FAQ Category: Pain

Acupuncture involves the use of tiny needles placed in the skin to stimulate acupuncture points in the body. Specific musculoskeletal problems like chronic headache and neck pain can be treated effectively this way.

Some people get immediate relief of painful symptoms with acupuncture. Others notice a gradual improvement over days to weeks. There are very few side effects from this treatment. Most of them are minor. Occasionally a patient will report local swelling, bruising, or skin rash around the area of a needle puncture.

Temporary redness of the skin may develop around the site of the needle. This may occur as a result of the release of hormones into the bloodstream. Rarely, patients feel faint from the needling, a condition called needle shock.

Acupuncture works so well for some conditions that doctors are starting to use it to combat the side effects of other treatment. For example, acupuncture helps reduce nausea in cancer patients receiving chemotherapy.

Most of the serious side effects of acupuncture such as lung puncture, internal bleeding, or increased pain are the result of improperly performed acunpuncture. Patients should only see an acupuncturist who is licensed or certified. It’s always a good idea to ask to see credentials.

Patients usually are given written instructions after any procedure, including steroid injections for piriformis syndrome. If you have any paperwork from your doctor’s visit, reread it for any specific instructions.

If you cannot find any instructions, contact the doctor’s office where you had this prodecure done. Ask for a review of the instructions. If you have access to a fax machine, have the form faxed to you.

Some general guidelines include avoiding high-intensity activities for 24-hours. This includes walking, aerobic exercise, using a stationary (or other) bicycle, sports activities, and any activity that requires repetitive use of that leg.

Most often, patients are encouraged to participate in general movement activities around the house and to avoid inactivity. Hot tubs, baths, and showers are restricted for at least the first 24-hours. Each physician may have individual restrictions beyond that.

You may experience some soreness or even a flare-up of symptoms from the injection. Give yourself some time to recover before jumping right back into activities and exercise. Stretching (when advised by the physician) must be done slowly and gently to avoid irritating the nerve again.

The sciatic nerve is a large nerve that starts in the low back and goes down the back of the leg from hip to foot. As it travels through the buttocks area, it passes out of the pelvis through the a hole called the greater sciatic foramen. Once it goes through this hole, it passes just below the piriformis muscle (PM).

In a small number of people (approximately 15 per cent), the sciatic nerve actually passes through the PM. Or sometimes, it is located above the PM rather than below it. In either case, contraction or tightness of the PM puts pressure on the sciatic nerve causing painful symptoms. This is just one of many possible causes of sciatica.

The pain occurs in the low back and/or buttock areas. It often travels down the leg to the knee and even down to the foot. Besides pain, patients with sciatica report numbness, weakness, and trouble moving or controlling the leg.

There are two sides to every coin. Whereas depression has become a very common disorder, especially in older adults, anti-depressants aren’t always the quick and easy answer.

On the other hand, depression is known to cause joint and/or muscle aches and pains. An antidepressant is certainly less invasive than surgery to correct the problem. And if the X-rays show a mild case, then other conservative measures might be helpful.

Besides antidepressants, nonsteroidal antiinflammatory drugs (NSAIDs) may be helpful. Physical therapy to improve posture and spinal alignment may also help. Sometimes a local injection of steroids gives patients long-lasting pain relief.

Surgery is the most successful treatment for moderate to severe cases. But if there is a mental disorder of any type, surgery isn’t likely to make a big difference.

According to social research, some children do exactly as you suggest. Remember the story about the little engine who thought she could? She chugged up the long hill chanting to herself, I think I can, I think I can. And she finally made it!

People often perform the same way or according to their beliefs. If they have confidence in themselves and think they can do something, they are more likely to accomplish the task compared to someone with a low view of their own abilities.

The concept of overcoming obstacles and bad experiences is based on a person’s belief in their own abilitites. This is called self-efficacy. Anyone (child or adult) with a high sense of self-efficacy is more likely to succeed. The opposite is also true. People with low self-efficacy are more likely to give up in defeat.

This is a good question and one that is highly debated by many people on both sides. The use of opioids for control of chronic non-cancer pain has increased by as much as 600 per cent in some countries. The availability of new drugs and advertising efforts of drug companies are two main factors in this change.

Denmark is one country with very high rates of regular opioid usage. The National Institute of Public Health in Denmark has started a study of the long-term effects of opioid use. Their first report shows that chronic pain patients taking opioids may not have any better pain control or function than nonusers.

With the potential for addiction and other negative effects, these researchers are calling into question the long-term use of such drugs. Their study showed no difference in quality of life between opioid and nonopioid users. And opioid users were more likely to be inactive, out of work, and on disability.

Short-term use to control pain or try to break the pain cycle may still have some merit. Anyone taking these drugs must be aware of the possible dangers and risks linked with long-term use. Besides addiction, there is evidence to suggest a negative impact on the immune system and the reproductive system.

If you decide to try this treatment, stay in close contact with your doctor. Report any unusual symptoms and the need for higher doses to obtain the same pain control. These are red flags of tolerance and dependence possibly leading to addiction.

A recent study in Germany showed acupuncture for chronic neck pain to be more effective than routine medical care. It was administered by physicians so the cost was more, too.

Another study from England had similar results using acupuncture for headaches. Most studies don’t include patients with both headache and neck pain in order to avoid too many factors.

Some of your decision may depend on the cost of each acupuncture session in your community. Sometimes acupuncture is performed by anesthesiologists or other highly trained physicians. The cost is likely to be more than when acupuncture is done by a nonphysician such as a nurse or layperson.

If you can get the results you want in a short amount of time, then acupuncture is likely worth the extra money. If the treatments extend beyond a three-month period of time (two to three sessions per week), then the cost may increase more than the benefit.

Dysport® (also known as Reloxin) is a type of botulinum type A toxin (Botox). You may have heard about Botox treatment for cosmetic purposes. It is currently being used in Germany and other European countries for the treatment of chronic pain conditions such as myofascial pain syndrome (MPS).

Botox appears to reduce painful symptoms in the muscles by blocking nerve endings that signal pain messages to the brain. It also has muscle relaxant properties. The two effects combined together seem to help patients with chronic muscle pain.

Long-term studies have not been done yet to see if the positive effects will last.

European studies have not investigated the use of multiple injections of Dysport®. Most studies have been small in number using a single injection of this product.

Dysport® is currently only available in Europe and slightly different from Botox®, which is available in the U.S. Dysport® isn’t expected to be available in the U.S. until 2008.

Botulinum type A toxin (BoNT-A) or Botox has been used in research trials for myofascial pain syndrome (MPS). Some studies have used Botox® while others have used a product called Dysport®. This product is not the same as Botox®. Dysport® has three times the dosage of Botox®.

Both types of botulinum type A toxin have been shown effective. Pain is reduced and sometimes eliminated. The benefit isn’t immediate but occurs about four to six weeks after the treatment.

Some scientists have questioned whether it’s just the needle being inserted that gives the pain relief. Studies to look at this question compared injections of lidocaine (numbning agent) versus just dry needling. Patients receiving the lidocaine had much better reduction in their pain levels.

More study is needed to find out what works and why. Botox injections are not routinely available for this problem. Most of the research being done on using Botox for MPS is taking place in Europe.

Patients are advised not to expect immediate pain relief. In about half the cases, patients notice a change within the first two weeks after injection. Many patients continue to notice gradual improvement over the next six months. Some patients even report continued gains up to a year later.

In some cases, symptoms get worse for a day or two after the injection. The average person gets pain relief three to four days later. If you’ve had a compressed disc for a long time, scar tissue or adhesions can form in the area where the injection goes.

When this occurs, a flare-up can occur after the injection. The air that is injected with the steroid puts pressure on the spinal nerve causing increased pain and other neurologic symptoms such as numbnes, tingling, or weakness. Many people do get good results with steroid injection, so it’s a good option when other conservative treatment has failed.

There are no studies comparing the results of lumbar nerve block to acupuncture. Both have been shown to help patients with low back pain. Research is still needed to identify which patients would do best with each type of treatment. Predictive factors might include age, gender, diagnosis, education level, or work status.

With acupuncture, tiny needles are used to stimulate acupuncture points. Nothing is injected into or under the skin. With a nerve block, a local anesthetic similar to novacaine used by your dentist is injected into the lumbar spine. This drug is mixed with a steroid to reduce inflammation and swelling around the nerve root.

The idea of a nerve block is to stop the pain messages from the nerve to the spinal cord and up to the brain. Some experts have suggested that just putting needles into the area is all that’s really needed. There’s some evidenc to suggest this may be true but it hasn’t been proved yet for all types of patient problems.

Talk with your doctor about your situation. You may want to try acupuncture first since it is less invasive than having a nerve block. If you don’t get the results you want, then a lumbar nerve block is still an option.

Research suggests there are some patients who “catastrophize” their pain. This means they focus on it, search endlessly for a cure, and lose the ability to pay attention to anything else.

Many of these patients persist in looking for a solution to their pain even though they don’t believe it’s possible. This type of negative coping style often results in greater disability and loss of function.

In fact studies show that people who find meaning in life despite their pain pay less attention to their pain. They are able to focus on other goals and activities in daily life.

Pain researchers are looking for ways to identify patient coping styles. They hope to match the patient up with realistic solutions to their pain. If a cure isn’t possible, then the goal is to find some other acceptable solution to the problem of chronic pain.

Right now, behavioral counseling along with trying different conservative treatment methods is the best hope patients have for reduced pain or increased function while still having the pain.

Patients who accept that pain cannot be cured must set new goals for themselves. The goals must be realistic and attainable. By reorienting yourself to new goals, you will begin to make sense of your life and the problem of your pain.

Experts refer to this less rigid style of coping as accomodative. Chronic pain patients often persist in seeing the only solution to their pain as a “cure.” When this is the center of their problem solving method, no other solutions are possible.

Now that you’ve moved away from this style of thinking, you can begin to explore alternate solutions to the problem of your pain. For some patients, that means increasing their activity despite the pain. For others it is a matter of thinking more about the meaning of life in a positive way despite the pain.

Taking your primary focus off the pain will help you reach your goals. If you set easy-to-reach goals at first, then you can make new goals. Slowly, by reorienting yourself to different goals, controlling the pain becomes less important.

For people who tend to catastrophize pain, it’s a natural response to assume others are in greater pain than they actually are. Caregivers such as your husband who perceive their own pain as excessive may become overly concerned about others’ pain. This may be what you are observing.

Nurses and doctors use a variety of ways to measure pain in older adults who are cognitively impaired. Sometimes dementia is the problem. Others suffer from strokes or other neurologic disorders.

For patients who can see but can’t speak, a verbal scale is used. The patient is shown the scale and asked to point to the number that matches their pain. For example, zero is no pain and one is slight pain. The highest number on the scale is a six for pain as bad as it can be.

Sometimes the only way to know is by observed behavior. The patient may become agitated or confused. If confusion is a normal part of the dementia, then watch for increased confusion. The person in pain may moan, gasp, or cry out. Breathing may become more labored. The patient may refuse to move or move slowly by bracing against or holding onto furniture.

Sleep disturbance, weight loss, and depression are other signs of uncontrolled pain or pain that is too much for the person to bear. It may be helpful to make an appointment with the doctor. Take a list of concerns, observations, and questions. You may not have an answer right away but this will help set a baseline for later comparison.

Health care professionals may observe verbal and facial expressions that indicate a patient is in pain. Grunts, sighs, and moans are examples of verbal cues showing that the person is in pain.

How the patient moves his or her body may also give good clues as to the intensity of the patient’s pain experience. For example, arching the neck and back or clenching the jaw may be signs of moderate to severe pain.

Other patients may use facial expressions, hand clenching, or body rocking to show the same thing. When rating pain, the patient may be asked questions to show frequency, intensity, and duration of the symptoms. Frequency (how often it happens), intensity (how strong it is), and duration (how long it lasts) give objective data to help measure the pain experience.

Number of body movements or facial changes may be counted by an observer to get similar data. All of this information can be used to measure progress or improvement in a patient. Sometimes it’s useful to help others see when patients need skills to manage their chronic pain.

Pain that lasts longer than the expected time for the injury is called chronic pain. Some experts say this starts at the end of two months. Others suggest three months as the turning point. Still others use six months as the dividing line between acute/subacute and chronic pain.

There are many theories about chronic pain — how it happens and why it happens. The answers to these questions still remain a mystery. Personality, temperament, and levels of anxiety and security are part of the mix.

People in pain with strong and secure attachments to others are usually better able to face and deal with their pain. This ability is called pain self-efficacy. People who are insecure and anxious have lower levels of pain self-efficacy. They are more likely to experience pain-related disability.

Knowing there are links between anxiety, levels of pain self-efficacy, and attachment style makes it easier to direct treatment. If you know you are a high-anxious individual, early psychologic and behavioral therapy may be helpful in avoiding chronic pain.

Ask your doctor for a referral to a behavioral psychologist who treats patients with chronic pain. According to the most recent research in this area, you may be able to avoid becoming a chronic pain patient yourself.

There are actually many different kinds of injections used to control or relieve painful conditions. You may have to ask for more specific information to find out what’s being used and why.

It’s possible she is receiving acupuncture. Acupuncture is a Chinese practice that has been around for centuries. It’s been used for everything from hangovers to allergies to headaches and other body pains. Tiny needles are placed along specific pathways called meridians. The goal is to release energy for healing and to restore normal function. It has few negative side effects.

Prolotherapy is another form of injection used with back pain patients. A solution is injected into the ligaments around the spine and pelvis. The idea is to cause growth of tissue. This could be done through an inflammatory reaction. The result may be to form new ligament and tendon tissue alongside the body’s natural ligaments and tendons. In some cases, it may just cause scar tissue to form. Either way, the area is “tightened up”. This gives the patient increased stability and may reduce pain.

Steroid injections are often used to interrupt the pain-spasm cycle by numbing the area and reducing inflammation. These injections can be placed inside the spinal canal or inside joints. Only a limited number can be given due to long-term side effects.

One last type of injection are trigger point injections. Trigger points (TrPs) are spots in the muscle and fascia that are overly irritated. TrP injections are usually combined with stretching exercises. Getting rid of the trigger points seems to alleviate the symptoms as well. The number of injections must be limited because local muscle damage from scarring can lead to more problems.

Hypnosis is an altered state of consciousness. The patient is responsive to suggestion and may even respond involuntarily. It has been used for a wide range of problems from addiction to performance anxiety.

Hypnosis is often used to reduce or eliminate feelings of fear, dread, or anxiety. Hypnosis can be used with chronic pain patients. New research shows that hypnosis can ease painful experiences by defusing the emotional response to it. Waiting and watching for pain or other symptoms to come back may actually bias the person toward feeling those responses just to get it over with.

Hypnosis won’t change the cause of the problem. But it can help you manage pain or unpleasant symptoms caused by the condition. There may be other treatment options that work as well. Relaxation, biofeedback, aromatherapy, and acupuncture are just a few of the other options to consider.

Doctors have found that pain control is a major key to success after orthopedic surgery. With less pain the patient is more likely to get up and move around. There’s less chance of blood clots, infection, scarring, and other complications.

Patient-controlled analgesia (PCA) is a fairly new method used after surgery to help control pain. It does just what it says — allows the patient to decide when the pain is no longer tolerable.

Most PCA devices are preprogrammed in several ways. First, when the button is pushed only a predetermined amount of drug is released. Second, most devices limit how much the patient actually gets. The device may be set to allow no more than one full dose per hour. When the patient pushes the button in between doses, nothing happens.

You can always discuss pain control with the nurses or doctors. Some things to keep in mind are that patients do get a certain placebo effect from pushing the button. In other words, even if no drug is released, the patient feels better because he or she thinks it’s working.

Second, if your mother-in-law isn’t complaining of excessive pain and she’s getting out of bed and moving around, then she may not need anything else. But if her movement is impaired because of pain, then oral medications are often used along with the PCA.

If she can’t sleep at night she may need a mild sedative. Find out from the nurse what’s been ordered for her and let them know what you’ve noticed. Getting good pain control is important in the early days after surgery and helps ensure earlier discharge.

Your concern is very admirable. Many people whose driving is impaired by pain, alcohol, depression, or dementia are unable to even ask this important question.

There are some studies that point to an increased risk of car accident for people who have chronic low back pain. Similar studies are needed to assess the effect of pain on people from other conditions such as chronic headache, neck pain, or nerve conditions.

Scientists who study driving behavior say that chronic pain may have similar effects on memory and attention as alcohol. A group of adults with chronic pain studied in the Netherlands had the same driving impairments as someone with an 0.80 percent blood alcohol level. An alcohol level this high is linked with three times the number of car accidents.

Chronic pain patients have a worse driving performance compared to normal, healthy adults. Older adults (65 years old and older) in pain seem to have a higher accident rate, too. Women in this group have the highest rate of motor vehicle accidents.

The statistics may not be enough to tell you to get off the road but your own concern is enough to follow-up with some testing. Talk to your doctor or the highway patrol about their recommendations.