Information on chronic pain and addicton

Christopher Frandrup, M.D., DABPM, FIPP

Category: Information (Page 1 of 2)

Is Pain Hereditary?

Is Pain Hereditary? | Allpria.com

Is Pain Hereditary?

Chronic pain is a complex medical condition with no easy answers. While acute pain can often be traced to one particular injury or illness, why acute pain turns into chronic pain long after the accident occurs remains a mystery. This mystery is the focus of a new study that attempted to answer the question: is pain hereditary?

Is pain hereditary?

A report in the journal PAIN®, the official publication of the International Association for the Study of Pain (IASP) published by Wolters Kluwer, looked at this question in-depth. Researchers visited with families to investigate the role genetics might play in chronic pain. Amanda L. Stone of Vanderbilt University and Anna C. Wilson of Oregon Health & Science University developed a framework of chronic pain transmission, writing:

“Such a framework highlights chronic pain as inherently familial and intergenerational, opening up avenues for new models of intervention and prevention that can be family-centered and include at-risk children.”

To be clear, this report does not indicate a clear genetic marker for pain. The report looks at not only genetic evidence but also environmental factors. This framework includes five specific ways in which chronic pain risk might be passed from parent to child.

Is pain hereditary?

Researchers believe that nearly half of the risk of chronic pain can be genetically linked.

Is pain biological?

The report found that neurobiological development in children could be affected by a parent’s chronic pain, especially in early, formative years.

Is pain social?

Children with a parent in chronic pain may be more prone to “maladaptive” behaviors such as negative thinking and catastrophizing (exaggerated response to or worries about pain).

Is pain practical?

How parents in pain interact with their children seems to play a role in chronic pain transmission. Parents in pain may not be as active or display as much warmth towards their children. They may also be more permissive or inconsistent in their rules and parenting due to pain level fluctuations.

Is pain environmental?

Simply living in an environment where pain is a daily event can be stressful. Add in the high cost of chronic pain and a parent’s inability to contribute to the household. Children may be affected by this stress for years, well into adulthood.

Researchers Stone and Wilson created this framework to help understand the complex ways in which chronic pain is passed down from parent to child. Their work does not quite answer the question “Is pain hereditary?” They looked to see more if pain was prevalent across generations in families and to figure out what factors influenced that.

Genetics and disc degeneration study

Other studies have specifically looked for a genetic link in pain across generations. A study out of King’s College London found a specific gene that is connected to degeneration of discs in the lower back. This degeneration is connected to an increased risk of age-related lower back pain.

Dr. Frances Williams, senior lecturer from the department of twin research and genetic epidemiology at King’s College London, summed up the genetic link, noting:

“We have performed, using data collected from around the world, the biggest genome-wide association analysis of lumbar disc degeneration (LDD). We know that people whose discs wear out are at increased risk of episodes of lower back pain, but normal human discs are hard to get hold of to study so until now our knowledge of normal human biology was incomplete. We have identified a gene called PARK2 as associated with LDD. We have shown that the gene may be switched off in people with the condition.”

Research on pain perception in families

Other research into the hereditary link to pain found that genetics may play a role in the perception of pain itself. Tobore Onojjighofia, MD, MPH, with Proove Biosciences and a member of the American Academy of Neurology, looked at over 2,700 people with chronic pain. All of these patients were taking opioids for pain.

He asked participants to rate their pain as follows on a scale from one to ten:

  • Low: One, two, or three
  • Moderate: Four, five, or six
  • High: Seven, eight, nine, or ten

Patients who rated their pain as zero were not included in the findings.

Of the study participants, 9% had low pain perception, 46% had moderate pain perception, and 45% had high pain perception.

Researchers compared the ratings to the presence of certain genes.  They looked for variations in the DRD1, COMT, OPRK, and DRD2 genes. Their findings indicated certain commonalities in gene variants, including:

  • Low pain perception: The DRD1 gene variant was 33% more prevalent in the low pain group compared to the high pain group
  • Moderate pain perception: COMT and OPRK variants were 25% and 19% more prevalent than in those with a high pain perception
  • High pain perception: DRD2 variant was 25% more common than in those with moderate pain

These results indicate that even if pain itself is not hereditary, pain perception may be. The findings of this study confirm earlier research done by King’s College London. This study showed that those with increased pain sensitivity had less variation in their genes than people who were less sensitive to pain.

What the research means for patients

Studying genetic links to pain can lead to more targeted and individualized treatments tailored to an individual’s DNA. Ruth McKernan, chief scientific officer of Pfizer’s research unit noted that research findings on genetic links to chronic pain can result in tremendous progress for effective pain medication, saying:

“This study demonstrates the value of collaborative efforts between academia and industry. The genetic influence on normal pain processing in human volunteer populations will add to other approaches and help us prioritise potential new mechanisms for treating pain.”

Has your family experienced intergenerational chronic pain? And what do you think: Is pain hereditary?

Why Pregnancy Back Pain Occurs (And What To Do About It!)

Why Pregnancy Back Pain Occurs (And What To Do About It!) | PainDoctor.com

Why Pregnancy Back Pain Occurs (And What To Do About It!)

It’s no secret that pregnancy brings sweeping changes in a woman’s body from head to toe, but what about from front to back? Approximately 75% of pregnant women experience some degree of pregnancy back pain. Here’s why, and here’s what to do about it.

Why pregnancy back pain occurs

It seems obvious to state that growing a child brings about tremendous changes in a woman’s body, but pregnancy back pain is not only about the what, but also the where. Pregnancy shifts a woman’s center of gravity as the baby grows. The average woman gains between 25 and 40 pounds during pregnancy. A growing baby puts pressure on blood vessels and nerves in the pelvis and lower back. Little by little, weight shifts forward. Without thinking about it, it is common for women to compensate for this shift by moving their shoulders back. After nine months of this compensation, the lower back begins to feel compressed and tight.

Ligaments and connective tissues are also getting more fluid and relaxing to make way for shifts in the pelvis that occur during childbirth. This results in tremendous structural instability within the body, including the spine.

Another reason for pregnancy back pain is muscle separation in the abdomen. As a woman’s belly expands, the rectal abdominis muscles (two parallel muscles on the abdomen) separate to make room. This separation weakens the abdominal muscles in general. Weak abdominal muscles increase the chances for pregnancy back pain.

What to do about pregnancy back pain

While it is common, pregnancy back pain does not have to be inevitable. There are several things pregnant women can do from the moment they see two pink lines to prevent pregnancy back pain.

Exercise

In the first trimester of pregnancy, when hormones are coursing through your body and wreaking havoc, it can be difficult to get motivated to get moving. Add fatigue to hormones and it’s a perfect storm of zero motivation.

Exercise, however, is imperative for a healthy pregnancy in general and to prevent pregnancy back pain specifically. When fatigue is high and hormones are raging, simple pelvic tilts to keep the muscles of the abdomen toned may be the only thing you can do. As you begin to feel better and more energetic, increase your exercise. Aim for low-impact workouts that engage the entire body. Think swimming, walking, and biking for full-body toning.

Prenatal yoga is also a great way to keep the back strong and healthy and to prepare for childbirth. Prenatal yoga focuses on breath as well as movement and can also help deal with the stress that may arise throughout pregnancy.

Improve your posture

Exercise will help with energy levels and keeping stress levels low, but poor posture when you aren’t exercising can still result in a sore back. If you are used to standing with poor posture, it can be challenging to re-train your body to stand correctly, but since it is already changing, pregnancy is a great time to make adjustments.

As a general rule, imagine that, when viewed from the side, there is a straight line that connects the ears, top of the arm bones, hip bones, knees, and ankles. Many of us slump forward, removing the curve in our backs, but pregnant women often have an exaggerated curve due to the weight of the baby. Learning how to stand correctly aligned helps the spine do the major work of supporting the body and allows the muscles to work more effectively with each other.

Try chiropractic care

Chiropractic care during pregnancy can be a great tool to help treat pregnancy back pain when it arises. When looking for a practitioner, ask if they have experience treating pregnant women, both before and after giving birth. Labor and relaxed, loose ligaments and tendons allow bones to actually shift during the powerful contractions of labor. Quality chiropractic care can help relieve back pain during pregnancy and may also help shorten labor, delivery, and recovery time post-partum.

Consider acupuncture

Acupuncture is an ancient Chinese medical practice that works with energy flow in the body. Practitioners believe that any sign of illness or pain in the body is a result of blockages in energy. These blockages are released when acupuncturists place hair-thin needles into specific points on the body to release the energy and allow it to move freely.

There is evidence that acupuncture can help with back pain, so it stands to reason that acupuncture could provide relief from pregnancy back pain. Large scale studies have shown that at the very least it provides relief similar to some medications. This is a plus for pregnant women who don’t want to (or can’t) take certain types of medicines. Additionally, acupuncture has few, if any, side effects and is rated as safe for people of all ages and conditions.

Consider drug-free post-partum solutions

Even if you have not experienced pain during pregnancy, pregnancy back pain may occur postpartum. Major shifts occur in the musculoskeletal system during pregnancy, labor, and delivery. A new study has found that osteopathic manipulative therapy (OMTh) in postpartum women can help reduce their back pain by as much as 70%.

Jennifer Caudle, DO, assistant professor of family medicine at Rowan University School of Osteopathic Medicine, pointed out that this type of care can relieve pregnancy back pain with little or no risk to the new mother, improving quality of life for both mother and child. She noted:

“Women who’ve recently given birth are rarely studied beyond screening for postpartum depression and delivery complications, even though it’s well documented that low back pain is a common issue that hinders their quality of life during an already stressful time. This study shows that osteopathic manipulative therapy can relieve their pain without medication that could be passed to a breastfeeding infant.”

Pregnancy back pain is common but not inevitable. If you have experienced (or are currently experiencing) pregnancy back pain, what worked to help you find relief?

Arthritis

What Is Arthritis?

Arthritis is a common condition that affects various components of the body including the cartilage, joints, bones, muscles, and connective tissues. Arthritis impairs an individual’s normal movement and functioning. There are over 100 different forms of arthritis that affect people of many different ages. The three most common types of arthritis are: osteoarthritis, rheumatoid arthritis, and juvenile arthritis.Osteoarthritis affects approximately 27 million people in the United States, making it the most common form of arthritis. Osteoarthritis is a degenerative disease that results when the cartilage surrounding the joints begins to wear down. The degeneration of the cartilage causes the bones to rub against each other, leading to joint pain, stiffness, and other issues within the affected joint. The cause of osteoarthritis is not fully understood; however certain risk factors that are associated with an increased risk of developing osteoarthritis have been identified, including increasing age, obesity, previous joint injuries, overuse of a joint, weak musculature, and certain genetic factors. Osteoarthritis can affect any joint in the body however it most commonly affects the joints in the hands, knees, hips, and spine.

The symptoms associated with osteoarthritis tend to develop gradually and usually include joint pain and stiffness that occurs after rest and improves with physical activity. Osteoarthritis is sometimes referred to as a progressive, degenerative joint disease as it is a disease that worsens over time. In the early stages of osteoarthritis, the pain may be moderate and intermittent, and may not have a negative impact on an individuals’ daily functioning. While some patients may not progress past the early stage of the disease, other patients progress to later and more debilitating stages of the disease. In the later stages of the disease the joint pain and stiffness worsens. For individuals with severe cases of osteoarthritis, normal activities such as walking, climbing stairs, and even sleeping can become difficult. At the present time there is no cure for osteoarthritis but maintaining a healthy weight, staying active, and other treatment options may help to reduce pain, improve joint functioning, and slow the progression of the disease.

Rheumatoid arthritis is another common type of arthritis, affecting approximately 1.5 million people in the United States. Women are three times more likely than men to develop this disease. Women are usually affected by rheumatoid arthritis between the ages of 30 and 60, while men are usually affected later in life. Rheumatoid arthritis is a chronic inflammatory disorder that is the result of inflammation of the membranes that make up the joint tissue lining. Rheumatoid arthritis causes joint pain, swelling, stiffness, and the joints are often warm to the touch. Rheumatoid arthritis can often lead to severe joint damage. Rheumatoid arthritis is commonly seen bilaterally, meaning that if a joint on one side of the body is affected by inflammation, the same joint on the other side of the body is usually affected as well. The severity of the symptoms associated with rheumatoid arthritis varies and can also change from day to day. However, if symptoms suddenly increase it is called a flare. When a flare occurs, it can last for several days to months.

Rheumatoid arthritis is considered an autoimmune disease. Under normal circumstances the body’s immune system acts to protect the body by attacking and destroying foreign substances, including bacteria and viruses. However, in patients who suffer with rheumatoid arthritis, the body’s immune system mistakenly attacks joint tissue. This abnormal immune system reaction results in inflammation that cannot only result in joint damage, but in organ damage as well. Early diagnosis of rheumatoid arthritis is essential in order to prevent severe joint damage and organ damage.

Juvenile arthritis is a term that is used to describe various inflammatory and autoimmune diseases that can develop in children below the age of 16. Juvenile idiopathic arthritis is the most common type of juvenile arthritis. In order to be diagnosed with this condition, the child must be experiencing the initial stages of swelling in at least one joint, for at least six weeks. At the present time there is no known cause of juvenile arthritis. Furthermore, there is no evidence to support the idea that certain foods, toxins, or allergies can cause children to develop juvenile arthritis. However, there is some evidence to suggest that there may be a genetic predisposition to developing this disease. An accurate diagnosis of juvenile arthritis is essential for proper treatment.

Epidemiology And Impact Of Arthritis

Approximately 50 million individuals in the United States are affected by arthritis, making it a serious health concern in the country. While many people think that arthritis only affects the elderly, it can affect individuals of any age. It has been reported that two-thirds of individuals who suffer with arthritis are under the age of 65. Moreover, approximately 300,000 children are afflicted by this painful condition. It has been estimated that the prevalence of arthritis will continue to rise over the next two decades. By 2030 it is estimated that approximately 67 million individuals in the United States will develop arthritis.Of the individuals affected by arthritis, approximately 36 million are Caucasian American, 4.6 million are African American, and 2.9 million are Latin American or Hispanic. Arthritis is also the leading cause of disability in the U.S. and results in more mobility issues than heart disease, cancer, or diabetes.

Arthritis has begun to place a burden on the economic and healthcare systems in the U.S. Arthritis is responsible for approximately 44 million physician appointments and over 900,000 hospitalizations each year. Reports investigated patients between 2003 and 2010 and found that certain surgical procedures that are used for the treatment of arthritis are associated with longer hospital stays, especially when they are performed on patients with later stages of the disease. These results may be due to the fact that patients in the later stages of the disease waited too long to seek out treatment, or that they suffered from certain types of arthritis. When arthritis is diagnosed and treated in the early stages of the disease, if surgery is required, it may be done as a day surgery procedure or require a one-day stay as opposed to requiring a hospital stay of a longer duration. Longer hospitalization times result in an increased need for healthcare personnel and equipment, and therefore higher medical costs.

In particular, for patients aged 18 to 64 who suffer from rheumatoid arthritis reports have shown that between 2002 and 2011 there has been a considerable increase in costs for these patients. An increase in prescription medications combined with a decrease in hospitalizations, as well as an increase in other costs such as sick leave and disability may be responsible for the increased costs. Additionally, since 2009 there has been an increase in the cost of medications used to treat rheumatoid arthritis, which may also contribute to the rising costs associated with this particular subset of arthritis patients.

Causes Of Arthritis

There are a variety of factors that can influence an individuals’ susceptibility for developing arthritis. In order to understand how arthritis often develops, understanding the way a joint works is beneficial. Joints are areas where bones intercept and the ligaments within the joints hold the bones together. Ligaments are comprised of tissue that contracts and expands, similar to elastic. Ligaments help to keep bones in place. Conversely, surrounding muscles contract and relax to allow for movement of the joint. Cartilage is another type of tissue that covers the surface of bones and helps to prevent bones from rubbing against each other and becoming damaged. Synovial fluid fills that space within the joint and helps to encourage mobility by nourishing the cartilage and the joint.The various components of the joint are all susceptible to damage from wear and tear from everyday use as well as from injury or acute traumatic events. When an individual is diagnosed with arthritis it may be indicative of a problem with the cartilage, synovial fluid, or immune system. The type of arthritis that an individual is diagnosed with provides an idea as to whether cartilage has worn away, synovial fluid has deceased, an abnormal immune response has occurred, that an infection is present, or that a combination of these activities has occurred.

Osteoarthritis is a chronic disease that involves damage to the cartilage located within the joint. The cartilage damage may be the result of wear and tear over time or may be the result of an injury. When the cartilage is damaged, it is unable to provide cushioning for the joint. If there is enough damage to the cartilage, there is a significant risk of bone rubbing against bone. This can lead to significant pain, especially with physical activity, in addition to a loss of joint flexibility.

On the other hand, rheumatoid arthritis is characterized by an abnormal immune response within the body to the joints. In particular, the immune system begins to attack the synovial membrane that lines that joint capsule and encloses the structures of the joint. As a result of this abnormal immune response, the synovial membrane becomes inflamed and swollen. If rheumatoid arthritis is left untreated it can progress from mild joint damage to serious organ damage.

While wear and tear, injury, trauma, and abnormal immune responses can lead to arthritis, research has shown that arthritis is often caused by a combination of various factors. The factors that have been associated with an increased risk of developing arthritis, include:

  • Weak muscles
  • Genetic predisposition
  • Overuse of a joint
  • Certain autoimmune conditions
  • Increasing age
  • Female sex
  • Certain allergic reactions or infections
  • Obesity
  • Previous joint injury
  • Physically demanding occupation
  • Repetitive heavy lifting
  • Certain foods

Symptoms Of Arthritis

Typically, patients suffering from arthritis will report joint pain and stiffness. These symptoms tend to get worse with age or as the disease progresses. Other relatively common symptoms of arthritis include:

  • Joint pain or stiffness during or after physical activity
  • Joint pain or stiffness after prolonged rest
  • Joint tenderness
  • Morning joint stiffness
  • Decreased range of motion
  • Grinding sound or sensation within the joint
  • Redness around the joint
  • Swelling of the joint
  • Warmth of the joint
  • Weight loss
  • Tiredness

Symptoms that are common in patients who suffer from osteoarthritis include:

  • Joint pain or stiffness (especially in the lumbar spine, hips, and knees)
  • Joint pain or stiffness that increases with rest or overuse
  • Joint pain or stiffness after rest that begins to resolve with movement
  • Joint pain or stiffness that worsens during or after physical activity or at the end of the day

Symptoms that are common in patients who suffer from rheumatoid arthritis include:

  • Chronic joint pain
  • Fatigue
  • Warmth of the joint
  • Swollen and red joints
  • Prolonged morning joint stiffness
  • Inflammation of the joints of the hand and wrist

Symptoms that are common in patients who suffer from juvenile arthritis include:

  • Chronic joint pain
  • Morning joint stiffness
  • Joint swelling
  • Joint tenderness
  • Irritability
  • Eye pain, eye redness, or blurred vision
  • Rash
  • Fever (persistent)
  • Limping

In patients who are very young, it may seem that the child cannot perform motor skills and activities that they were previously able to perform.

Symptoms of arthritis can vary drastically among patients. Symptoms may be temporary for some patients while others will develop chronic arthritis symptoms. The severity of arthritis pain can range from relatively mild to debilitating, and may be intermittent or constant. At times patients with arthritis will report that they have some days that are better than others when it comes to their arthritis symptoms.

Diagnosis Of Arthritis

osteoarthritis

There are a number of types of arthritis, including osteoarthritis, that are usually diagnosed following a medical assessment by a physician. The assessment typically includes a detailed history of symptoms as well as a physical examination. Diagnostic imaging tests, such as X-ray or magnetic resonance imaging (MRI), may be utilized to visualize the affected joint. If certain types of arthritis, such as rheumatoid arthritis or juvenile arthritis, are suspected, lab testing of urine, blood, or synovial fluid may also be performed to help confirm the diagnosis. Furthermore, lab testing of these body fluids helps to rule out other conditions that may be contributing to a patient’s symptoms.

In regard to rheumatoid arthritis, blood tests that reveal specific markers are necessary to properly diagnosis this condition. The specific markers that are revealed by these tests include various antibodies that are present in about 70 to 90% of individuals who suffer from rheumatoid arthritis. These specific markers sometimes circulate in the blood of individuals who do not suffer from rheumatoid arthritis, however the specific markers are usually present in higher levels in individuals suffering from this painful condition. The results of the lab testing can be used in conjunction with the medical history, physical examination, and any imaging performed to make an accurate diagnosis.

In regards to juvenile arthritis, there is no single lab test that can exclusively confirm this disease. In many patients the lab testing that is used reveals the presence of inflammation or possibly an infection; however, these results do not generally provide a physician with information to help make a clear diagnosis. Therefore in order to make a proper diagnosis of juvenile arthritis a detailed medical history combined with a thorough physical examination that includes special imaging tests is essential.

Early diagnosis of arthritis is essential in order to receive treatment that may help to reverse or prevent disease progression. If arthritis is left untreated it can lead to permanent damage to the joints, ligaments, cartilage, and bones. This damage can result in deformity and decreased mobility that may be irreversible. Moreover, arthritis can damage other structures within the body, including vital organs. Early diagnosis of arthritis can also help to prevent the need for invasive types of treatment, including surgery.

Treatments For Arthritis

At the present time, no cure has been developed for arthritis so treatment focuses on providing pain relief and improving joint functioning. Treatment for arthritis initially includes pain medication and non-steroidal anti-inflammatory drugs (NSAIDs), protective devices (e.g. braces), cold and hot packs, and exercise. Many patients suffering from arthritis pain believe that they should avoid exercise. However, there is a significant amount of research that suggests that certain forms of endurance training and resistance exercises are actually beneficial for individuals suffering from the early stages of both osteoarthritis and rheumatoid arthritis.There is also a body of evidence that has found that weight management, exercise, and avoiding injuries to joints helps to reduce the occurrence of osteoarthritis and may also help to avoid flare-ups of arthritis symptoms. It has been found that weight loss in individuals who are overweight is especially effective. For every pound of weight loss, there is four pounds of pressure being taken off the knees. This can help to prevent or reduce inflammation and joint injury.

If there is no response to initial treatment methods, physical therapy may be recommended. Research has shown that physical therapy; in addition to regular physical activity is beneficial for arthritis sufferers. It has been found that individuals who suffer from arthritis often exercise less than the recommended amount to maintain a healthy lifestyle. Physical therapists often use techniques that alter normal behaviors to address both the biological and psychosocial aspects of an individual’s life. Patients are educated by their physical therapist on arthritis and the benefit of engaging in a healthy lifestyle that includes physical activity. Current statistics show that individuals who are in the later stages of arthritis, on disability, or that have strong familial and social support are more likely to receive the services of a physical therapist.

Often a combination of treatments provides arthritis symptom relief. However, for some individuals their arthritis symptoms fail to respond to treatment or serious damage has occurred and surgery is necessary.

Proper Diet

In addition to a healthy lifestyle consisting of exercise and physical therapy, there is some evidence to suggest that a healthy, nutritious diet can help to minimize the complications that are associated with arthritis. In particular, certain foods including those that contain trans and saturated fats tend to increase inflammation in the body and should therefore be avoided.

It is suggested that the following foods should be limited in the diet or completely avoided:

  • Fatty pork or beef
  • Chicken skin
  • Dairy foods (full fat)
  • High sugar foods
  • Baked goods (made with white flour)
  • White rice
  • White bread
  • Foods that contain palm oil or palm-kernel oil

It is recommended that these foods be replaced by healthier food options, including:

  • Lean cuts of pork and beef
  • Skinless turkey and chicken
  • Fat-free or reduced-fat dairy products

Certain types of fish and nuts contain omenga-3 fatty acids, which have been demonstrated to reduce arthritis symptoms, particularly rheumatoid arthritis symptoms. Furthermore, extra virgin olive oil contains high levels of a naturally occurring compound, oleocanthal, which helps to prevent and reduce inflammation associated with arthritis. Oleocanthal has also been shown to block the inflammatory pathways in the same manner that anti-inflammatory medications, including aspirin and ibuprofen do. Moreover, vitamin C, bioflavonoids, and carotenes are antioxidants that can help to protect the body from the negative effects of inflammatory compounds. Foods containing these antioxidants have the ability to help in the prevention of arthritis, slow the disease progression, and help to reduce pain.

It is recommended that the following healthy food options be added into the diet of individuals suffering with arthritis:

  • Fish (e.g. herring, salmon, sardines, mackerel, rainbow trout, and anchovies)
  • Flax seeds (ground)
  • Chia seeds
  • Soybeans
  • Walnuts
  • Vegetables and fruits with high levels of vitamin C (e.g. oranges, grapefruits, guava, strawberries, lemons, pineapples, bell peppers, broccoli, kale, sweet potatoes, Brussels sprouts, carrots, butternut squash, spinach, and sweet red peppers)

Guided Imagery

Alternative treatment options that are available for individuals suffering with arthritis include relaxation and guided imagery. Visualization, also referred to as mental imagery, is the act of an individual imagining themselves engaging in a certain action. It is also referred to as guided imagery as a professional trained in this technique often helps to guide an individual through the imagined activity.

Studies have shown that by mentally rehearsing an activity prior to actually executing the needed motor skills to complete the activity has the ability to improve future activity performance. The strength of visualization is dramatic, as research has shown that imagining an activity prior to engaging in it has a more significant effect on overall performance than by engaging in motor and strength exercises, when there is no history of guided imagery. Recent research also alludes to the fact that visualization is an effective technique that shows that the mind has the ability to transform mental imagery into improved physical activity performance.

Treatment With Medication

Over-the-counter medication may be recommended for patients suffering from mild to moderate pain due to their arthritis. However, prescription medication may be required for patients suffering with severe or chronic arthritis symptoms. Currently there are over 100 different types of medications available for the treatment of various forms of arthritis. The first-line treatment, from a pharmacological approach, are non-steroidal anti-inflammatory drugs (NSAIDs). Physicians usually recommend NSAIDs due to their ability to reduce joint inflammation, thereby helping to reduce pain. NSAIDs that can be taken orally are a very common prescription for the treatment of inflammation related to arthritis. Analgesic medication may also be recommended to treat pain that is related to arthritis; however, this type of medication does not offer the same anti-inflammatory effects that NSAIDs do.

When inflammation occurs, harmful fluids that contain enzymes that cause pain typically build up. NSAIDs help to reduce the buildup of these pain-inducing enzymes. These medications also help to block the release of pain-inducing enzymes, which enhance inflammatory reactions.

Many patients consider more invasive types of treatment for their arthritis symptoms. There is some evidence that suggests that corticosteroid injections can help reduce the degree of inflammation, in addition to providing pain relief for arthritis sufferers. Corticosteroids, including cortisone and prednisone, may be recommended in an effort to reduce inflammation, and in some cases to suppress an individual’s immune system. This is particularly true in cases where the immune system has begun to attack the joints of the body, as is seen in individuals affected by rheumatoid arthritis. There are a variety of corticosteroid injections and treatment plan regimens that are available that usually involve multiple injections for optimal pain relief.

Joint injections are a common procedure that is often recommended for patients suffering with arthritis. This procedure involves injecting medication directly into a joint, which helps to relieve inflammation and pain. Joint injections usually involve injecting an anesthetic combined with a corticosteroid into the affected area. The anesthetic helps to reduce pain while the corticosteroid helps to reduce inflammation. This procedure is relatively quick and simple to perform and some patients have reported immediate relief of pain symptoms. Joint injections can be repeated multiple times in order to enhance symptom relief. Various studies have shown that patients who receive joint injections report significant pain relief, increased range of motion, and improved quality of life.

Medial branch blocks are another type of treatment that can be offered to patients suffering with arthritis pain. A medial branch block involves injecting medication into the facet joints, which are structures that connect the vertebrae within the spinal column. Within the facet joint are networks of medial branch nerves that are responsible for the transmission of pain signals to the brain when nerve tissue is damaged or inflamed. When an individual begins to experience chronic arthritic pain, a medial branch block is usually recommended to help destroy the medial branch nerves, thereby blocking the transmission of pain signals to the brain. This results in a reduction, or elimination of pain. The use of medial branch blocks to relieve pain associated with arthritis has been well documented as an effective treatment option. The use of medial branch blocks has been shown to provide significant pain relief and improved mobility.

Joint injections and medial branch blocks may be used in cases where the physician suspects that surgery may be necessary. These treatment options may be used to provide some pain relief to these patients but can also provide physicians with information regarding how the body and nerves may react to certain surgical procedures. Diagnostic injections usually involve nerve blocks where a needle is inserted into the spinal column at specific areas where the affected spinal nerves are located. Fluoroscopy, or X-ray guidance, is used to ensure proper needle placement. Once proper placement is confirmed, a catheter is inserted through the needle to deliver pain medication directly to the spinal nerves that are believed to be responsible for the arthritic pain. An anesthetic and corticosteroid, or a substance that disintegrates nerve tissue, is injected to provide pain relief. This procedure leads to prolonged pain relief by blocking pain signal transmission.

Diagnostic nerve blocks provide the physician with an idea of whether a particular surgery will be effective for reducing arthritic pain for periods longer than the nerve block itself. A diagnostic nerve block is usually performed a minimum of two times. If the patient experiences greater pain relief with repeated injections, there is an increased probability that they will experience positive surgical outcomes. Prior to recommending surgery for arthritic pain, physicians usually like to observe the results of at least two diagnostic nerve blocks.

Osteoarthritis Treatment

Medication can be taken as needed for patients who are suffering from pain that is associated with the early stages of osteoarthritis. If the disease begins to progress, the physician may recommend occupational therapy or physical therapy to help maintain muscle strength and joint functioning. When the pain becomes severe, mobility becomes limited, or the patient becomes unable to perform daily activities, physicians may recommend more aggressive treatment options, including surgery.Patients suffering with osteoarthritis are advised to engage in regular physical activity and maintain a healthy lifestyle. If patients follow these recommendations in the early stages of the disease, it may help to prevent the disease from progressing. Patients who limit their physical activity due to pain may end up with weak joints and increased joint stiffness which can add to the pain that they are experiencing. Engaging in regular physical activity helps to strengthen muscles, which helps to protect the joints. Additionally, avoiding excessive weight gain is also important for patients who suffer with osteoarthritis as extra weight places added pressure and stress on the joints of the body. Other aspects of osteoarthritis management include eating a healthy diet, maintaining a good sleep schedule, and maintaining good mental health.

Rheumatoid Arthritis Treatment

rheumatoid arthritis

The goals of treatment for rheumatoid arthritis are to reduce pain and inflammation, and slow disease progression. Over-the-counter pain medications and prescriptions medication are often quite effective for reducing rheumatoid arthritis symptoms. Medication that specifically works to suppress abnormal immune system responses are also effective for the management of rheumatoid arthritis and may help to lead to a state of remission. This means that the inflammation associated with this disease completely ceases or is extremely low. Even if a patient experiences a state of remission they will still be monitored for inflammatory markers with regular lab testing as well as a physical examinations. Monitoring these patients at regular intervals will help to determine how well the treatment is working for their condition. Additionally, if the symptoms of rheumatoid arthritis begin to re-occur, the physician may adjust the medication dosage or prescribe a new type of medication.

Patients suffering with rheumatoid arthritis are also advised to remain physically active as this will help to keep their joints flexible. Additionally, it is advisable that these patients also receive physical therapy in order to learn appropriate types of exercises that they should perform in addition to learning proper techniques of the exercises to avoid potential injuries. In addition to exercise and physical therapy, patients with rheumatoid arthritis are encouraged to consume a nutritious diet and maintain a healthy weight. Patients that follow these recommendations may notice a dramatic improvement in their pain levels.

Juvenile Arthritis Treatment

The goal of treatment for juvenile arthritis is to reduce inflammation and pain in an effort to improve a child’s quality of life. A combination of a healthy diet, physical activity, medication, and eye care is usually recommended. The treatment plan for a child with juvenile arthritis is developed specifically for their case and often involves multiple healthcare practitioners. The healthcare team may include an ophthalmologist, dentist, pediatric rheumatologist, nurse practitioner, and physical therapist. The healthcare team will evaluate and monitor a child’s condition and adjust the treatment plan as needed. This is vital as each child responds differently to arthritis treatment.Non-steroidal anti-inflammatory drugs (NSAIDs) and analgesic medications as well as disease-modifying anti-rheumatic drugs (DMARDs) are the two types of medications that are commonly used to treat juvenile arthritis. NSAIDs and analgesic medication are used due to the fact that these medications help to relieve pain and inflammation. Disease-modifying anti-rheumatic drugs are used because they may cause the disease to go into a remission state, thereby helping to prevent joint damage. In rare cases medication doses or different types of medications may be prescribed until the child begins to respond positively to treatment. Certain medications that are prescribed to children affected by juvenile arthritis affect the immune system and/or cause undesirable side effects; therefore these children are monitored closely for adverse reactions.

Conclusion

Arthritis is a term that is used to describe over 100 conditions and diseases that affect individuals of all ages. The three most common types of arthritis are osteoarthritis, rheumatoid arthritis, and juvenile arthritis. Common symptoms of all of these conditions include joint pain, swelling, stiffness, and weakness. Osteoarthritis is caused by degeneration that may be the result of normal wear and tear of the joint or by an acute traumatic event. Rheumatoid arthritis is caused by an abnormal immune response, whereby the body begins to attack the joints of the body. The cause of juvenile arthritis is unknown, although most children who develop this disease are genetically predisposed to this condition.There is currently no cure for arthritis, but a variety of treatment options exist to help manage the pain and inflammation associated with this condition. Typically, conservative treatment methods including medication, exercise, physical therapy, and hot and cold compresses are recommended. Patients with more severe or chronic symptoms may be advised to undergo more invasive treatment options including corticosteroid injections, medial branch blocks, and possibly surgery.

Most cases of early stage arthritis can be successfully managed with conservative treatment options. Early diagnosis and treatment of arthritis is essential for optimal treatment outcomes. Receiving early treatment is particularly important for patients with rheumatoid arthritis as it can help to prevent deformities, disability, and organ damage. Symptoms of chronic pain and inflammation should not be ignored; patients are encouraged to speak with their physicians if they begin to experience any joint pain or stiffness as they may be suffering from the early stages of this painful condition.

References

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  2. Erdem E. Prevalence of chronic conditions among medicare part a beneficiaries in 2008 and 2010: are medicare beneficiaries getting sicker? Prev Chronic Dis. 2014;11:E10.
  3. Fleming A. Drug management of arthritis in the elderly. J R Soc Med. 1994; 87(Suppl 23):22-25.
  4. Gvozdenović E, Dirven L, van den Broek M, Han KH, Molenaar ET, Landewé RB, Lems WF, Allaart CF. Intra articular injection with corticosteroids in patients with recent onset rheumatoid arthritis: subanalyses from the BeSt study.Clin Rheumatol. 2014; in press.
  5. Huscher D, Mittendorf T, von Hinüber U, Kötter I, Hoese G, Pfäfflin A, Bischoff S, Zink A; for the German Collaborative Arthritis Evolution of cost structures in rheumatoid arthritis over the past decade. Ann Rheum Dis. 2014; in press.
  6. Iversen MD, Chhabriya RK, Shadick N. Phys Ther. Predictors of the use of physical therapy services among patients with rheumatoid arthritis. Phys Ther. 2011;91(1):65-76.
  7. Javadi S, Kan JH, Orth RC, Deguzman M. Wrist and ankle MRI of patients with juvenile idiopathic arthritis: identification of unsuspected multicompartmental tenosynovitis and arthritis. AJR Am J Roentgenol. 2014;202(2):413-417.
  8. Messier SP, Mihaiko SL, Legault C, et al. Effects of intensive diet and exercise on knee joint loads, inflammation, and clinical outcomes among overweight and obese adults with knee osteoarthritis: The IDEA randomized clinical trial. JAMA. 2013;310(12):1263-1273.
  9. Mori M, Takei S, Imagawa T, Imanaka H, Nerome Y, Kurosawa R, Kawano Y, Yokota S, Sugiyama N, Yuasa H, Fletcher T, Wajdula JS. Etanercept in the treatment of disease-modifying anti-rheumatic drug (DMARD)-refractory polyarticular course juvenile idiopathic arthritis: experience from Japanese clinical trials. Mod Rheumatol. 2011;21(6):572-580.
  10. Nessen T, Opava CH, Martin C, Demmelmaier I. From clinical expert to guide: Experiences from coaching people with rheumatoid arthritis to increased physical Phys Ther. 2014;in press.
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  12. Scott IC, Tan R, Stahl D, Steer S, Lewis CM, Cope AP. The protective effect of alcohol on developing rheumatoid arthritis: A systematic review and meta-analysis. 2013;52(5):856-867.
  13. Superio-Cabuslay E, Ward MM, Lorig KR. Patient education interventions in osteoarthritis and rheumatoid arthritis: A meta-analytic comparison with nonsteroidal anti-inflammatory drug treatment. Arthritis & Rheumatism.1996;9(4):292-301.
  14. Vitiello MV, McCurry SM, Shortreed SM, Balderson BH, Baker LD, Keefe FJ, Rybarczyk BD, Von Korff M. Cognitive-behavioral treatment for comorbid insomnia and osteoarthritis pain in primary care: The lifestyles randomized controlled trial. J Am Geriatr Soc. 2013;61(6):947-956.
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Vestibular Migraine – Migraine With Vertigo

Vestibular Migraine - Migraine With Vertigo | Allpria.com

Vestibular Migraine – Migraine With Vertigo

Migraine is one of the most common chronic conditions, with migraine sufferers outnumbering both asthma and type 1 diabetes sufferers in the U.S. While many use the term migraine to identify every severe headache, there are actually seven types of migraine headaches. Some of those can then be broken down into other types, often by their symptoms. This week we are looking at a rare sub-category of migraine: vestibular migraine.

What is a vestibular migraine?

Migraine headaches in general share some symptoms. Most migraine sufferers experience four distinct phases of migraine headache:

  • Prodromal: This is the days or hours before a migraine. Symptoms could include fatigue, irritability, and mood swings.
  • Aura: Not everyone will experience the aural stage, but if they do, sensory changes occur, as does sensitivity to sound and light.
  • Attack: The attack phase is the acute period of migraine. Symptoms such as pain, fatigue, and nausea occur.
  • Postdromal: After an attack has passed, sufferers may feel a sense of euphoria. They may also be tired.

Vestibular migraine is a type of migraine headache that adds a complicated symptom: dizziness and vertigo. The causes of this type of migraine are unclear, but there is a connection between migraine and the inner ear. The inner ear is the organ that affects balance and equilibrium. For a person who sufferers from vestibular migraine, this equilibrium is thrown off during a migraine. Instead of pain being the main symptom of migraine, dizziness is most prominent.

Other symptoms of vestibular migraines include:

  • Vertigo
  • Poor balance
  • Muted hearing
  • Ringing in the ears (tinnitus)
  • Extreme motion sensitivity

Any of these symptoms can lead to fatigue and nausea, but in general pain is not present. A vestibular migraine can last anywhere from days or hours.

Dr. Susan Broner, an attending neurologist at Roosevelt Hospital’s Headache Institute in New York City, describes the symptoms of this migraine like this:

“Vestibular migraine is a variant of migraine in which instead of headache being the most predominant feature, dizziness is. Patients usually say that out of nowhere they got extremely dizzy and don’t feel like they’re on even ground. Some describe a spinning or rocking sensation. They have light or sound sensitivity and get nauseous or throw up.”

Causes of vestibular migraines

There are several theories as to what causes vestibular migraine.

  • Blood vessel spasm: Vascular spasm in the brainstem may cause vertigo.
  • Changes in the neurotransmitters: As with most migraines, patients with vestibular migraine often have changes in serotonin levels.
  • Disturbance in the cerebellum: Changes in the metabolism of the cerebellum may be a cause of vestibular migraine.

Patients who are extremely sensitive to changes in sensory detail – sound, light, and movement – are more likely to experience vestibular migraine than any other type.

Women are three times more likely to experience any kind of migraine than men, leading researchers to hypothesize that fluctuations in hormones play a role in causing migraines. A genetic predisposition may also be a cause of this type of migraine.

Getting a diagnosis for vestibular migraines

Diagnosis of vestibular migraine can be complicated. As with most migraines, accurate patient reporting is key. In the case of vestibular migraine, there may be a misdiagnosis of Meniere’s disease or benign positional vertigo. Dr. Broner pointed out that although these conditions share similarities, these migraines are not quite the same, noting:

“There may be an overlap between Meniere’s and vestibular migraine. With vestibular migraine, people are exquisitely sensitive to motion, but they seem to be more sensitive to migraine triggers like fluorescent lighting or drinking wine. All the migraine triggers affect these patients; vestibular migraine is a disorder of exclusion—you have to rule out seizures and structural abnormalities—so it’s one of the clues.”

In other words, vestibular migraine is often diagnosed by process of elimination. In order to do this, doctors take a thorough patient history that includes any family incidence of migraine of any type. They may administer a CT scan or MRI to look for brain activity that indicates vascular involvement.

Because this type of migraine can involve the areas in the ear that deal with balance, patients may be referred to an otolaryngologist (ear, nose, and throat doctor) or an audiologist (to test for hearing loss or other symptoms of vestibular migraine).

Treatments for vestibular migraine

There are two types of treatments for this condition: preventative and reactive treatments.

1. Preventative

Preventative treatments for this type of migraine include identifying potential migraine triggers and removing them. These triggers can include:

  • Food: Certain aged cheeses, chocolate, and salt can be triggers for vestibular migraine.
  • Additives and preservatives: The additives and preservatives that keep processed foods shelf-stable can sometimes trigger migraine headaches. Monosodium glutamate (MSG) in particular has been associated with migraine, but other preservatives like sulfites and nitrates are also common culprits.
  • Drinks: Caffeine and alcohol should generally be avoided.
  • Stress: Chronically high stress levels can cause a number of different health problems, including vestibular migraine.

Other preventative measures for frequent or chronic vestibular migraine include the following medications:

2. Treatment for acute attack

For this type of migraine, many treatments during the attack phase include anti-emetics to control nausea and muscle relaxants.

Other treatments may include:

Vestibular migraine can be a seriously debilitating condition for those who suffer from it. Because it does not generally occur with pain, it is often misdiagnosed or underdiagnosed.

If you feel like you may be experiencing the symptoms of vestibular migraine, talk to your doctor about possible treatment options.

Marijuana can impair memory

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“Rocky mountain high” is a common phrase in Denver, CO but that transient high so sought after by pot-smokers may be doing long-term harm to their brains.  Researchers in Switzerland track the marijuana use of 3,400 users over 25 years and tested them on memory, mental processing speed and executive function.  The results are concerning. For each five years of pot use, 50% of smokers remembered one fewer of fifteen words from a numbered list.  That may seem like a small difference, but it is significant and may indicate direct toxic effects to neurons.

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