Chronic Fatigue Syndrome

Chronic Fatigue Syndrome is one of the most discouraging things that can happen to you. You feel lousy all the time, and nobody can find out what is wrong with you. Sometimes health care professionals treat you like a crazy lady, and after a while you begin to wonder if they are right.

CFS really does exist. And you are not crazy. There’s a lot we don’t understand about this mysterious illness, but at least a million Americans have it. That is, about a million Americans meet the strict “research diagnostic criteria” for CFS. Another ten million or more have severe fatigue, but do not have all the accompanying symptoms. Women are four times more likely to have CFS than men are, and it most often begins in their 40’s or 50’s.

SYMPTOMS

People with Chronic Fatigue Syndrome are tired. They experience extreme fatigue, and it doesn’t get better with sleep. Stress or activity can make it worse. These people are unable to function at the same level of activity they are used to. There is no diagnostic test for CFS.

The “diagnostic criteria” for CFS are:

• Severe chronic fatigue for at least six months

• PLUS four or more of the following symptoms

o Poor short term memory

o Trouble concentrating

o Sore throat

o Tender lymph nodes

o Muscle pain

o Pain in more than one joint without redness or swelling

o Headaches

o Unrefreshing sleep

o Post-exertional fatigue that lasts more than 24 hours

• The accompanying symptoms must have persisted or recurred during at least six consecutive months, and started after the fatigue began

• There is no other discoverable cause for the fatigue

CAUSE

The cause of CFS is unknown. Some possibilities include immune system disorders, endocrine disorders, nervous system disorders, genetic factors, environmental factors, viral infections and others. One thing that has been established is that CFS is NOT caused by depression, although many CFS sufferers do become depressed.

MEDICAL TREATMENT

There is no definitive treatment for CFS, and what helps one person may not help another. For the most part, physicians treat the symptoms. Anti-inflammatory medications are given for pain. Antidepressants are used to treat depression if it is present. Antidepressants may also help with pain. Sometimes stimulants, such as modafinil (Provigil) provide some relief from the fatigue.

Physical therapy may be very helpful in dealing with pain and in determining a tolerable exercise regimen.

For the most part, treating CFS involves lifestyle changes to manage the fatigue. Techniques that help some people include:

• Keeping a diary to find out what times of day your energy normally peaks, so that you can schedule activities during those times. This also helps identify things that help or that worsen the fatigue.

• Massage therapy.

• Acupuncture.

• Chiropractic treatments.

• Therapeutic touch.

• Herbal treatments, such as ginko biloba.

• Omega 3 fatty acid supplements, such as fish oil or flax seed oil.

• Establishing a predictable daily routine.

• Pacing yourself.

• Avoiding stress.

• Getting some exercise every day.

• Expressing emotions, including the normal grief over the loss of energy and lifestyle, and depression.

• Getting good support. Sometimes a support group of other CFS sufferers helps.

• Stretching once or twice a day.

It may take some experimentation to discover what works for you. You will have to take charge of your own health if you have CFS; there is not much your doctor can do to help you. There is, however, a lot you can do to help yourself. You will have limitations, and you will have to learn to adapt to and live with those limitations, but having CFS isn’t a hopeless situation. You can still enjoy life and loving relationships while living within your limitations.

ABOUT THE AUTHOR: Penny Watkins is a freelance writer working for [http://pillspills.net]. She worked for over twenty years as a registered nurse, specializing in cardiovascular nursing.

Chronic Pain Management for Cancer Patients

Chronic untreated pain is debilitating, it dramatically affects a patient's ability to participate in daily routines and in some cases takes away their will to live. Tragically, many people are suffering chronic pain unnecessarily. This in part, due to them not being made aware of the importance of pain management and being shown the simple tools necessary to achieve it. Lack of knowledge regarding the benefits and side effects of available medication is also a factor.

Many patients associate morphine and methadone with drug addiction and are reluctant to take it due to their belief that it will cause them to become "high" or sedated, this and their attempts to brave out the pain, results in their pain spirally out of control. This could be prevented if they were informed that chronic pain effectively "uses up" medication and that these drugs when taken for the relief of pain associated with cancer, can dramatically reduce both the occurrence and intensity of pain, without causing sedation.

Not long after my husband's terminal cancer diagnosis, I observed that despite his medication, he was in considerable pain and this upset me greatly - determined to help him, I turned to the internet to learn about the progressive symptoms of his disease, the pain he would experience and methods available to control it.

One of the most important things I learned, was that in order to obtain the best possible pain control - medication must be taken at regular prescribed times, regardless of whether pain is or isn't present, effectively keeping in front of the pain.

I learned that there are different types of pain and that not all pain responds to the same medication; and how to measure intensity of pain and encouraged Brian to communicate to me - the type of pain he was experiencing and its intensity by using a pain scale. Brian soon realized the benefits of this - It was an immense relief for him- to know that I understood what he was experiencing and more importantly - that I could do something about it.

Despite the large amount of methadone Brian was taking; he remained active and alert, drove his car for eighteen months after diagnosis and was able to continue going fishing, which was the passion of his life. Keeping him out of pain became the reason for my existence and I was vigilant in giving him his medication at prescribed times.

There were many occasions when caring but uninformed loved ones and friends, said to me. "Brian does not need for you to be giving him medication at this time - he is not in pain". And I would patiently explain to them, that the reason Brian was not in pain, was because the regular medication he was receiving effectively allowed for him to remain in front of it.

Experience has taught me that knowledge is the key, to better quality of life, not only for the cancer patient but for those who care for them. My understanding of the stages and symptoms of Brian's disease, allowed for me to be one step ahead of its progression and gave me the opportunity to have medication and later, physical aids such as oxygen, wheelchair etc - on hand BEFORE Brian needed them. This alleviated much of the fear, pain and discomfort he would otherwise have suffered.

Pain Management - How to Survive Living With Chronic Pain

Pain is one way for the body to get our attention. It is like a wake up call from the grand reaper tapping you on the shoulder when you least expect it, but the fact is he has being tapping you on the shoulder for quite sometime, and you were busy looking left when he was standing on your right.

Now he is staring you right in the face and he keeps poking you with that machete causing you pain. Are you ready to make some changes?

I guess it is time to deal with him and learn how to take control of your pain by taking some positive action.

Survival Tips

Exercise on a Regular Basics

You don't have to start training for a marathon but get up of the couch and do what you can. Trust me you will feel a million times better if you are stretching and moving your body in some way. Exercise can improve your overall health and fitness, as well as your arthritis or joint and muscle pain.

Give Yourself Plenty of Rest

Sleep this is the time when the body takes the opportunity to do some well needed repairs, so if you are not sleeping then figure out why. If you feel like you need more sleep but there doesn't seem to be enough hours in the day, then try to manage your time. You will be amazed at the free time you can create when you manage your time more creatively. If pain is preventing sleep then try some relaxation techniques before you go to bed.

Try Massage

What's not to like about massage this is truly a gift to your self. You may try self massage or ask your doctor to recommend a trained expert in this area. Massage gives a wonderful feeling of relaxation to painful joints and muscles.

Try Relaxation Techniques

Learn how to relax. Most of us do not take enough time out to just breathe each day, pain effects most people emotionally and physically. Unfortunately one seems to feed of the other. Speaking of breathing this is one way to relax. When you take a deeper breath you bring more oxygen into the lungs creating more energy. Try to focus on each area of the body, one section at a time, while taking a breath relax the area you are focusing on.

Use Medication Wisely

It is easy for people who are suffering from chronic pain to over medicate when pain gets so unbearable nothing seems to offer relief. Remember the side effects from pain medication can be much worse than the pain itself.

Respect Your Joints to Prevent Further Injury

Get a clue if you keep using those joints the same way you did before they were inflamed then you are asking for trouble. Don't try to do activities that will aggravate your pain further prolonging your recovery.

Get Advice From Professionals

Leave it to the experts to give you the best advice, be it emotional or physical. But at the end of the day trust your body because the body knows best, and where there is pain there is a problem. Do take the time to do your own research and find out what works for you and your well being.

Chronic Pain Management Clinics

Pain management is one area of medicine which has seen several technological advancements across the globe. Spurred by this global happening, chronic pain management clinics in developing countries have also begun using novel techniques in the areas of pain imaging, pain assessment, and intervention for chronic pain management.

Chronic pain can refer to any type of pain that endures even after an injury has been healed, pain connected to any degenerative or relentless disease, long-standing pain for which the cause cannot be identified, or cancer pain. In general, pain that continues even after six months is chronic and requires treatment.

The diagnosis and treatment of a particular patient at a chronic pain management clinic usually requires the involvement of several specialists including anesthesiologists, psychiatrists, physiatrists, neurologists, and nurses. Several therapies are combined in order to at least make the patient feel more comfortable if the pain cannot be stopped, to help him/her return to work, to do away with his/her depression, and to improve his/her physical functioning. Thus, these therapies are medication, surgery, psychological counselling, therapies to stimulate the nerves, lifestyle changes, anesthesiological therapies, and rehabilitation.

Medication recommended for patients in chronic pain management clinics can vary from NSAIDS for pain that is not too bad to narcotic drugs for more severe pain. Physical therapy is one common therapeutic technique used in the management of chronic pain in such clinics. It involves training the patient to enhance his flexibility, endurance, and strength; to move in a way that is structurally correct and safe; and most importantly to handle pain. Therapeutic exercise is an important feature of physical therapy.

Another important technique used in chronic pain management clinics is Transcutaneous Electrical Nerve Stimulation (TENS). This technique provides relief for patients suffering from conditions such as arthritic pain or pain in the lower back, by the use of low-voltage electric current.

To sum up, once pain has become chronic, complete freedom from the pain is difficult. However, chronic pain management clinics, through the use of multiple techniques used in conjunction with one another, can help sufferers of chronic pain enjoy a happier and more active life.

How Pain Management Specialists Treat Chronic Back Pain and Headaches

Everyone experiences physical discomfort at some point in some part of their body whether it is due to injury, illness, or stress. But when those aches become a constant or a daily part of life, that is a sign of a more serious condition or problem that should be addressed. Two common types of pain are chronic back pain, which is when a patient experiences discomfort in the back for three months or more, and chronic headaches, which is when a patient experiences headaches at least 15 days a month. Over-the-counter medication can sometimes help the symptoms. For long-term relief, patients should seek a pain management specialist.

Chronic back pain is a common reason that people visit pain management specialists. Many times, this soreness is due to an injury that caused damage to the spinal column. Some kinds of spinal column damage include degenerative disc disease, compression fractures, disc herniation, and spinal stenosis. However, many times there is no clear cause of what is hurting the patient. When this happens, it is likely that the nervous system is mistakenly sending a signal of injury even though there is actually no damage at all. This misfiring of signals makes the patient believe there is damage that is not actually present. Pain management specialists who treat patients with chronic back pain will help identify the source of the patient's discomfort, offer an aggressive care program as an alternative to surgery, or, if surgery is necessary, they will uncover the areas that need surgical treatment and help rehabilitate patients after surgery. This type of treatment is beneficial because, in some cases, specialists are able to help patients to pinpoint the areas that hurt and psychologically address the misfiring of nervous system signals without having to undergo surgery.

Chronic headaches are another reason patients seek pain management treatment. The majority of people who suffer from these kinds of headaches experience either chronic migraines, which can predominantly affect one side of the head and cause a pulsating sensation throughout the head, or tension-type headaches, which are usually felt as a throbbing band across the forehead. These types of headaches can be depressing and debilitating to patients, causing them to be unable to attend work, spend time with others, and to sleep through the night. After many years of searching for a cure, doctors are now able to offer patients Botox injections that can reduce the frequency of agonizing headaches. These injections are normally given in the forehead and in the back of the head. Botox is believed to inhibit the processing systems in the brain that create migraines.

Those who suffer daily from chronic aches and strains now have hope that they can end their discomfort once and for all and enjoy the quality of life they deserve. Thanks to the dedication of hard-working doctors, the lives of patients who endure these torments can be drastically improved.

What Are the Symptoms of Myofascial Pain Syndrome?

People with Myofascial pain syndrome have chronic muscle pain in specific locations. This pain can sometimes be severe, and is caused by trigger points.

Trigger points are tightened bands within the muscle. They are switched on by a protective reflex - ie. when you are thrown suddenly to one side your muscles will to into spasm to protect themselves from being stretched too far.

The problem occurs when this muscle spasm is not turned off. Trigger points are spasms in the muscle that remain switched on. They can cause pain locally in the muscle or refer pain to other locations. For example, a trigger in the trapezius muscle of your shoulder can refer pain up your neck.

Myofascial Pain Syndrome describes when you have many of these trigger points actively causing you pain.

To break down the term - Myo is the Greek word for muscle. This is skeletal muscle that moves your joints and bones (as opposed to muscles that work automatically without you thinking like your heart.)

Fascia is the layer beneath your skin that covers all your muscles and joints. It acts like the glue that binds all these together. It does the important job of smoothing out movements by organising the individual muscles into groups which act together.

Syndrome is a word describing a collection of symptoms. This is quite different from a disease. A syndrome is a malfunction that isn't destructive and doesn't cause ongoing damage.

So the malfunction here is the muscles going into a protective spasm and then not releasing. Although Myofascial Pain Syndrome can be extremely painful, it doesn't cause long term damage and can be treated.

You can employ massage, acupuncture and myofascial release to help stop the pain. It's also important to examine your posture and workstation to see if you're causing stress and tension in your muscles that can lead to muscle knots being switched on.

There is a relationship between myofascial pain syndrome and fibromyalgia. People with fibromyalgia tend to have a lot of active trigger points.

In general, fibromyalgia pain is felt all over the body in a diffuse way, while myofascial pain syndrome is specific to a muscle or a group of muscles. The exact muscle or muscle group that's causing the pain can sometimes be difficult to track down without some knowledge of trigger points.

This is because muscles can refer pain, sometimes to surprising locations, and sometimes quite far from the trigger point itself.

Does Marijuana Work For Chronic Pain Management?

Is medical marijuana superior to prescription analgesics in controlling chronic pain? Chronic pain overall constitutes the single largest usage of medical marijuana. The opioid narcotics that are commonly used to treat chronic pain, like codeine, morphine, oxycodone, and methadone, are potentially addictive. Chronic pain medications may end up leading to tolerance with a need of increasing dosage to maintain effectiveness.

A substantial number of patients find that when treating their chronic pain with medical marijuana, they are able to eliminate or significantly cut down their opiate intake. THC and the other cannabinoids inhibit the acute responses to painful stimuli. They are effective at relieving chronic pain associated with nerve damage and inflammation. There aren't any large scale research projects looking at marijuana's pain relieving efficacy. But there are plenty of case reports showing that marijuana works well for peripheral nerve pain such as the phantom limb pain occurring after an amputation.

Marijuana blocks pain pathways in the central nervous system, but through a different neurochemical signaling system than opiates. Therefore opiates and marijuana may act together as complementary analgesic medications since they are acting in two different ways. Cannabiniods in marijuana may act directly on injured tissues by reducing inflammation around damaged nerves. An example of this would be with a patient who has post-laminectomy syndrome. After a compressed nerve is surgically freed up, the result may be impressive pain relief. However, after a few months to a year one may develop scar tissue around the nerve and have persistent leg pain which then has no further surgical answer.

This peripheral neuropathic pain is where it appears that marijuana treatment shines. Peripheral neuropathy from diabetes, HIV, post-surgical scarring, have responded well in case studies to medical marijuana. There is also a neuropathic pain that occurs in MS patients called allodynia which entails significant pain to a normally non-painful stimuli.

Opiates do not have clear indications for neuritis and neuropathy, but marijuana actually has been shown to relieve peripheral neuropathy due to HIV and diabetic neuropathy. THC has been useful for treating phantom pain with amputees, causalgias, neuralgias, and conditions like trigeminal neuralgia.

Medical marijuana has also found success with chronic cancer pain. A study at Univ. of Iowa found oral THC at 5 to 10 mg was as effective as 60mg of Codeine for terminal cancer pain relief.

One question that is obvious - Does marijuana alleviate pain simply because patients no longer care about it? Do the psychoactive effects of marijuana simply shift a patient's attitude about the pain and allow one to "sideline" it? Then the patient may focus on other things. Patients in case studies have stated that while taking opiates for chronic pain it tends to have a depression effect and other side effects such as constipation.

For a patient with debilitating diabetic or chemotherapy induced neuropathy, is it so bad if medical marijuana alleviates pain partially from acting directly on the inflamed and injured nerves and the other part by simply allowing patients the ability to focus on more pleasurable aspects of life?

It's estimated that 20% of Americans are afflicted with migraines. 3/4 of these are women. Back in the 1800's, cannabis was the migraine drug of choice. Many patients say that once the first sign of a migraine attack occurs, such as visual disturbance or ringing in the ears, smoking a joint averts the migraine attack.

What Are the Pain Management Options For Treating Chronic Low Back Pain?

Over 80% of Americans will suffer from back pain at some point in their lives. Within 3 months of onset over 90% of back pain goes away on its own or with conservative treatment, however, the other 5-10% will be left with chronic back pain.

Once back pain becomes chronic, patients have several options.

1) Living with the pain as it is - It's not mandatory to undergo treatment if it's endurable. Chronic back pain can act as a "pebble in one's shoe" and affect capacity to work, concentration, social life, and lead to depression.

2) Traditional medical treatment - This includes physical therapy with lumbar stabilization, core strengthening, and other therapeutic measures.

3) Medication management - The basics of medication include Tylenol, non-steroidal anti-inflammatories (Ibuprofen, Advil, Naproxen, etc), muscle relievers (Valium), and narcotics (Percocet, Oxycontin, etc). One needs to be careful of the doseage to prevent side effects (such as liver or kidney issues) along with addiction to narcotics.

4) Interventional pain management - Pain injections can help with pain relief dramatically and also decrease the need for pain medication. If a patient has a radicular component to the back pain (sciatica), then an epidural injection can be of benefit. If there is arthritis or inflammation in the facet joints, then facet injections can help. Medial Branch Blocks and Radiofrequency Ablation can help as well. As a last resort, a spinal cord stimulator can be considered, but this falls into the surgical intervention category.

5) Alternative treatments - More and more these types of treatments are becoming mainstream. Chiropractic manipulation is very common these days and there is some literature showing effectiveness for chronic back pain. Acupuncture and massage therapy can be helpful for pain relief as well. Spinal Decompression Therapy, which is intermittent spinal traction, has been shown in numerous studies to be effective too.

6) Surgical Intervention - If conservative treatments fail, surgery can enter the picture as an option. Surgical options can range from spinal fusion to artificial disc replacement. Results are variable, and compilations of spine surgery results show effectiveness to average right around 60%.

What to Expect From Pain Management?

People often erroneously think of treatment by a pain management specialist as consisting of only narcotic "pain killers."

However, the practice of pain medicine or pain management is diagnosis driven just like other medical specialties. Just as one goes to a cardiologist for an evaluation of heart disease and receives treatment based on a unique diagnosis, a visit to a pain management specialist results in unique treatment because every patient with pain is also different. The discipline of pain medicine is concerned with the prevention, evaluation, diagnosis, treatment, and rehabilitation of painful disorders.

Pain affects more Americans than diabetes, heart disease and cancer combined. There are approximately 116 million Americans with chronic pain, defined as pain that has lasted more than three months and 25 million people with acute pain.

Like other doctors, the pain management specialist must examine each patient and create a treatment plan based on the patient's symptoms, examination and other findings. For example, the cardiologist must first examine you and make several determinations. These include deciding whether your heart disease will respond to weight loss and exercise, whether you have high blood pressure and need medication to lower your blood pressure or whether your cholesterol is elevated or whether you have a blockage and need an interventional procedure or as a last resort, whether you might need to be referred to a cardiac surgeon for coronary bypass surgery.

All patients with heart disease do not take the same medications. It depends upon the cause of the problem. Just as there are different treatment options available for heart disease, there are a vast number of treatment options available for spinal or orthopedic pain.

While patients may go to a pain management physician because they "hurt," just as they go to a cardiologist because they all have heart problems, all pain does not respond to narcotics. It is an unfortunate and common misconception that if patients go to the pain management doctor, they will be treated with narcotics.

Treatments for spinal or orthopedic pain vary just like treatments for heart disease vary. It depends on what is the cause of your problem.

First of all, it is important to understand that there are different types of spinal or orthopedic pain. One might have muscular pain, ligamentous pain, joint pain, bone pain, pain due to a herniated disks, pain from a fracture, or pain from a pinched nerve or a nerve injury. Pain medicines are prescribed based upon the source of the pain.

Some patients who come to pain management never need pain medications. They may respond to an injection, other intervention, bracing, or to physical therapy. Our knowledge has increased to where we understand more on how poor posture and walking improperly all perpetuate musculoskeletal pain. With sophisticated use of exercises, tailored to a patient's specifics needs, physical therapy may be helpful.

An evaluation in physical therapy may reveal that the patient's pain is a result of poor movement, tight muscles, stiff muscles, weak musculature, or postural problems. For example, we know that patients who have degenerative disk disease, where the disk between two bones has started to wear and tear, can decrease the pressure on the disk by doing exercises to increase your core musculature and eliminate or reduce back pain.

Like the cardiologist who performs interventional procedures such as cardiac catheterizations, pain management physicians perform interventional procedures to eliminate or reduce pain, and surgery as in other areas of medicine should always be the last resort.

When you initially go to your cardiologist because of a minor problem, I am sure that most of you would not ask "do I need surgery?" One usually wants to explore other options before surgical interventions are explored.

From experience, I have learned that patients do best with treatment by a pain management specialist when they come with the same open mind and attitude where they are willing to explore numerous options and not become focused primarily on getting narcotics or thinking that surgery is their only option.

I used the example of the cardiologist because I know that most of us would prefer that the cardiologist explore all options before referring us to a cardiac surgeon. This is the same approach that one should use when they have an orthopedic or spinal problem. Always ask about non-surgical options for your orthopedic or spinal pain.

The pain management physician, like the cardiologist, does not perform surgery. The cardiologist does interventional techniques, prescribes medications, and oversees your cardiac rehab program. Likewise, a pain management physician manages and directs your physical therapy or rehabilitation program, prescribes medications, and performs interventional procedures. Both the cardiologist and pain specialist will refer you to a surgeon when needed.

Timing is key to the success of your treatment. You should not delay an evaluation for heart disease, nor should you continue to ignore spinal or orthopedic pain, and wait too long before seeking an evaluation with a pain specialist. I have seen far too many patients wait too late in their treatment before seeking care with a pain specialist. Like other specialties, early intervention might lead to a better outcome.

Pain management is a process. It consists of many treatment options and more importantly, the treatment for your pain may not be the same as it is for your neighbor. Just like a pacemaker may be the treatment of choice for your spouse but not the treatment of choice for you when you see a cardiologist.

With advances in pain management there are a number of treatment options and narcotics are not the treatment of choice for everyone who sees a pain management specialist.

©2011Winifred D. Bragg, MD. All Rights Reserved.

Chronic Pain: Barriers to Effective Pain Management

Chronic pain affects the physical, mental, emotional, and spiritual aspects of a patient's life. Daily non-cancer pain in the elderly has been associated with impaired activities of daily living, change in mood, and decreased involvement in social activities. Chronic pain impairs function, can lead to depression, and can even result in suicidal behavior. Chronic pain due to arthritis affects approximately 20 million Americans. This represents almost 50% of all pain sufferers.

What are the barriers to effective pain management?

Barriers to effective pain management are imposed by the health care system, physicians, and by patients themselves.

Patient Barriers:

-Reluctance to report pain to physicians.

-Reluctance to take pain medication

-Lack of education regarding available pain therapies.

-Compromised cognitive function secondary to certain pain medications.

Physician Barriers :

-Inadequate training and knowledge concerning pain management.

-Improper assessment of pain.

-Concern about scrutiny from regulatory agencies.

-Fear of patient addiction.

-Concern regarding analgesic side effects.

-Concern regarding the development of tolerance to analgesics.

Health Care System Barriers :

-Pain management is given a low priority in the system.

-Treatment availability problems exist in the system.

-Treatment access problems exist in the system.

-Inadequate reimbursement for pain management remains a problem.

-The most appropriate treatment may not be reimbursed or it may be too costly for the patient.

Many arthritis sufferers continue to take anti-inflammatory medications that no longer control their symptoms. Physicians, fearful of regulatory investigation, avoid appropriate treatment while switching patients from on ineffective medication to another. Some patients are forced to consider joint replacements prematurely, due to unrelenting, under-treated pain.

The net result of these barriers is that countless patients are forced to endure life instead of enjoy it. The squeaky wheel gets the oil. If your doctor is unable or unwilling to manage your pain insist on a referral to a pain specialist.

Pain Management - Teaching Your Patient to Relax

The experience of pain affects every aspect of a person's life including the person's mental, physical and emotional state. Those who experience it for a prolonged period are incapacitated, unable to lead a normal life and deal with the requirements of everyday reality. Prolonged and persistent pain, needless to say, can cause unbearable anguish and depression.

Kinds of pain

It comes in many forms, and can be classified as chronic, acute or breakthrough. Chronic is the kind of pain that persists for a month or more, or one that persists beyond the normal recovery time of a particular illness. Pain that persists for months or even years as a result of a chronic condition is also classified as chronic, and may vary in intensity; low intensity chronic pain can also be debilitating. Acute pain is a short-lived one that results from injury or an acute illness. Breakthrough pain is a flash that can vary in intensity, from moderate to severe, typically transitory and occurring in the background of an otherwise controlled pain.

Conscious experience of it

Pain is felt through the nervous system. Primarily, it is a strategy of our biological instinct to make us avoid experiences and situations which may cause us harm. However, there are times when the sensation of pain prolongs unnecessarily, when the information of it is no longer useful but is still felt. In some illnesses and injuries, the brain receives information about the pain and the person feeling the pain can do very little to avoid the stimuli. Also, it may not be just a simple stimulation. The conscious experience of pain can involve other factors such as emotion, memory, and physical condition. Some of it may not even have an organic-related cause such as a disease or injury.

As memory

It has been described as a construct that involves pain remembered in the past, experienced in the present, and anticipated in the future. This is the reason why chronic pain can be so debilitating, no matter what intensity. The experience is heightened with the thought and anticipation that feeling will be there tomorrow, and the day after that, and so on. Learning to relax and letting go of the fear and anticipation can do a lot to change the experience for the better.

Techniques for alleviating it

For patients who have chronic pain, getting addicted to narcotic painkillers is the last resort. Natural remedies to help alleviate it are preferred. One of the best ways is to learn how to relax. While this may sound easy, it takes a lot of practice to consciously relax. The best way to go about this is with meditation and breathing exercises. The idea is to focus on the breathing or an object and chant a word such as "Om" until one gets into a trance. Another meditative approach is called osteomyelitis. The goal is to focus all the attention on the pain in a relaxed way as possible. Don't think about negative thoughts about the pain (such as cursing to yourself or pitying yourself or getting angry). Make the pain a focus of your meditation, observed dispassionately for what it is.

Chronic Pain - Acute Pain

Pain is an emotional and personal issue. No one can know how much you hurt or understand how overwhelming  pain can be when it creeps through the smallest cracks in your support structure, threatening your health, your stability and sometimes even your life. 

Pain can affect blood pressure, and many other body functions. By itself, pain can suppress the immune system and can encourage the growth of some forms of cancer. Acute pain can be a blessing when it serves as a warning of possible tissue damage because it can help prevent further injury.

Physical and emotional trauma releases the body's own painkillers, the endorphins, which are produced in response to orders from the hypothalamus and the pituitary glands. When the stress response is triggered by acute pain, endorphins flood the body, dampening the pain to allow response with the threat. This does not happen with chronic pain. You don't get "used to pain." Chronic pain becomes harder to endure and after a time, fewer endorphins are produced to counter the same amount of pain. The body is not able to stay in a fight or flight mode for too long without giving up to exhaustion. The mechanism for coping with physical pain is subject to malfunction just as is any organ system.

Pain is easier to tolerate when you know that your pain is eventually going to end and that you will recover, so it is easier to tolerate. If you have chronic pain, you may feel hopeless and helpless, and your physicians may feel the same, until you get a diagnosis and some specific help.

Chronic pain institutes an extended and destructive cascade of fatigue, general discomfort, muscle aches and decreased physical function. When you feel that the pain is uncontrollable, a sense of hopelessness adds to your stress.

If your job, family, and social life changes, your identity is damaged.Your doctor can help or prevent this from happening by controlling your pain. In chronic pain, your doctor can't put a finger on an obvious reason for your pain. That does not mean it does not exist. your doctor must understand that chronic pain is not the same as acute pain, and can't be managed the same way. A lack of understanding on the part of the physician has too often caused chronic pain patients to be branded with labels like "neurotic" .

There are many nonmedicinal treatments for pain and these should be explored first. You can also minimize your pain indirectly by dealing with contributing factors, such a lack of sleep or stress. There are many neurotransmitters involved in you chronic pain, so you probably have to try a number of different medications before finding the combination that works for you.

Also,you must do what you can to minimize your pain by being good to your body, avoiding over work, and refusing to perform activities when you are exhausted or in pain. If you suffer from chronic pain and you feel that your physician is not helping or understanding your pain, make arrangements to see a different physician. Seek a physician that understands pain.

Pain Management

Pain management is a multidisciplinary approach of medicine intended to improve the quality of life for the patient who otherwise is limited by sufferings caused by pain. The analysis of pain and its origin is critical in the entire course of pain management. The specialty of pain is mainly comprised of a team from various sections of medicine such as Physicians, anesthesiologists, psychiatrists, physiotherapists, occupational therapists and nurses.

The typical approach followed in pain management would be as follows.

Diagnosis of pain - identifying the reason for pain is the first step towards relieving the pain for the patient. Once the underlying pathology is treated then the pain is relieved for the patient. This process of identifying the underlying pathology can be achieved by the following standard method

Patient interview

Pain history details such as development and timing, intensity, character, associated symptoms, aggravating and relieving factors, previous treatment etc.

Medical history details such as Review of systems, past medical history, past surgical history will provide the clinician with valuable inputs which may directly or indirectly be related to the present condition of the patient.

It also provides the information on present condition which is either sequel to the chronic condition present in the past or not.

Drug history is as important as any other because it gives the information of what drugs the patient has taken to help the pain and what effect those drugs had in relieving the pain.

Social history element such as personal history, family history and occupational history will give the clinician an indication about the patient life style, psychological factors, habits, genetic profile etc, which might directly or indirectly have an significance on the present condition

Patient examination

Physical examination generally follows the history recording. This is the step in which the clinician identifies the signs of the diseases, the clinician correlates the symptoms given by the patient while he does the physical examination. The clinician will do elaborate physical examination of the entire body to understand and assess the impact leading to the present condition of the patient, as well as to assess the risk factors for any procedures being considered for pain management.

Chronic Pain Management Services

Chronic pain can be defined as a progressive discomfort which can be of different degrees - from mild to severe. Chronic pain is usually linked to a chronic disease and persists longer than acute pain, and lacks a clear cause. Millions of people suffer from chronic pain, and effective tackling of chronic pain is necessary. It is here that chronic pain management services become important in lessening or eliminating the pain.

Pain management specialists help patients adopt a multifaceted approach to treat pain. They also teach people how to live with the chronic pain. These treatment programs are specific for each patient as different people have different pain tolerance levels and different reactions to pain. Persistent lower-back pain, chronic headaches and cancer pain belong to the category of chronic pains. Chronic pain may be the result of autoimmune diseases such as lupus or rheumatoid arthritis, thyroid conditions including Grave's disease, genetic disorders such as multiple sclerosis, back or neck trauma and less defined disorders like fibromyalgia.

Chronic pain is usually managed by medical methods, psychological methods or alternate therapy approaches. Medical approaches can be divided into two - drug treatment and surgical intervention. Medications prescribed for pain management include non-steroidal anti-inflammatory drugs (NSAID), steroids to reduce inflammation, muscle relaxants, or anti-anxiety medication to reduce tension, and antidepressants or anti-convulsants to help control specific types of nerve pain.

Non-drug therapies employed include individual/family therapy, hot and cold therapy, physical therapy, biofeedback, chiropractic and acupuncture massage, breathing exercises, self hypnosis and transcutaneous electrical nerve stimulation (TENS). However, these therapies don't work fast and require regular practice. Exercise, stretching and physical therapy reduce chronic joint pain and muscle soreness and spasms by increasing strength, tone and flexibility. Along with medications and therapies, psychological therapy should also be employed for anxiety and depression and is helpful in managing the emotional consequences of chronic pain.

Painkillers and other drug medications used in pain management sometimes have side effects which include nausea, dizziness and fatigue. Although with chronic pain management services, the pain may never go away completely, it is possible to reduce pain levels and thereby improve the quality of your life.

Chronic Pain and Suicide - Paging Dr. Kevorkian

The connection between chronic pain and thoughts of suicide is a strong one. Studies have shown that as many as 50% of people with chronic non-malignant (non-cancer) pain have thought about suicide. In the late 1990's there were two well-publicized cases of people with chronic pain (one had arthritis and one had fibromyalgia) who were apparently assisted in suicide by Dr. Kevorkian. While those cases triggered a lot of discussion about the ethical, moral and legal issues related to suicide, they also speak to the very real issue of chronic pain and suicide.

There is a close association between chronic pain and depression, which is very understandable in light of the chronic drain in emotional and physical energy that comes with chronic pain. There are also, of course, the losses; of income, relationships, and ability to engage in the activities you used to enjoy.

So what triggers that leap from depression to suicidal thoughts? Research has identified two primary factors:

1) Feelings of Hopelessness that makes relief seem impossible.

2) Catastrophic Thoughts that anticipate the worse possible outcome.

The risk of suicide in chronic pain has been documented all over the world. A study of farmers in Finland showed that there is a clear connection between chronic back pain and suicidal ideation. There was also an increased risk for people with chronic migraine headaches. As you would expect, the longer the pain had gone on, the greater risk of suicide.

What Can Be Done

The problem of suicidal thoughts in people with chronic pain can be addressed in two ways.

Better accessibility of treatment for depression.

Most people with chronic pain have depression, but too few can access treatment for it. Cognitive behavior therapy has been shown to help depression, decrease suicidal thoughts. and improve overall pain management.

Better treatment for chronic pain.

Sometimes a person's feelings of hopelessness about their pain is all too real. Years of looking for a doctor who will listen, trying multiple medications that may not work, and problems getting an accurate diagnosis all contribute to poor medical outcomes, and poor emotional ones. If you or someone you know has chronic pain, encourage them to make sure they are getting all the treatment they need, including psychological support.

Pain Management

Nobody likes to suffer pain. An unpleasant sensation, pain is a reaction of the body to physical illness, injury, or mental disease. Pain is generally divided into two categories: acute and chronic. The former occurs suddenly because of injury suffered by a tissue. The injury can be inflicted by anything that damages body tissue, i.e., surgery, trauma or cancer. Heart rate and blood pressure usually rises in acute pain. But once the cause of the pain is eliminated, the pain normally goes away. Chronic pain, usually linked to a chronic disease, persists longer and lacks a clear cause. Chronic lower-back pain, chronic headaches, or cancer pain belongs to this category.

A pain management strategy usually depends on the nature of the pain, i.e., whether it is acute or chronic. Pain is generally managed by using medical methods, psychological methods or alternative therapy approaches. In the case of short-term acute pain caused by a trauma, standard medications available over the counter, herbal or natural remedies and alternative medicines can be used. Chronic pain is harder to tackle, as it lasts longer and is more complex.

Medical approaches can be divided into two main methods: drug treatment and surgical intervention. Analgesic drugs can reduce or eliminate pain without affecting consciousness. Psychotropic drugs act on the brain, influencing the patient's emotional state. One should, however, be careful about their long-term effects. Another method used is nerve blocking, in which a drug is injected around the appropriate nerve to prevent the pain message from reaching the brain.

The rationale behind the surgical division of nerve pathways is that if the pathway is broken, the pain message cannot get through. Although not surgical in the true sense, Transcutaneous Electrical Nerve Stimulation (TENS) stimulates the skin area over the site of the pain with the help of an electric stimulator, and replaces the pain messages with a tingling sensation.

Although useful in some cases of acute pain, acupuncture may not prove very effective in chronic pain. Some advocate the use of hypnosis to reduce pain, as well.

The Chronic Pain of Arthritis

Joint inflammation is the literal definition of arthritis, this term is often used to group over one hundred rheumatic diseases that cause pain, stiffness and swelling in your joints. We are going to look at the three main type and who is effected by them.

The pain of arthritis is not limited to just the joints it can and does spread to other parts of the body as well. Your muscles, tendons, ligaments and bones and possibly some internal organs can all be effected by arthritis. We are going to talk about your pain and some natural therapies that you can do to alleviate that pain.

Pain can be classified into two main categories, chronic and acute. An acute pain is one that is temporary and often sudden. The pain dissipates as you heal. When you think of acute pain and what would cause think along the lines of a burn, a cut, a broken bone. Yes, they don't sound acute, but the point is that as you heal the pain lessons. This is a contrast to chronic pain.

Chronic pain is pain that does not go away, there isn't a healing process that lessens that pain for you. Chronic pain is one of America's leading causes for disability and one of the most weakening effects of arthritis.

The intensity of the pain associated with any form of arthritis varies from person to person. Some people have a higher tolerance for pain then others. Factors that contribute to this pain can include swelling within the joint, heat or redness present, and the damage that has already been done to the joint.

The most common type of arthritis is osteoarthritis this is also called degenerative arthritis. Your cartilage that is meant to protect your bones, is slowly worn away over time. This causes stiffness and pain. This seems to effect people more so as they age, men after the age of 50 and women after the age of 40.

Rheumatoid arthritis is considered a chronic, inflammatory autoimmune disorder. This arthritis occurs when your body's defense mechanisms fight when there isn't a threat. The body essentially is beginning to attack itself. Rheumatoid arthritis effects over 2 million Americans, or 1% of the adult population. Women are almost three times more likely to develop rheumatoid arthritis as men. The age group most affected is between the ages of 20 and 50.

Children are affected as well and the type of arthritis that they get is a version of rheumatoid arthritis called juvenile rheumatoid arthritis. There is also Gout which is a form of arthritis. Gout usually presents itself in men over the age of 40. It is caused by increased levels of uric acid which forms crystals in the joints. The body then attacks these crystals and the joints become inflamed.

There are natural treatments or therapies that you can use to help alleviate the pain. Believe is or not, for some people the best treatment is exercise. Low impact exercise, or exercises that improve flexibility and range of motion. Non-use of any effected joint is not recommended because you are then encouraging the stiffness. Keeping the joint moving and functional will help alleviate some of the pain. Many find water aerobics and swimming the most beneficial.

Exercise is also important in helping you control your weight. Added or extra body weight puts and undue stress on your joints which speeds that progress of arthritis and increases the amount of pain one experiences.

Consider adding glucosamine sulfate and chondroitin to your diet. These have both been shown to help decrease pain and improve the condition of the joint for arthritis suffers. The chondroitin draws fluid into the cartilage to help improve the shock absorbency and the glucosamine helps to build new cartilage with very few side effects.

There is hope and help for you to help alleviate the pain that you are in. Talk with your doctor about ways to improve your symptoms and be able to enjoy the life you want and deserve.

Fibromyalgia - What is This Chronic Pain Condition?

Fibromyalgia means pain in the fibrous tissues in the body and it is thought that the pain comes from the connective tissues, such as the muscles, tendons, and ligaments.

Most people with fibromyalgia say that they ache all over and this chronic condition changes with time, with no cure that is generally accepted although individuals benefit from a variety of therapies.

There is still no consensus on what causes this chronic pain condition. There is an identifiable criteria to diagnose fibromyalgia, with a history of chronic symptoms of at least three months' duration. Doctors will perform a simple physical exam of 18 specific points where at least 11 of the 18 points are tender or painful to pressure.

Symptoms

• Pain

• Fatigue

• Irritable Bowel Syndrome

• Chronic headaches

• Multiple Chemical Sensitivity Syndrome

Other common symptoms - Sleep problems, painful menstrual periods, chest pain, morning stiffness, memory impairment, numbness and tingling sensations, muscle twitching, irritable bladder, the feeling of swollen extremities, dry eyes and mouth, dizziness, and impaired coordination can occur.

Common Treatments

Medications: Traditional treatments attempt to improve the quality of sleep, as well as reducing pain. Some people benefit from medications such as amitriptyline, doxepin and paroxetine. A low dose of one of these medications improving the quality of sleep, reducing fatigue and may reduce the perception of pain. Routine use of most sleeping pills should be avoided, as they are addictive and require increasing doses to gain the same results.

Other treatments which may be helpful:

Acupuncture, nutrition, relaxation techniques, osteopathic manipulation, chiropractic care, therapeutic massage, or a gentle exercise program have all reports as working for different people. Other complementary therapies people have benefited from are heat or hot baths, ice massage, biofeedback and other relaxation techniques, stress reduction, behaviour modifications, posture training, cognitive behavioural therapy and meditation.

The Hidden Source of Soft Tissue Pain

What is Myofascial Pain(MP)? If it feels like your muscles are literally in knots, and pressing on those knots creates pain someplace else on your body, then you are more than likely experiencing MP, also known as Myofascial Pain Syndrome(MPS). The prefix "Myo" means muscle, and the suffix "Fascia" means connective tissue, therefore the word "Myofascial" translates to muscle and connective tissue. The word "Syndrome" basically means a group of symptoms. In essence, MPS literally means muscle and connective tissue pain symptoms. MPS is directly related to and associated with Trigger Points.

What is the definition of a Trigger Point (TP)? TP's are extremely irritable knots in taut bands of muscle and connective tissue that produce a phenomena of referred pain to different locations of the body when external pressure is placed upon them, hence the term "trigger point".

Where can Trigger Points be Found? TP's have different qualities and predictable pain patterns that can overlap and require extensive treatment to eliminate them. They can be found in many different types of soft tissue such as muscle, tendon, ligament, skin, scar tissue, and joint capsules. TP's points can be caused by other trigger points, direct trauma to soft tissue, infection, disease, radiculopathy, repetitive stress injury, smoking, or psychological distress. Trigger points also inhibit blood flow, which can make the pain worse unless treated.

How are Trigger Points and Myofascial Pain Syndrome treated? There are a few options when it comes to treatment of TP's and MPS. Depending upon the health or medical practitioner, treatment options include low-level laser therapy, ultrasound, dry needling, injections, spray and stretch using a vapocoolant spray, electrostimulation, ischemic compression, and medical massage therapy emphasizing the specified treatment of trigger points. Stretch and spray technique is when the muscle and trigger point are sprayed with a coolant, then the muscle is slowly stretched. Myofasical therapy works by stretching and loosening the fascia so it and your body can move freely, removing pain and restriction. Injections of Lidocaine can be performed by Physiatrists, but keep in mind that DOMS-Delayed Onset Muscle Soreness is a common side effect.

What are the Characteristics of Trigger Points? Active TP's actively refer pain along nerve pathways locally or to adjacent locations. Latent TP's only refer pain when some type of pressure or force is placed upon the trigger point itself or to the soft tissue structure where the latent trigger point is located. Key TP's have pain referral patterns that activate or create a Latent trigger point along a nerve pathway. Key trigger points also activate "Satellite Trigger Points" in other soft tissue structures. Both must be treated in order to alleviate both sources of pain. Primary TP's may activate Secondary TP's in other structures, and again, both must be treated in order to alleviate both sources of pain.

What does Myofascial Pain Syndrome and Trigger Points Represent? It is important to understand that MPS and TP's represent the effect of a problem or problems, and NOT the cause of a problem. So what does that mean? It means that Myofascial Pain or Trigger Point were created MOST COMMONLY because of some kind of soft tissue injury. What causes injury in most cases? Repetitive Stress, trauma, weakness in most cases. So is it enough just to treat the Trigger Points and Myofascial Pain? The obvious answer is a BIG NO!

So then what is the best way to make sure that Myofascial Pain and Trigger Points are treated and don't return? If repetitive stress is the cause of the problem, then the source of that repetitive stress must be alleviated to provide for a rehabilitative environment, or healing will never take place. Weakness is usually a very big cause of the problem, and if strengthening of the wrong muscle groups are taking place in the belief of solving the problem, then that will only serve to make the problem worse, not better. A Diagnostic Pain Assessment that tests for Soft Tissue Palpation, Muscular Strength, Muscular Weakness, AROM-Active Range of Motion, PROM-Passive Range of Motion, and RROM-Resisted Range of Motion needs to be conducted in order to determine the most effective treatment plan for Muscles and Soft Tissue that need to be Strengthened, as well as shortened Soft Tissue Structures that need to be lengthened.

What else needs to be done at home? There is no way that Myofascial Pain and Trigger Points can be treated solely and effectively by a healthcare practitioner, if repetitive stress, muscle weakness, and shortened musculature is the cause of the problem. A sufferer of Myofascial Pain Syndrome will benefit from self-stretching and strengthening, aerobic home exercises, and self-trigger point therapy at home to prevent recurrence of trigger point restriction, increase blood flow, maintain flexibility, and promote healing.

Impact of Post-Accident Chronic Pain Syndrome

Most people feel some sort of temporary pain after being injured in an accident. After all, pain is the way our body tells us that we are injured, and it serves a useful function by restricting our movement whilst our injuries heal. Where pain persists after an injury has healed then it loses its usefulness and becomes a problem. This type of long term unresolved pain is known as chronic pain.

Chronic pain can dramatically impact on your quality of life after an accident. In some cases, the pain may get worse as time goes on. This is due to the nervous system becoming "trained" to better transmit the pain signals to the brain. As well the signals of pain becoming more intense, at the same time your brain becomes more sensitive to these signals. This means that your pain may feel like it is getting worse, even though the injury that originally caused it is not getting any worse, or may in fact be healing.

The sensation of being in pain when you might not have a specific injury can be at best inconvenient and distressing, and at worst it can prevent you from living a normal life, as you might not be able to hold down a job or do everyday tasks like going shopping, doing housework or looking after your family.

Types of chronic pain that might be caused by your accident

Chronic pain is divided into several types, based on where in your body the pain appears to be coming from. Here are the most common types:

• The first type of chronic pain is somatic pain, where the pain appears to be coming from outside your body. Normally somatic pain will get better in a few days. The types of pain that fall into this category include Fibromyalgia and Chronic Back Pain.


• The next category of chronic pain is visceral pain, where the pain appears to be coming from the internal organs. This pain is similar to what you might feel if you have indigestion, but conditions such as pancreatitis or hepatitis might cause visceral pain that lasts for a long time and is very difficult to treat.


• Bone Pain is another category of pain which you might suffer after an accident through a bruise or a fracture. Your accident might also have worsened a pre-existing medical condition which affects the bones, such as osteoporosis or arthritis.


• Lastly, headaches and migraines can be caused by a variety of injuries and accident circumstances. Migraines are often associated with nausea, vomiting, sensitivity to light and sounds and blurred vision. A less common form of headache that might be caused by an accident is Trigeminal Neuralgia which occurs on one side of the head and can cause intense pain if a specific point on the head is touched.

The treatment of chronic pain can often take months or even years as various different approaches are tried by health professionals. Often it might be necessary to change your treatments if, for example, you build up a tolerance to a particular type of painkiller or medicine. The length of time taken to treat chronic pain can place a strain not only on you but also on your finances. Where your chronic pain was caused by an accident that wasn't your fault, it might be worth seeking independent legal advice to help you make a personal injury compensation claim.