Category: Painful Conditions

Insomnia is the inability to fall asleep or remain asleep. It is a large problem in our society, but fortunately for most people, insomnia occurs only on occasion. However, for others insomnia can become chronic. Early morning awakening can become a problem resulting in persistent sleepiness during the day. Contributing factors to insomnia consist of:

• Change of environment
• Drug abuse / alcoholism
• Depression Lack of physical activity
• Grieving the death of a loved one
• Certain medications
• Medical problems
• Caffeine consumption
• Stress
• Eating late
• Improper diet

Diagnosis

Insomnia may be related to other health problems, therefore, it is important to tell the doctor about sleep problems. A diagnosis of insomnia is based on:

• History
• Physical
• Diagnostic tests
• Sleep lab findings

Treatment

Primary treatment is to avoid those elements causing the insomnia. Long-term drugs are not appropriate because they interfere with the body’s normal rhythm and over time will decrease the restful function of normal sleep. Because patients begin to feel their sleep is poor, they may take more and more medications, entering a viscous cycle. It is okay to take a sleep-inducing drug on occasion when difficulty sleeping is anticipated, such as a business trip or stimulating vacation.

Prevention

• Reduce stress
• Avoid caffeine (especially after dinner)
• Relax two hours before bedtime e.g: read, meditate, journal. Do not go to bed tense.
• Exercise regularly.
• Move your body regularly throughout the day.
• Practice the same routine every night.
• Wake at approximately the same time of day.
• Make a quiet sleep environment.

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Arthritis is inflammation of one or more joints. A joint is the area where two bones meet. There are over 100 different types of arthritis. When the cartilage that cushions between bones wears down the result can be the bones rubbing together causing irritation, swelling and stiffness at the joint. The most common type of Arthritis is Osteoarthritis.

Osteoarthritis is a disorder affecting our joints; causing pain and gradual deterioration of function. Every joint is composed of two bones with a gap between them.  Lining the bone on either side of the gap is a smooth material called cartilage that allows the joint to move freely. In the gap between the two cartilage surfaces is joint fluid. Around the joint is a capsule called the synovium. It contains the joint fluid. Overlying the synovium are ligaments and muscles keeping the joint intact and the bones in place. 

In osteoarthritis there is a progressive loss of the smooth cartilage, exposing the rough bone underneath. The bone will compensate by increasing its growth. This causes spur formation where the ligaments and capsule attach to the bone. This combination of exposed bone and spurs make the joint stiff and painful.

Causes

• Joint overuse
• Obesity
• Fractures
• Trauma to the soft tissues (cartilage)
• Genetics

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Osteoarthritis is a gradual deterioration of the spinal column that occurs in everybody by the time they are 50 years of age. Fortunately, the majority of the people are not symptomatic from the arthritis. In contrast, however, for reasons we do not yet know, some patients may suffer severely. The deterioration causes a low-grade inflammation in the joints of the spinal column.

Each joint is composed of two surfaces of cartilage that are normally very smooth and lubricated by joint fluid. Normal joints move smoothly, similar to two pieces of glass with a little bit of water in between them. Gradual calcium build-up gets deposited into the soft tissue around the joints causing inflammation and the soft tissues to become very hard. This hardening is called spur formation because a small mound of bone develops. The spinal joint is very close to the nerve and is susceptible to this bony spur putting pressure on the nerve, causing significant pain in association with the arthritis.

Diagnosis

Patients with spur disease of the spine will have symptoms related to their arthritis such as pain in the neck or low back as well as pain secondary to nerve root irritation where the spinal cord starts to branch out. This will usually cause radiating pain down the arm or leg. A simple spine X-ray is usually adequate for diagnosis of spinal spurs. Spurs that are just forming can sometimes be diagnosed earlier with a CAT scan.

Treatment

There are essentially five treatment strategies for nerve irritation secondary to spurs.

1. Medications. A combination of anti-inflammatory drugs and mild narcotics can be used to reduce pain.
2. Physical therapy. Sometimes patients with  spurs  may  benefit  from  mild traction, which reduces pressure on the nerve. In addition, keeping the joint from moving with a soft collar can help.
3. Epidural injection.  During an epidural injection, medications are placed close to the nerve to relieve the inflammation associated with the arthritis.  These injections consist of  anti-inflammatory cortisone type  steroids. They are usually given as a series of two to four injections over a period of weeks. Relief will usually begin within 72 hours and can last for many months.
4. Surgery.  During surgery the spur is removed, relieving the pressure on the nerve.  Unfortunately, the tendency to form arthritis still remains.  The spur can regrow and pain may recur.
5. Transcutaneous electrical nerve stimulator, also known as a TENS unit.  This device is worn externally and delivers a mild electrical stimulation over the nerve, interfering with the conduction of pain.  While the TENS unit does not change the underlying condition, it can definitely reduce symptoms while it is being worn.

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