Carpal Tunnel, Pain Relief, Pain Management, Peripheral Neuropathy, Carolina Pain Scrambler Center, Greenville South Carolina

Symptoms of Carpal Tunnel Syndrome

Pressure on the median nerve – the central nerve that connects to the hand – causes carpal tunnel syndrome. In carpal tunnel patients, it causes pain and lack of function in the hand when squeezed. People whose work requires repetitive hand movements often experience this disorder. For example, people who work on computers and hair stylists commonly experience carpal tunnel syndrome. Pregnant women are also highly susceptible. A wrist splint or exercises can ease symptoms in the early days, however, in advanced cases surgery is necessary.

1. Pins and Needles

Everyone recognizes the tingling sensation known as pins and needles. This easily happens to someone who stays in an awkward position without moving hands and legs over a period. In these cases, the feeling is no more than a slight irritant, but with carpal tunnel syndrome, the sensation is far more intense and unpleasant. Usually, it only affects the thumb and fingers, but it can also spread to other areas.

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2. Pain

Even in the early stages, carpal tunnel syndrome can be extremely painful. The pain is usually in the hands and fingers, however, in severe cases it may travel through the arm to the shoulder. Pain patterns vary from patient to patient. Doctors are continuously researching to understand more about carpal tunnel syndrome.

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3. Numbness in the fingertips

Carpal tunnel syndrome may cause loss of feeling in the fingers. The fingers may feel very little to no sensation at all. As a result, patients may be unable to complete normal day to day tasks. Surgical treatment is usually necessary to restore sensation and function. However, exercise and home treatment may be enough in some cases.

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4. Sensation of swelling

Quite regularly people with carpal tunnel syndrome feel as though their hands or fingers have become swollen. When the doctor checks them, they find no evidence of swelling, but patients continue to feel that sensation. Minor swelling may occur above the wrist at times in carpal tunnel syndrome. However, most patients report the feeling in the fingers, localized to where the numbness occurs.

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5. Hands feel weak

One of the most common carpal tunnel syndrome feelings is a sense of hands that have lost their power. In particular, people claim that they find it harder to grip small objects and this causes many breakages in the kitchen. Medical tests do not reveal any marked loss of hand power in these cases, so doctors remain uncertain why so many patients feel this way. However, some slight deterioration in grip control may happen after surgical treatment.

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6. Responds to changes in wrist movements

People with carpal tunnel syndrome often find that they can get relief by moving their hand into a different position. Symptoms are usually worse at night – presumably because of fewer hand movements. In the most severe cases, the symptoms might be so intense that they disturb sleep and cause night waking.

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7. A condition that worsens over time

Carpel tunnel syndrome worsens with time, especially if symptoms go ignored and untreated. Surgery is usually necessary for the later stages of the condition. Early detection is best, as treatment is quite simple in the early stages. Wrist splints and exercise are usually enough to relieve symptoms in the early stages.

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8. Skin color changes

A certain number of people might notice changes in the color of the skin of their hand as a consequence of this condition. Sometimes the skin could become dry. Tingling and numbness feelings in their hand is also a good indication that they might have carpal tunnel syndrome. This is especially likely to be the case if they also feel that their fingertips have become frigid.

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9. Stiffness of the fingers

Some carpal tunnel syndrome patients complain that they feel as though their fingers are very stiff. However, when the doctor examines them, they fail to find any evidence to support this feeling. If the patient’s fingers actually have become stiff, it’s likely they are experiencing rheumatic or arthritic condition.

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10. Like the twang of a rubber band

One of the strangest feelings associated with carpal tunnel syndrome is in response to a certain hand movement. People say they sense something comparable to the twang of a released rubber band in their hand and fingers. Nobody is sure what exactly causes them to have this feeling. In particular, patients report this happening after they have had surgery performed.

Carpal Tunnel, Pain Relief, Pain Management, Peripheral Neuropathy, Carolina Pain Scrambler Center, Greenville South Carolina

Article Provided By: FactyHealth

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Chemotherapy, Chronic Pain, Pain Therapy, Chronic Pain Therapy, Neuropathic Pain Therapy, Greenville SC

Peripheral Neuropathy and Diabetes

Peripheral neuropathy is nerve damage caused by chronically high blood sugar and diabetes. It leads to numbness, loss of sensation, and sometimes pain in your feet, legs, or hands. It is the most common complication of diabetes.

About 60% to 70% of all people with diabetes will eventually develop peripheral neuropathy, although not all suffer pain. Yet this nerve damage is not inevitable. Studies have shown that people with diabetes can reduce their risk of developing nerve damage by keeping their blood sugar levels as close to normal as possible.

What causes peripheral neuropathy? Chronically high blood sugar levels damage nerves not only in your extremities but also in other parts of your body. These damaged nerves cannot effectively carry messages between the brain and other parts of the body.

This means you may not feel heat, cold, or pain in your feet, legs, or hands. If you get a cut or sore on your foot, you may not know it, which is why it’s so important to inspect your feet daily. If a shoe doesn’t fit properly, you could even develop a foot ulcer and not know it.

The consequences can be life-threatening. An infection that won’t heal because of poor blood flow causes risk for developing ulcers and can lead to amputation, even death.

This nerve damage shows itself differently in each person. Some people feel tingling, then later feel pain. Other people lose the feeling in fingers and toes; they have numbness. These changes happen slowly over a period of years, so you might not even notice it.

Because the changes are subtle and happen as people get older, people tend to ignore the signs of nerve damage, thinking it’s just part of getting older.

But there are treatments that can help slow the progression of this condition and limit the damage. Talk to your doctors about what your options are, and don’t ignore the signs because with time, it can get worse.

Symptoms of Nerve Damage From Diabetes

Numbness is the most common, troubling symptom of nerve damage due to diabetes. The loss of sensation is a special concern. People who lose sensation are the ones most likely to get ulcers on their feet and to end up needing amputations.

People describe the early symptoms of peripheral neuropathy in many ways:

  • Numbness
  • Tingling
  • Pins and needles
  • Prickling
  • Burning
  • Cold
  • Pinching
  • Buzzing
  • Sharp
  • Deep stabs

Others describe sharp pain, cramps, tingling, prickling, a burning sensation. Still others have exaggerated sensitivity to touch.

The symptoms are often worse at night. Be on the look out for these changes in how you feel:

  • Touch sensitivity. You may experience heightened sensitivity to touch, or a tingling or numbness in your toes, feet, legs, or hands.
  • Muscle weakness. Chronically elevated blood sugars can also damage nerves that tell muscles how to move. This can lead to muscle weakness. You may have difficulty walking or getting up from a chair. You may have difficulty grabbing things or carrying things with your hands.
  • Balance problems. You may feel more unsteady than usual and uncoordinated when you walk. This occurs when the body adapts to changes brought on by muscle damage.

Because people with type 2 diabetes may have multiple health problems, doctors don’t always diagnose peripheral neuropathy when symptoms first appear. You need to be aware that your pain may be confused with other problems.

Make sure your pain is taken seriously.

Article Provided By: WebMD

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What to Say to Someone in Chronic Pain

Helpful Things to Say to Someone in Chronic Pain

Supporting someone in chronic pain can be difficult.  There is nothing that can be done to ease someone’s pain and sometimes, it leaves friends and family at a loss for words. There are no magic words or actions, but there are suggestions for things to say that could possibly help your loved one feel better.

Here is a list I have compiled from personal experience and research of helpful things to say to someone in chronic pain:

1-     “You look well today/good, but how are you feeling?”  Many times people with chronic pain feel like people see how they look on the outside, not how they feel on the inside.  This statement is helpful because you are stating something positive about the person, but asking how they are feeling despite looking good.  Additionally, asking “how are you holding up?” is a similar and helpful comment that lets the person in pain know that you acknowledge they are in pain and you wish to know how they are handling it.

2-     “I am going to be going to the store. Can I get you something?” After my second surgery my best friend would often call on weekends and tell me she was at the store and did I need anything.  The way she asked didn’t hit my pride, because I felt like she was already there and I wouldn’t bother her if I said, “sure, can you get me bread?”

3-     “I can’t imagine how hard this is for you, but you seem to be handling it well and I think you are so strong.” I often feel weakened by pain, but statements like these make me feel stronger and supported.

4-     “You are in my thoughts and prayers” As opposed to telling someone to ‘pray’ or ‘have faith,’ this statement expresses a good intention and lets us know you care.

5-     Mirror back what is being said.  If the person says “my back is really hurting me” Tell them, “Your back hurts, that must be difficult for you.”  By mirroring their statement, the person feels their pain was heard, even though there is nothing you can really say or do to help, they know you listened/heard their pain.

6-     “This must be so difficult for you, I can’t imagine.”  There are no magic words, and unless you are living with chronic pain, it’s difficult to understand what we are going through.  Comments like this show support without pretending you know how we feel.

7-     “I wish I had something to say that would help/take away the pain, but I don’t.  But I am here to listen.”  Sometimes, the best thing to say is nothing at all.  Sometimes it is best to just listen, without judgment, and just be there for someone.  Admitting you are at a loss and offering an ear is one of the most helpful things a loved one can do.

8-     “Please don’t feel bad if you have to cancel, I understand and I hope I can see you when you feel well.” This statement expresses concern without making the person feel bad about their limitations.

9-     “I hope that you feel as well as possible.”  Since we are talking about chronic pain, ‘feel better’ can be frustrating because many people don’t have ‘better’ days.  This statement is more genuine, in a way.

10- “I heard about _______(fill in miracle cure of the say).  I know every case is different, but would you like to hear about it?”  We have a lot of advice thrown at us by well-meaning people, but much of it is unwanted because it can make us feel as though others think we are not trying to help ourselves.  We also do a lot of research and see a lot of doctors, so we have probably heard it already.  By asking if the person would be interested in receiving advice shows respect for our situation and gives us the option to say ‘not right now’ or ‘sure.”

Actions speak louder than words so, remember, it can be very helpful to DO something nice for that person, like bring a meal, offer to do a load of laundry or make the bed.  Help.  But don’t make a big deal out of it.  Many times people who need help have a sense of pride and don’t like to feel they are being a burden, so by doing something and making it seem as if it’s “no big deal,” you are helping us without making us feel guilty.

Something I encounter a lot is that friends omit telling me things that have happened with their own health.  They say, “it was no big deal, it’s nothing compared to what you are going through.”  If you are supporting someone with chronic pain and you care about them, chances are they care about you and your health problems, so share what’s going on with your health as well.  It will help the person in pain feel the friendship is not one-sided.  Just because we are in pain doesn’t mean we forgot how to listen and care and, if your health issues involve pain, we can certainly sympathize better than anyone.

And, please don’t turn your back on those of us living with chronic pain just because you feel like you can’t help us.  This lifestyle carries with it so much isolation, depression and loneliness.  We count on our support system to help us.  We know we are not always the easiest of people to deal with, but please remember, we did not ask for this and we would love to have our “old lives” back.

Remember, sometimes the best thing you can say is the simplest: “I love you.”

Article Provided By: PsychCentral

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Pain Center, Pain Management, Nerve Pain Therapy, Pain Relief

How to Sleep Well Despite Chronic Pain

Chronic pain and insomnia are an unhealthy combination. According to the National Sleep Foundation, chronic pain disturbs the slumber of one in five Americans at least a few nights a week. Whether it’s from a bad back, arthritis, or headaches, chronic pain puts you in double jeopardy: the pain robs you of restful sleep and makes you more fatigued, and thus more sensitive to pain.

But you can start to break this vicious cycle.

“For chronic pain conditions, what you need is good sleeping habits from the beginning — things that will last,” says Dr. Padma Gulur, a pain medicine specialist at Harvard-affiliated Massachusetts General Hospital. That means relying on the brain’s natural sleep drive as much as possible.

Try “relaxing distraction”

Dr. Gulur recommends “relaxing distraction” to her patients. Some relaxation techniques use basic rhythmic breathing meditation; others focus on guided imagery, in which you imagine being in a calm, peaceful location. Find something that appeals to you and helps you fall asleep. You might look for these exercises on CD, or consider group or individual trainings or sleep education sessions.

Getting back to sleep

For some people, chronic pain not only makes it harder to fall asleep, but can also interrupt sleep. Simply shifting position in bed can trigger pain from a back condition or arthritic knee.

One approach is to take your pain medication right before bed. Check with your doctor to be sure that fits into your treatment plan. If pain does wake you in the middle of the night, first try meditation, visualization, or whatever relaxing distraction you favor. But if it doesn’t work, getting up to read a book in a quiet room with low light can help you to get back to sleep. Avoid loud sounds and bright light (that means TVs, smartphones, tablets, and computers).

Staying on a regular sleep schedule is also important. Go to bed at the same time every night and, no matter how the night goes, rise the next day at the same time and remain awake until your planned sleep time. This helps to set your internal sleep clock and enhances the natural sleep drive.

Article Provided By: Harvard Health Publishing

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Tips for Appointments

A Pain Doctor’s Tips for Getting the Most out of Your Appointment

Are you feeling frustrated every time you see your doctor? Like you aren’t being heard and not getting the help you need? My guess is that if you are feeling disappointed with your visits with your pain doctor, you probably aren’t alone.

Let’s face it, it can be difficult to create a satisfying doctor-patient relationship, largely because time together is so limited. Physicians only have about 15 minutes to meet with their patients, and much of that time is spent focused on a computer screen doing electronic record-keeping (which frustrates everyone). Making matters worse, the fallout from the opioid crisis has put tremendous pressure on doctors to focus more time and attention on precautionary protocols, further lessening the time we have to devote to treating patients. All of this can leave very little time for you to have meaningful conversations with your doctor.

To get the most out of your time with your doctor, arm yourself with a strategic plan. Here are a few tips for productive appointments that will result in better pain management:

  • Have a clear goal: Be clear, with yourself and with your doctor, about your true goals. For example, you may want to go back to work, run a 5K again, or play catch with your kids. Whatever the goals may be, that is where you want to keep the focus when meeting with your physicians. Sure, you may want to be pain-free so you can do whatever you want, but keeping your goals more practical and tangible will move things along in a more positive direction.
  • Be descriptive: Let your doctor know exactly what is standing in the way of you reaching your goals. Remember – the most important part of any evaluation is what the patient communicates to their doctor; test results and MRI reports should be secondary. When you walk, where exactly does it hurt? Is it a sharp pain, dull ache, or burning sensation? The more descriptive the picture, the better equipped your physician will be to understand how to help you. Try to be clear and focused at your appointment, and avoid tangents or deviating from your script.
  • Take notes: Write out your questions and concerns ahead of time to ensure your doctor covers what is most important to you. Sometimes medical appointments can feel overwhelming, making it hard to remember key details later. So, take notes during your visit, or bring somebody to take notes for you, so you can review it all later (having your doctor write things down for you or print something off the computer takes precious time away from your appointment, so do as much of the note-taking on your own as you can).
  • Talk about how you function: Regardless of what type of pain problems you may have, there is a good chance that it is impacting how you function on a daily basis. That includes everything from walking, driving, doing chores at home, to working and playing. And how well you can engage in these types of activities directly correlates to your quality of life, sense of independence, and general happiness. Shift the focus of your medical visits away from just how you feel, and more toward how you function.
  • Acknowledge progress: Resist the temptation to unload only negative feedback and complaints. Be sure to let your physician know what is helping, and talk about the steps you’re taking to improve your health. Discussing the positive impact that your work together is having in your life can help your doctor-patient relationship grow and deepen.

Try incorporating these 5 basic strategies into your future appointments and watch your results and satisfaction rise to new heights.

Article Provided By: WebMD

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CRPS, Complex Regional Pain Syndrome, Pain Relief, Pain Therapy, Carolina Pain Scrambler, Greenville South Carolina, Peripheral Neuropathy

Symptoms and Causes of CRPS

Following an injury or surgery, even something as simple as a sprained ankle, some people begin experiencing intense pain that seems to spread from the injury and makes the entire limb feel on fire or as if electrical shocks are running up and down the area. Often, doctors diagnose these individuals with complex regional pain syndrome (CRPS), a condition for which there are many causes and symptoms.

1. What is Complex Regional Pain Syndrome?

Complex regional pain syndrome is a rare condition that can occur after surgery, stroke, heart attack, or an injury. It is thought to be an unusual autoimmune response to the trauma. Unfortunately, this pain is often more impactful than the injury or preceding illness itself.

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2. What Causes Complex Regional Pain Syndrome?

Complex regional pain syndrome is believed to be caused by the malfunction of, or from damage to, the peripheral and central nervous systems, combined with the immune response. The pain causes the immune system to overreact, resulting in swelling and stiffness in the affected joints. The initial cause is the trauma, which leads to a cascade of events resulting in complex regional pain syndrome.

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3. How Long Does Complex Regional Pain Syndrom Last?

Complex regional pain syndrome is often a chronic condition lasting more than six months. You may experience symptoms for a while and go into remission, only to have the condition flare up again at a later date. CRPS will affect some people just once and never again, while others are in constant pain and need treatment regularly.

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4. What are the Symptoms of Complex Regional Pain Syndrome?

Complex regional pain syndrome manifests itself in several ways. You may feel constant dull or severe pain, or feel electric shocks or “pins and needles”; others describe the pain as burning and intense. Some people with CRPS have difficulty moving the affected limb, or the pain may travel to the opposite limb, as well. You may experience sweating in the affected area, where the skin may appear thin and shiny. Some people notice changes to hair and nail growth patterns and have tremors or jerking in the limb. Lastly, the affected limb may change color, becoming purple, red, blue, blotchy, or pale.

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5. How Does a Doctor Diagnose Complex Regional Pain Syndrome?

There is no one test that definitively diagnoses complex regional pain syndrome. Instead, your doctor will look at your past case history and your symptoms and make an evaluation. He or she may run tests to rule out other diseases since the symptoms of complex regional pain syndrome mimic other diseases with different treatments.

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6. Are There Different Types of Complex Regional Pain Syndrome?

There are two types of complex regional pain syndrome: type 1 and type 2. Most people (90 percent) have type 1 complex regional pain syndrome. Also called reflex sympathetic dystrophy syndrome or RSD, it occurs following trauma that did not damage the nerves. Type 2 or causalgia occurs when the trauma damages the nerves.

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7. Complications of Complex Regional Pain Syndrome?

If you fail to receive treatment for CRPS, you could experience severe complications including atrophy and muscle contraction. Atrophy causes your muscles, skin, and bones deteriorate due to lack of use. Affected extremities become weakened to the point where they cannot be used at all. Alternatively, your muscles may begin to contract, fixing the injured body part in one position, again rendering the limb unusable.

 

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8. How is Complex Regional Pain Syndrom Treated?

There are many options for treating complex regional pain syndrome. Your doctor may prescribe physical therapy, medications, and psychotherapy. You may find some relief from sympathetic nerve blocks, spinal cord stimulation, neurostimulation, intrathecal drug pumps, or Graded Motor imagery. Some people find alternative therapies helpful and turn to acupuncture, chiropractic, and biofeedback for relief. Other modalities that work toward relaxing the limb include behavior modification, relaxation techniques, progressive muscle relaxation, and guided motion therapy.

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9. Who is At Risk of Complex Regional Pain Syndrome?

Complex regional pain syndrome may affect anyone at any age, but the median age is 40. Children and adults younger than 30 have been known to develop CRPS. Women seem to develop the condition more than men, but men can get it, too. Anyone who has had an injury is at risk, especially if the injury affects the extremities.

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10. What is the Prognosis for Recovery from Complex Regional Pain Syndrome?

The earlier CRPS is diagnosed and treated, the better the prognosis. Younger people, especially those under the age of 20 are more likely to recover from complex regional pain syndrome than older individuals. However, the disorder is different for everyone and some people deal with chronic pain and disability, even with treatment.

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Article Provided By: FactyHealth

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Peripheral Neuropathy, Carpal Tunnel, Nerve Pain Relief, Pain therapy

When Your Pain Is Disabling

Pain can entirely change our lives. Ongoing pain problems can lead to disabilities like not being able to work, drive, or even maintain a home. Pain in a dominant hand or arm can make it difficult to button a shirt, comb hair, or carry groceries. Lower back pain can make it hard to sit, stand, bend, tie shoelaces, or just about anything else you can imagine. Intense, recurring headaches, like migraines, can make it difficult to concentrate, listen, read, eat, or even turn the lights on. When your pain is disabling – it is called high-impact chronic pain. Research done on high-impact chronic pain by groups like the National Center for Complementary and Integrative Health have published some important findings:

  • Approximately 10.6 million Americans, or 4.8% of the population, have high-impact chronic pain.
  • Disability is typically more commonly associated with chronic pain than with a number of other chronic conditions, including stroke and kidney failure.
  • Those with high-impact chronic pain reported higher levels of mental health problems and cognitive problems, compared to those with chronic pain without disability.
  • High-impact patients reported greater difficulty performing daily self-care activity and greater healthcare utilization.

These findings suggest that an awful lot of folks are not only living with intense pain, but also experiencing life-altering limitations as a result.

When pain becomes this overwhelming, pain management becomes a far bigger challenge. Finding the best pain relief strategies while also exploring ways of engaging more with daily activities can seem like a daunting task. How can you reduce the effect that pain has on your life without undoing all the hard work you have put in to get the pain under better control?

For starters, I think it helps to focus on only a couple of tasks at a time. What function or activity would be most meaningful to have back in your life? For example, becoming just a bit more mobile can mean the difference between spending more time with friends or missing out, and being able to cook a prized recipe once again will delight all who get to enjoy it with you. Consider consulting with an occupational therapist that typically specialize in helping patients hone in skills that boost their ability to perform home or work activities.

It isn’t easy to do any activity that you haven’t done in a while. There is a good chance that being in pain has caused important muscles groups to get deconditioned and stiff, and overdoing it too quickly will only set off the pain. But building back up a strong foundation or core that can help support your arms, legs, and spine as they become more active helps prevent overstressing them. Working with a physical therapist or exercise expert can help you find ways to recondition key muscle groups and build up more foundational or core stability, so you can do more with less pain. Diminishing the impact of pain is a much taller order than getting physically stronger. Research has taught us that those living with high-impact chronic pain often experience psychological distress and mood disorders like depression and anxiety. It is hard to function when you feel overwhelmed, so try to get involved in practices that can bring a sense of calm – meditation, yoga, breathing exercises, enjoying nature, or seeing a counselor all have the potential to help. If you are suffering from a challenging chronic pain problem and feel you and your doctors have done your best to manage the symptoms, consider having a conversation with your healthcare team about how you might be able to lessen the impact that your pain has on your life.
Article Provided By: WebMD

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Good Friend to Someone in Chronic Pain

Being a Good Friend to Someone with Chronic Pain

Many individuals experience acute or chronic pain at some point in their life. Many that suffer from chronic pain can go years without finding the appropriate relief which leads to extended discomfort, depression, and a sense of loneliness.

Chronic pain affects everyone surrounding the actual sufferer. Frustration and exhaustion can consume the sufferer making it difficult to even get through the day. Many suffers don’t see how their emotions and attitude are being inflicted on others around them. Lifestyle changes alter the relationships with family, friends, and colleagues. If you have no direct experience with chronic pain, you might not able to relate adding additional stress and anxiety to their life.

Listed below are a few tips to help someone with chronic pain:

  • Ask to attend their appointments or therapy sessions. You will be able to relate and discuss their pain.
  • Educate yourself. With medical research and their history of chronic pain.
  • Don’t feel sorry for yourself. The sufferer doesn’t want to burden you or be in a constant foul mood. Try putting yourself in their shoes. Treasure your relationship!
  • Offer a lending hand. Help clean their house, drive them to the grocery store, or any other chore.
  • Listen. At times they just want to be heard!
  • Accept Cancellations. Sufferers like to be included even if they regularly cancel.
  • Limit talking about their pain. Distract yourselves with hobbies that interest you both.
  • Be supportive. Learn and teach them how to be mentally and physically independent.
  • Be sensitive and positive. Criticism, stress, and conflict increases pain. Avoid questioning the sufferer’s pain this can hurt them and your relationship.
  • Remember to take care of yourself. Take time out to recharge. Research indicates spouses of those dealing with chronic pain show increased weakened immune system, withdrawal, discouragement, loneliness, and deteriorating physical health. It can be helpful to better understand how to care for your loved one while always remembering to take care of yourself.

Article Provided By: PainScale

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Complex Regional Pain Syndrome Facts

What is complex regional pain syndrome?

Complex regional pain syndrome (CRPS) is a chronic (lasting greater than six months) pain condition that most often affects one limb (arm, leg, hand, or foot) usually after an injury.  CRPS is believed to be caused by damage to, or malfunction of, the peripheral and central nervous systems.  The central nervous system is composed of the brain and spinal cord; the peripheral nervous system involves nerve signaling from the brain and spinal cord to the rest of the body.  CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and/or swelling in the affected area.

CRPS is divided into two types:  CRPS-I and CRPS-II. Individuals without a confirmed nerve injury are classified as having CRPS-I (previously known as reflex sympathetic dystrophy syndrome).  CRPS-II (previously known as causalgia) is when there is an associated, confirmed nerve injury.  As some research has identified evidence of nerve injury in CRPS-I, it is unclear if this disorders will always be divided into two types.  Nonetheless, the treatment is similar.

CRPS symptoms vary in severity and duration, although some cases are mild and eventually go away.  In more severe cases, individuals may not recover and may have long-term disability.

Who can get CRPS?

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

What are the symptoms of CRPS?

The key symptom is prolonged severe pain that may be constant.  It has been described as “burning,” “pins and needles” sensation, or as if someone were squeezing the affected limb.  The pain may spread to the entire arm or leg, even though the injury might have only involved a finger or toe. In rare cases, pain can sometimes even travel to the opposite extremity.  There is often increased sensitivity in the affected area, known as allodynia, in which normal contact with the skin is experienced as very painful.

People with CRPS also experience changes in skin temperature, skin color, or swelling of the affected limb.  This is due to abnormal microcirculation caused by damage to the nerves controlling blood flow and temperature.  As a result, an affected arm or leg may feel warmer or cooler compared to the opposite limb.  The skin on the affected limb may change color, becoming blotchy, blue, purple, pale, or red.

Other common features of CRPS include:

  • changes in skin texture on the affected area; it may appear shiny and thin
  • abnormal sweating pattern in the affected area or surrounding areas
  • changes in nail and hair growth patterns
  • stiffness in affected joints
  • problems coordinating muscle movement, with decreased ability to move the affected body part
  • abnormal movement in the affected limb, most often fixed abnormal posture (called dystonia) but also tremors in or jerking of the limb.

What causes CRPS?

It is unclear why some individuals develop CRPS while others with similar trauma do not.  In more than 90 percent of cases, the condition is triggered by a clear history of trauma or injury.  The most common triggers are fractures, sprains/strains, soft tissue injury (such as burns, cuts, or bruises), limb immobilization (such as being in a cast), surgery, or even minor medical procedures such as needle stick. CRPS represents an abnormal response that magnifies the effects of the injury.  Some people respond excessively to a trigger that causes no problem for other people, such as what is observed in people who have food allergies.

Peripheral nerve abnormalities found in individuals with CRPS usually involve the small unmyelinated and thinly myelinated sensory nerve fibers (axons) that carry pain messages and signals to blood vessels. (Myelin is a mixture of proteins and fat-like substances that surround and insulate some nerve fibers.) Because small fibers in the nerves communicate with blood vessels, injuries to the fibers may trigger the many different symptoms of CRPS.  Molecules secreted from the ends of hyperactive small nerve fibers are thought to contribute to inflammation and blood vessel abnormalities.  These peripheral nerve abnormalities trigger abnormal neurological function in the spinal cord and brain.

Blood vessels in the affected limb may dilate (open wider) or leak fluid into the surrounding tissue, causing red, swollen skin.  The dilation and constriction of small blood vessels is controlled by small nerve fiber axons as well as chemical messengers in the blood.  The underlying muscles and deeper tissues can become starved of oxygen and nutrients, which causes muscle and joint pain as well as damage.  The blood vessels may over-constrict (clamp down), causing old, white, or bluish skin.

CRPS also affects the immune system. High levels of inflammatory chemicals (cytokines) have been found in the tissues of people with CRPS.  These contribute to the redness, swelling, and warmth reported by many patients. CRPS is more common in individuals with other inflammatory and autoimmune conditions such as asthma.

Limited data suggest that CRPS also may be influenced by genetics.  Rare family clusters of CRPS have been reported.  Familial CRPS may be more severe with earlier onset, greater dystonia, and more than one limb being affected.

Occasionally CRPS develops without any known injury.  In these cases, an infection, a blood vessel problem, or entrapment of the nerves may have caused an internal injury.  A physician will perform a thorough examination in order to identify a cause.

In many cases, CRPS results from a variety of causes.  In such instances, treatments are directed at all of the contributing factors.

How is CRPS diagnosed?

Currently there is no specific test that can confirm CRPS. Its diagnosis is based on a person’s medical history, and signs and symptoms that match the definition.  Since other conditions can cause similar symptoms, careful examination is important.  As most people improve gradually over time, the diagnosis may be more difficult later in the course of the disorder.

Testing also may be used to help rule out other conditions, such as arthritis, Lyme disease, generalized muscle diseases, a clotted vein, or small fiber polyneuropathies, because these require different treatment.  The distinguishing feature of CRPS is that of an injury to the affected area.  Such individuals should be carefully assessed so that an alternative treatable disorder is not overlooked.

Magnetic resonance imaging or triple-phase bone scans may be requested to help confirm a diagnosis.  While CRPS is often associated with excess bone resorption, a process in which certain cells break down the bone and release calcium into the blood, this finding may be observed in other illnesses as well.

What is the prognosis?

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

How is CRPS treated?

The following therapies are often used:

Rehabilitation and physical therapy.  An exercise program to keep the painful limb or body part moving can improve blood flow and lessen the circulatory symptoms.  Additionally, exercise can help improve the affected limb’s flexibility, strength, and function.  Rehabilitating the affected limb also can help to prevent or reverse the secondary brain changes that are associated with chronic pain.  Occupational therapy can help the individual learn new ways to work and perform daily tasks.

Psychotherapy. CRPS and other painful and disabling conditions often are associated with profound psychological symptoms for affected individuals and their families.  People with CRPS may develop depression, anxiety, or post-traumatic stress disorder, all of which heighten the perception of pain and make rehabilitation efforts more difficult.  Treating these secondary conditions is important for helping people cope and recover from CRPS.

Medications. Several different classes of medication have been reported to be effective for CRPS, particularly when used early in the course of the disease.  However, no drug is approved by the U.S. Food and Drug Administration specifically for CRPS, and no single drug or combination of drugs is guaranteed to be effective in every person.  Drugs to treat CRPS include:

  • bisphosphonates, such as high dose alendronate or intravenous pamidronate
  • non-steroidal anti-inflammatory drugs to treat moderate pain, including over-the-counter aspirin, ibuprofen, and naproxen
  • corticosteroids that treat inflammation/swelling and edema, such as prednisolone and methylprednisolone (used mostly in the early stages of CRPS)
  • drugs initially developed to treat seizures or depression but now shown to be effective for neuropathic pain, such as gabapentin, pregabalin, amitriptyline, nortriptyline, and duloxetine
  • botulinum toxin injections
  • opioids such as oxycodone, morphine, hydrocodone, and fentanyl.  These drugs must be prescribed and monitored under close supervision of a physician, as these drugs may be addictive.
  • N-methyl-D-aspartate (NMDA) receptor antagonists such as dextromethorphan and ketamine, and
  • topical local anesthetic creams and patches such as lidocaine.

All drugs or combination of drugs can have various side effects such as drowsiness, dizziness, increased heartbeat, and impaired memory. Inform a healthcare professional of any changes once drug therapy begins.

Sympathetic nerve block. Some individuals report temporary pain relief from sympathetic nerve blocks, but there is no published evidence of long-term benefit.  Sympathetic blocks involve injecting an anesthetic next to the spine to directly block the activity of sympathetic nerves and improve blood flow.

Surgical sympathectomy.  The use of this operation that destroys some of the nerves is controversial.  Some experts think it is unwarranted and makes CRPS worse, whereas others report a favorable outcome.  Sympathectomy should be used only in individuals whose pain is dramatically relieved (although temporarily) by sympathetic nerve blocks.

Spinal cord stimulation.  Placing stimulating electrodes through a needle into the spine near the spinal cord provides a tingling sensation in the painful area.  Electrodes may be placed temporarily for a few days in order to assess whether stimulation is likely to be helpful.  Minor surgery is required to implant all the parts of the stimulator, battery, and electrodes under the skin on the torso.  Once implanted, the stimulator can be turned on and off, and adjusted using an external controller.  Approximately 25 percent of individuals develop equipment problems that may require additional surgeries.

Other types of neural stimulation. Neurostimulation can be delivered at other locations along the pain pathway, not only at the spinal cord.  These include near injured nerves (peripheral nerve stimulators), outside the membranes of the brain (motor cortex stimulation with dural electrodes), and within the parts of the brain that control pain (deep brain stimulation).  A recent option involves the use of magnetic currents applied externally to the brain (known as repetitive Transcranial Magnetic Stimulation, or rTMS).  A similar method that uses transcranial direct electrical stimulation is also being investigated.  These stimulation methods have the advantage of being non-invasive, with the disadvantage that repeated treatment sessions are needed.

Intrathecal drug pumps.  These devices pump pain-relieving medications directly into the fluid that bathes the spinal cord, typically opioids, local anesthetic agents, clonidine, and baclofen.  The advantage is that pain-signaling targets in the spinal cord can be reached using doses far lower than those required for oral administration, which decreases side effects and increases drug effectiveness.  There are no studies that show benefit specifically for CRPS.

Emerging treatments for CRPS include:

  • Intravenous immunoglobulin (IVIG).  Researchers in Great Britain report low-dose IVIG reduced pain intensity in a small trial of 13 patients with CRPS for 6 to 30 months who did not respond well to other treatments.  Those who received IVIG had a greater decrease in pain scores than those receiving saline during the following 14 days after infusion.
  • Ketamine. Investigators are using low doses of ketamine—a strong anesthetic—given intravenously for several days to either reduce substantially or eliminate the chronic pain of CRPS.  In certain clinical settings, ketamine has been shown to be useful in treating pain that does not respond well to other treatments.
  • Graded Motor imagery.  Several studies have demonstrated the benefits of graded motor imagery therapy for CRPS pain.  Individuals do mental exercises including identifying left and right painful body parts while looking into a mirror and visualizing moving those painful body parts without actually moving them.

Several alternative therapies have been used to treat other painful conditions.  Options include behavior modification, acupuncture, relaxation techniques (such as biofeedback, progressive muscle relaxation, and guided motion therapy), and chiropractic treatment.

What research is currently being done on CRPS?

The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.  The NINDS is part of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.

NINDS-supported scientists are studying new approaches to treat CRPS and to intervene more aggressively to limit the symptoms and disability associated with the syndrome.  Other NIH institutes also support research on CRPS and other painful conditions.

Previous research has shown that CRPS-related inflammation is caused by the body’s own immune response.  Researchers hope to better understand how CRPS develops by studying immune system activation and peripheral nerve signaling using an animal model of the disorder.  The animal model was developed to mimic certain CRPS-like features following fracture or limb surgery, by activating certain molecules involved in the immune system process.

Limb trauma, such as a fracture, followed by immobilization in a cast, is the most common cause of CRPS.  By studying an animal model, researchers hope to better understand the neuroinflammatory basis of CRPS in order to identify the relevant inflammatory signaling pathways that lead to the development of post-traumatic CRPS.  They also will examine inflammatory effects of cast immobilization and exercise on the development of pain behaviors and CRPS symptoms.

Peripheral nerve injury and subsequent regeneration often lead to a variety of sensory changes.  Researchers hope to identify specific cellular and molecular changes in sensory neurons following peripheral nerve injury to better understand the processes that underlie neuroplasticity (the brain’s ability to reorganize or form new nerve connections and pathways following injury or death of nerve cells).  Identifying these mechanisms could provide targets for new drug therapies that could improve recovery following regeneration.

Children and adolescents with CRPS generally have a better prognosis than adults, which may provide insights into mechanisms that can prevent chronic pain.  Scientists are studying children with CRPS given that their brains are more adaptable through a mechanism known as neuroplasticity.  Scientists hope to use these discoveries in order to develop more effective therapies for CRPS.

NINDS-funded scientists continue to investigate how inflammation and the release of adenosine triphosphate (ATP) may induce abnormal connections and signaling between sympathetic and sensory nerve cells in chronic pain conditions such as CRPS. (ATP is a molecule involved with energy production within cells that can also act as a neurotransmitter.  Neurotransmitters are chemicals used by nervous system cells to communicate with one another.)  A better understanding of changes in nerve connections following peripheral nerve injury may offer greater insight to pain and lead to new treatments.

Article Provided By: NIH

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
Chemotherapy, CRPS, Pain Center, Nerve Pain Therapy, Back Pain Relief

Mistakes That Make Pain Worse

What if I told you that, besides being generally unpleasant (to put it mildly), pain can also be deceiving and misleading? Yes! Pain can play tricks with our heads and fill us with thoughts that can be harmful and hold us back from getting better. Here are two of the most powerful mind tricks that pain plays on us (they may surprise you!): 
Catastrophizing
Think of catastrophizing as a thought process where you see the worst in a situation and consider only the most negative of possible outcomes. Catastrophizing is often associated with rumination, meaning you keep thinking that something terrible is going to happen and you can’t get it out of your head. This constant negative thinking can then directly impact your feelings and emotions, which means you can start to freak out or get really depressed. A lot of pain research done over the years suggests that catastrophizing can have a big impact on how we hurt. Not only does catastrophizing influence the intensity of our pain, but it seems to play a significant role in whether the pain becomes chronic or not. In fact, studies have found that catastrophizing can lead to an increased chance of long-term disability.In some cases, how we interpret the words we hear from our doctors can determine how much we catastrophize. For example, if your physician tells you that you have really degenerated discs in your lower back, you could respond by ruminating that this a “terrible” problem that will never go away and will likely lead you down a path of becoming wheelchair dependent. Or, you could choose to interpret this as a common diagnosis that happens as we get older and decide you are going to do whatever you can to minimize its impact so you can continue to lead an active and happy life. Two different mindsets to the same problem can lead to very different outcomes.

But if you are the person hurting and you don’t have a medical background, how do you know if what you are thinking is reasonable or catastrophizing? This is might be a good topic to bring up with your doctor, especially since research shows that catastrophizing is usually overlooked by most doctors. If you find yourself feeling very worried about anything related to your health, why not let your physician know how you feel and get their perspective on how realistic your fears might be. There is a good chance that your doctor has treated similar situations to yours many times in the past.

If you find yourself ruminating excessively, ask your physician for assistance in learning tools for quieting these thoughts and finding ways you can see your health in a more positive light. Studies show that decreasing levels of catastrophic thinking actually lead to better pain treatment outcomes. 
Associating Pain With Harm  
Pain and injury don’t go hand in hand when it comes to chronic pain. Granted, pain is the hallmark sign of an acute injury like a broken bone, and the disappearance of that acute pain is a notable sign of tissue healing and repair. Starting in childhood, our brains learn to equate pain with harm or injury that we carry into adulthood and use as a protective mechanism. But this typical learned behavior can pose a problem for those working to overcome a condition that is more chronic. When pain triggers this warning alarm, we go through a fight or flight response as a protective mechanism to either fight off or run from danger. But if we go through this type of fire drill every day, then we develop a dysfunctional behavior pattern where we keep our attention focused on a perceived threat that doesn’t really exist. This can leave us feeling agitated, anxious, and fearful, and prevents us from moving on with our day and engaging in otherwise meaningful activities. Consider the example of neck pain from a whiplash injury. The pain you feel right after getting rear-ended is related to acute tissue inflammation, but feeling neck pain a whole year later is a different matter. When pain is felt with moving chronically tight and sore muscles or joints, that doesn’t mean injury is taking place. Rather, it is a sign that your body has learned to resist such movements and needs to go through a careful process to recondition and retrain certain muscles, tendons, joints, and nerves to behave differently.But if you continue to avoid turning your neck for many months because of the negative feedback of the pain, then your neck will only get stiffer and hurt even more, and keep you from engaging in meaningful activities. Yes, pain can play wicked games on our minds and hold us back from getting better if we let it! Overcoming this tricky “pain – fear – avoidance” loop is not easy and may require assistance, but the first step is getting to a place where you understand the difference between experiencing pain versus doing something that is actually harmful or dangerous to your body.

With both catastrophizing and the misconception that chronic pain is a sign of further harm, we see ourselves misinterpreting our medical condition to the point of letting it disrupt our lives in very negative and lasting ways. Turning the tide on these two barriers to recovery might be just the thing that helps you find relief.

Article Provided By: WebMD

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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