surrounding the knee may indicate nerve damage, although the condition does not always cause this. Color changes are most common when the damage has been caused by a trauma that has otherwise left bruising on the skin, and in these cases it can be tough to distinguish between specific causes.
Diagnosis and Treatment Options
Injury to the soft tissue of the knee does not necessarily mean nerve damage has occurred. Ligaments or tendons may have been torn, yet surrounding nerves may be left undamaged. Although a physician or other healthcare expert may recommend a magnetic resonance imaging (MRI) test to determine if there are tears of tendons or ligaments, nerve damage will not always show up on this imaging, and as such still more testing may be required. In most cases these sorts of extreme measures are only taken if there’s no other way to treat a patient’s symptoms.
Care providers often recommend diagnostic tests if symptoms of peripheral neuropathy are present, which are basically more systemic nervous system problems. A test known as an electromyography (EMG) can determine if symptoms are related to knee nerve damage. From there, medical teams can come up with treatment plans. Sometimes physical therapy and rehabilitation can bring a person back to normal, but in other cases more invasive therapies like surgery are necessary. It’s not always possible to reverse nerve damage, and a lot of times the best that can be done is to mitigate the problem and stop it from spreading or getting worse.

Article Provided By: Wisegeek

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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Neuopathy Flares

What Makes Neuropathy Flare up? Here Are 4 Common Causes and The Top 3 Solutions
Last Updated on April 16, 2019

Neuropathy can make life far more difficult than it has to be. Of course, there will always be some struggle when it comes managing the pain and the uncomfortable feelings that come with the condition.

For the most part, treatment is straightforward: manage the symptoms that are able to be managed and find ways to cope with the ones that aren’t.
Sadly, there are times when neuropathy can flare up, making management significantly more troublesome.
Being able to understand why neuropathy is flaring up is one of the first steps to preparing, coping, and managing with the condition.
Sometimes, they are even caused by things that are relatively easy to change and fix, meaning that there are some ways that a person can make it easier to deal with neuropathy.
What Causes Neuropathy To Get Worse?
Because neuropathy is a disease that focuses on the nerves of the body, nearly anything can make it flare up. Flare ups are generally classified as an intensifying of the chronic pain that a person is used to, although it often goes back down to its typical level given time.
As neuropathy is a disease concerned with the nerves, anything that affects the nerves can cause a flare up. This can range from the food that a person eats in a day, to the temperature outside, to the way that person lives his or her life. There are many things that can cause a flare up but many of these things are somewhat preventable.
The things that a person physically cannot change, such as the temperature outside, are things that the person can remedy in other ways. This means that once a person knows what common triggers are, it will be easier to avoid them in the future, leading to an easier and more comfortable life.

The Wrong Foods
The food that a person intakes plays a significant role in neuropathy symptoms. As many people have come to learn, the kinds of foods that can affect it are generally grains, sugars, gluten, and fat. In particular, refined grains have a high glycemic content in them.
This will greatly affect a person’s blood sugar. Diabetic neuropathy is one of the most common forms of neuropathy, meaning that it is crucial that a person keeps his or her blood sugar at an appropriate level whether or not he or she is diabetic.
If a person eats a lot of refined grains, it is best to replace them with whole grains to prevent this issue with blood sugar.

Likewise, sugar directly correlates to a person’s blood sugar levels. Added sugars are even worse as they are only there for flavor and nothing more.
Especially if a person is diabetic, it is best to avoid foods with added sugar. Too much sugar can cause a flare up as it will cause the blood sugar to fluctuate.
This is one of the most common triggers, especially in people who have diabetic neuropathy. Nutritional deficiencies caused by relying too much on the flavor that added sugars provide can not only worsen neuropathy but they can also cause symptoms in someone who does not have it.
If a person has a gluten allergy, it is common sense that he or she stays away from food with gluten. Managing neuropathy symptoms is all the more reason to stay away from gluten. If a person’s body cannot process gluten, then it can severely worsen the symptoms of neuropathy, causing a flare up. This means that these people should search for gluten-free products to avoid these symptoms.
Lastly, saturated fats can cause inflammation, which is definitely a trigger for a neuropathy flare up. If a person does not already have type 2 diabetes, too much saturated fat can put this person on the road to developing diabetes.
To prevent this, the best thing that a person can do is find foods that don’t have a lot of saturated fats in them. Ultimately, the best thing that a person can do to alter any food-related triggers for neuropathy is to avoid sugars, refined grains, gluten, and saturated fat. This will take care of some of the triggers for flare ups.
Poor Physical Health
Since neuropathy is focused on the nerves in the body, the physical health of a person’s body will of course play a big role in how often neuropathy flare ups happen. Some major triggers for a flare up could be smoking, injuries, and illnesses. For instance, it is a well-known fact that smoking is very bad for the human body.

Smoking is one of the many triggers, because smoking constricts the blood vessels in the body, which constricts the blood that goes to the extremities.
This can quickly and easily worsen the symptoms of neuropathy, ultimately resulting in a flare up that nobody wants to deal with.
In addition to this, it should be relatively obvious that injuries to the body can cause a flare up as they can open many nerve endings to more pain that a person typically experiences.
On the chance that a person’s extremities have become so numb that the person is not aware of an injury, it is imperative that this person regularly checks to ensure that there are no injuries on the feet or hands. An injury can put a lot of physical stress on the body, which can lead to a neuropathic nightmare.
As the health of a person’s body plays a large role in whether or not the person is nearing a flare up, another thing that is important to pay attention to is health. Being sick puts quite a bit of stress on the body and thus the nerves. The stress on the nerves can translate into a neuropathic flare up, which can only make dealing with the sickness even worse.
In some cases, underlying issues can even be the cause of the neuropathy in the first place. If a person has any reason to suspect being sick, it would be a good idea to visit the doctor. Besides visiting the doctor, a person should take the appropriate measures to stay as healthy as possible both physically and mentally, to avoid worsening conditions.
Poor Mental and Emotional Health
Just as physical stress plays an enormous role in whether or not a person’s body is at risk for a flare up, mental stress and temperature also play a role. Emotional stress, while people might not think about it much, can be extremely hard on the nerves. This can make emotional stress a trigger for a neuropathic flare up.

One of the ways that a person could alleviate and remove this trigger is to make sure that there isn’t really anything stressful going on.
If there is something stressful, measures should be taken to remove that stressor, whether that means taking care of a particular task or ignoring some people for a period of time.

The temperature of a room or location also plays into the idea of triggers both emotional and physical.
After all, temperature is signaled to the brain through the nerves. Depending on the type of neuropathy a person has, temperature can quickly become a trigger for a flare up.
Typically, cooler temperatures are better, although the change should be gradual so as not to jolt the nerves too much. Cooler temperatures are best as they cause a slower heart rate and slow blood flow a little bit, slightly numbing any pain that a person might be feeling.

Contradicting Medications

Anything that is ingested into the body is going to affect the health of nerves and this especially goes for medication.
Medication can bring about worse side effects that can trigger a neuropathic flare up that nobody wants to deal with.
This can be difficult to deal with as finding the medication that is causing the flare up can be tough. Sometimes, that medication is something that a person needs.
When this happens, it might be worth talking to a doctor about alternatives to reduce the chances that a person’s own medication is causing symptoms to get worse.
How Can They Be Prevented?
Out of the many things that cause flare ups, there are several that can easily be changed. With time, diet and nutrition can change to a more suitable situation for a person’s needs. Stress will come and go with time and managing that stress will be important in regulating flare ups.
Know Your Triggers
Making sure that a person knows what his or her triggers are is essential in preventing flare ups from happening. This means that one of the best things a person can do is keep track of what came before a flare up so that he or she can get a good idea of what triggers neuropathic flare ups. Once the person understands what causes the flare ups, the hard work is halfway done.
Optimize Your Lifestyle
All that needs to be done now is changes in lifestyle to create a life where a person doesn’t have to worry nearly as much about triggering a neuropathic flare up. By having a journal that logs what triggers are and what can be done to avoid them, a person can begin taking the steps needed to live a life without neuropathic flare ups.
Take Supplements
Nutritional supplementation is a safe, low cost way to provide your nerves with the right herbs, vitamins, and nutrition they need for proper functioning. Many people are deficient in key vitamins like thiamine and methyl b12 due to lower nutrient density in today’s foods. People can either take multiple nerve health supplements individually or use a pre-formulated solution like Nerve Renew, which consists of proven ingredients in the optimal dosages according to clinical studies.

Article Provided By: Nerve Pain Guide

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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Paresthesia

What Is Paresthesia?

If you’ve ever felt as though your skin was crawling, or had numbness or itching for no apparent reason, you may have experienced paresthesia.
Almost everyone has experienced paresthesia on occasion. One of the most common times people get that familiar feeling of pins and needles is when their arms or legs “fall asleep.” This sensation usually occurs because you’ve inadvertently put pressure on a nerve. It resolves once you change your position to remove the pressure from the affected nerve. This type of paresthesia is temporary and usually resolves without treatment. If the paresthesia persists, you may have an underlying medical disorder that requires treatment.
What are the symptoms of paresthesia?
Paresthesia can affect any part of the body, but it commonly affects the:
hands
arms
legs
feet
It can be temporary or chronic. The symptoms can include feelings of:
numbness
weakness
tingling
burning
cold
Chronic paresthesia may cause a stabbing pain. That may lead to clumsiness of the affected limb. When paresthesia occurs in your legs and feet, it can make it difficult to walk.
See your doctor if you have symptoms of paresthesia that persist or affect with your quality of life. It could be a sign that you have an underlying medical condition that needs treatment.

What causes paresthesia?
It’s not always possible to determine the cause of paresthesia. Temporary paresthesia is often due to pressure on a nerve or brief periods of poor circulation. This can happen when you fall asleep on your hand or sit with your legs crossed for too long. Chronic paresthesia may be a sign of nerve damage. Two types of nerve damage are radiculopathy and neuropathy.
Radiculopathy
Radiculopathy is a condition in which nerve roots become compressed, irritated, or inflamed. This can occur when you have:
a herniated disk that presses on a nerve
a narrowing of the canal that transmits the nerve from your spinal cord to your extremity
any mass that compresses the nerve as it exits the spinal column
Radiculopathy that affects your lower back is called lumbar radiculopathy. Lumbar radiculopathy can cause paresthesia in your leg or foot. In more severe cases, compression of the sciatic nerve can occur and may lead to weakness in your legs. The sciatic nerve is a large nerve that starts in your lower spinal cord.
Cervical radiculopathy involves the nerves that provide sensation and strength to your arms. If you have cervical radiculopathy, you may experience:
chronic neck pain
paresthesia of the upper extremities
arm weakness
hand weakness
Neuropathy
Neuropathy occurs due to chronic nerve damage. The most common cause of neuropathy is hyperglycemia, or high blood sugar.
Other possible causes of neuropathy include:
trauma
repetitive movement injuries
autoimmune diseases, such as rheumatoid arthritis
neurological diseases, such as MS
kidney diseases
liver diseases
stroke
tumors in the brain or near nerves
bone marrow or connective tissue disorders
hypothyroidism
deficiencies in vitamin B-1, B-6, B-12, E, or niacin
getting too much vitamin D
infections, such as Lyme disease, shingles, or HIV
certain medications, such as chemotherapy drugs
exposure to toxic substances, such as chemicals or heavy metals
Nerve damage can eventually lead to permanent numbness or paralysis.

Who is at risk for paresthesia?
Anyone can experience temporary paresthesia. Your risk of radiculopathy increases with age. You also may be more prone to it if you:
perform repetitive movements that repeatedly compress your nerves, such as typing, playing an instrument, or playing a sport such as tennis
drink heavily and eat a poor diet that leads to vitamin deficiencies, specifically vitamin B-12 and folate
have type 1 or 2 diabetes
have an autoimmune condition
have a neurological condition, such as MS

 

How is paresthesia diagnosed?
See your doctor if you have persistent paresthesia with no obvious cause.
Be prepared to give your medical history. Mention any activities you participate in that involve repetitive movement. You should also list any over-the-counter or prescription medications that you take.
Your doctor will consider your known health conditions to help them make a diagnosis. If you have diabetes, for example, your doctor will want to determine if you have nerve damage, or neuropathy.
Your doctor will probably perform a full physical exam. This will likely include a neurological exam as well. Blood work and other laboratory tests, such as a spinal tap, may help them rule out certain diseases.
If your doctor suspects there’s a problem with your neck or spine, they may recommend imaging tests, such as X-rays, CT scans, or MRI scans.
Depending on the results, they may refer you to a specialist, such as a neurologist, orthopedist, or endocrinologist.

What is the treatment for paresthesia?
Treatment depends on the cause of your paresthesia. It may be possible to treat your condition by eliminating the cause in some cases. For example, if you have a repetitive movement injury, a few lifestyle adjustments or physical therapy may solve the problem.
If your paresthesia is due to an underlying disease, getting treatment for that disease can potentially ease the symptoms of paresthesia.
Your individual circumstances will determine whether your symptoms will improve. Some types of nerve damage are irreversible.

What is the outlook for people with paresthesia?
Temporary paresthesia usually resolves within a few minutes.
You may have a case of chronic paresthesia if those strange sensations don’t go away or they come back far too often. It can complicate your daily life if the symptoms are severe. That’s why it’s so important to try to find the cause. Don’t hesitate to seek a second opinion or see a specialist if necessary.
The severity of chronic paresthesia and how long it will last largely depends on the cause. In some cases, treating the underlying condition solves the problem.
Be sure to tell your doctor if your treatment isn’t working so they can adjust your treatment plan.
How can you prevent paresthesia?
Paresthesia isn’t always preventable. For instance, you probably can’t help it if you tend to fall asleep on your arms. You can take steps to reduce the occurrence or severity of paresthesia, though. For example, using wrist splints at night may alleviate the compression of the nerves of your hand and help resolve the symptoms of paresthesia you experience at night.
Follow these tips for preventing chronic paresthesia:
Avoid repetitive movement if possible.
Rest often if you need to perform repetitive movements.
Get up and move around as often as possible if you have to sit for long periods.
If you have diabetes or any other chronic disease, careful monitoring and disease management will help lower your chances of having paresthesia.

Article Provided By: healthline

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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

 

IfCarolina 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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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

 

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Neuropathic Pain Management

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

ICarolina Pain Scrambler Logo, Chronic Pain, Greenville, SCf 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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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, 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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