read
at
http://www.spinalcordinjury-paralysis.org/forums/viewtopic/11775/54375
Pain is experience by an estimated 81% of individuals with SCI. That is a huge number. The good thing to remember is that pain comes but it also goes. There are treatments that can help you deal with pain and even make it not a control factor in your life. There is a lot of information about pain and neurological injury and disease. I have written about it previously but there are so many questions about treatment that I thought it would be good to bring it up again, especially focusing on treatment.
There are several types of pain. Surgical pain is felt after an operation. It is treated with narcotics and then analgesics for a temporary period of time until the effects of the surgical pain resolve. Muscular pain is felt when muscles are over used from activity such as exercise or from pushing a chair or transferring from place to place. Muscular pain is also felt when an individual has paralysis. All of the muscles in the trunk and abdomen are used to hold up our bodies for activities such as sitting. When some of the muscles don’t work well, other muscles have to compensate which makes them tire quicker. Treatments include strengthening and rest. Analgesics can be taken for a short period of time until the muscles adapt to their new level of function.
The pain that concerns most individuals with paralysis is neuropathic pain which is pain due to miscommunication of the nerves as interpreted by the brain. Neuropathic pain can be a signal from a nerve below your level of injury that sends a pain message to the brain but it may not take the correct route. The route of the message could be disrupted because the myelin or insulation of the nerve is missing causing the signal to stray off of the nerve pathway or it could be a jumble in the area of damage of the nerve in the spinal cord or even misread by the brain especially if you have had a brain injury or stroke.
Treatment consists of various modalities and is often most successful with a combination of therapies.
Movement
The most overlooked treatment for pain is stretching, range of motion and exercise. Think about parts of your body with nerves that function well. Often you will hear people comment that they slept funny or got a cramp from sitting too long. This can happen after a nerve injury also but the body does not respond in the same way. Moving your body, doing pressure releases, turning, stretching, range of motion helps your muscles and joints stay limber without cramping. Just because a person does not feel a muscle cramp does not mean that you won’t get one. Movement is the first line of defense for everyone to avoid pain.
If you have the opportunity to use a standing frame or any of the activity based therapies, the repetitive movement is a great treatment to avoid the onset of pain as well as to relieve pain as it provides a workout for the nerves and muscles below the level of injury. This is a great stretching and movement exercise as the nerves and muscles of your body are actively doing the work of movement.
Your body wants to move so providing any sort of movement is an opportunity for the body to do what it wants and needs. Stretching, range of motion and exercise is often overlooked. Using these basic strategies is a good place to start.
Medication
Medications are another treatment for pain relief. When someone has extreme pain, they often think of narcotics because that is a strong medication. Unfortunately, narcotics don’t treat nerve pain. They dull the brain so it does not receive or interpret the pain message as well leading the individual to think that the narcotic is controlling the pain. In neuropathic pain, it is the nerve transmission where medication needs to work. Narcotics can dull your brain and lead to addiction issues but not control neuropathic pain.
Non-steroidal anti-inflammatory drugs (NSAIDS) are often overlooked for the treatment of neuropathic pain but they do affect it. I think they are overlooked because they are easy to get so people don’t feel they offer the treatment needed for such severe pain however, they have been demonstrated to have a good response to neurologic pain control. This classification of medication includes aspirin, ibuprofen and naproxen.
Other medications with success in treating neuropathic pain include antidepressants such as SSNRIs (selective serotonin norepinephrine reuptake inhibitors), venlafaxine and tricyclics (amitriptyline). These are taken at very low doses which affects neuropathic pain but not a large enough dose to treat depression. Some individuals who are treated for depression find their neuropathic pain resolved with treatment. If you do not have depression, you can manage neuropathic pain with extremely low doses of these medications.
Muscle relaxants and anti-spasticity medication can be tried as well as use of anesthetic cream applied just to one area where neuropathic pain persists. Some of these drugs are diazepam, baclofen, tizanidine and cyclobenzaprine. If your nerves are contracting your muscles pain can occur. These medications will relax your muscles and thereby reduce pain.
Two drugs work to treat neuropathic pain. These are the seizure medications, gabapentin (Neurontin) and pregabalin (Lyrica). Both are serious medications with possible severe side effects so you want to be well informed prior to taking either of these medications.
Surgery
Surgery is another form of therapy that is used for neuropathic pain. Surgically implanted devices can be used to interrupt pain signals at the nerve root. This is called a dorsal column stimulator. It is implanted in the body close to the nerve root where the pain is being processed. A low intensity signal is transmitted which breaks the pain pathway to the brain.
Another surgical intervention is an intrathecal pump which is a catheter implanted in the spinal column (not in the spinal cord). Baclofen or baclofen and morphine are pumped into the spinal column to calm nerve impulses. The catheter is connected to a pump which is placed under the skin in the abdomen. It must be refilled by syringe on a regular basis to maintain the continuous therapy. The pump can be turned up or down by a trained health professional using a specialized magnet so you can have the dosage adjusted as your pain resolves.
These surgical interventions are used long term however, sometimes after several years, the pain cycle is permanently broken and the devices are turned off.
Psychotherapy
Neuropathic pain is a real problem but just like everyone, it can be aggravated by depression and stress. Having a neurologic injury or disease can be challenging to even the hardiest of individuals. If you are finding difficulty with your life situation, your pain can be affected.
Psychological treatment may help reduce your pain. You may find biofeedback and other stress reduction treatments may also help treat your neuropathic pain. Some individuals find relief through alternative and complementary therapies. If these work for you without adding complications, you should certainly use them. Your general state of health can also affect pain. Be sure to have regular checkups and treat health issues promptly.
Equipment
Many individuals come into the clinic with back pain. After numerous tests, they find they have no identifiable problem. I always ask how long it has been since they got a new mattress or pillow. It is the same for individuals with paralysis: to examine their bed and seating surfaces as well as their mobility and exercise equipment. Our bodies are constantly changing. Worn out equipment or under or over inflated surfaces can make a difference in your pain levels. Ill-fitting exercise equipment or mobility equipment can lead to pain issues as well as skin and joint problems. Be sure to have all of your equipment checked.
Pain is an ongoing issue for many individuals in the community. Treatments that others have found successful may work for you or you might have a totally different solution. What works for one may or may not be the right treatment for another. When treating neuropathic pain, you have to use a trial approach to find the solution that works best for you. Some have advanced to high levels of medication and other treatments without finding success. Sometimes tapering off high level medications and starting with a simpler remedy works today when it did not work last month. This is shocking and does not seem possible but it is true for many individuals. We think we need more and more but bodies and pain are constantly changing. Simpler can be better. Keep at it. Keep moving. You will find the solution that is just right for you.
at
http://www.spinalcordinjury-paralysis.org/forums/viewtopic/11775/54375
Pain is experience by an estimated 81% of individuals with SCI. That is a huge number. The good thing to remember is that pain comes but it also goes. There are treatments that can help you deal with pain and even make it not a control factor in your life. There is a lot of information about pain and neurological injury and disease. I have written about it previously but there are so many questions about treatment that I thought it would be good to bring it up again, especially focusing on treatment.
There are several types of pain. Surgical pain is felt after an operation. It is treated with narcotics and then analgesics for a temporary period of time until the effects of the surgical pain resolve. Muscular pain is felt when muscles are over used from activity such as exercise or from pushing a chair or transferring from place to place. Muscular pain is also felt when an individual has paralysis. All of the muscles in the trunk and abdomen are used to hold up our bodies for activities such as sitting. When some of the muscles don’t work well, other muscles have to compensate which makes them tire quicker. Treatments include strengthening and rest. Analgesics can be taken for a short period of time until the muscles adapt to their new level of function.
The pain that concerns most individuals with paralysis is neuropathic pain which is pain due to miscommunication of the nerves as interpreted by the brain. Neuropathic pain can be a signal from a nerve below your level of injury that sends a pain message to the brain but it may not take the correct route. The route of the message could be disrupted because the myelin or insulation of the nerve is missing causing the signal to stray off of the nerve pathway or it could be a jumble in the area of damage of the nerve in the spinal cord or even misread by the brain especially if you have had a brain injury or stroke.
Treatment consists of various modalities and is often most successful with a combination of therapies.
Movement
The most overlooked treatment for pain is stretching, range of motion and exercise. Think about parts of your body with nerves that function well. Often you will hear people comment that they slept funny or got a cramp from sitting too long. This can happen after a nerve injury also but the body does not respond in the same way. Moving your body, doing pressure releases, turning, stretching, range of motion helps your muscles and joints stay limber without cramping. Just because a person does not feel a muscle cramp does not mean that you won’t get one. Movement is the first line of defense for everyone to avoid pain.
If you have the opportunity to use a standing frame or any of the activity based therapies, the repetitive movement is a great treatment to avoid the onset of pain as well as to relieve pain as it provides a workout for the nerves and muscles below the level of injury. This is a great stretching and movement exercise as the nerves and muscles of your body are actively doing the work of movement.
Your body wants to move so providing any sort of movement is an opportunity for the body to do what it wants and needs. Stretching, range of motion and exercise is often overlooked. Using these basic strategies is a good place to start.
Medication
Medications are another treatment for pain relief. When someone has extreme pain, they often think of narcotics because that is a strong medication. Unfortunately, narcotics don’t treat nerve pain. They dull the brain so it does not receive or interpret the pain message as well leading the individual to think that the narcotic is controlling the pain. In neuropathic pain, it is the nerve transmission where medication needs to work. Narcotics can dull your brain and lead to addiction issues but not control neuropathic pain.
Non-steroidal anti-inflammatory drugs (NSAIDS) are often overlooked for the treatment of neuropathic pain but they do affect it. I think they are overlooked because they are easy to get so people don’t feel they offer the treatment needed for such severe pain however, they have been demonstrated to have a good response to neurologic pain control. This classification of medication includes aspirin, ibuprofen and naproxen.
Other medications with success in treating neuropathic pain include antidepressants such as SSNRIs (selective serotonin norepinephrine reuptake inhibitors), venlafaxine and tricyclics (amitriptyline). These are taken at very low doses which affects neuropathic pain but not a large enough dose to treat depression. Some individuals who are treated for depression find their neuropathic pain resolved with treatment. If you do not have depression, you can manage neuropathic pain with extremely low doses of these medications.
Muscle relaxants and anti-spasticity medication can be tried as well as use of anesthetic cream applied just to one area where neuropathic pain persists. Some of these drugs are diazepam, baclofen, tizanidine and cyclobenzaprine. If your nerves are contracting your muscles pain can occur. These medications will relax your muscles and thereby reduce pain.
Two drugs work to treat neuropathic pain. These are the seizure medications, gabapentin (Neurontin) and pregabalin (Lyrica). Both are serious medications with possible severe side effects so you want to be well informed prior to taking either of these medications.
Surgery
Surgery is another form of therapy that is used for neuropathic pain. Surgically implanted devices can be used to interrupt pain signals at the nerve root. This is called a dorsal column stimulator. It is implanted in the body close to the nerve root where the pain is being processed. A low intensity signal is transmitted which breaks the pain pathway to the brain.
Another surgical intervention is an intrathecal pump which is a catheter implanted in the spinal column (not in the spinal cord). Baclofen or baclofen and morphine are pumped into the spinal column to calm nerve impulses. The catheter is connected to a pump which is placed under the skin in the abdomen. It must be refilled by syringe on a regular basis to maintain the continuous therapy. The pump can be turned up or down by a trained health professional using a specialized magnet so you can have the dosage adjusted as your pain resolves.
These surgical interventions are used long term however, sometimes after several years, the pain cycle is permanently broken and the devices are turned off.
Psychotherapy
Neuropathic pain is a real problem but just like everyone, it can be aggravated by depression and stress. Having a neurologic injury or disease can be challenging to even the hardiest of individuals. If you are finding difficulty with your life situation, your pain can be affected.
Psychological treatment may help reduce your pain. You may find biofeedback and other stress reduction treatments may also help treat your neuropathic pain. Some individuals find relief through alternative and complementary therapies. If these work for you without adding complications, you should certainly use them. Your general state of health can also affect pain. Be sure to have regular checkups and treat health issues promptly.
Equipment
Many individuals come into the clinic with back pain. After numerous tests, they find they have no identifiable problem. I always ask how long it has been since they got a new mattress or pillow. It is the same for individuals with paralysis: to examine their bed and seating surfaces as well as their mobility and exercise equipment. Our bodies are constantly changing. Worn out equipment or under or over inflated surfaces can make a difference in your pain levels. Ill-fitting exercise equipment or mobility equipment can lead to pain issues as well as skin and joint problems. Be sure to have all of your equipment checked.
Pain is an ongoing issue for many individuals in the community. Treatments that others have found successful may work for you or you might have a totally different solution. What works for one may or may not be the right treatment for another. When treating neuropathic pain, you have to use a trial approach to find the solution that works best for you. Some have advanced to high levels of medication and other treatments without finding success. Sometimes tapering off high level medications and starting with a simpler remedy works today when it did not work last month. This is shocking and does not seem possible but it is true for many individuals. We think we need more and more but bodies and pain are constantly changing. Simpler can be better. Keep at it. Keep moving. You will find the solution that is just right for you.
No comments:
Post a Comment