Category: Painful Conditions

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

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

The symptoms of osteoporosis prior to a bone fracture are:

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

Treatment

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

Prevention

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

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

Diagnosis

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

Treatment

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

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

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

Diagnosis

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

Treatment

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

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Shingles is an infection of an individual nerve root by the same virus that causes chicken pox, also known as the herpes zoster virus. The disease can be painful and can develop almost anywhere in the body, but is most commonly displayed on the face, chest and abdomen.

A day or two after the pain begins; a characteristic rash erupts, which is composed of small fluid-filled blisters on top of reddened skin. The blisters are limited to a band on the right or left side of the body. If the rash crosses over the middle of the body it is not shingles because the virus affects one nerve corresponding to an area of the skin. Each cutaneous or skin nerve in the human body stays on the right or left side and does not cross over. Initial infection of the shingles virus occurs when chicken pox is contracted as children or young adults. The body’s immune system forces the virus to settle in an inactive form inside the nerve cells. When the chicken pox virus reactivates, it moves down the nerve fibers to the skin and the rash erupts. In addition to the skin, the nervous system is involved. In fact, if the virus attacks the optic nerve of the eye, it may leave the patient with temporary blindness.

In most patients, after the eruption of shingles, the rash will heal and the pain will subside after a period of three to five weeks. However, there are exceptions. In older patients there is a greater risk the virus can actually leave permanent nerve damage, causing pain long after the rash is healed. In some patients, the pain may persist for the rest of their lives.

Treatment

Medical science is now developing antiviral drugs. These are similar to antibiotics that were developed in the 1950’s to treat bacterial infections. One of the first antiviral drugs developed was acyclovir. This drug can help resolve herpes infections. As soon as the rash breaks out, acyclovir is prescribed in large doses for a period of approximately 10 days. This can help alleviate the attack and prevent permanent nerve damage in some patients.

Additionally, early intervention with nerve blocks done by pain physicians can also prevent the development of post-herpetic neuralgia. Post-herpetic neuralgia is the name given to the painful condition that exists long after the viral infection is over. Combination therapy of the acyclovir and nerve blocks is the most effective treatment strategy for preventing this painful development.

There is treatment for patients suffering from post-herpetic neuralgia. Drugs used to treat seizures, such as Tegretol and Dilantin, can be of some help. Antidepressants are used to treat post-herpetic neuralgia as well. The antidepressants raise levels of chemicals in our brain that are the body’s natural mood elevators. These mood elevators also raise levels of endorphins in the brain, which are the body’s natural narcotics. Consequently, by taking antidepressants, we can elevate the body’s internal narcotics without having to rely on narcotics prescribed by the doctor.  Therefore, antidepressants are superior to narcotics because dependence can develop in narcotics.

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