Overview (7)

Thứ ba, 15 Tháng 4 2014 07:24

Effects of Chronic Alcohol Abuse on Pain Management

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(ĐTĐ) - Many people turn to alcohol to solve problems. Alcohol is more than a way to relax or a way to forget hard times for some of these people. They use it in an attempt to self-medicate for a number of situations: sadness, insomnia, stress, and in some cases, even pain relief. Since pain and stress often exacerbate each other, it’s not hard to see why approximately 28% of chronic pain sufferers use alcohol in an attempt to manage their pain.

Alcohol can have a mild analgesic, or pain relieving, effect due to the way it affects the central nervous system. However, this is purely an incidental effect. Alcohol has no direct value as a pain reliever. Quite to the contrary, the use of alcohol for pain management can cause serious problems, especially with excessive consumption or when mixing alcohol with pain medication.

Many over-the-counter pain medications (such as acetaminophen or ibuprofen) can contribute to damage to internal organs, such as the stomach or liver. Alcohol can damage these same organs, so mixing alcohol with these medications significantly increases the risk of lasting damage to internal organs. Many prescription medications can cause side effects; one of the more common being drowsiness. Alcohol, as a central nervous system depressant, also causes drowsiness. Combining alcohol with a prescription medication not only significantly increases the likelihood of nausea, vomiting, and sleepiness, but also can significantly slow the body’s non-voluntary functions, leading to decreased heart rates, slowed breathing, sometimes resulting in death.

Alcohol can lead to one feeling sleepy, which many take as a sign that is a sleep aid. However, alcohol use can disrupt sleep patterns just as much as chronic pain can. Sleep deprivation can cause many types of harm to the body. Some of the more prominent effects of sleep deprivation are on emotional well-being: irritability, depression, and fatigue, both mental and physical. This has a negative impact on a person’s ability to cope with pain, making the pain feel more severe and the patient feel hopeless as to finding a resolution to the pain. This can lead some to a vicious cycle: Sleep deprivation leads to exacerbation of pain leads to alcohol consumption leads to disruption of sleep cycle leads to sleep deprivation, repeat, repeat, repeat.

While the temptation is understandable, alcohol consumption does not help with chronic pain relief. Talk with your doctor about your pain condition. He can not only help you determine the best course of treatment, but also the amount of alcohol consumption that is safe for you.

Source Pain.com
Thứ hai, 13 Tháng 9 2010 16:07

Pain relief ladder

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Tiếng Việt >>

1. WHO's pain ladder

The World Health Organization has developed a three-step ladder for cancer pain relief.

On the WHO website they write:

"If a pain occurs, there should be a prompt oral administration of drugs in the following order: non-opioids (aspirin or paracetamol); then, as necessary, mild opioids (codeine); or the strong opioids such as morphine, untill the patient is free of pain. To calm fears and anxiety, additional drugs - "adjuvants" - should be used.  To maintain freedom from pain, drugs should be given "by the clock", that is every 3-6 hours, rather than "on demand". This three-step approach of administering the right drug in the right dose at the right time is inexpensive and 80-90% effective......." 

This is a message that is easy to deliver and easy to understand, but since it was introduced in 1986 there has been a major development in the field of palliative medicine and thus some of the recommendations have been modified:

  • Pain relief should be provided to all seriously ill and dying patients, not only cancer patients.
  • the middle step of the ladder using mild opioids is often skipped in  seriously ill and dying patients as their pain is so severe that strong opioids are needed.
  • Adjuvant drugs should also be used to treat neuropathic pain and other specific pain conditions.  

2. Dieutridau.com's pain ladder for Musculoskeletal Pain relief

We suggest a new pain ladder for musculoskeletal pain relief:

Thứ hai, 13 Tháng 9 2010 15:07

Treatment for Spinal Compression Fractures

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(ĐTĐ) - If osteoporosis has caused a spinal compression fracture, the treatment should address the pain, the fracture, and the underlying osteoporosis to prevent future fractures.


All components of treatment have improved greatly in the last decade, says Michael Schaufele, MD, a physiatrist and professor of orthopaedics at Emory University School of Medicine in Atlanta . "We have better interventional options to treat fractures and better treatments to prevent future fractures," he tells WebMD.

The majority of fractures heal with pain medication, reduction in activity, medications to stabilize bone density, and a good back brace to minimize motion during the healing process. Most people return to their everyday activities. Some may need further treatment, such as surgery.

Nonsurgical Treatment for Spinal Compression Fractures

Pain from a spinal compression fracture allowed to heal naturally can last as long as three months. But the pain usually improves significantly in a matter of days or weeks.

Pain management may include analgesic pain medicines, bed rest, back bracing, and physical activity.

Pain medications. A carefully prescribed "cocktail" of pain medications can relieve bone-on-bone, muscle, and nerve pain, explains F. Todd Wetzel, MD, professor of orthopaedics and neurosurgery at Temple University School of Medicine in Philadelphia. "If it's prescribed correctly, you can reduce doses of the individual drugs in the cocktail."

Over-the-counter pain medications are often sufficient in relieving pain. Two types of non-prescription medications -- acetaminophen and non-steroidal anti-inflammatory drugs (NSAIDs) -- are recommended. Narcotic pain medications and muscle relaxants are often prescribed for short periods of time, since there is risk of addiction. Antidepressants can also help relieve nerve-related pain.

Activity modification. Bed rest may help with acute pain, but it can also lead to further bone loss and worsening osteoporosis, which raises your risk for future compression fractures. Doctors may recommend a short period of bed rest for no more than a few days. However, prolonged inactivity should be avoided.

Back bracing. A back brace provides external support to limit the motion of fractured vertebrae -- much like applying a cast on a broken wrist. The rigid style of a back brace limits spine-related motion significantly, which may help reduce pain. Newer elastic braces and corsets are more comfortable to wear but don't work, says Wetzel. "There's an old saying, 'The inconvenience of the brace is directly proportional to its effectiveness,'" he tells WebMD.

Osteoporosis treatment . Bone-strengthening drugs such as bisphosphonates (such as Actonel, Boniva, and Fosamax) help stabilize or restore bone loss. This is a critical part of treatment to help prevent further compression fractures.

Surgical Treatment for Spinal Compression Fractures

When chronic pain from a spinal compression fracture persists despite rest, activity modification, back bracing, and pain medication, surgery is the next step. Surgical procedures used to treat spinal fractures are:

  • Vertebroplasty

  • Kyphoplasty

  • Spinal fusion surgery

Vertebroplasty and Kyphoplasty

These procedures for spinal compression fractures:

  • Involve small, minimally invasive incisions, so they require very little healing time.

  • Utilize acrylic bone cement that hardens quickly, stabilizing the spinal bone fragments and therefore stabilizing the spine immediately.

  • Most patients go home the same day or after one night's hospital stay.

Vertebroplasty. This procedure is effective for relieving pain from spinal compression fractures and helping to stabilize the fracture. During this procedure:

  • A needle is inserted into the damaged vertebrae.

  • X-rays during the procedure help ensure that it's done with accuracy.

  • The doctor injects a bone cement mixture into the fractured vertebrae.

  • The cement mixture hardens in about 10 minutes.

  • The patient typically goes home the same day or after a one-night hospital stay.  

Kyphoplasty: This procedure helps correct the bone deformity and relieves the pain associated with spinal compression fractures. During the procedure:

  • Through a half inch cut in the back, a tube is inserted into the damaged vertebrae. X-rays help ensure the accuracy of the procedure.

  • A thin catheter tube -- with a balloon at the tip -- is guided into the vertebra.

  • The balloon is inflated to create a cavity in which liquid bone cement is injected.

  • The balloon is then deflated and removed, and bone cement is injected into the cavity.

  • The cement mixture hardens in about 10 minutes.

"These procedures are amazing, when you look at how well patients do," says Rex Marco, MD, chief of spine surgery and musculoskeletal oncology at the University of Texas Health Science Center at Houston . "They're often in terrible, terrible pain, and it's not going away. But with two small incisions we can take care of something that needed a huge operation in the past but without really good results."

"We do everything we can to make the operation go as smoothly as possible," says Marco. "Antibiotics decrease the chance of infection. And a special x-ray machine helps us get the needle into the bone and assure that cement goes into the bone and stays in the bone."

Spinal Fusion Surgery

Spinal fusion surgery is sometimes used for spinal compression fractures to eliminate motion between two vertebrae and relieve pain. The procedure connects two or more vertebrae together, holds them in the correct position, and keeps them from moving until they have a chance to grow together, or fuse.

Metal screws are placed through a small tube of bone and into the vertebrae. The screws are attached to metal plates or metal rods that are bolted together in the back of the spine. The hardware holds the vertebrae in place. This stops movement, allowing the vertebrae to fuse. Bone is grafted into the spaces between vertebrae.

"Spinal fusion is often the last resort," Wetzel tells WebMD. "If the bone is more than 50% compressed in height, if patients are in a great deal of pain, and if they have had complications from another spinal surgery, we suggest spinal fusion surgery."  

The patient's own bone or bone from a bone bank can be used to create a graft. The patient's own bone marrow or blood platelets -- or a bio-engineered molecule -- can be used to stimulate growth of bone for the procedure.

Recovery from spinal fusion surgery takes longer than with other types of spinal surgery. Patients often have a three- or four-day hospital stay, with a possible stay on a rehabilitation unit. Patients typically wear a brace immediately after surgery. Rehabilitation is often necessary to rebuild strength and functioning. Activity level is gradually increased. Depending on the patient's age and health status, getting back to normal functioning can happen within two months or up to six months later.

There are drawbacks to spinal fusion surgery. It eliminates the natural movement of the two vertebrae, which limits the person's movement. Also, it puts more stress on vertebrae next to the fusion - increasing the chance of fracture in those vertebrae. Even after healing is complete, patients may need to avoid certain lifting and twisting activities to prevent putting excess stress on the spine.

"But if someone has persistent pain from the fracture and they have been aggressively treated for osteoporosis they can do very well with spinal fusion," says Wetzel.  

Source WemMD.com

Chủ nhật, 12 Tháng 9 2010 21:39

How Is Pain Treated?

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The goal of pain management is to improve function, enabling individuals to work, attend school, or participate in other day-to-day activities. Patients and their physicians have a number of options for the treatment of pain; some are more effective than others. Sometimes, relaxation and the use of imagery as a distraction provide relief. These methods can be powerful and effective, according to those who advocate their use. Whatever the treatment regime, it is important to remember that pain is treatable. The following treatments are among the most common.

Chủ nhật, 12 Tháng 9 2010 21:23

Treatment Overview

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What Are the Treatments for Chronic Pain?

The treatments for chronic pain are as diverse as the causes. From over-the-counter and prescription drugs to mind/body techniques to acupuncture, if one approach doesn't work, another one might. But when it comes to treating chronic pain, no single technique is guaranteed to produce complete pain relief. Relief may be found by using a combination of treatment options.

Chủ nhật, 12 Tháng 9 2010 09:18

Pain Management Whiplash

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(ĐTĐ) - Whiplash, also called neck sprain or neck strain, is injury to the neck. Whiplash is characterized by a collection of symptoms that occur following damage to the neck. In whiplash, the intervertebral joints (located between vertebrae), discs, and ligaments, cervical muscles, and nerve roots may become damaged.

Thứ bảy, 04 Tháng 9 2010 14:01

Pain management

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(ĐTĐ) - Pain management (also called pain medicine; algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.

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