Articles on chronic pain

Low Back Pain: What All You Must Know

Dr. (Maj) Pankaj N Surange, Spine and Pain Specialist
Back pain is a problem which is very often faced by all the human beings at least once in their lifetime. This pain, if not taken seriously can turn into a deadly disease which can put your life at stake.Some important facts about back painLow back pain is the most common musculoskeletal complaint, with potentially devastating consequences.90% of patients with acute low back pain do not require surgery. Most specialists agree that non-surgical treatment should be tried first. Surgery as first line treatment is indicated only in few selected cases. These are medical emergencies such as a broken neck or if you have symptoms such as weakness in the legs that gets progressively worse and/or bladder and/or bowel incontinence caused by the back problem.The incidence of back pain is highest between the ages of 35 and 55.Disc is not always the culprit. Small joints of spine are the source of pain in majority of patients.The pain combined with depression and anxiety in long-term cases places sufferers at risk for suicide.People who work at sedentary occupations are at a higher risk of disk injury than those who do moderate amounts of physical work.Up to 85 per cent of persons with back pain can’t recall a specific incident that brought on their pain.Early interventional treatments in back pain management have been found to return patients to work and regular activities more rapidly than past conservative therapies.Early intervention decreases unnecessary chronic pain, long-term treatments and disabilities.Heat and massage therapy cannot cure the disease. These do not provide long term solutions to the problems of back. These are mainly used for managing pain during the recovery period.Newer Developments and Better Understanding in Management of Back painA wide range of treatment is available for low back pain, depending on what is causing the pain and how long it lasts.Most people find that their low back pain improves within a few weeks. Chances are good that your pain will go away soon with some basic self-care.If you have recently developed low back pain, stay active and consider taking over-the-counter pain medicines .Staying active is better for you than bed rest. In fact, staying in bed more than 1 or 2 days can actually make your pain worse and lead to other problems such as stiff joints and muscle weakness.If your low back pain has lasted longer than 3 months, you will probably benefit from more intensive treatment.Must visit Interventional pain and spine specialist :-If you have moderate to severe low back pain that lasts more than a couple of Days;If you have back or leg symptoms that have gotten worse; If your symptoms have not gone away after 2 weeks of home treatment; Or, if improved symptoms flare up again.A physical examination by pain specialist and possibly an imaging (x-ray/MRI) test may produce new information about your condition and help direct your treatment decisions.Physical Therapy: TENS, UltrasoundHeat and Cryotherapy:These Modalities should always be considered an adjunct to an active treatment program in the management of acute low back pain. They should never be used as the sole method of treatment.Interventions: Minimally invasive non surgical procedures for management of Back PainFor back pain sufferers, interventional pain management techniques can be particularly useful. In addition to a thorough medical history and physical examination, interventional pain management physicians have a wide array of treatments that can be used including the following: Epidural injections (in all areas of the spine):The use of anesthetic and anti-inflammatory medications injected into the epidural space to relieve pain or diagnose a specific condition.Nerve, root, and median branch blocks:Injections done to determine if a specific spinal nerve root is the source of pain. Blocks also can be used to reduce inflammation and pain. Facet joint injections: An injection used to determine if the facet joints are the source of pain. These injections can also provide pain relief. Discography:An "inside" look into the discs to determine if they are the source of a patient's pain. This procedure involves the use of a dye that is injected into a disc and then examined using x-ray or CT Scan.Pulsed Radiofrequency otomy (PRFN): A minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain. Rhizotomy:A procedure in which pain signals are "turned off" through the use of heated electrodes that are applied to specific nerves that carry pain signals to the brain. Spinal cord stimulation:The use of electrical impulses that are used to block pain from being perceived in the brain. Intrathecal pumps: A surgically implanted pump that delivers pain medications to the precise location in the spine where the pain is located. Percutaneous Discectomy / Nucleoplasty:A minimally invasive day care procedure in which tissue is removed from the disc with the help of decompressor through a very minute hole ,in order to decompress and relieve pressure on the spinal nerves. Ozoneucleolysis or Ozone discectomy: Has emerged as an affordable, least invasive approach and costs 2/3rd of the price of conventional surgery. Ozone injected inside the affected intervertebral disc under c- arm guidance, causes shrinkage of disc and thus, reducing the volume and lessening the pressure on nerves.Intradiscal Electrothermoplasty (IDET) This procedure involves the insertion of a needle into the affected disc with the guidance of an x-ray machine. A wire is then threaded down through the needle and into the disc until it lies along the inner wall of the annulus. The wire is then heated which destroys the small nerve fibers that have grown into the cracks and have invaded the degenerating disc. These techniques are exciting. They offer the possibility of treating low back pain and sciatica with much less trauma and risk than surgery.Quick tips to a healthier backFollowing any period of prolonged inactivity, begin a program of regular low-impact exercises. Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility.Yoga can also help stretch and strengthen muscles and improve postureAlways stretch before exercise or other strenuous physical activity. Don’t slouch when standing or sitting. When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced. At home or work, make sure your work surface is at a comfortable height for you. Sit in a chair with good lumbar support and proper position and height for the task.Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for a long period of time, rest your feet on a low stool or a stack of books. Wear comfortable, low-heeled shoes. Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed. Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body. Do not twist when lifting. Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles. If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Pain Management: Why Is It Important

Dr. G P Dureja, Spine and Pain Specialist
Most of the people suffer from different kinds of pain because of various reasons. Most of the people also tend to ignore it and move on. It is not advisable to ignore pain because you don’t know if that is casual or something serious to pay attention to. Avoiding pain will only make it worse, so it is essential to manage and treat pain. What is pain management? As the name suggests, managing your pain in a way that either it is treated or relieved, is pain management. It is also a branch in medicine called Pain Medicine, which involves in-depth procedures and techniques to ease out the pain. What are the types of pain?Majorly pain can be classified into two types, acute and chronic. Any pain that is short lived or short lasting comes under acute pain while, any pain that is long lasting or forever, comes under chronic pain. Chronic pain generally is the pain that lasts for 3 or more months. Based on, where, in the body, the pain is present, there are further three types. Somatic This type of pain is more like an exterior pain. Caused generally by the activation of receptors on the body surface or musculoskeletal tissues, it can be treated with proper rest and medication. Surgical pain comes under this type. Visceral Internal pain caused due to damage to the organs or tissues is known as visceral pain. This is not localized to just one body part. It might pain in different organs or body parts. Neuropathic Pain related to the spinal cord or peripheral nerves is called neuropathic pain. It generally occurs at the level or below the level of injury. How can you manage pain?Managing acute pain is easier than chronic. You can involve in a healthy lifestyle and physiotherapy but for advanced management and care, there are pain hospitals that manage pain well. These healthcare facilities are established especially to diagnose and manage chronic pain. What are the kinds of pain that can be treated?Various kinds of chronic pain can be treated in pain hospitals such as cancer pain, back pain, knee pain, neck pain, arthritis, fibromyalgia, migraine, etc. What are the treatments available? There are various treatment procedures that are involved in treating pain. These can be simple and complex both. It truly depends on upon the kind of pain you are suffering from. Some pain needs just lifestyle modification and counseling to be treated while the others require more complex treatments. Treatments like X-Ray guided injections, intrathecal pump implants, radiation therapy, Botox therapy and Platelet rich plasma therapy are some from a several more. These treatments can be very effective when performed by experts.

Myths and Facts About Low Back Pain

Dr. (Maj) Pankaj N Surange, Spine and Pain Specialist
· Low back pain is the most common musculoskeletal complaint, with potentially devastating consequences.· 90%of patients with acute low back pain do not require surgery. Most specialists agree that non-surgical treatment should be tried first.· Surgery as first line treatment is indicated only in few selected cases. These are medical emergencies such as a broken neck or if you have symptoms such as weakness in the legs that gets progressively worse and/or bladder and/or bowel incontinence caused by the back problem.· The incidence of back pain is highest between the ages of 35 and 55.· Disc is not always the culprit. Small joints of spine are the source of pain in majority of patients.· The pain combined with depression and anxiety in long-term cases places sufferers at risk for suicide.· People who work at sedentary occupations are at a higher risk of disk injury than those who do moderate amounts of physical work.· Up to 85 per cent of persons with back pain can’t recall a specific incident that brought on their pain.· Early interventional treatments in Back pain management have been found to return patients to work and regular activities more rapidly than past conservative therapies.· Early intervention decreases unnecessary chronic pain, long-term treatments and disabilities.· Heat and massage therapy cannot cure the disease. These do not provide long term solutions to the problems of back. These are mainly used for managing pain during the recovery period.NewerDevelopments and Better Understanding in Management of Back painA wide range of treatment is available for low back pain, depending on what is causing the pain and how long it lasts. Most people find that their low back pain improves within a few weeks. Chances are good that your pain will go away soon with some basic self-care.· If you have recently developed low back pain, stay active and consider taking over-the-counter pain medicines .· Staying active is better for you than bed rest. In fact, staying in bed more than 1 or 2 days can actually make your pain worse and lead to other problems such as stiff joints and muscle weakness.· If your low back pain has lasted longer than 3 months, you will probably benefit from more intensive treatment.· Must visit Interventional pain and spine specialist :-· if you have moderate to severe low back pain that lasts more than a couple of days;· if you have back or leg symptoms that have gotten worse;· if your symptoms have not gone away after 2 weeks of home treatment;· or if improved symptoms flare up again.·  A physical examination by pain specialist and possibly an imaging(x-ray/MRI) test may produce new information about your condition and help direct your treatment decisions.· Physical Therapy: TENS, Ultrasound, Heat and Cryotherapy:o These modalities should always be considered an adjunct to an active treatment program in the management of acute low back pain.o They should never be used as the sole method of treatment.Interventions: Minimally invasive non surgical procedures for management of Back PainFor back pain sufferers, interventional pain management techniques can be particularly useful. In addition to a thorough medical history and physical examination, interventional pain management physicians have a wide array of treatments that can be used including the following: Epidural injections (in all areas of the spine):The use of anesthetic and anti-inflammatory medications injected into the epidural space to relieve pain or diagnose a specific condition. Nerve, root, and median branch blocks:Injections done to determine if a specific spinal nerve root is the source of pain. Blocks also can be used to reduce inflammation and pain.Facet joint injections:An injection used to determine if the facet joints are the source of pain.These injections can also provide pain relief. Discography:An "inside" look into the discs to determine if they are the source of a patient's pain. This procedure involves the use of a dye that is injected into a disc and then examined using x-ray or CT Scan.Pulsed Radio frequency Neurotomy (PRFN): A minimally invasive procedure that disables spinal nerves and prevents them from transmitting pain signals to the brain. Rhizotomy:A procedure in which pain signals are "turned off" through the use of heated electrodes that are applied to specific nerves that carry pain signals to the brain. Spinal cord stimulation:The use of electrical impulses that are used to block pain from being perceived in the brain. Intrathecal pumps: A surgically implanted pump that delivers pain medications to the precise location in the spine where the pain is located. Percutaneous Discectomy / Nucleoplasty:A minimally invasive day care procedure in which tissue is removed from the disc with the help of decompressor through a very minute hole ,in order to decompress and relieve pressure on the spinal nerves. Ozoneucleolysis or Ozone discectomy: Has emerged as an affordable, least invasive approach and costs 2/3 of the price of conventional surgery. Ozone injected inside the affected intervertebral disc under c- arm guidance, causes shrinkage of disc and thus reducing the volume and lessening the pressure on nerves.These techniques are exciting. They offer the possibility of treating low back pain and sciatica with much less trauma and risk than surgery.Following any period of prolonged inactivity, begin a program of regular low-impact exercises:· Speed walking, swimming, or stationary bike riding 30 minutes a day can increase muscle strength and flexibility.· Yoga can also help stretch and strengthen muscles and improve posture· Always stretch before exercise or other strenuous physical activity.· Don’t slouch when standing or sitting.When standing, keep your weight balanced on your feet. Your back supports weight most easily when curvature is reduced.· At home or work, make sure your work surface is at a comfortable height for you.· Sit in a chair with good lumbar support and proper position and height for the task. Keep your shoulders back. Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of your back can provide some lumbar support. If you must sit for along period of time, rest your feet on a low stool or a stack of books.· Wear comfortable, low-heeled shoes.· Sleep on your side to reduce any curve in your spine. Always sleep on a firm surface.· Ask for help when transferring an ill or injured family member from a reclining to a sitting position or when moving the patient from a chair to a bed.· Don’t try to lift objects too heavy for you. Lift with your knees, pull in your stomach muscles, and keep your head down and in line with your straight back. Keep the object close to your body.Do not twist when lifting.· Maintain proper nutrition and diet to reduce and prevent excessive weight, especially weight around the waistline that taxes lower back muscles.· If you smoke, quit. Smoking reduces blood flow to the lower spine and causes the spinal discs to degenerate.

Back Pain – What You Should Know

Dr. Vishwas Virmani, Physiotherapist
Ow! My aching back! Most of us have stuttered these words at one time or another. Worldwide back pain affects 4 out of 5 people at some point in life. It is one of the top ten high burden diseases and is largely responsible for decreased quality of life and disability in young adults.  Back Pain SymptomsBack pain can range from a dull nagging ache to sudden debilitating pain. It can affect anyone at any age, but becomes more common as you grow older. People, who are overweight, lead a sedentary lifestyle, under extreme psychological stress and smokers have been found to be at a higher risk for back pain. Some of the common symptoms that occur with back pain include stiffness, trouble flexing your back, difficulty with range of motion, sharp shooting pain, pain radiating down the legs and numbness in the legs or groin.Common CausesBack pain that develops abruptly, often after some activity, is known as acute pain. If your pain lasts for more than three months, it is known as chronic pain. Most causes of acute back pain are related to the muscles and/or ligaments, widely known as strains. Back strains usually result from activities such as heavy lifting, overuse, abrupt movement and poor postures. Chronic pains may be associated with infections, trauma, spinal deformities and problems with the discs, nerves and bones.Understanding the root cause of your back pain is key to preventing it from worsening or recurring. A better resolution of this problem can be achieved when you learn more and start identifying the factors that trigger your pain.10 Tips to Beat Back PainMost episodes of back pain resolve within a few days on its own. Sadly, for some people it can return and can be the most frustrating and bothersome problem to manage. Here are few tips that you can try to minimise your discomfort and prevent the back pain from becoming a long-term issue.Ice the area – Keep ice on the area for the first one or two days. Ice helps slow down inflammation that occurs after an injury. You may switch to heat after two days. Do not place heat or ice directly on your skin and do not keep it for more than 20 minutes at a time.Be active  – Continue your normal activities such as walking and mild exercises, but don’t overdo it. Avoid sitting at a place for more than half an hour, get up and do some mild stretching.Make your workstation ergonomic – Use chairs that have proper back support. Avoid hunching forward often and keep both your feet firmly planted on the floor.Maintain good posture – Avoid stooping or bending over from your waist when lifting heavy objects. Lift with bent knees.Wear footwear with low heels – High heels threaten good posture and put more pressure on the lower spine.De-stress – Anxiety, stress and depression can worsen back pain. Engage in activities that keep you happy.Get enough sleep – Inadequate sleep can aggravate your back pain. Sleep plays a major role in healing your body and mind. Sleep on a mattress that provides good back support. Keep a pillow between your knees if sleeping on your sides. If sleeping on your back, keep a pillow under your knees. These measures help maintain neutral spine position.Quit smoking – Smokers are at a greater risk of developing bone problems that worsen back discomfort.Exercise – Once your back pain has subsided, perform exercises to strengthen your back muscles.Shed some weight – Being overweight can put excess pressure on your spine. Losing weight can help relieve your back pain.There is often no single solution for back pain. You may need to explore and find out what works best for you, which often involves a process of trial and error.It is advised that you consult a qualified doctor if your back pain does not subside within 72 hours. Depending on your type of back pain, your doctor may recommend blood tests and/or imaging studies to identify the root cause of your pain. Depending on your specific condition, treatment options can include oral medications, injections or surgery. You may also choose complementary therapies such as exercises, massage, yoga, biofeedback, acupuncture, physiotherapy and chiropractic treatments that may offer some relief.

Comprehensive Approach to Back Pain

Dr. Rakesh Kumar, Physiotherapist
Perfect physio is always with you in your pains. Please read specially who are in chronic back or musculoskeletal pains. The mind-body issue Traditionally we have thought of pain as a signal transmitted from the periphery to the brain – such as when a finger touches a hot plate. This understanding of pain serves well for very brief acute pain; however, it is only a small part of the story when pain is longer lasting. Just as there are nerve tracts that carry pain signals upward to the brain, there are also tracts coming down from the brain that regulate the sensitivity of the spinal cord and thus determine how much pain we perceive. These tracts can amplify pain – making a trivial stimulation seem terrible – and can block it, which probably explains why quarterbacks and combat soldiers can carry out remarkable activities, and only after some time realize that they’ve been injured. Additionally there are genetic differences in the responses to stimulation. For example, a metal disc heated to exactly 120° and placed on the forearm will be experienced by some as barely uncomfortable (pain of 1/10) and by others as excruciating (pain of 9/10). Functional brain imaging at the time of the experiment confirms that those who report severe pain actually have greater activation of several areas in the brain that process pain, while those who feel little pain have little brain activation. Thus we conclude that, unless other factors interfere, pain is whatever the patient tells us it is. Is it mental? Psychological factors rarely seem to be an important cause of prolonged pain, but they invariably affect it – for better or for worse. Attention and vigilance account for much of the psychological modulation of pain. Pain that the brain thinks is important will be amplified, and those that it thinks are of no consequence will be lessened. (Just as a mother in a noisy New York apartment sleeps soundly as ambulances and car horns sound through the night, but awakens instantly when her baby whimpers.) Mood profoundly affects pain, and even something as simple as reading a short story that it either funny or tragic changes people’s thresholds and tolerance to experimental pain. Research over the last 35 years has demonstrated that pain, as well as numerous other factors, change the central nervous system in ways that lead to prolonged pain, even when the illness or injury that initiated it has healed. In fact, most chronic pain is more attributable to sensitization of the nervous system than to problems in the body parts that hurt. These findings help to explain why people with normal-looking feet can have constant burning, why perfectly healthy people have headaches, and why the majority of people with chronic back pain have no findings on exam or imaging to account for it. In the past, it was often assumed that when people had serious complaints of pain in healthy body parts, that their pain was imagined, psychologically induced, or exaggerated. We now know that this was a misjudgment on the part of medical providers. What you think governs what you do Behavior, however, is another matter, and here psychological and environmental reinforcers play a prominent role in determining function. So we see people with very severe health problems and very severe pain who have well preserved work, play, and socialization, while we see others with far less pathology whose lives appear to have stopped. In addition to such obvious factors as anxiety, stress, and depression, there are others that impact function. One is the person’s intellectual understanding of their health – the person who believes that activity endangers their spinal fusion may become an unnecessary invalid, while a more confident person with the same medical condition may be golfing. A person’s confidence in his/her own strength and abilities is also important. Those who feel competent tend to function better and have better quality of life than those who lack self confidence.Catastrophic thinking Catastrophizing, the tendency to assume that the worst that can happen is true, has been shown to promote pain and dysfunction. In the case of back pain, a person whose thoughts tend to run in the direction of, "This is horrible, there’s no way I can stand it, I’m damaged for the rest of my life," will likely suffer more (and have less fun) than one who thinks, "the majority of people have back pain, and I’m getting more than my share of it, but I know there will be days that are better and days that are worse."Who’s got the power? People who believe that their future depends on others – surgeons, spouses, Workers’ Compensation insurors, foremen, etc, – tend to be more depressed, more functionally impaired, and in worse pain than those who recognize that they are in charge of their own lives.Learn to Live with It These may be the most feared words that a person with chronic pain can hear, with the implication that the rest of your life is going to be about enduring suffering. Fortunately that is not the case. Those who learn to live with pain do have to accept that there is so far no cure for most chronic pains, but most go on to have joyous and productive lives in which they feel a blessing and not a burden to their loved ones. It’s not easy or automatic, and we don’t come with instruction manuals telling us how to do it. These may be useful hints:Acceptance In order to do what we can, we need to stop trying to do what we can’t. At some point, it’s time to stop looking for diagnoses and cures, and to decide to make the best life possible out of an unfortunate situation. Acceptance does not mean giving up; it means taking charge and having the fullest life possible, despite the pain.Fitness There may be nothing more important for reducing pain and increasing function than maintaining physical fitness. It clearly improves not only pain, but the anxiety and depression that often accompany it. Yes, it hurts at first. Yes, it would feel better at first to take a pain pill and go to bed. But over the long term, the fitter you are, the better you’ll feel – and the more you’ll be able to do with those who love you. You do need advice for this, though. The wrong exercises can increase many pains, and most patients require a slow and gradual increase in activities in order to avoid overdoing and crashing. Fitness means weight management as well. Many studies show that obesity is associated with chronic pain. Weight loss is difficult, but with commercial weight loss programs that provide food guidance along with ongoing support, one can lose weight and keep it off without ever going hungry.Staying active One of the fathers of pain psychology noted that patients who have something better to do don’t seem to hurt as much. The converse of this is the aphorism that if your life is empty, pain will fill it up.Indeed, most patients find that when they’re preoccupied with their grandchildren, or involved in some activity that consumes them, they are much less aware of the pain. Medical advice to "let pain be your guide" is great for acute pain, but it is toxic for chronic pain. Seek clear answers from your physician as to whether you are at risk for harm to your body (as distinguished from hurt), and then let life be your guide. Interpersonal support During acute pain, most have loved ones who are sympathetic and helpful. As the pain becomes chronic it seems that whatever they do is wrong. If they note that there isn’t much physical disease going on and wonder if you’re exaggerating the pain, it tends to lead to depression, anger, and decreased function. If they baby you, wait on you, and/or begin to make decisions for you, it tends to lead to regression, helplessness, and then depression. If friends get tired of hearing about the pain and drift away, it leads to loneliness and resentment. It seems that the best response for those who love you is to accept that the pain is real, that they can’t take it away, and that you aren’t sick and don’t need to be treated like a child. It helps if they give attention in the form of an invitation to the movies or a picnic rather than in the form of caretaking. It is important that loved ones ensure that your pain does not govern their lives.

The Holistic Way of Approach to Get Rid of From Your Chronic Musculoskeletal Pain

Dr. Alagappan Thiyagarajan, Physiotherapist
When it comes to pain management we have lot of remedies starting from traditional home remedies to current trend applications like Ayurveda,siddha, etc etc... in this blog i would like to share how effective exercise therapy and self healing techniques helps you to heal yourself from chronic pain and discomfort which is the most effective one on evidence and psychological basis.. I always feels PAIN IS EXPERIENCED IN THE BRAIN here are those... 1. Release your inner endorphins. Endorphins are the natural pain relievers produced by your body. They work by binding to the opioid receptors in your brain to block the perception of pain, similar to opioid pain medications, such as oxycodone or morphine. Spurring increased production of these natural hormones can substantially help reduce your pain, as well as produce profound feelings of pleasure and satisfaction.2. Find support and understanding.Unlike a broken leg or other obvious sign of injury, chronic pain is usually unseen. It is a profoundly personal—and often lonely—experience. For many, it is difficult to find support and understanding from family and friends who may be well intention but don't really get what you're dealing with. If this is the case for you, we encourage you to find your own group of people who can be supportive and understanding. There may be a chronic pain support group at your local hospital or church. Or you may prefer to interact online. You may get started with a local or online forum seeking help, and then go on to find that you have a lot to contribute, and helping others is also a way to help yourself.3. Soak in warm water. Soaking your body in warm water can alleviate many forms of muscle pain and muscle spasm, as well as many types of arthritis. There are many options for a warm soak, including a deep bathtub, whirlpool tub, or warm pool for water therapy.Some people find that adding an essential oil or Epsom salts improve the muscle-relaxation benefits.Sometimes soaking in a warm tub is the best way to warm up the muscles before stretching—making stretching and exercise more tolerable and beneficial.4. The pain reliving tools. now a days trying myofacsial release ie; releasing tight structures by our own body with assistance of tools like form roller,trigger nobler,home care partner etc can helps to relive your pain.. it is must to consult a PHYSIOTHERAPIST/ORTHOPEDICIAN IF YOUR PAIN GETS WORSENED OR THE ISSUE WITH SERVER ONSET.5. Loosen up. Almost everyone can benefit from stretching the soft tissues (the muscles, ligaments, and tendons) in and around the spine. Your back is designed for movement, and if your motion is limited because you are in pain, it can make your back pain worse.If you suffer from chronic back pain, you may find it takes weeks or months of stretching to loosen up your spine and soft tissues, but meaningful and sustained pain relief will follow the increase in motion. Warming up your muscles by applying a heating pad for 15 minutes before stretching can help make the stretching more tolerable.It is best to work with a physical therapist or other health professional before starting any type of stretching routine, as the type of stretching should be tailored to your specific condition6. Enjoy the outdoors. 10 to 15 minutes of sun exposure a day can help the body produce vitamin D. People who got the recommended daily 400 to 800 IU of vitamin D experienced less pain than those who didn't, according to a Boston University study of 221 men and women with knee osteoarthritis.7. Imagine yourself in a better place. This option has to do with a form of meditation - called guided imagery - harnesses the power of your mind to devalue pain signals. Guided imagery allows you to hear and internalize therapeutic suggestions that help you feel better.8. Reduce the inflammation that's contributing to your pain.It may seem obvious but it bears repeating; inflammation is a contributor to most forms of chronic pain, and reducing the inflammation will help reduce your pain. A simple way to address inflammation is to regularly apply a cold pack or ice to the local area of pain. Ice also helps by acting as a local anesthetic and by slowing nerve impulses, which in turn can interrupts the pain signals generated in the affected area.9. Meditate twice daily. Meditation comes in many varieties, some complex, others simple. One common approach is just to find a sound that is pleasing to you but has no particular meaning , close your eyes, sit still and comfortably, and repeat the sound in your mind. When your thoughts wander, notice that they have wandered and return to your sound. If you feel your pain, notice the pain and return to your sound.You don't have to sit up straight with your legs crossed—any position that you find comfortable is fine. You can sit in your recliner with a heating pad on your back if that is best for you. You can sit back and soak in a warm bathtub.Start with a few minutes, and gradually lengthen to thirty minutes. You will find yourself refreshed and reinvigorated, with less pain overall.10. Laugh more often. One study showed that social laughter actually increases pain tolerance. Laughing along with others was shown to have the highest positive impact. Laughter has many positive effects, including increasing circulation and oxygen, and raising your body's level of endorphins (the body's natural pain killers). There is a whole movement called "laughter yoga"—which helps people enjoy the many benefits of laughter without having to need a reason to laugh—it just focuses on laughing for its own sake.11. Get enough restorative sleep. Getting enough sleep is critical to managing pain and promoting healing, so it's important to employ a variety of sleep aids to help you get a healthy amount of sleep. Regular exercise that physically exhausts the body helps promote deep sleep. Visualization, meditation, and other psychological techniques can also help you get to sleep and stay asleep.12. Stay well hydrated. It is common knowledge that drinking enough water throughout the day is good for you, but did you know it can also help reduce pain? For people with back conditions, staying well hydrated helps the inter vertebral discs stay healthy. Drinking enough water also helps reduce stiffness, it helps your blood carry healing nutrients and oxygen throughout the structures of you body, and helps flush toxins out of your muscles and other soft tissues. It will help prevent constipation (a side affect of many pain medications).All of the above are not prescriptive; rather, they are intended as ideas for you to consider on your personal journey with managing chronic pain... AS A ORTHOPEDIC AND SPORTS PHYSIOTHERAPIST I BELIEVE THAT RATHER THEN YOU GET TREATED THERE ARE OTHER FACTORS THAT AS A PATIENT/CLIENT YOU NEED TO FOLLOW TO GET RID OF YOUR PAIN.. ELSE YOU DIDN'T CHANGE YOU WILL BE KEEP MOVING FROM ONE CONSULTANT TO OTHER...STAY FIT, BE HEALTHY

Is Your Jaw Pain Causing Discomfort and Headaches?

Dr. Yogesh Rao, Dentist
What kind of problems might I have?If your teeth don't fit together properly, you can have problems not only in your teeth themselves, but also in the gums, the temporo-mandibular joint or the muscles that move your jaw. These problems are called 'occlusal' problems. Dental occlusion is another name for the way your teeth meet when your jaws bite together.TeethTeeth that are out of line, heavily worn or constantly breaking, fillings that fracture or crowns that work loose may all be signs of occlusal problems. Your teeth may also be tender to bite on or may ache constantly.GumsLoose teeth or receding gums can be made worse by an incorrect bite.TMJ The letters TMJ are short for 'temporo-mandibular joint', which is the joint connecting your lower jaw and your skull. The movement in this joint lets you open and close your mouth and chew from side to side.Clicking, grinding or pain in your jaw joints, ringing or buzzing in your ears and difficulty in opening or closing your mouth could all be due to your teeth not meeting each other properly.MusclesIf your jaw is in the wrong position, the muscles that move the jaw have to work a lot harder and can get tired. This leads to muscle spasm. The main symptoms are continual headaches or migraine, especially first thing in the morning; pain behind your eyes; sinus pain and pains in your neck and shoulders. Sometimes even back muscles are involved.How can I tell if I have a problem?Many people have imperfect occlusion and missing teeth, yet never have symptoms because they adjust to their problems. Occasionally, in times of increased stress and tension, the symptoms may appear and then go away immediately. Or, your teeth and gums may be affected straight away and, instead of headaches, you may suffer from:flattened, worn teeth broken teeth, fillings and crowns loose teethcontinual sensitivity of your teeth to temperature changetoothache with no apparent cause.If you think you have any of these problems, ask your dentist.You may find that you clench or grind your teeth, although most people who do aren't aware of it. Sometimes this can be caused by anxiety, but generally most people clench their teeth when they are concentrating on a task - housework, gardening, car mechanics, using a keyboard and so on.You may wake up in the morning with a stiff jaw or tenderness when you bite together. This could be due to clenching or grinding your teeth in your sleep. Most people who grind their teeth do it while they are asleep and may not know they are doing it.If you suffer from severe headaches, or neck and shoulder pain, you may not have linked this with possible jaw problems. Or you may keep having pain or discomfort on the side of your face around your ears or jaw joints or difficulty in moving your jaw. These are all symptoms of TMJ problems.If you are missing some teeth at the back of your mouth, this may lead to an unbalanced bite, which can cause uneven pressure on your teeth.Together, all these symptoms are called ‘TMJ syndrome'.How are these problems treated?See your dentist. They may be able to help you or may refer you to a specialist who deals with occlusal problems.Depending on the symptoms you are having, it can be possible to spot the signs of an occlusal problem. Various muscles may be sore when tested, or the broken and worn areas of your teeth will show you are grinding your teeth - a common sign of an incorrect bite.RelaxationCounseling and relaxation therapy may help in some cases. These techniques help the patient to become more aware of stressful situations and to control tension.Diet and exerciseAs with any joint pain, it can help to put less stress on the joint. So a soft diet can be helpful, as can corrective exercises and applying heat. Physiotherapy exercises can often help, and your dental team may be able to show some of these to you. Dental GuardThere are ready to wear devices available which are designed to protect the teeth and help prevent the TMJ from clenching and grinding.Tooth adjustment (equilibration)Your teeth may need to be carefully adjusted to meet evenly. Changing the direction and position of the slopes that guide your teeth together can often help to reposition the jaw.If your dentist suspects that your symptoms are due to an incorrect bite, they may help to improve the problem by giving you a hard plastic appliance that fits over your upper or lower teeth. This appliance needs to be measured and fitted very accurately so that when you bite on it, all your teeth meet at exactly the same time in a position where your muscles are relaxed. You may have to wear this all the time or just at night. If the appliance relieves your symptoms then your bite may need to be corrected permanently. Relief in some patients is instant: in others it can take a long time.Replacement of teethThe temporo-mandibular joint needs equal support from both sides of both jaws. The chewing action is designed to work properly only when all your teeth are present and in the correct position. Missing teeth may need to be replaced either with a partial denture or a bridge.Your dentist will not usually replace missing teeth until they are certain you have occlusal problems.MedicationCertain drugs can help in some cases, but this is usually only temporary. Hormone replacement therapy may also help some women.Will straightening my teeth help?If your teeth are too far out of line or in a totally incorrect bite position, you may need to have an orthodontic appliance (brace) fitted to move them into a better position.How many people suffer from these problems?Up to 1 in 4 people may have some symptoms. Both men and women are equally affected, although women tend to ask for treatment more often than men. The symptoms can often start with the menopause or other hormonal changes.

Know About Joint Pain

Dr. G.K. Kumar, Neurologist
Pain in the joints affects millions of people worldwide. There are many different types of joint pain—pain related to osteoarthritis, pain after traumatic injury, pain after joint surgery, pain related to inflammatory joint disorders such as rheumatoid arthritis and psoriatic arthritis, and pain related to crystal deposition in the joints such as gout or chrondrocalcinosis. Depending on the individual, pain might be felt in the joint or in the muscles around the joint. The pain may be diffuse and constant, or it may occur at rest or while moving, depending on the cause. Despite the wide range of conditions and symptoms, different types of joint pain might share similar underlying mechanisms, manifestations, and potential treatments. Why Pain in the Joints? The following issues may contribute joint painTreatment for joint pain is often inadequate. Joint pain is associated with loss of function, and treatment should focus not only on pain but also on activity and function. Medications are sometimes unsafe, and rehabilitation and physical therapy are essential. Chronic joint pain can be manageable, but patients might continue to suffer.A person's joint pain often bears little relationship to what the joint looks like on x-rays or scans, and this makes joint pain especially challenging to understand. Even when the source of the joint pain is identifiable, this might not fully explain the severity of the pain.  In addition to the suffering and discomfort associated with joint pain, the problem can exact substantial financial and other costs. These include high medical expenses, lost work days, and diminished quality and productivity in people's work and personal lives. Aging populations, sedentary lifestyles, and an increasing propensity toward obesity all mean that the problem of joint pain is likely to continue unabated worldwide. What Is Pain? Pain is a protective mechanism that alerts the brain when damage has occurred. But pain isn't just a sensation, it is a personal experience. It has emotional effects too, making us feel upset or distressed. Pain may continue when the damage seems to have gone. This is a feature of some chronic pain syndromes. Pain may be caused by a physical injury or damage to body tissues, chemicals produced by inflammation, or damage to the nerves or nerve endings. The most common causes of chronic pain in joints are osteoarthritis, rheumatoid arthritis, spondyloarthritis and psoriatic arthritis, systemic diseases, and crystal deposition disease, also known as chondrocalcinosis or pseudogout. Pain severity can be affected by a number of factors. For example: the extent to which one concentrates on the pain; the ability to enjoy various activities that can take one's mind off the pain and make it more manageable; unhappy feelings, anxieties, or depression, which can worsen pain; and prescription drugs, which can have a direct effect on the brain, chemically reducing the impact of pain. How Is Joint Pain Treated? A number of approaches are available to help manage pain, including various drug therapies, physiotherapy, and exercise.Painkilling drugs, ranging from paracetamol to codeine and, only in few cases, up to stronger options such as oxycodone, slow-release morphine, or patches containing fentanyl or buprenorphine.Non-steroidal anti-inflammatory drugs (NSAIDs) and coxibs, which are painkillers and have anti-inflammatory effects.Corticosteroids, often called steroids for short, given mostly by injection Drugs for nerve pain and chronic pain syndromes.Tricyclic antidepressants (for example, amitriptyline or dosulepin), which improve sleep and help the brain control sensations from the upper body and limbs Gabapentin, carbamazepine, and pregabalin help control some types of pain, especially when there is nerve damage.Transcutaneous Electrical Nerve Stimulation (TENS) can help ease pain, though evidence on its effectiveness is mixed (A TENS machine is a small electronic device that sends pulses to nerve endings via pads placed on the skin. TENS produces a tingling sensation and is thought to alter pain messages sent to the brain.) Other pain-relief treatments and therapies include a heating pad or hot-water bottle and technologies such as ultrasound, laser, or interferential treatment In all cases, individually tailored exercise programs are essential and contribute to regained strength and function In some cases, surgery can be effective, but individuals should always discuss this option with doctors in light of the intensity of their pain and the extent of their disability.Interventional Procedures Interventional procedures are non surgical method of pain relief. This may be useful for some of the patients with joint pain especially knee, hip& shoulder. Medications are injected accurately into & around the joint with the help of x Ray guided or ultra sound. The pain producing nerves are managed by radio frequency ablation method. Some time the swollen joints are decompressed with X-ray or ultra sound guided aspiration of joint fluids. In some conditions there may not be adequate lubricant in the joint, in such conditions synthetic synovial fluids are accurately injected into the joint with the help of X-ray or ultra sound.This particular method is called synovial fluid replacement,especially useful for knee joint pain.Multimodal Approach  All joint pains are evaluated after careful clinical examination along with biochemical ( blood investigation) , and radiological ( X-ray,CT , MRI,Bone Scan) investigations. Then treatment is planed accordingly. Multiple methods like drugs, nutritional supplements, intervention procedures,physical exercise & rehabilitation methods, life style modifications like weight reduction & posture correction, surgery are available & chosen according to the clinical condition of the patient.Multimodal approach is choosing more than one method to handle the pain effectively.Unfortunately, for some people pain is long lasting, doesn't respond fully to drugs or physical treatments, and cannot be cured by surgery. In such cases, multimodal method will be useful and also it is worth thinking about lifestyle changes, such as learning to rest sensibly (but not giving up all exercise), avoiding certain activities, asking for help, or using gadgets and home adaptations. A doctor, physical therapist, social worker, or occupational therapist can offer expert help and advice with these changes. For a small minority of people, pain can be severe and disabling. This can result in a vicious cycle of pain,anxiety, depression, and deteriorating physical fitness. People affected in this way should be referred to a pain-management clinic to learn new ways to cope with pain. 

Killing Your Back Pain Is Easier Than You Think!

Dr. Vishwas Virmani, Physiotherapist
Perhaps you have an old injury that you ignored and is now bothering you. Or maybe you slept in an odd position and woke up to feeling really uncomfortable and uneasy. Whatever might be the reason for your back pain, this is one problem that is hard to easily get rid of. However, there are relief therapies to reduce your back pain, which, eventually completely cure your back pain. These are:Cold therapyEven with all the high tech medical options available, a simple ice or cold pack application can still be one of the more effective, proven methods to treat a sore back or neck. Ice is typically most effective if it is applied soon after an injury occurs, or after any activity that causes pain or stiffness.Ice can also be very helpful in alleviating postoperative pain and discomfort. While any form of applying cold to the injured area - such as a bag of ice wrapped in a towel or a commercial ice pack - should be helpful, combining massage therapy with ice application is a nice alternative for pain relief.Heat therapyWhile the overall qualities of warmth and heat have long been associated with comfort and relaxation, heat therapy goes a step further and can provide both pain relief and healing benefits for many types of lower back pain.In addition, heat therapy—such as heating pads, heat wraps, hot baths, warm gel packs, etc.—is both inexpensive and easy to do. Some patients find more pain relief with heat (either moist heat or dry heat) and others with ice. You can also try alternating the 2 therapies.Note: If you still do not see any changes in your condition, check with your doctor.

Five Causes of Back Pain Arising Out of Our Lifestyle in the Current Age!

Dr. Vishwas Virmani, Physiotherapist
Ouch! The very term back pain makes you wince in discomfort! Unfortunately, back pain is becoming increasingly common. Not only is it affecting ladies after a certain age, but is surprisingly being suffered by youth and working professionals of all ages.We all want solutions to get rid of this really painful problem. After all, your back is the fundamental support system for the entire body!However, rushing to the solutions, it is utmost crucial to go to the root of the matter and understand why and what we are doing wrong so as to inflict back pain upon us!First – Wrong Posture for prolonged hours is the primary cause for Back Pain!Wrong posture is the most common cause for both, lower back and upper back pain. It is very important to be deliberately conscious of your sitting posture, your reading posture and your standing posture.You back muscles are particularly strained when they are forced to be in a wrong posture for long hours.It is amusing because we are all taught the right postures in schools in our growing up years, and yet, as ’grown ups’, we forget the basics and land ourselves in such painful physical ailments!Second – Inactivity and Lack of Exercise can cause your Back Pain to last forever!On an average, we work for anything between 8 to 12 hours in our offices on a regular basis. As a result, we end up sitting all day long barring a few coffee breaks or lunch wherein we end up stuffing our body with more food and caffeine!We come back late evening, too tired and sometimes lazy enough to go for exercise. And we are of course unable to wake up early in the morning for exercise due to working late till night or late heavy dinner. Thus forms a vicious cycle and we are stuck in it!This lack of exercise on daily basis eventually leads to weakening of the back muscles simply because the back muscles are not being ‘used’. And its obvious, that weak back muscles cannot support the whole body. Only strong muscles can. As a result, one fine day, your back starts to scream in pain!Third – Stressful anxious mind and absence of a peace within you can torment your upper back!Stress is one of the major reasons that causes upper back pain in particular.Increasingly today, people suffer from cervical attacks not only due to constant wrong posture of looking down while reading or working, but also because the mind is not at rest due to work or domestic life stresses of various nature which the body is unable to bear.If you are mentally stressed with negative emotions, undoubtedly, it will impact your body sooner or later. And one of the first body parts to suffer is the upper back region comprising of your beck, shoulders, head and upper spine.Fourth – Lack of rest and adequate hours of sleep can aggravateBack pain multifold!It is fundamental truth that if you body is not well rested resulting from a decent seven to eight hours sleep, you will be vulnerable to multiple health problems. Lack of sleep causes a drop in immunity level of the body and weakens it internally.As a result, when you push your body through the rigours of your daily routine, you back is sure to be inflicted with suffering because it has to support your whole body even though it is not well rested and feeling fresh! On the contrary, your muscles are already tense!Fifth – A protruding stomach with fat accumulated in the centre of your body is a cause of lower back pain!Fat is bad in any case. And fat, when accumulated in the lower abdomen region causing a pot belly to develop, can be even more damaging!This is because you are shifting the centre of gravity of the body towards the front thereby causing further pressure on your spine to keep your body straight! Thus, a big belly primarily caused due to our sedentary lifestyle can cause lower back pain.