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Allodynia

What to know about allodynia

Someone who has allodynia feels pain from non-painful stimuli. For example, a person may feel pain from a light touch or when brushing their hair.
Allodynia can be a symptom of several different nerve conditions, or it can occur on its own.
Allodynia is not the same thing as an increased response to painful stimuli.
Some people feel extreme pain from something minor, such as a paper cut. Feeling increased pain or being hypersensitive to mild pain is called hyperalgesia.
Individuals with allodynia, however, feel pain when something is ordinarily painless.

Symptoms

Allodynia is characterized by intense feelings of pain with no clear cause.
Pain is one of the body’s protective mechanisms. It tells a person to stop doing something that is harmful.
For instance, a pain response causes a person to pull their hand away from a hot stove, preventing a severe burn. But people with allodynia perceive pain even though there is nothing harmful causing the pain.
The main symptom of allodynia is pain from non-painful stimuli.
Some people with allodynia may experience severe pain even from a few hairs brushing against their skin.
Symptoms can vary from mild to severe. Some people may feel a burning sensation while others feel an ache or squeezing pain.
Allodynia can limit the activities a person is able to do and decrease their quality of life. Common complications of allodynia include:
depression
anxiety
sleep disturbances
fatigue

Types of allodynia
There are three main types of allodynia, which are classified according to what causes the pain.
Regardless of the type of allodynia, pain is still the main symptom. Some people may only have one type of allodynia. Others may have all three types of the condition.
Types of allodynia include:
Thermal allodynia: Thermal allodynia causes temperature-related pain. Pain occurs due to a mild change of temperature on the skin. For example, a few drops of cold water on the skin may be painful.
Mechanical allodynia: Movement across the skin causes mechanical allodynia. For instance, bedsheets pulled across a person’s skin may be painful.
Tactile allodynia: Tactile allodynia, also called static allodynia, occurs due to light touch or pressure on the skin. For example, a tap on the shoulder may cause pain for someone with tactile allodynia.

Causes and risk factors

Something as simple as hair being brushed may cause intense pain to someone with allodynia.
The exact cause of allodynia is not known.
Allodynia may occur due to increased responsiveness or malfunction of nociceptors, which are a particular type of nerve.
Having one of the following medical conditions may also increase a person’s risk of developing allodynia.
Migraines: Migraines can cause debilitating head pain, but a headache is often not the only symptom. Migraines can also cause additional symptoms, such as nausea and sensitivity to sound and light. According to the American Migraine Foundation, up to 80 percent of people experience symptoms of allodynia during a migraine.
Postherpetic neuralgia: Postherpetic neuralgia is a complication of shingles, which is caused by the same virus that causes chicken pox. Shingles can cause damage to the nerve fibers, which leads to persistent nerve pain and is associated with allodynia.
Fibromyalgia: Fibromyalgia is a medical condition that causes widespread pain in the body. The cause of fibromyalgia is not known, but there does appear to be a genetic link in some instances. There also seems to be a connection between allodynia and fibromyalgia.
Diabetes: Over time, diabetes can cause damage to nerves, increasing the likelihood that a person will develop allodynia. Nerve growth factor (NGF) is essential to the nervous system, and some experts have suggested that diabetes can lower NGF levels. A recent study in rodents showed that low levels of NGF led to both hyperalgesia and allodynia.
Complex regional pain syndrome: Complex regional pain syndrome (CRPS) is a long-term pain condition that tends to affect one limb, typically after the person injures the area. People believe CRPS occurs due to problems with the nervous systems.

Diagnosis and when to see a doctor
There is not one specific medical test to diagnose allodynia. Instead, a doctor will perform a physical exam, take a medical history, and review a person’s symptoms.
Many common conditions can cause chronic pain, so doctors may need to rule out certain medical conditions before they can make a diagnosis of allodynia.
Various nerve sensitivity tests may also be performed to help make a diagnosis.
Anyone who experiences pain from non-painful stimuli, such as light touch, should see their doctor.
Dealing with chronic pain that develops after even the mildest touch can be frustrating and upsetting. Receiving an accurate diagnosis can help someone start the treatment and management process.

Treatment

Topical creams may help to treat the symptoms of allodynia. Recommended treatment will be based on the cause of the condition.
Currently, there is no cure for allodynia. Treatment is aimed at decreasing pain, using medications and lifestyle changes.
Pregabalin is a medication used to treat nerve pain associated with conditions, such as spinal cord injuries, diabetes, fibromyalgia, and shingles. It may also decrease pain in some people with allodynia.
Topical pain medications, such as creams and ointments containing lidocaine, may be helpful in some cases. Over-the-counter, non-steroidal medicines may also be effective.
Complementary approaches to pain management, such as acupuncture and massage, may not be tolerated as they involve touch and can lead to discomfort for a person with allodynia.
Treating an underlying condition that is causing allodynia may also help. For example, preventing migraines or treating migraines straightaway can help reduce the risk of allodynia symptoms. Getting diabetes under good control can also be helpful.
Some people might find that lifestyle changes, such as light exercise, a healthful diet, and getting enough sleep might help.
Research shows that smokers experience more chronic pain than nonsmokers. Quitting smoking can be beneficial on many levels, from improving circulation to decreasing inflammation.
Although living a healthful lifestyle will not cure allodynia, it can enhance overall health and help people with the condition cope more efficiently.
Identifying and decreasing pain triggers as much as possible may also reduce symptoms. It may not be possible to limit all the things that cause discomfort, but some changes may help.
For example, it might not be reasonable for someone to shave their head if brushing their hair hurts. But switching to a different type of brush or brushing it less frequently may be possible.
Similarly, if certain fabrics hurt the skin, a person can try clothing made of a different, less irritating material.
Stress may make the pain worse in some people. So, learning stress management techniques may also help.
Although stress reduction may not improve allodynia in every case, developing better stress management techniques can help a person cope with their condition.

Outlook
Allodynia is not life-threatening, but it can make daily life difficult and cause frustrating limitations. It can also lead to anxiety and other mental health conditions.
The outlook for people with allodynia varies depending on the severity of the condition. Taking a comprehensive approach to treatment can improve the outlook.
Using a combination of pain management techniques along with lifestyle changes may decrease symptoms of allodynia.
A holistic approach can also help someone feel more in control of their condition and improve their overall quality of life.

Last medically reviewed on August 10, 2017

Article Provided By: Medical News Today

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

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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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

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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

 

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Peripheral Neuropathy

Peripheral Neuropathy

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

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

 

Article Provided By: hopkinsmedicine

 

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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