Category: Painful Conditions

ABDOMINAL MYOFASCIAL PAIN

Overview

Myofascial pain is a term used to describe inflammation of the muscles. This inflammation can occur anywhere in the body including the abdominal area. The pain is often found in the upper abdomen just below the ribs or in the lower portion of the belly near the pubic bone. Most people with this disorder find the pain begins or increases when these muscles are stressed. Women may feel the pain coming from the vaginal area due to pelvic muscle irritation. Men can develop this problem after hernia surgery because it leaves the muscle less flexible due to scar tissue.

Diagnosis

Abdominal pain can result from a variety of disorders. The doctor will conduct a careful history and physical exam. The doctor may possibly order blood tests, urine analysis, and X- ray studies like ultrasound or computed tomography (CT scan) to rule out diseases affecting the internal organs. Once internal problems have been eliminated, the most likely diagnosis is fibrositis or abdominal muscle inflammation. This diagnosis can be confirmed through a physical exam, which shows the muscles to be painful to light touch. There are no X- ray or laboratory studies that determine if a patient has abdominal myofascial pain. These tests are only useful to rule out serious internal problems.

Treatment

In many cases, doctors can prescribe nonsteroidal anti-inflammatory drugs like Motrin and/or muscle relaxants for some relief. Heat and massage can also be helpful in relieving some of the pain, but will not do anything to improve the underlying condition. Injection of the muscles with local anesthetics and anti-inflammatory drugs can control long-term pain by decreasing the underlying irritation of the muscles. In addition, there are times when the cause of the pain comes from a group of nerves in the lower abdomen. In these cases injections may be given in the abdomen where the nerve is trapped in a scar, or in the back where it originates. Injections are usually given as a series of three over a period of weeks. All procedures can be given under light, intravenous sedation so there is no discomfort. If injections fail to relieve the pain, the doctor may prescribe an external electronic nerve stimulation device (TENS unit). These units work only for abdominal pain and not for pelvic or vaginal pain. While they do not cure the underlying problem, they can bring pain relief as long as they are worn. Physical therapists place these devices on patients and provide the necessary instruction for long-term use. Patients occasionally benefit from a behavioral and psychological analysis to determine whether there is something in their lifestyle or behavior contributing to the pain. This testing can reveal the emotional impact the pain is having, and whether it is aggravated by psychological or emotional problems. Some patients find biofeedback, stress reduction and muscle relaxation therapy beneficial for reducing symptoms aggravated by stress and emotional tension.

Prevention

• Stress reduction
• Avoid smoking
• Maintain ideal body weight

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OCCIPITAL NEURALGIA

Overview

This disorder is a type of headache with discomfort noted at the back of the head, beginning at the base of the skull and radiating upward toward the top of the head. The symptoms can occur on either side of the head, or it can include both sides. The symptoms can be sharp, spasm-like pains that occur at different intervals. It is caused from irritation of the occipital nerves, which begin at the back of the head and extend to the top of the head. Occipital neuralgia is caused by inflammation or injury to these nerves. It can also be caused by excessive muscle tension in the muscles at the back of the head through which these nerves pass.

Diagnosis

A physical examination will usually show signs of increased tenderness in the tissues at the base of the skull and at the top of the spine. Doctors can use X-rays to determine whether there is any narrowing of the vertebra at the top of the spine, where the occipital nerves pass to the back of the head. The best test to confirm occipital neuralgia is an injection of anesthetic, called a nerve block, given at the base of the skull around the occipital nerve itself. If blocking the occipital nerve results in resolution of the symptoms, the diagnosis of occipital neuralgia is usually confirmed.

Treatment

One of the greatest concerns to doctors treating this problem is to make sure that these symptoms do not indicate an increase in intracranial pressure within the skull, which could signal a vascular, infectious or other significant problem. Some patients will find temporary relief from the pain with the use of non-steroidal anti-inflammatory drugs and muscle relaxants. Physical therapy exercises will also provide some limited effectiveness. Doctors believe the best approach for long-term relief is the use of nerve block treatments. In some cases, an injection of local anesthetic combined with medication to reduce inflammation can result in long-term relief following a series of treatments. At times, the pain at the base of the skull is related to other disorders or arthritis in the joints of the upper portion of the spine. Doctors may use nerve block injections around these structures to help in the treatment of occipital neuralgia. Surgery can sometimes provide relief for several months, but most patients find the pain may return. Surgery is usually reserved as a last option. Some patients will find additional help through a combination of muscle relaxation techniques, known as biofeedback, in conjunction with physical therapy that focuses on manual therapy to the muscles at the back of the neck and head.    Newer block treatments at the occipital nerves can also be utilized for long-term treatment at appropriate intervals.

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OSTEOPOROSIS

Overview

Osteoporosis is a disease in which bone mass decreases. Osteoporosis literally means “porous bone” because the bones have less substance and are less dense. As bone mass decreases, susceptibility to fractures increases. A fall, a blow or lifting a heavy object that would normally not strain us, can easily cause a broken bone in somebody with osteoporosis. The spine, the wrist and the hip are the most common sites for osteoporosis fractures. This disorder is particularly common in females. It affects more than half of the women over the age of 45 and over 90 percent of women over the age of 75. It has been called the silent disease because it begins without symptoms when we are much younger. Osteoporosis is six to eight times more common in women than in men. There are a number of risk factors for osteoporosis:

• Female gender
• Post menopausal women
• Early menopause before age 45
• White, Caucasian or Asian
• Low calcium intake
• Lake of physical exercisse
• Family history of osteoporosis
• Cigarette smoking
• Excessive use of alcohol

The symptoms of osteoporosis prior to a bone fracture are:

• Occasional back pain
• Loss of height or curvature of the upper back

Treatment

The doctor may prescribe estrogen replacement after menopause for women who are at risk for osteoporosis. Menopause occurs naturally in most women by the age of 50, or earlier if the ovaries have been removed by surgery. Estrogen reduces the amount of calcium taken out of the bone and slows or halts postmenopausal bone loss. It cannot, however, restore bone mass to pre-menopausal levels. Once osteoporosis develops there are drugs that may be beneficial to slow bone breakdown. Your doctor can help you develop a program that will best treat and prevent further osteoporosis.

Prevention

• Avoid smoking
• Calcium intake between 1,000 – 1,500 mg/day
• Proper strength training
• Regular proper physical activity
• Moderate to no alcohol consumption

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TRIGEMINAL NEURALGIA

Overview

This pain occurs in branches of the trigeminal nerve that courses along the sides of the face. The trigeminal nerve arises at the side of the head and has three branches that extend on the upper aspect of the face, around the eye, the cheek and along the jaw. Trigeminal neuralgia involves irritation along one or more of these branches of the trigeminal nerve. These symptoms of trigeminal neuralgia result in development of highly sensitive areas, usually along the side of the cheek or jaw.

Diagnosis

Physicians will examine the face to determine the sensitive points in an effort to help determine which branch or branches of the trigeminal nerve are involved. They will be careful to distinguish this disorder from other disorders that cause facial pain, such as shingles. Doctors should complete a comprehensive ear, nose and throat exam to eliminate the possibility of other disease processes. X-ray studies that are used to diagnose TMJ (Temporomandibular Joint Disorder) are often used. An MRI may find an underlying cause within the head such as multiple sclerosis or other disorders. Sometimes laboratory studies will be used to rule out the possibility of an underlying infection. In many cases, the use of nerve block procedures or the injection of anesthetic medicine around the branches of the trigeminal nerve will help confirm the diagnosis of trigeminal neuralgia.

Treatment

For some patients the use of oral medications is typically used to relive the symptoms. Nerve block treatments, usually containing a combination medication with anti- inflammatory medications are used independently or in conjunction with oral medications. For some patients with trigeminal neuralgia, surgery is utilized to treat the affected branches of the nerve giving rise to the symptoms and offer more permanent relief.

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POST THORACTOMY PAIN SYNDROME

Overview

While surgery and surgical procedures have become specialized and involve as little tissue damage as possible, they nonetheless involve the cutting, removing and suturing of skin, muscles, nerves and other structures. Therefore some surgical procedures can cause chronic pain due to the trauma of the procedure. Post thoracotomy pain is an example of pain associated with the surgical procedure. Doctors define post thoracotomy pain as pain that returns or persists around the surgical incision for at least two months after the surgery. The pain is generally located along the chest wall. Patients who have post thoracotomy pain describe it as achy-like, burning or sharp. Pain can result from entrapped nerve fibers in the area of the scar tissue.

Sometimes a neuroma or painful lump of nerve tissue can form at the tip of a nerve in the chest wall where it has been cut during surgery. Pain from the muscles in the chest or shoulder may contribute to post thoracotomy pain syndrome as well. If the thoracotomy was performed to remove a tumor involving the lining of the chest or the chest wall, continued pain may indicate tumor recurrence.

Diagnosis

Doctors will use a physical examination to confirm a painful area near the surgical scar and to map the area of irritation. A CT scan of the chest sometimes helps determine if a tumor has reoccurred. Doctors may use a kind of nerve block or injection of anesthetic medications around a neuroma or nerve in the chest wall to help confirm the diagnosis.

Treatment

Some patients benefit from oral non-steroidal anti-inflammatory medications with the addition of pain medicine. Long-term relief is often obtained from the use of nerve blocks given into a neuroma, local anesthetics and anti-inflammatory medications. Other nerve block treatments can be given along the path of the various nerves in the chest, which contribute to the pain after thoracotomy surgery. Sometimes nerve stimulation procedures are used to help relieve pain along the chest wall. Physical therapy exercises may be utilized to regain the ability to perform normal daily activities.

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