Archive for August, 2007
Chronic pain|sleep disruption
August 31, 2007 10:04 amFriday, August 31, 2007
During sleep, patients with chronic pain could trigger a sleep awaking response over all sleep stages and not only in light sleep. Thus, sleep disruption is usually considered to be a consequence of the pain experience.
The patients with a sleep problems had significantly higher maximum and medium pain, a significantly higher level of psychosocial disability and a significantly lower overall subjective well-being. The medium pain and psychosocial disability in leisure and social activities are significant predictors for sleep disorder.
Even in normal subjects, disrupting slow wave sleep, without reducing total sleep or sleep efficiency, for several consecutive nights is associated with decreased pain threshold, increased discomfort, fatigue, and the inflammatory flare response in skin. These findings are common in patients with fibromyalgia. These results therefore suggest that disrupted sleep is probably an important factor in the pathophysiology of symptoms in fibromyalgia.
Sleep deprivation and restriction diminish vigilance, alter neuroendocrine control, and negatively impact immune function. Decrements in vigilance can negatively impact performance.
However, studies have shown that sleep disturbance may have a bidirectional relation with other features of chronic pain such as disability, daily uptime and physical symptoms independent of pain or depression. Therefore, it needs to be confirmed that repairing disrupted sleep leads to an improvement in patients' daily activity and a reduction in their suffering.
Clinically, since sleep disorder may be a factor in the persistence and aggravation of pain as well as psychosocial disability, sleep disorders should be integrated in the therapeutic targets.
© 2007 copyright all rights reserved www.stopmusclepain.com Chronic pain| sleep disruption
Chronic pain| Sleep disturbances
August 24, 2007 12:29 pmFriday, August 24, 2007
Sleep disturbances have been known to cause or modulate acute and chronic pain. Some studies have shown a relationship between sleep disruption and pain hypersensitivity.
Pain hypersensitivity from paradoxical sleep deprivation could be due to a reduction of participation of the opioid and serotoninergic mechanisms of action in neurotransmission in the brain. Apparently, sleep deprivation can interfere with analgesic treatments involving opioid and serotoninergic mechanisms of action. Substance P (SP) and neurokinins have been implicated in modulating pain and mood and have also been found to produce disturbances in sleep to action on different receptors.
Whether the pain hypersensitivity effects are due to the deprivation of specific sleep stages or whether they result from a generalized disruption of sleep continuity are still not known.
However, in a study on normal participants, loss of 4 hours of sleep and specific rapid eye movement (REM) sleep loss cause the pain-free participants to be hyperalgesic the following day. These findings imply that pharmacologic treatments and clinical conditions that reduce sleep and REM sleep time may increase pain.
Sleep quality is also found to be significantly predictive of pain, fatigue, and social functioning in patients with fibromyalgia interfering with health-related quality of life. Interventions designed to improve sleep quality may help to improve health-related quality of life for patients with fibromyalgia.
Since depression is a significant contribution to sleep problems, treatment of associated depression will need to be also addressed for those who suffer from pain related sleep disturbances.
© 2007 copyright all rights reserved www.stopmusclepain.com Chronic pain| sleep disturbances
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Neck pain| Low back pain| Nerve injuries
August 17, 2007 5:08 pmFriday, August 17, 2007
Neck pain| Low back pain| Nerve injuries
Usually, when we think about nerve injuries we think of presence of paralysis or weakness in the distribution of the muscles supplied by that nerve, loss of function, presence of trophic skin changes and presence of deformities.
Most of the injuries to the nerves that occur with blunt trauma such as car accidents, falls, lifting injuries, repetitive strain injuries, sports injuries occur to the nerve roots in the neck, mid back or lower back regions.
Nerve root injuries also occur gradually and insiduously with the aging process compounded by the activities of daily living. The subsequent course of the nerve injury will be dependent on (1) time lapsed since injury and (2) the degree of nerve injury.
When the nerve root injuries occur acutely as with blunt trauma or gradually as with aging, the nerve root injuries are partial. The common presentation is that of pain, stiffness or tightness rather than weakness.
When the patient presents with nerve related problems, the symptoms may be described as sharp, radiating, dull, throbbing, aching or burning. There may also be associated tingling and numbness or even itching.
The muscle symptoms due to nerve involvement may be described as tightness, stiffness, heaviness, swelling. The muscles will also be tender to touch with superficial or deep palpation.
Often, patients will complain of a deep feeling of coldness in the limbs. There may also be skin color changes such as blotching, deep redness or dusky hue to the skin or extreme pallor. These color changes are noted especially in the fingers or toes especially when dependent.
There may be patchy areas of hair loss in the distribution of the injured nerve root.
Patients may also complain of intolerance to heat and cold, humidity and weather changes.
They may have changes in bowel and bladder habits such that they may have frequency in urination or bowel movements.
Nerve related muscle symptoms may be constant or intermittent and usually made worse by movements and activities. Resting is usually helpful.
Nerve manifestations are manifold and unless one is aware of such diverse presentations, nerve root injuries as an underlying cause of the symptoms may be entirely unsuspected.
© 2007 copyright all rights reserved www.stopmusclepain.com Neck pain| Low back pain| Nerve injuries
Low back pain| Cupping of the sole of the foot
August 10, 2007 3:34 pmFriday, August 10, 2007
Patients with lower back pain due to irritation of the S1 and S2 nerve roots can present first with pain in the ankle, foot and toes.
Muscles that perform cupping of the sole of the foot are supplied by the S1 and S2 nerve roots. When these muscles are in pain and spasm, the foot can go into a cramp with the toes hyperflexed making the foot go into a cupping movement. Also, the short muscles of the foot may go into spasm with the toes spread wide apart.
The intrinsic muscles of the foot supplied by the medial plantar nerve, S1, S2 that perform cupping are:
- Flexor digitorum brevis. This muscle will flex the metatarsophalangeal and proximal interphalangeal joints
.- abductor hallucis spreads the big toe away from the second digit.
The intrinsic muscles of the foot supplied by the lateral plantar nerve, S1, S2 that perform cupping are:
- Flexor digiti quinti brevis which flexes the toes at the metatarsophalangeal joint and interphalangeal joints
- Abductor digiti quinti spreads the little toe away from the fourth digit.
- Adductor hallucis which brings the big toe toward the second digit.
The intrinsic muscles of the foot supplied by the medial and lateral plantar nerves S1, S2 that assist in performing cupping are:
- Lumbricals and interossei. These muscles will flex the metatarsophalangeal joints and extend at the interphalangeal joints.
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| foot cupping
Dissection photograph showing the intrinsic muscles of the foot from the lateral aspect (below).
Low back pain| toe flexion
August 3, 2007 12:10 pmFriday, August 03, 2007
Patients with lower back pain due to irritation of the L5 and S1 nerve roots can present first with pain in the ankle, foot and toes.
Muscles that perform flexion of the toes are supplied by the L5 and S1 nerve roots. When these muscles are in pain and spasm, performing plantar flexion of the toes can result in the cramps in the toes muscles causing the toes to go down into flexion. This can be quite painful.
Muscles that flex all the toes except the big toe:- Flexor digitorum longus (supplied by the posterior tibial nerve L5, S1). This muscle will flex the toes at the distal interphalangeal joints.
- Flexor digitorum brevis (supplied by the medial plantar nerve, S1, S2). This muscle will flex the metatarsophalangeal and proximal interphalangeal joints.
- Lumbricals and interossei (supplied by the medial and lateral plantar nerves namely S1, S2. These muscles will flex the metatarsophalangeal joints and extend at the interphalangeal joints.
Other muscles that assist in flexion of the other toes except the big toe are:
- flexor digiti quinti brevis (supplied by the lateral plantar nerve S1, S2)
- abductor digiti quinti (supplied by the lateral plantar nerve S1, S2)
Muscles that flex the big toe are:
- Flexor hallucis brevis: supplied by the medial plantar nerve (S1, S2). Flexes the great toe at the metatarsophalangeal joint.
- Flexor hallucis longus: supplied by the posterior tibial nerve (L5, S1). Flexes the great toe at the interphalangeal joint.
Other muscles that assist in flexion of the big toe are:
- abductor hallucis (supplied by the medial plantar nerve, S1, S2)
- adductor hallucis (supplied by the lateral plantar nerve, S1, S2).
© 2007 copyright all rights reserved www.stopmusclepain.com Low back pain| toe flexion
Photograph of dissection of the muscles and nerves in the tarsal tunnel on the inner aspect of ankle (below)
