Permanent End To Chronic Pain

Peace in Pain

Peace in Pain

Free Your Mind And Achieve Peace. Discover How To Live In Peace And Harmony In A World Full Of Uncertainty And Dramatically Improve Your Quality Of Life Today. Finally You Can Fully Equip Yourself With These “Must Have” Tools For Achieving Peace And Calmness And Live A Life Of Comfort That You Deserve.

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Erase Chronic Pain

The Ease Chronic Pain Program is a complete how to guide for permanently curing even the worse cases of chronic pain. Youll be given a comprehensive list of different foods and supplements which, when combined in the specific way. Every single food or supplement youll find inside The Erase Chronic Pain Program is 100% natural. The Key to why this works is that for each evil neurotransmitter in your brain, there are other natural organic chemicals that, when introduced into your body, immediately break down those pain-causing agents and bansih them from your body. Scientific study after scientific study has already shown that the different chemical compounds, included inside this guide counteract these biological pain amplifiers.

Erase Chronic Pain Overview

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Pharmacological Management Of Chronic Pain

In the treatment of chronic pain, drugs (analgesics) are usually administered in a stepwise fashion beginning with mild, relatively safe agents and progressing to stronger agents as necessary. In 1986, the World Health Organization (WHO) proposed a stepwise plan, frequently called the ANALGESIC LADDER, for the oral treatment of cancer pain. This plan provides adequate pain relief for up to 90 percent of cancer patients but may have limited success for other chronic pain patients. Step one of the ladder is recommended for patients with mild pain and consists of nonopioid analgesics, step two is for moderate pain and consists of mild opioids, and step three is for severe pain and consists of strong opioids. More than one analgesic may be used at a time for an added effect, a procedure called adjuvant therapy. Other medications used in the treatment of chronic pain include antidepressants and anticon-vulsants. Nerve blocks, injection of anesthetics into trigger points, or injection of...

General Features Of Chronic Pain

Back pain, particularly lower lumber and cervical pain, commonly complicates chronic pain conditions where the pains start are elsewhere. The adaptive positioning of a young person with leg or abdominal pains particularly affect the gait and resting positions and thus alter the loads on the spine and pelvis.

Classification of Chronic Pain Syndromes

While chronic pain and pain-associated disability can complicate any chronic illness, there are certain pain syndromes that are recognized in children. These have been mentioned previously. Although the emphasis in this text is on pain syndromes, it must not be forgotten that chronic pain can complicate any other musculoskeletal diseases, including JIA, muscular dystrophies, and dysplasias. If the chronic pain condition is not recognized and treated, many of these adolescents develop associated disabilities that continue into adult life. They are unable to continue education peer relationships fall away family life remains disrupted dysfunctional and physical and emotional well-being is lost. Chronic fatigue and secondary depression become as disabling as the pain.

Chronic Pain

Numerous studies with rodent models of acute and chronic pain have suggested that adrenal chromaffin cells implanted into the intrathecal space and in the periaqueductal gray relia bly produce significant analgesic effects see (117,118) for a review . Although the majority of these studies have used unencapsulated cells, recent studies suggested that encapsulated cell implants also produce analgesia in rats. The analgesic effects of adrenal chromaffin cells in rodent model have provided the rationale to pursue clinical trials in patients with chronic pain. Small, open-label trials demonstrated that the implantation procedure was minimally invasive and well tolerated (119,120). Neurochemical and histological studies determined that the encapsulated cells survived and were biochemically functional for up to 1 year. Because reductions in morphine intake were noted following implantation (suggesting efficacy), larger-scale, randomized studies were initiated in a collaborative study...

Lesion mechanisms of dry needling

It should be emphasized that dry needling, as a nonpharmaceutical modality, promotes self-healing by reducing the mechanical and biological stress of the body. Some patients with soft-tissue pain will achieve self-healing without any medical intervention after a sufficient period of time. Nevertheless, dry needling accelerates this self-healing process and reduces unnecessary suffering. This acceleration also helps to prevent the development of chronic pathology. Without this understanding there is a potential for confusion. For example, a recent study showed that in the first 10 weeks of treatment, a needling-treated group experienced a much higher level of improvement (4.4 points) than a group treated with conventional methods (2.1 points). After 52 weeks, however, there was little difference between the group treated with needling and the control group. 8 This result is objective and can be correctly interpreted if the physiological nature of needling therapy is understood both...

Dry needling is a specific therapy for restoring softtissue dysfunction

More than 100 billion is spent every year for pain management. Recent studies suggest that more than 6 in every 10 adults over the age of 30 experience chronic pain. Expenditure on the relief of back and neck pain alone has risen to more than 80 billion per year in the United States, a dramatic increase over the past 8 years. In addition to the lost productivity of employees who can no longer work because of pain, an estimated 64 billion per year is lost due to the reduced performance of workers who continue to work while in pain.4

Epidemiology Of Adolescents And Adolescent Rheumatology

The epidemiology of adolescent rheumatology cannot be considered in isolation. It is also important to reflect upon the predictors of adult disease identified during this developmental stage. In a study of 668 premenopausal women aged 18 to 35 years, menarche at age 15, physical inactivity as an adolescent, and low body weight were identified as independent predictors of low bone mass (14). Pain reports in childhood and early adolescence have been reported to be associated with the report of pain in early adulthood, supporting the need for effective pain management during adolescence (15). Of relevance to rheumatologists is the fact that the majority of childhood pain is musculoskeletal in origin (16). Of concern, a cost-of-illness to U.K. Society of Adolescent Chronic Pain discussed later in Chapter 9 has been estimated at approximately 3840 million in one year (17).

Addiction And Dependence

It is now well recognized that a person can become physically dependent on a drug given in high doses for medical reasons (e.g., morphine given repeatedly for relief of chronic pain) and yet not show any subsequent tendency to seek and use the drug for non-medical purposes. The WHO Expert Committee therefore revised its definitions and concepts in 1973, substituting the single term dependence for the two terms addiction and habituation. Unfortunately, this change has not led to uniform terminology or concepts.

Limitations Of Human Performance In Sports And Exercise

To 9.69 seconds in the Beijing Olympic Games, 0.03 seconds faster than the mark he set in May of the same year. Bolt knows that he could have achieved better he visibly eased his pace when he saw that he already had secured the gold medal. According to research, the theoretical limit of the 100-meter dash could be as low as 9.2 seconds. The world record set by American athlete Jim Hines in 1968 was 9.95 seconds thus, in four decades, the best performance improved by 0.26 seconds. Whether this research on performance limits can be considered reliable or not, it is beyond doubt that elite athletes will continue to break current records. This is because almost all athletes carry some level of both acute and chronic stress in their musculo-skeletal systems as the effect of strenuous and often excessive long-term training. Younger athletes such as Michael Phelps can adjust and adapt to this stress, whereas older athletes are progressively less able to tolerate it and increasingly...

Personal beliefs and treatment selection

Extensive research has found that personal beliefs can predict a range of outcomes, including quality of life, help-seeking behaviour and treatment adherence 16-18 . These beliefs have also been shown to affect treatment choice, mainly by way of selecting between conventional treatment and complementary and alternative medicines (CAM) for conditions, such as chronic pain, hypertension, and both localised and advanced prostate cancer 19-22 . These studies reported that patients who used CAM were more likely to hold negative beliefs about their illness (i. e. , that their illness was chronic and that they had little personal control over its management) and about conventional treatments (i. e. , believed the treatments would result in significant undesirable side-effects). In contrast, patients who were less likely to favour CAM held positive beliefs about their illness and its treatment (i. e. , believed the condition was not severe and would easily be controlled with conventional...

Considering Who Gets Fibromyalgia

What about children and adolescents Do they have fibromyalgia Sadly, yes. If your child or teenager has FMS, he may have a difficult time because most physicians, as well as the general public, still don't realize that kids can experience chronic pain from FMS. Instead, they think kids are faking it when they say that they're too sick to go to school. Maybe they are, but then again, maybe they're not. Skip ahead to Chapter 20 for some advice on how to tell the difference.

When Nothing Is Found

Often in this situation physicians will recommend a psychological evaluation. Parents often interpret this as a suggestion that they or their child are crazy or that the child must be faking the symptoms. Both physician and family must realize that while psychological illness may cause chronic complaints of pain, chronic pain may also cause psychological illness. However, referral of the child to a psychologist should not stop the ongoing medical evaluation

Precipitating Events and the Possible Role of Central Sensitization

Scientists know that a local injury resulting from trauma can lead to lingering pain. Pain that lasts for weeks, months, or years is termed chronic pain and is accompanied by changes in the chemical and anatomical makeup of the brain and spinal cord. Chronic pain that goes untreated can increase in intensity and spread from an original site to body areas that weren't previously affected, further damaging health and functioning. At that point, chronic pain becomes a disorder in itself. Why this happens in some people and not others is unclear, although genetics may play a role. What is certain is that sometimes an injury will lead to a constellation of changes, including an elevation of spontaneous CNS firing, an increase in pain response level and length, and a decrease of pain threshold. These are the changes collectively termed central sensitization, and they appear to be fundamental to the pain sensitivity that defines chronic pain. stimulation. Pain signals are an important part...

Tolerance Dependence And Addiction

For chronic pain patients taking opioids, tolerance and physical dependence are not indicators of addiction. Addiction is not a characteristic of opi-oid use, rather, it is dependent upon the user. In fact, the medical use of opioids is only very rarely associated with addiction. The agonist-antagonist class of opioids (buprenorphine, butorphanol, nalbuphine, pentazocine, and dezocine) has a low abuse potential. Any patient taking opioids to treat chronic pain can meet the criteria for addiction set forth by the American Psychiatric Association in the Diagnostic and statistical manual of mental disorders DSM-IV. Therefore, it is very difficult to diagnose addiction in chronic pain patients who are taking opi- oids. Chronic pain patients who are being ineffectively treated could display the drug-seeking behavior that is characteristic of addiction, a phenomenon called pseudoaddiction. Alternatively, the patient receiving effective pain treatment may take extreme measures to insure an...

Working with Your Doctor to Manage Fibromyalgia Pain

Some pain can be cured permanently, but most chronic pain, such as the pain of FMS, can't be eradicated altogether and forever. Instead, the goal should be to manage FMS pain by radically decreasing it to a tolerable level. You can attain this goal through pain management. With the help of a good doctor (or two or more sometimes, you need the help of a specialist as well as your regular doctor), you can beat most pain into submission.

Winning the Pain Game

I have read that up to 80 percent of U.S. population suffers with some type of pain. Medications have come and gone with high hope and expectation of eliminating some types of pain. Pain caused by an injury, most of the time, heals without any residuals unless it was severe with extreme tissue damage. insidious, or chronic pain (the annoying type), can literally wear a person out.

Major Depressive Disorder

There is strong evidence that major depression is associated with FM, although the nature of the association has remained controversial. For example, some clinicians still hold that psychosomatic illness plays a large role in chronic pain conditions, including FM. In the past, clinicians endorsed a theory of Tension Myositis Syndrome (TMS). Practitioners who treat TMS consider that when pain cannot be relieved by standard medical treatments, psychosomatic illness is the likely cause, especially chronic pain in the back, neck, and limbs. The theory is that untreatable pain functions as an unconscious distraction from dangerous emotions, and when patients recognize this is the situation and confront their emotions, their symptoms no longer serve a useful purpose and go away. TMS treatment involves attitude change, education, and psychotherapy. Emerging objective evidence in pain processing in FM has led most researchers and clinicians away from TMS as an explanation for FM. Further,...

Working with Your Primary Care Doctor

Or an X-ray, or in some other quantifiable test, they may have trouble making the diagnosis of FMS. They may send off people who suffer from symptoms of chronic pain and fatigue (but who have normal lab results) for psychological counseling only, and they won't prescribe the important comprehensive therapy that's necessary to treat FMS.

Gastrointestinal System Involvement in SLE

Another cause of chronic pain in children with SLE is serositis, inflammation of the lining of the lungs or abdomen (serosa). An inflamed serosa will respond by releasing inflammatory cells and inflammatory chemicals into the abdomen. In mild cases this causes diffuse pain. In severe cases the pain may be quite marked and associated with rebound tenderness (the child experiences pain when the abdomen is pressed but worse pain when the pressure is quickly released). Any child with this problem needs to be evaluated promptly by a physician, as it is an indication of serious irritation in the abdomen. There are many possible causes, including infections. If SLE is determined to be the cause, it may need to be better controlled with more corticosteroids or immunosuppressive drugs.

Gene Gunmediated Gene Therapy In Other Systems

Most gene gun applications in neuronal systems have been performed for basic research studies to characterize the biology of these cells. The gun provides the unique ability to deliver substances directly into not only neuronal cells in culture (164,165), but also into whole brain slices (120,166). The gene gun has been used to deliver not only DNA, but also fluorescent tracer molecules to track neuronal phenotype and survival (165). Direct gene gun delivery into the brain in vivo has been reported for transfection of the lamprey brain neurons and glia in the exposed floor of the fourth ventricle (167), and for direct transfection of the exposed brain in live mice (168). An alternate in vivo approach of gene guns has been to manipulate neuron behavior, but not to directly transfect the neurons themselves. In this case, the gene for semaphorin A was delivered into corneal epidermal cells of rabbits (18). In this model, local production of semaphorin A after gene gun transfection...

Fighting Fibromyalgia with Antidepressants

Two common antidepressant medications used by people with FMS are Elavil and Desyrel. In addition, a newer antidepressant, Cymbalta (generic name duloxetine), approved by the FDA in 2004 to treat depression, also provides significant pain relief to many people with FMS. Cymbalta increases the levels of both serotonin and norepinephrine, important neurochemicals that can improve mood as well as decrease chronic pain. (For this reason, it is called a serotonin norepinephrine reuptake inhibitor, or SNRI see the nearby sidebar.) This medication may cause weight loss in some individuals.

Food stress and reward

Recent evidence also links brain areas associated with reward with those that sense physical pain. It is common notion that chronic pain can cause depression, and depression can increase pain. Most patients who have depression also present with mainly physical symptoms 89 . Studies using functional MRI have shown that social rejection lights up brain areas that are also key regions in the response to physical pain. The area of the anterior cingulate cortex that is activated by visceral pain also is activated in cases of social rejection 90 . The importance of these brain areas is underscored by the observation that the right ventral prefrontal cortex that mitigates emotional distress caused by pain is activated when placebo administration relieves pain 91 .

Im not depressed Why do I need an antidepressant

Some patients with fibromyalgia may have a problem with depression. But, often, people with fibromyalgia are taking antidepressants not for depression but rather for their fibromyalgia. Research has demonstrated that low doses of some antidepressants, taken on a daily basis (or, rather, nightly because most doctors recommend the drugs be taken in the evening), can help block the pain of fibromyalgia or other chronic pain. Serotonin norepinephrine reuptake inhibitors (SNRIs), particularly the drug Cymbalta (generic name duloxetine), are a new category of antidepressants shown to be effective in treating chronic pain. Cymbalta helps the body retain two key neurochemicals (brain chemicals, in this case, those affecting mood) serotonin and norepinephrine and thus, it is not only effective at reducing depression but also has demonstrated effectiveness in reducing chronic pain, including the chronic pain of fibromyalgia. Note that another medication, Effexor (generic name venlafaxine), is...

The Impact Of Adolescent Pain On Quality Of Life

Recurring episodes of chronic pain often have a major impact on the daily lives of adolescents and their families. Not only does the pain have a direct affect on physical function but also on sleep, mood, appetite, social interaction, hobbies, and education. It is essential that that any planned rehabilitation takes these factors into account, concentrating solely on the pain is often futile. In the Roth-Isigkeit study, 54 of adolescents who reported pain also had problems with sleep and appetite, 49 had long-term absences from school and 47 were unable to meet friends (7). A separate outpatient survey showed that 72 suffered impairment in sports activities, 51 reported absence from school, 40 experienced limitations in social functioning, and 34 had problems with sleeping (77). Sleep disorders with frequent nocturnal arousals or daytime somnolence are common in children suffering juvenile rheumatoid arthritis (76) similar sleep disturbances are seen in adolescents with chronic pain....

Key Areas Affected by Persistent Pain in Adolescents

Adolescence is a time of fierce independence. Chronic pain conditions markedly curtail this freedom as the young person relies totally on carers for tasks that were previously done with ease. Mobility, eating, toileting, and dressing may all need external help. This has an enormous impact on the emotional well-being of the young person. Chronic pain can cause enormous upheaval even in the most functional families. Initially there are the hospital visits and uncertainty about diagnosis. Parents lose time off work and it is not unusual for one parent to stop working completely. There have been a number of studies looking at parental stress and anxiety and affect on family function, perceived disability, There is a common misconception that chronic pain is only found in families that are, in some ways, dysfunctional. Most family units are, premorbidly, functioning normally. Ongoing pain has catastrophic effects on these families that can lead to overwhelming anxiety and breakdown of...

Heating Up the Problem Heat Therapy

Ffl& t Heat is most often best for chronic pain, such as with the aches usually experienced by people with FMS cold seems to work better for acute pain and inflammation. So if you're experiencing chronic pain, try heat first. But if it doesn't work for you, try cold next.

The working theory behind TENS

Here's the basic theory to explain why TENS may help people who experience chronic pain When painful areas of the body are directly stimulated with regular bursts of a very mild electrical current over a short time, these hurting areas of your body are thought to respond to this electrical stimulation by releasing endorphins (pain-reducing chemicals in the brain).

Self Help Therapies for Insomnia

Insomnia frequently co-occurs with another medical or psychiatric disorder (Lichstein, McCrae, & Wilson, 2003 Zorick & Walsh, 2000). Fifty-two percent of insomnia cases in the WHO general health care study were diagnosed with another mental disorder (Ustun et al., 1996). In epidemiological studies the comorbidity of insomnia and psychiatric disorders occurs in between 40 and 65 of cases (Lichstein et al., 2003 Ohayon, 2002). Specific patient groups have been identified as being particularly vulnerable to sleep disturbances. For example, up to 70 of treatment-seeking chronic pain patients report significant insomnia (Moldofsky, 1990 Pilowsky, Cre-ttenden, & Townley, 1985 Wilson, Watson, & Currie, 1998). High rates of insomnia are associated with major depression (Morawetz, 2003), anxiety disorders (McCall & Reynolds, 2000), and alcohol dependence (Brower, 2001 Currie, Clark, Rimac, & Malhotra, 2003). Historically, disturbed sleep in these populations has been...

Pelvic Pain Syndrome PPS

Out infection, malignancy, postoperative complications, and referred pain from other locations or disorders. Ruling out other factors is important, since in FM chronic pelvic pain also may be related to abdominal wall myofascial (my-oh-FASH-ee-al) trigger point pain, chronic pain postures, hernias, and irritable bowel syndrome. The pathophysiology of PPS remains unclear, but abnormal pain processing is consistently noted on neuroimaging studies. Treatments include pain medications, tricyclic antidepressants, and anticonvulsants. Topical treatments are used in vulvodynia and vulvar vestibulitis.

Reflex Sympathetic Dystrophy

Because there is virtually always a well-documented history of injury preceding the chronic pain, families and physicians are often distraught over their inability to fix the problem. The key to understanding RSD is to recognize that the problem is no longer a simple physical injury. Children with RSD are very often overachievers who have been put under too much pressure to perform for example, a talented figure skater who makes it all the way to the regional championships but takes a fall and, despite proper orthopedic treatment, is unable to put any weight on the foot, or sometimes even is unable to tolerate the pressure of a sock or shoe.

Psychological Intervention

Once when I had a patient who complained of severe hand pain but had no objective findings (his physical examination, x-rays, and lab tests were completely normal), I sent him for a consultation with a colleague who specializes in treating chronic pain. My colleague concurred with my workup he agreed that there was no identifiable reason for this man's pain. Yet we both believed that this patient was suffering. My colleague suggested a psychiatric consultation to evaluate and treat the patient's anxiety. As I explained the reason for the referral to my patient, I told him that we did not believe the pain was all in his head but that his overall anxiety was affecting his ability to cope with the pain. Indeed, once his anxiety was under control, despite continued hand pain, he felt much better.

For Deactivating Myofascial Trigger Points And Improving Range Of Motion

A series of 52 consecutive patients with chronic pain syndromes involving the neck, the shoulder girdle and the arm was examined. The exclusion criteria for my evaluation were psychiatric disorders, cognitive impairment, intake of analgesics, psychoactive drugs and corticosteroids administered less than 12 hours previously.

Neurofibromatosis 365

Treatment of a child with NF1 involves managing symptoms. Children with complications of the eye, nervous system, spine, or bones will be referred to an appropriate specialist for treatment. Surgical removal of neurofibromas is required if they are causing chronic pain, become infected, are pressing or growing into vital body organs, or for cosmetic reasons.

Moving Yourself to a Better Frame of Mind

Both extremes are unreasonable positions to take. For example, although people who don't have fibromyalgia really can't feel your pain, they may have arthritis or another chronic-pain problem and, thus, can understand what chronic pain feels like, even if it's not your specific type of chronic pain. On some level, they should be able to grasp your problem. On the other hand, people shouldn't be expected to automatically sympathize with poor you even when those people are your own loving family members. You're setting yourself up for disappointment if you take either of these polar positions.

A specific health problem smoking

Perhaps the most important final point to make in this chapter is that health is not simply a physical or biological matter. Psychological factors are heavily involved in it in all of its aspects. Stress, anxiety and emotion, in general, all have their effects on the immune system, health in general and in reactions to disease. Although this makes health a more complex matter than it was once thought to be, it also means that various psychosocial factors can be used in order to bring about positive changes to the health of individuals, from dealing with stress and the control of chronic pain through to increased chances of longevity.

Motor Cortex Stimulation

There has been anecdotal evidence of improvement in patients treated with stimulation of the motor cortex for chronic pain (22,23). This has led to the suggestion that stimulation of the motor cortex might be an effective means of treating patients with tremor-dominant PD. A group in Italy has performed motor cortex stimulation for PD in three patients (24-26). They reported that a benefit comparable to STN DBS could be achieved with low-frequency not high-frequency stimulation. Advantages of this procedure might include safer placement, without the risk of deep hemorrhage, and perhaps greater efficacy.

The Social Context Of Pain In Cancer Survivors

As in other illnesses, the cancer patient is likely relieved of domestic and occupational responsibilities and the social environment provides support and care. As the cancer-free period extends over time, there will be increasing call for the resumption of activities. This transition to the resumption of pre-cancer life role activities is likely to be determined by numerous social contextual factors. Pain symptoms are likely to play a role in the degree to which life role responsibilities are resumed. Depressive symptoms when present will add to the burden of disability and further impede life role resumption. Factors external to the individual might also play a role. Family support (or lack thereof) might impact on the degree to which pre-cancer responsibilities are resumed. In other domains of chronic pain research, it has been shown that patients with solicitous partners are more likely to display high levels of pain-related functional limitations than patients with partners who...

Matrices Used In Encapsulation

Cells placed within encapsulation devices generally fall into 1 of 3 categories. The first category is represented by primary postmitotic cells such as islets of Langerhans for diabetes, adrenal chromaffin cells for chronic pain, or hepatocytes for liver devices. Second, immortalized (or dividing) cells such as PC12 cells have been used to deliver dopamine for PD. The third category is typically cell lines that have been genetically engineered to secrete a bioactive substance such as baby hamster kidney (BHK) cells to secrete factors like human nerve growth factor (hNGF) for a potential therapy in AD. Dividing tissue has advantages over postmitotic tissue it can be expanded, banked, and thus more easily tested for sterility and contaminants. However, dividing tissue is also constrained by the potential for overgrowth within the capsule environment, resulting in an accumulation of necrotic tissue that could potentially diminish the membrane's permeability characteristics, further...

Q How can animal pain be recognized

Beyond this critical anthropomorphism, diagnosing animal pain, especially chronic pain, can be very difficult. Pain diagnosis will depend on the species of animal, the experimental manipulations, and the type of pain expected. Animals in pain may limp or refuse to move on the other hand, they may be nervous and excitable. They may stop grooming themselves, or decrease their food or water intake.

Proper Duration of Needling Time

In most cases, needles can be left in the ARPs from a few seconds to a few minutes. In cases of acute pain, a few seconds are sufficient for healing because the muscles may relax very quickly. In cases of chronic pain or internal disease, the needles should be retained longer to achieve more muscle relaxation, and this may cause the needle-induced lesions to stay longer and may reduce the swelling. In chronic cases, even 20-minute needling may not be

Asthenia And Familial Hypertension And Diabetes

Chronic pain, depression, sleep disorders, fibromy-algia and of course with infectious diseases or chronic disorders of the heart, lung or kidney. If we simply compare ESRT and PPT in a group with this symptom we can see that the first diagnostic method shows several groups with significant concentrations of points. The richest cluster of points in proportion to the total (25 ) corresponds to the pituitary-adrenal gland area. Next is the cervical muscle area on the medial side and in third place we have a broad area covering both the Chinese kidney and bladder area (on the left of Fig. 7.8). TCM could also be cited for this area because asthenia with depression and chronic pain, often reported by my middle-aged patients, particularly females, could imply a deficiency of Yin Yang Kidney. Regarding PPT, there is a major sen-sitization of one of the depressive mood areas which nevertheless does not reach a significant difference compared to ESRT (on the right of Fig. 7.8).

Physiology of Acu Reflex Points

Each peripheral nerve, whether muscular or cutaneous, has a physiologic relationship with other distal peripheral nerves, as described previously. The sensitized tibial nerve on the leg, for example, can affect the greater occipital nerve from the posterior ramus of CII. Thus all the peripheral nerves form a physiologic network. This network is of great clinical importance, particularly in explaining the process and development pattern of chronic pathologic processes, especially chronic pain.

Overeating to Make Yourself Feel Better

Sometimes when a person has severe chronic pain that doesn't improve (possibly because she hasn't obtained a diagnosis of fibromyalgia or hasn't gotten any treatment), she becomes depressed and upset. Instead of seeking treatment, she seeks solace in candy, cakes, pies, and other high-calorie and high-fat foods. Such foods may provide a temporary good feeling but it's one that doesn't last.

Psychosocial Influences On Painrelated Limitations In Cancer Survivors

Although pain has typically been considered the primary determinant of functional limitations in chronic pain sufferers, it has also been suggested that pain and disability are distinct and partially independent phenomena.99,103 Research suggests that, in chronic pain patients, pain intensity rarely accounts for more that 10 of the variance in the severity of functional limitations.97 Although the relation between pain and functional limitations has yet to be examined in cancer survivors, Sullivan et al9 reported that pain symptoms accounted for only 9 of the variance in self-rated functional limitations in a sample of mixed neuropathic pain patients. In recent years, increasing attention has been devoted to assessing the degree to which psychosocial factors might contribute to heightened risk for prolonged pain-related functional limitations. Numerous investigations have been conducted addressing the role of psychosocial factors in the prediction of prolonged pain and disability...

How much Botox costs and whether insurance pays

If you're currently considering Botox therapy, keep in mind that this form of therapy is generally not a low-cost option, and if you have a shortage of dollars, you may not even be able to afford it. In general, Botox is more like the upscale, form of treatment. Always check first by simply calling and asking your insurance company if Botox treatments are covered. If and when the FDA approves Botox as a therapy for chronic pain, more health-insurance providers will likely cover such treatments. Most patients need to receive at least two vials of Botox to gain a sufficient amount of the substance to obtain relief from their chronic pain, and one vial costs about 600. As a result, in considering all the costs involved, a Botox procedure can cost at least 1,200 and the price can go much higher than that. The gentle art of the basic Chinese exercise movements of tai chi are usually not overly difficult to master, and generally these movements can also be a very good form of exercise for...

Available Self Help Materials and Target Audience

A search of the Amazon.com Web site using the keywords self-help and sleep produced over 40 hits. Included in the top-selling books were No More Sleepless Nights (Hauri, 1996), Can't Sleep, Can't Stay Awake A Woman's Guide to Sleep Disorders (Kryger, 1999), Say Good Night to Insomnia (Jacobs, 1999), and Seven Days to a Perfect Sleep (Gordon, 2003). The majority of available materials come in book form. Audio media (tapes or compact disks) comprise the remaining commercially available titles. The latter products typically consist of audio recordings of relaxation or self-hypnotic exercises. It should be noted that these titles are ones devoted exclusively to the topic of sleep. Many self-help books on other health problems (e.g., chronic pain, depression, menopause) include abbreviated advice for enhancing sleep or combating insomnia.

Measures to Prevent Postmastectomy Pain

A possible role for postoperative pain management is suggested by one study of 110 breast cancer patients who were interviewed 3-4 years after breast surgery. Twenty-eight patients (25 ) reported chronic pain. Of these, 21 (75 ) had received conventional postoperative analgesia whereas 53 of the original cohort had received conventional analgesia.113 In a survey of 57 lung cancer survivors, 56 had frequent pain, 46 had chronic pain from scars and surgery 25 had pain not controlled by medication.124 median follow-up of 36 months, 27 VATS and 24 thoracotomy survivors completed a telephone survey with the EORTC QLQ-C30, LC-13 and a chest pain subscale. No difference was found between the two arms for any of the pain items. Only one third of the original pool was able to participate in the study because of other medical conditions, illustrating the difficulty of recruiting patients.132 An extensive body of work has been done and is ongoing regarding the use of perioperative epidural...

Local Skin Reaction And Cutaneous Microcurrent Mechanism

The body surface always has a layer of electric charge because the human body is bathed in the electromagnetic field of the earth. Normally, dry skin has a direct current (DC) resistance of 200,000 to 2,000,000 ohms. At sensitive points this resistance is reduced to 50,000 ohms.7 However, Melzack and Katz8 found no difference in conductance between traditional ISDN points and nearby control points in patients with chronic pain. This phenomenon can be explained by the dynamic nature of the sensitive tissues. It is understandable that the area of sensitized tissue is larger in patients with chronic pain, whereas the same location in healthy persons is less or not at all sensitized. In a healthy person, the DC resistance of sensitive points is the same as for other areas. There is 20 to 90 mV of resting potential across the intact human skin, negative on the outer surface and positive on the inside.9 Most sensitive points show a measurement of 5 mV higher than for nonacupoint areas.7

Box 1 Translating PHQ9 scores into action

The IMPACT and related studies illustrate the tensions involved in the use of a disease-specific instead of a generic complexity-specific focus. The possible superiority of a complexity-specific approach is illustrated by the fact that, on average, patients had 3.8 chronic conditions in addition to the depression. More than 50 of these patients suffered from high blood pressure, arthritis, loss of hearing or vision, or chronic pain. Thirty percent had heart disease (angina, failure, valve problems), and between 20 and 25 had asthma, chronic bronchitis or emphysema, or diabetes 20,21 . These comorbidities, as well as social comorbidities, interfere with the treatment of depression, for example, with regard to the adjustment of antidepressants to the needs of the physical morbidities, the compliance management or to the social situation of the patients. Current epidemiologic findings report that about 40 to 50 of patients who have chronic conditions have multiple chronic conditions....

Regarding Gulf War Syndrome

Researchers say that stressful conditions can inhibit the production of growth hormones. (It's not only children who produce growth hormone. All through your life, some levels of growth hormone are produced by the body.) So, perhaps the military veterans who were in a state of heightened stress under war conditions produced less growth hormone, which then led to the development of fibromyalgia. This theory remains unproven, but it's an intriguing possible explanation for the higher-than-normal incidence of chronic pain and fatigue among the military veterans who have served in the Gulf War.

Four types of myofascial pain and their different pathology

Soft tissue pain, especially chronic pain, always involves all these dysfunctions and clinicians should treat all of them to achieve the optimum level of pain relief and recovery of tissue function. For example, when a joint is out of alignment, it causes both the attached and opposing muscle groups to be shortened or lengthened, which compromises the surrounding neuromuscular structures and connective tissues. Muscle spasm, muscle tension, and increased sympathetic output ensue, resulting in soft tissue pain, and the development of trigger points, edema, ischemia, and tissue degeneration. If the condition continues to the point of becoming chronic, tissue adhesion and the formation of scar tissue will occur and central sensitization will follow. Clinicians should keep in mind that chronic pain may involve all types of soft tissue dysfunction and varied techniques should be incorporated to achieve maximal healing and restoration of function. There is considerable clinical evidence...

Summary and conclusion

- Early childhood caries is a chronic disease with a form of rampant decay of the primary dentition distinguished by the specificity of tooth surfaces involved and the rapid progression of carious lesions on those surfaces. It is usually associated with the onset of acute or chronic pain and infection. It appears that the chronicity of childhood caries might have the same influence on a child's ability to sustain normal growth patterns as any other chronic disease or infection, and therefore caries may impact upon general health and well being. Numerous studies have reported the prevalence of the disease as to affect up to 70 of the childhood population, especially in socio-economically deprived population.

Botox and fibromyalgia

As of this writing, the FDA hasn't approved Botox injections to treat chronic pain from fibromyalgia or any other chronic-pain condition. This approval may come in the near future, but it's not here yet. Despite this fact, doctors may still legally administer the injections.

Magnetically Decreasing Your Pain Transcranial Magnetic Stimulation

TMS is the use of powerful magnets targeting the brain's cortex. A surface coil is applied to the scalp, and it generates magnetic fields, which in turn create electrical currents that travel to the brain. Nerve cells that are related to mood are stimulated, which can improve mood and may decrease chronic pain. You may feel as though you're hearing a tapping noise during the treatment, which lasts about 30 minutes.

Symptoms And Diagnosis

In 1990, based on a multisite research study, the American College of Rheumatology adopted the classification criteria for FM. The research study compared patients with FM to people with other chronic pain conditions, such as lupus and rheumatoid arthritis, and then considered the symptom findings in FM against people with no known disease (called healthy controls). In addition to a body pain diagram and Tender Point Survey exam, all research subjects completed questionnaires about many other symptoms associated with FM. Interestingly, it was the combination of widespread pain on the body diagram and at least eleven of eighteen tender points on the physical exam that differentiated the FM patients from not only the healthy controls but those with other pain conditions. Regarding tender point exams, it is possible that the female-to-male gender discrepancy seen in FM diagnosis could be artificially inflated due to the 4 kg of pressure used in Tender Point Survey criteria. The pain...

Reducing Inflammation with Non Steroidal Anti Inflammatory Drugs

NSAIDs generally are taken by fibromyalgia sufferers on a daily basis to combat chronic pain, and they can be moderately effective. The primary drawback to NSAID medications is that they can cause gastrointestinal upset, which can sometimes be severe. For this reason, they should always be taken with meals, and NSAIDs should never be taken on an empty stomach. In some cases, NSAIDs can cause ulcers. Anyone who's experiencing severe abdominal pain should stop taking her NSAID medication immediately and should consult with her physician. Other side effects of NSAIDs may include rashes, rapid heartbeat, stuffy nose, blurred vision, and lightheadedness.

Considering pramipexole and ropinirole Parkinsons drugs may offer pain relief

Some studies have indicated that two drugs that are technically called dopamine receptor agonists and that are used by patients with Parkinson's disease (a degenerative disease of the nervous system) may also be helpful in decreasing the chronic pain of individuals with FMS.

Grasping Pain and Why People Have to Have It

1 Chronic pain is pain that is sometimes worse and sometimes better, but it's basically always hanging around at some level. i Chronic pain wears down the body. Like a truck spinning its wheels in the mud, smoke pouring from the engine, your body starts to break down under the added strain of chronic pain. i People who have chronic pain are prone to other illnesses. Their immune systems may become weakened, and they may become more at risk for contracting the flu or the latest virus making the rounds among their family, friends, and co-workers. If you find yourself getting a strep throat and then the flu and then a bladder infection, you need your doctor's help to break out of this pattern. One way to break away is to accept the fact that chronic illness and pain are part of your problem, ask for help, and then work on rebuilding your health. Don't start doubting yourself when people say that they can't find anything wrong with you. Causes for chronic pain are frequently hard to...

Making Lifestyle Changes Pulling Yourself into a Non Fibro World

Stress is a normal part of life, but if you have fibromyalgia on top of the usual daily stresses, or maybe with some extra stress thrown in once in a while, you're in a bad situation. Stress can greatly worsen the chronic pain, fatigue, and other symptoms of the person with fibromyalgia. Be sure to read Chapter 13 for my suggestions on relaxation therapy, hypnosis, meditation, and other methods to destress yourself. They work

Three Dynamic Phases Of Acureflex Points

In healthy people, most acu-reflex points are latent. In the presence of pathophysiologic disturbances, such as muscle injury, chronic pain, or disease, nonsensitive (latent) acu-reflex points are gradually transformed into sensitive (passive) acu-reflex points. Almost everyone has a number of passive acu-reflex

Integrated Clinic

Once modern practitioners become more receptive to alternative medicine and once it is proven that Chinese herbal medicine is efficacious in treating certain difficult problems, integrated clinics could be started, no longer bearing only rehabilitation orientation but catered toward evidence-based clinical trials and evidence-based clinical service. Clients do not come for general care of all disease entities, but for specific problems that modern practitioners face. Such integrated clinics deal with special problems in allergy, viral infection, degenerative diseases, metabolic disorders, chronic pain, cancers, and other pathologies. Such clinics are run for both research and service. They cannot be solely research-oriented for obvious reasons of the high demand for clinical research and the cost involved. They cannot be solely service-oriented either because efficacy tests are still much desired. The compromise needs to be careful data collection and observation for all clients...

NickE Goeders

Antidepressants can also be useful in a number of medical and psychiatric disorders where depression is not the major feature. For example, some categories of antidepressants can be used to treat anxiety and panic disorders, and they are often useful as adjunctive medications for chronic pain. Antidepressant drugs are not generally helpful for short-term depressed moods that are part of everyday life or for the normal period of grief that follows the loss of a loved one.

Mindbody Therapy

It has also been discovered that the immune system has memory and can learn, which means that there is intelligence in every cell and that individuals can influence that intelligence by conscious effort. Studies have shown that attitude, emotions, thoughts, stress, depression, lifestyle, as well as food, exercise, and environment, can have a direct affect on health conditions from chronic pain and coronary heart disease to cancer and AIDS.

Back Pain

Chronic pain may require changes in mental and emotional attitude and lifestyle. An osteopathic method called counterstrain may be helpful in correcting nerve patterns.30 Drinking lots of water for back pain is beneficial because dehydration, which occurs even though not thirsty, allows acidic wastes to build up in muscles, causing pain. Avoid animal fat in the diet as it contains substances that are inflammatory.

Burning Mouth

Burning mouth is an intraoral chronic pain disorder that is usually without associated mucosal or oral signs. You may feel a burning sensation on your tongue, and stinging and itching in the front and back regions of your tongue. It can be caused by a geographic tongue (inflammation sporadically mapped out on your tongue) or an infection such as candidiasis. Or you may have a contact allergy from wearing dentures.

Epidemiology

Patients after mastectomy may experience shoulder pain, phantom breast sensations, and otherwise unexplained sensations in addition to postmastectomy pain. In one study of Finnish hospitals, the prevalence of chronic pain ranged from 43 to 56 , strange sensations 26-45 , phantom breast sensation 26-66 .98 Mastectomy-related symptoms are highlighted by a survey of 124 Quebec City survivors at 8 years after mastectomy. In comparison with a control group, survivors were more likely to report arm problems, defined weakness, stiffness, pain, swelling, loss of sensation, and limited range of movement (64 vs. 43 , p < 0.04).99

Illness

In many of the diffuse pain conditions, there is a history of a preceding illness including glandular fever, tonsillitis, and influenza. Diffuse and localized chronic pains can also complicate almost any other chronic childhood illness (16) including juvenile arthritis, inflammatory bowel It is difficult to know whether the direct infectious or inflammatory condition has effect on the evolution of chronic pain or whether the pain is a consequence of the immobility, medical therapies, environmental changes, etc. There is a strong association between joint hypermobility and diffuse pain (22).

Pathophysiological

Once more there are few data on the pathophysiology of childhood chronic pain. It has been widely postulated that, in childhood CRPS, there is either overactivity of the sympathetic nervous system or under-responsiveness of the alpha adrenergic pathways. Despite a lot of studies in adults with Pain sensitivity varies substantially among humans. A significant part of the human population develops chronic pain conditions that are characterized by heightened pain sensitivity. A group in North Carolina recently showed that catecholamine-O-methyltransferase (COMT) activity substantially influences pain sensitivity, and the three major haplotypes determine COMT activity in humans that inversely correlates with pain sensitivity and the risk of developing a chronic pain condition. This again is early work, but it underlines the need to continue research in this area (41). There has also been interest in the preliminary findings that pain sensitivity may be higher in adolescents who were born...

Pass the Honey

Honey is talked about throughout the Bible. Honey can be an excellent source of a natural sweetener, but I have seen major issues with overdoing honey similar to what I see with sugar consumption. Honey is 95 percent sucrose and sucrose is sugar. Yes, honey is not white table sugar, but I have treated patients with chronic pain who use honey as a sugar substitute and suffer with sugar headaches, pain syndromes, mood swings, depression, etc. just like those who consume sugar.

Pain Education

In order to move forward with rehabilitation it is essential that the adolescent and family have an understanding of chronic pain. This is a very difficult concept for many individuals to understand (including professionals) as there is a belief that pain is always a warning sign that a disease process or abnormality is present. There is a need for the young person and family to find a cause, and often skepticism from health professionals that the pains are present at all. During the consultation it is initially important to investigate what thoughts the family and the young person have about the cause of the Analgesics are often unhelpful in chronic pain conditions. The adolescent may have tried a variety of nonsteroidals, codeine preparations, and or opioids with no lasting effect. This can be confusing. An explanation that chronic pain conditions (whether directly related to disease, e.g., cancer or not) are notoriously difficult to treat should be given. For reasons that are...

Medical Therapies

The number of analgesics and interventions used is a sign that there are no well controlled therapeutic trials in the arena of childhood chronic pain. It is becoming widely accepted, however, that any analgesic intervention should be alongside multidisciplinary therapy (58-61). It is unusual for analgesia to work alone. Oral treatments that have been used, with variable success, include tricyclic antidepressants, nonsteroidals, opioids, anticonvulsants and glucocorticoids (62,63). Sympathetic blocks (64), TENS (23) and botulinum injections have been used in localized pain (62). In some centers spinal stimulation are also advocated. Complementary therapies are commonly utilized by patients with chronic pain (65). The evidence supporting many of these therapies in children and adolescents is poor (66) but many young adults find certain therapies such as acupuncture, massage and aromatherapy helpful.

Outcome

The natural history of chronic pain in children shows that, in many cases, outcome is improved compared to that in adults (73-75). It has been shown that early, multidisciplinary input (including cognitive behavioral therapy) has favorable outcome. In our outcome study we showed that the back to school rate significantly improved after an intensive, residential, multi-disciplinary programme (71), as did functional ability, anxiety (parents and young person) and mood.

Prognosis

Adolescent back pain generally has a better prognosis than adult back pain. Mechanical causes usually respond to conservative treatment, as they are only rarely caused by degenerative or progressive conditions such as spinal stenosis or disk herniation. Nonspecific back pain in adolescents is also thought to have a better outcome than adult nonspecific back pain. Few adolescents (7-11 ) seek medical treatment for their back pain, and only rare cases are hospitalized or become disabled (4,6,15,19,20,5,70,75). In contrast, back pain in adults is the fifth most common reason for physician visits (76), and although most adults with acute LBP will improve within three months, 6 to 20 will develop chronic back pain, and 25 to 75 still have back pain one year later (13,72,73,77). In adults, preexisting psychological distress, work compensation issues, other chronic pain issues and job dissatisfaction are all associated with an increased risk of developing

Web Resources

The Kovacs Foundation, a Spanish organization interested in promoting medical work, runs this site. This site reviews anatomy, etiologies, diagnosis, and exercises. It also provides the information in Spanish. This site has a medical advisory board from different areas related to spine care, which provide peer-reviewed patient information. Topics covered included spondylolysis, Scheuermann disease, scoliosis, and sports related back problems in children and teens. Calcium requirements during growth are also reviewed. Adult topics include back exercise, chronic pain, osteoporosis, surgical treatment, office furniture selection, and sleep advice. This web site of the National Pain Foundation reviews common causes of adult and pediatric back pain, and discusses psychological factors related to chronic pain in pediatric patients and their treatment. This is the site of the National Institutes of Health, with links to other sites. Many topics are

In Cancer Survivors

Research to date highlights several important aspects of depression associated with chronic pain in cancer survivors.27,81 Depression not only impacts negatively on the quality of life of the individual suffering from persistent pain, but there are indications that depression adds to the burden of impairment associated with persistent If has oft been noted that pain patients appear to be particularly sensitive to the side effects of antidepressant medication.33,87 This view is expressed with sufficient frequency in clinical discussions giving the impression that side-effect sensitivity has been extensively studied in chronic pain. However, a search of the available literature provides little concrete evidence to clarify the relation, if any, between persistent pain and exaggerated reactivity to medication side effects. Clearly, this is an area that requires further investigation. An early review of the literature on the treatment of depression in chronic pain suggested that treatment...

Detoxification

There are few controlled studies on the clinical course and optimal therapies for detoxification from multiple psychoactive substances. Patients can be detoxified from all psychoactive substances together, or maintained on one or more drugs while being detoxified from others. When the drugs used are all part of the same class (e.g., alcohol and sedatives methadone, Codeine, and heroin), a complete detoxification is more common. When the drugs used are from different classes, partial or sequential detoxification usually occurs. An example of the latter situation is an opioid, cocaine, alcohol, and nicotine user who is detoxified from alcohol and cocaine, but maintained on methadone and allowed to continue tobacco use. Sometimes a partial detoxification is indicated because of the need for continued psychotropic medication for medical or psychiatric illnesses, such as continued opioids for chronic pain or benzodiazepines for anxiety.

Alcoholism

Recent additions to the pharmacotherapy of alcohol withdrawal include clonidine and carbamaz-epine. Clonidine is an antihypertensive agent (i.e., it lowers blood pressure) that has recently been used in the treatment of drug withdrawal states and chronic pain. This medication decreses autonomic hyperactivity (i.e., it lowers an increased pulse and blood pressure), but it does not have the anticonvulsant properties of the benzodiazepines or barbiturates. Carbamazepine has also been employed in the treatment of alcohol withdrawal and does have anticonvulsant properties. Neither medication is habit forming and thus may have potential in the treatment of alcohol withdrawal.

Anatomy

Adrenal Gland A small walnut-shape gland located on top of the kidneys. The adrenal gland makes several hormones necessary for optimal health. It is important to make natural cortisone, male and female hormones, and is critical for the maintenance of various minerals. The adrenal gland also creates the chemicals necessary for you to respond to emergencies. It is commonly weakened by sugar and stress. Chronic pain, female hormone issues, asthma, allergies plus so much more are directly affected by adrenal function. Two CD programs are available through our on-line resource library.

Anemia

In a similar case recently, a 36-year-old with a history of colon cancer came to the emergency department. She was on chemotherapy and was experiencing chronic pain and depression. She had undergone surgery on her ileum years before. She had never received B12 treatment, but she should have because of the ileal surgery. We tested her and she was found to be grossly B12 deficient at 126pg ml. She had received multiple blood transfusions in the past for her anemia of chronic disease.

Arthritis

Overweight is a risk factor in arthritis because of the pressure put on weight-bearing joints increasing the pain. Early diagnosis is essential in limiting the long-term effects of the disease. The kind of fat in the diet influences the symptoms. Omega-3-fatty acids help regulate hormone-like substances called eicosanoids that control inflammation and pain. The fats in meat have the opposite effect by stimulating the production of inflammatory agents. Food allergies may play a prominent role in precipitating arthritis. Common allergens are milk products, refined sugar, citrus fruits, and nightshade vegetables such as tomatoes, potatoes, eggplant, peppers, and chili. It is recommended that these foods or any food suspected of causing an allergic reaction be eliminated from the diet for a period of 2 months and then be reintroduced to observe the reaction. Moderate exercise is very beneficial for arthritic individuals in relieving stress, improving circulation, and increasing mobility....

Symptoms

As in OSAS, snoring is a common symptom, predominantly in males, although the absence of snoring has also been described in this syndrome, the so-called silent UARS (Kristo 2005). In recent years, several studies have demonstrated strong associations between UARS and functional somatic syndromes, such as chronic fatigue syndrome, chronic insomnia, chronic pain, irritable bowel syndrome, fibromyalgia, depression, parasomnias and posttraumatic stress disorders (Gold 2003, 2011). Due to its association with chronic somatic diseases, UARS has been postulated to activate the hypothalamic-pituitary-adrenal axis (HPA) (Gold 2010), although not all studies support the association of sleep disordered breathing with these somatic functional disorders. (Vgontzas & Fernandez-Mendoza 2011, Trakada 2007).

Spondylolysis

Most young athletes with spondylolysis report excellent functional outcomes after diagnosis, with poorer outcomes seen in those with bilateral defects. Complications of a pars interarticularis fracture include nonunion, chronic pain, and a spondylolisthesis. A spondolisthesis or slip occurs if there are bilateral pars defects with forward slippage of the anterior vertebral body. A spondylolisthesis can be seen and measured on a lateral

Linda Dykstra

When considering pain, it is important to classify it as either acute (short-term) or chronic (long-term). The duration of many kinds of pain can be anticipated. The acute pain associated with surgery is usually limited in duration and, over the period of several days, decreases markedly. In contrast, the chronic pain associated with disseminated cancer can often be severe and persistent, actually increasing over time. Acute pain is associated with a number of very specific symptoms that are usually recognized by others making it relatively easy to be believed. Patients may be pale and sweaty, the heart may be beating rapidly, and they may be grimacing. Chronic pain is different it is usually defined as pain that persists for six months or longer. Many of the signs we see acutely wear off during this time, despite the continued pain, leading some observers to conclude that the pain is minimal or even absent this conclusion is incorrect and often leads to undertreatment and therefore...

Midfoot Pain

Chronic pain in the middle of the foot is often the result of a variety of bony abnormalities. The most common of these is flat feet. Painless flat feet are most often a variation of normal and require no treatment. However, if a child with flat feet has foot pain, it requires evaluation. Often no significant abnormality is found and the pain is relieved with the use of an orthotic.

What is ketamine

Ketamine is currently used in many general hospitals around the world, with a recent increase in use in Emergency Departments and in chronic pain clinics (Parke-Davis 1999-2000 Bell et al. 2006 Sehdev et al. 2006). It is often used during severe asthmatic crisis, childbirth, and surgical operations, and occasionally in the treatment of migraine and in anesthesia for children (Jansen 2001). It is relatively safe because it does not usually suppress breathing as much as other anesthetics and it has a short duration of action (30-60 minutes). The substance also has good analgesic and amnesic properties. At small doses (0.1-0.5 mg kg hr), it appears to stimulate rather than depress the central nervous system (for instance, Jansen 1989), and it has been used for treatment of pain associated with movement and neuropathic pain. However, as I will discuss later in greater detail, at sub-anesthetic doses (10-25 per cent of a surgical dosage), ketamine can produce effects similar to those...

Other Modalities

Another home-based remedy is transcutaneous electrical nerve stimulation (TENS), which is administered by a unit with electrodes that stick to the skin. This device is first used in physical therapy to assess whether it is helpful in relieving the pain. TENS units are small and compact (similar in size to a cell phone) and can be easily hidden under one's clothes. They are typically worn intermittently during the day. Interfer-ential units are similar to TENS. Occasionally this is used for chronic pain, but it tends to work better for acute pain issues such as the reduction of swelling. Neither unit is recommended for use directly over a tumor because of the potential risk of stimulating malignant cells.