Archive for April, 2008
Chronic pain| Foot Hydrotherapy
April 26, 2008 12:13 am Saturday, April 26, 2008 Alternate hot and cold hydrotherapy of the legs were given at ten 25-minute treatments during a three-week period to 20 patients with walking induced pain in the feet and lower limbs. 70% of the patients reported reduced pain after treatment, walking ability before pain and also maximal walking ability sustained up to 1-year later. Among those who reported improved walking ability one year after treatment, systolic blood pressure in both right and left ankles and toes increased. (Elmstahl S. Lilja B. Bergqvist D. Brunkwall J. Hydrotherapy of patients with intermittent claudication: a novel approach to improve systolic ankle pressure and reduce symptoms. International Angiology. 14(4):389-94, 1995).
Footbathing at 42 degrees C for 10 min, with or without additional mechanical stimulation (air bubbles and vibration) has also been shown to increase autonomic nerve and immune function. White blood cell (WBC) counts, ratios of lymphocyte subsets, and natural killer (NK) cell cytotoxicity were used as indicators of immune function. Footbathing with mechanical stimulation produced (1) significant changes in the measured autonomic responses, indicating a shift to increased parasympathetic and decreased sympathetic activity which are measures indicating pain relief and (2) significant increases in WBC count and NK cell cytotoxicity, suggesting an improved immune status. Saeki Y. Nagai N. Hishinuma M. Effects of footbathing on autonomic nerve and immune function. Complementary Therapies in Clinical Practice. 13(3):158-65, 2007
www.stopmusclepain.com Chronic pain| Foot Hydrotherapy
Headaches | Sleep Apnoea
April 17, 2008 11:36 pmFriday, April 18, 2008
In a study to investigate the co-morbidity of chronic refractory headache with obstructive sleep apnoea syndrome, seventy-two patients (51 women and 21 men) with chronic and refractory headaches, whose headache occurred during sleep or whose sleep was accompanied by snoring, were submitted to polysomnography.
Patients diagnosed with obstructive sleep apnoea syndrome began continuous positive airway pressure (C-PAP) treatment and were followed up for >or= 6 months. Twenty-one cases of obstructive sleep apnoea syndrome were identified (29.2% of the total investigated).
Headaches were classified into several headache disorders, medication overuse headache and cluster headache being the most prevalent. Multivariate regression analysis revealed that age, male gender and body mass index were associated with obstructive sleep apnoea syndrome. C-PAP treatment improved both sleep apnoea and headache in only a third of the cases.
Patients suffering from chronic refractory headache associated with sleep or snoring, in particular those who are also middle-aged, overweight men, should be considered for polysomnography. C-PAP treatment alone does not seem to improve headache, but further investigation is needed. (Mitsikostas DD. Vikelis M. Viskos A. Refractory chronic headache associated with obstructive sleep apnoea syndrome. Cephalalgia. 28(2):139-43, 2008).
In another study, it was found that headache and neck pain were more likely among patients admitted for polysomnography compared with the general population (n = 41 340). This association was mainly restricted to those with frequent complaints (> or =7 days per month).
Chronic headache (headache > or = 15 days per month) was seven times more common among individuals with and without confirmed obstructive sleep apnoea syndrome than in the general population. There was no linear dose-response relationship between headache and neck pain and severity of apnoea or oxygen desaturation. Thus, hypoxia per se is less likely to explain the high headache prevalence among patients admitted for polysomnography. (Sand T. Hagen K. Schrader H. Sleep apnoea and chronic headache. Cephalalgia. 23(2):90-5, 2003 Mar)
It is essential to have chronic pain patients especially those on long-term narcotics complaining of sleep difficulties examined for sleep apnoea. There is a dose-dependent relationship between chronic opioid use and the development of a peculiar pattern of respiration consisting of central sleep apneas and ataxic breathing. (Walker JM. Farney RJ. Rhondeau SM. Boyle KM. Valentine K. Cloward TV. Shilling KC. Chronic opioid use is a risk factor for the development of central sleep apnea and ataxic breathing.[erratum appears in J Clin Sleep Med. 2007 Oct 15;3(6). Journal of Clinical Sleep Medicine. 3(5):455-61, 2007)
www.stopmusclepain.com Headaches | Sleep Apnoea
Neck and Thoracic Pain| Atypical Chest and Abdominal Pain
April 11, 2008 12:03 amFriday, April 11, 2008
Patients may present with atypical abdominal and chest pain that may be related to spinal problems. The key features on history that point to spinal referred pain are pain on movement, tenderness and tightness of musculoskeletal structures at a spinal level supplying the painful area, and an absence or paucity of symptoms suggestive of a nonmusculoskeletal cause. Harding G. Yelland M. Back, chest and abdominal pain - is it spinal referred pain?. Australian Family Physician. 36(6):422-3, 425, 427-9, 2007 Jun.
In those who have chest/abdominal pain due to musculoskeletal causes, the prevalence of thoracic intervertebral dysfunction could be as high as 65.5%. Intervertebral dysfunction prevalence could be even as high as 72.0% in those with back pain and 79.0% in those with back pain with chest/abdominal pain. Chest pain was more commonly associated thoracic intervertebral dysfunction compared to abdominal pain.
For those with cervical problems having pain in the back, chest and/or abdomen, there was an association with pain on active movements and overpressure at end range and with loss of range of motion. Range of motion restriction was not noted in patients with thoracic intervertebral dysfunction.
The minimum examination for the detection of intervertebral dysfunction is testing for pain with spinal movements and palpation for tenderness. The interpretation of positive signs requires knowledge of their prevalence in pain free controls and in patients with visceral disease. The prevalence of thoracic intervertebral dysfunction was 25.0% in controls. Yelland MJ. Back, chest and abdominal pain. How good are spinal signs at identifying musculoskeletal causes of back, chest or abdominal pain?. Australian Family Physician. 30(9):908-12, 2001 Sep.
eToims treatments for atypical chest and abdominal pain involve not only treating paraspinal muscles supplied by cervical and thoracic nerve roots but also the chest and abdominal wall musculature. Treatments must also involve the paraspinal muscles of the lower spine and even the muscles of the upper and lower limbs.
© 2008 copyright all rights reserved www.stopmusclepain.com Neck Pain and Thoracic Pain| Atypical Chest and Abdominal Pain
Neck Pain| Temporomandibular Joint (TMJ) Pain
April 4, 2008 6:38 pmFriday, April 04, 2008
The temporomandibular joint (TMJ) is in front of the ear and the joint movements can be felt if you place your finger at that level. To examine the movements of this joint, the rhythm of the closing and opening of the jaw must be noted. The jaw should open and close easy and the teeth come together and separate easily.
If there is jaw pain, that will be a break in the arc of motion on the painful side with obvious movement of the jaw to one side or the other. When the mouth is closed, the line drawn between the tip of the nose and midpoint of the chin will be in the same vertical line and the jaw is centered well. The teeth can also close symmetrically in the midline. When the patient has pain in the jaw, the line drawn from the tip of the nose will not be able to go through the midpoint of the chin since the jaw will not be centered well.
With problems of the temporomandibular joint, jaw movements may create a clicking sound, due to problems with that joint cartilage. Problems with the inner lining of the joint known as the synovium may also be the cause that causes the joint to click. In such situations with trauma to the joint cartilage, the joint may dislocate when the mouth is opened as wide as possible.
This joint is prone to trauma especially in auto accidents where the head is thrown backward and the mouth opens wide in a sudden and forceful motion. The joint may dislocate in these positions. The cartilage as well as the joint capsule can be torn. Joint overload may occur when the head is placed in traction, or when a person has poor dentition or when a person grinds his teeth during sleep.
Testing of range of motion of this joint involves examining the movements of the mouth and jaw. Normally, the mouth can be opened wide enough to insert three fingers between the to and bottom teeth. Horizontal movements should be free enough so that a person when sliding the lower jaw forward, the bottom teeth can be placed in front of the upper teeth. Limitations in range of motion can be due to pain from arthritis of the joint or from muscle spasm.
Muscles involved in opening the mouth are:
- External pterygoid muscle supplied by the mandibular portion of the fifth cranial nerve.
- Hyoid muscles.
Muscles involved in closing the mouth are:
Primarily masseter and temporalis muscles aided by the internal pterygoid muscle. All these muscles are supplied by the trigeminal nerve.
In all cases of TMJ problems, it is essential to examine the movements of neck and shoulders and spine. Patients with neck pain who keep the head forward and downward can cause abnormalities in the line of action of the muscles which open and close the mouth and eventually put wear and tear on the jaw joint.
Therefore, treatments directed only to the TMJ will not alleviate the jaw pain problems unless head and neck posture is also corrected. Examine the muscles of the jaw and the masseter muscle, is easiest to examine. You can feel this muscle just above the angle of the jaw as you clench your teeth.
If there are myofascial pain problems, tight and tender myofascial bands can be felt in the masseter muscle. There can be tenderness in the temporalis muscle also which can be felt at the side of the head above the ear. It is essential to treat the myofascial pain problems not only for the muscles responsible for jaw movements but the treatments must include muscles of the neck in order to alleviate jaw pain problems.
© 2008 copyright all rights reserved www.stopmusclepain.com Neck Pain| Temporomandibular Joint (TMJ) Pain
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