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Pain Management

What is Chronic Pain

Millions of Indians suffer from chronic pain -- pain that lasts longer than six months. Chronic pain can be mild or excruciating, episodic or continuous, merely inconvenient or totally incapacitating. With chronic pain, signals of pain remain active in the nervous system for weeks, months, or even years. This can take both a physical and emotional toll on a person. The most common sources of pain stem from headaches, joint pain, pain from injury, and backaches. Other kinds of chronic pain include tendinitis, sinus pain, carpal tunnel syndrome, and pain affecting specific parts of the body, such as the shoulders, pelvis, and neck. Generalized muscle or nerve pain can also develop into a chronic condition. Chronic pain may originate with an initial trauma/injury or infection, or there may be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage. The emotional toll of chronic pain also can make pain worse. Anxiety, stress, depression, anger, and fatigue interact in complex ways with chronic pain and may decrease the body's production of natural painkillers; moreover, such negative feelings may increase the level of substances that amplify sensations of pain, causing a vicious cycle of pain for the person. Even the body's most basic defenses may be compromised: There is considerable evidence that unrelenting pain can suppress the immune system. Because of the mind-body links associated with chronic pain, effective treatment requires addressing psychological as well as physical aspects of the condition.


Symptoms of Chronic Pain

The symptoms of chronic pain include:

  Mild to severe pain that does not go away.
  Pain that may be described as shooting, burning, aching, or electrical.
  Feeling of discomfort, soreness, tightness, or stiffness
 

Pain is not a symptom that exists alone. Other problems associated with pain include:
  Fatigue
  Sleeplessness
  Withdrawal from activity and increased need to rest
  Weakened immune system
  Changes in mood including hopelessness, fear, depression, irritability, anxiety, and stress
  Disability

Medication of Chronic Pain

Medicines can often help control chronic pain. Many different drugs, both prescription and nonprescription, are used to treat chronic pain. All these medicines can cause side effects and should be taken exactly as they are prescribed. In some cases, it may take several weeks before medicines work to reduce pain. To avoid dangerous drug interactions, tell your doctor all the medicines you are taking (including herbal and other complementary medicines).


Medication Choices

You will likely be given medicines that cause the fewest side effects first (such as acetaminophen) to treat chronic pain. The dose will be increased or the medicines will be changed as needed. Medicines used to treat chronic pain include the following:

  1. Acetaminophen, such as Tylenol.
  2. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen (Advil, for example), ketoprofen, and naproxen (Aleve, for example). Always take NSAIDs exactly as prescribed or according to the label. Do not take a nonprescription NSAID for longer than 10 days without talking to your doctor.
  3. Tricyclic antidepressants, such as amitriptyline.
  4. Serotonin and norepinephrine reuptake inhibitors (SNRIs), such as duloxetine (Cymbalta).
  5. Corticosteroids, such as prednisone. Sometimes, steroids are injected around the base of the spine to relieve low back pain (epidural steroid injections).
  6. Oral medicines that act like a local anesthetic, such as mexiletine.
  7. Anticonvulsants, such as gabapentin (Neurontin) and pregabalin (Lyrica)
  8. Pain relievers that are applied directly to the skin (topical analgesics), such as EMLA cream or a lidocaine patch (Lidoderm)
  9. Capsaicin, a naturally occurring substance that is found in chili peppers and is used to make certain topical analgesic creams.
  10. Cooling spray. This involves using a cooling spray (such as Biofreeze) directly on the skin. This may be repeated several times.
  11. Creams or gels containing medicines or combinations of medicines. The cream or gel is rubbed directly on the painful area. Some of these creams or gels can be made at the pharmacy according to your doctor's directions.
  12. Opiate pain relievers, such as hydrocodone (such as Vicodin).

Other therapies that may be used to treat chronic pain include:

  1. Nerve block injections. An anesthetic is injected into the affected nerve to relieve pain. The anesthetic may relieve pain for several days, but the pain often returns. Although nerve blocks do not normally cure chronic pain, they may allow you to begin physical therapy and improve your range of motion.
  2. Epidural steroid injections (injecting steroids around the spine). Although these injections have been used for many years and may provide relief for low back or neck pain caused by disc disease or pinched nerves, they may not work for everyone.
  3. Trigger point injections. These may relieve pain by injecting a local anesthetic into trigger points (or specific tender areas) linked to chronic fascial pain or fibromyalgia. These injections

Medicine may work best when it is used in combination with other types of treatment, such as physical therapy and counseling, to address the different causes of chronic pain. Each person tolerates and responds to medicines differently. Medicines can reduce or provide temporary relief of chronic pain. At first, you may be given medicines that cause the fewest side effects. Then, if needed, the dose will slowly be increased, or you will be switched to a different medicine. In general, avoid drinking alcohol while taking pain medicines. And do not take higher doses of any medicine than your doctor prescribed. Daily medicines can be an effective part of long-term treatment for chronic pain. But sometimes a medicine loses some or all of its effectiveness when it is used daily over a long period of time, because your body develops a tolerance to it. If you take opiate pain relievers for longer than a week or so, they can cause your body to keep expecting the medicine. This is called drug dependency. Over time, you may need more of the drug to get the same effects. This is called tolerance. This is not the same as addiction. You may become physically dependent on opiate pain relievers if you take them regularly. Physical dependence is not addiction, but it is a gradual change in your body in response to the opiates. If you stop taking opiate pain relievers abruptly, you may develop nausea, sweating, chills, diarrhea, and shaking. The physical dependence and withdrawal symptoms are not life-threatening. You can avoid withdrawal symptoms if you gradually stop taking the opiates over a set period of time.

Migraine and Headache

There are many different types of headaches. Although not all headaches are the same, they all share at least one thing in common -- they cause pain. But many headaches also cause other unwanted symptoms, including nausea and vomiting. This article addresses the most common headache symptoms associated with the different types of headaches.

  A. Tension Headaches
  B. Migraines

Symptoms of Tension Headaches

  1. Episodic Tension Headaches (occur less than 15 days per month)
Pain is mild to moderate, constant band-like pain, pressure or throbbing
Pain affects the front, top or sides of the head.
Pain usually begins gradually, and often occurs in the middle of the day
Pain may last from 30 minutes to several days
  2. Chronic Tension Headaches (occur more than 15 days per month)
Pain may vary in intensity throughout the day, but the pain is almost always present
Pain affects the front, top or sides of the head
Pain comes and goes over a prolonged period of time
  3. Irritability
  4. Headache upon awakening
  5. Difficulty falling asleep and staying asleep
  6. Chronic fatigue
  7. Disturbed concentration
  8. Mild sensitivity to light or noise
  9. General muscle aching

Symptoms of Migraine

  1. Sensitivity to light, noise or odors
  2. Blurred vision
  3 Nausea or vomiting, stomach upset, abdominal pain
  4. Loss of appetite
  5. Sensations of being very warm or cold
  6. Paleness
  7. Fatigue
  8. Dizziness
  9. Fever (rare)
  10. Bright flashing dots or lights, blind spots, wavy or jagged lines (aura)


Medical Treatment for Migraines

Drugs for migraine headaches can relieve the pain and symptoms of a migraine attack and prevent further migraine attacks. Migraines can be treated with two types of drugs.

  A. Abortive
  B. Preventive

Abortive

The goal of abortive treatment is to stop a migraine once it starts. Abortive medications can be taken by self-injection, mouth, skin patch, or nasal spray. These forms of medication are especially useful for people who have nausea or vomiting related to their migraine, and they work quickly.

The following drugs are used for treatment:

  1. Acetaminophen -isometheptene-dichloralphenazone (Midrin).
  2. Dihydroergotamine (D.H.E. 45 Injection, Migranal Nasal Spray)
  3. Ergotamine tartrate (Cafergot)
  4. Over- the-counter medications such as Advil Migraine (containing ibuprofen), Excedrin Migraine (containing aspirin, acetaminophen, caffeine), and Motrin Migraine Pain (containing ibuprofen)

The following drugs are mainly used for Nausea related to Migraine Headaches in addition to Migraine Treatment:
  1. Metoclopramide (Reglan)
  2. Prochlorperazine (Compazine)
  3. Promethazine (Phenergan)
 
Some drugs are used for headache pain but are not specific for migraines. These include analgesics, narcotics, and barbiturates. Since they can be habit forming, they are less desirable than specific headache drugs listed above. These drugs should be used primarily as a "backup" for the occasions when a specific drug does not work.

Preventive

This type of treatment is considered if migraines occur frequently, typically more than one migraine per week, or if migraine symptoms are severe. The goal is to lessen the frequency and severity of the migraine attacks. Medication to prevent a migraine can be taken daily. Preventive treatment medications include the following:

  1. Medications used to treat high blood pressure: beta-blockers (propranolol (Inderal), timolol), calcium channel blockers (verapamil (Covera))
  2. Antidepressants : amitriptyline (Elavil), nortriptyline (Pamelor)
  3. Antiseizure medications: gabapentin (Neurontin), topiramate (Topamax), valproic acid (Depakote)
  4. Botox
  5. Some nontraditional supplement treatments for migraine prevention include butterbur, coenzyme Q10, and fever

Cluster Headaches

  1. Intense one-sided pain described as having a burning or piercing quality that is throbbing or constant
  2. Pain is located behind one eye or in the eye region, without changing sides.
  3. Pain lasts a short time, generally 30 to 90 minutes (but can last for three hours); the headache will disappear, only to recur later that day (most sufferers get one to three headaches per day during a cluster period).
  4. Headaches occur very regularly, generally at the same time each day, and they often awaken the person at the same time during the night.

Sinus Headaches

  1. Deep and constant pain in the cheekbones, forehead or bridge of the nose
  2. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Foot Pain

Foot pain is a common complaint, and it can have many causes. Read on to learn more about different types of foot pain, diagnosis, and treatments.

Causes of Foot Pain
Pain in the foot can be due to a problem in any part of the foot. Bones, ligaments, tendons, muscles, fascia, toenail beds, nerves, blood vessels, or skin can be the source of foot pain. The cause of foot pain can be narrowed down by location and by considering some of the most common causes of foot pain.


Heel Pain

Plantar fasciitis is the most common cause of heel pain. The Plantar Fascia, a band of tough tissue connecting the heel bone to the toes, becomes irritated or inflamed. Heel pain, worst in the morning when getting out of bed, is the most common symptom. Arch pain may also be present.

Treatment for plantar fasciitis includes:

  Rest
  Calf and foot muscle stretches
  Over-the-counter pain relievers.
  Shoes with good arch support and a cushioned sole.


Heel Spurs

Heel spurs are abnormal growths of bone on the bottom of the heel bone that may be caused by an abnormal gait, posture or walking, inappropriate shoes, or certain activities. Spurs may cause foot pain while walking or standing. Although one in 10 people has heel spurs, only one in 20 of these people will have foot pain. Heel spurs can occur in people with plantar fasciitis, but they do not cause plantar fasciitis. People with flat feet or high arches are more likely to have foot pain from heel spurs.

Treatment for heel spurs include:

  Cutout heel pad
  Custom-made insert (orthotic) worn in the shoe
  Over-the-counter pain relievers.
  Rest
  Surgery (rarely)
  Physical Therapy


Stone Bruises

A Stone Bruise is a bruise of the fat pad of the heel. It can occur after stepping on a rock or other hard object.


Fracture of Heel Bone

A Fracture of the heel bone (calcaneus) is the most commonly fractured foot bone. It is most often caused by high impact to the heel. For eg. when person has fallen from a height or been in a car accident, Injuries can range from a bone crack from a new vigorous exercise plan to a shattered bone from a high fall. Heel pain, bruising, swelling, limping, or difficulty walking are the main symptoms.

Calcaneus fracture treatment includes:

  Rest from weight bearing, often with crutches.
  Thorough padding of the heel.
  Splinting or casting to protect the heel bone.
  Pain relievers.
  Surgery.
  Physical Therapy.


Ball of Foot Pain

Metatarsalgia is pain and inflammation in the ball of the foot. Strenuous activity or ill-fitting shoes are the usual causes. Treatment for metatarsalgia includes

  1. Pain relievers
  2. Change to more comfortable footwear
  3. Inserts for the shoes to relieve pressure on the ball of the foot


Morton's Neuroma

Morton's neuroma is thickening of the tissue around the nerve between the bases of the toes (usually between the third and fourth toes). Foot pain, odd sensations, or numbness over the ball of the foot are the usual symptoms. It is more common in women and can be a result of wearing high heels or tight shoes.

Morton's Neuroma Treatment includes:

  Shoe inserts to reduce pressure on the nerve.
  Steroid or other injection into the area of foot painr
  Pain relievers
  Surgery (occasionally)


Sesamoiditis

Sesamoiditis occurs when tendons around the big toe are injured and inflamed.

Treatment for Sesamoiditis includes:

  Rest
  Ice
  Wearing a foot pad under the toe in a comfortable shoe
  Wearing low-heeled shoes
  Steroid injections


Arch Pain

Arch pain is most often caused by plantar fasciitis, which can affect the heel, arch, or both. Plantar fasciitis treatment is the same, regardless of the location of foot pain (see above). For persistent plantar fasciitis, an injection with a mixture of a steroid and local anesthetic can be helpful. Fallen arches -- or flat feet -- occurs when the arches of the feet flatten out (often when standing or walking), causing foot pain and other problems. Flat feet can be treated with shoe inserts (orthotics), shoe adjustments, rest/ice, using a walking case or brace, or physical therapy. Occasionally, surgery is necessary.


Toe Pain

Arthritis , including gout, can cause pain in the toes. Gout is an inflammatory condition in which crystals periodically deposit in joints, causing severe pain and swelling. The big toe is often affected by Gout.

Treatment for Gout includes:

  Rest
  Medication such as colchicine, non-steroidal anti-inflammatory (NSAID) medications, or prednisone
  Pain relievers
  Daily medication and diet restriction to prevent gout attacks


Bunion ( Hallux Valgus)

A bunion (hallux valgus) is a bony prominence along the edge of the foot, next to the base of the big toe. Bunions may occur in anyone, but are often caused by ill-fitting footwear in women. Hammer toes often occur with bunions.

Treatment for Bunion includes:

  Changing to more comfortable shoes; if this is unsuccessful in relieving foot pain, orthotics may be tried. If those are unsuccessful, surgery might be considered.


Hammer Toe

Hammer toe occurs when the near joint in the toe is bent, creating a hammer-like appearance. Wearing tight shoes is the main cause of hammer toe. .


Claw Toe

Claw toe occurs when the joint at the end of a toe may become unable to straighten, causing the toe to point down or up. Irritation of the feet and other feet problems may develop, without special footwear to accommodate the claw toe.

Treatment of hammer toe and claw toe includes:

  Changing to better-fitting footwear; avoiding high heels and tight shoes
  Stretching exercises for toes and toe joints.
  Shoe inserts
  Orthotics
  Surgery may sometimes be necessary


Ingrown Toenails

Ingrown toenails occur when skin on one or both sides of a toenail grow over the nail. Ingrown toenails may be painful or lead to infections.

Treatment for ingrown toenail includes:

  Soak the foot in warm water four times a day.
  Once daily, wedge a piece of gauze between the nail and wet skin.


Turf toe

Turf toe refers to pain at the base of the big toe resulting from athletic activities. Turf toe is an overuse injury usually caused by strain from running or jumping. Turf toe may also be a form of sesamoiditis or sesamoid fracture.


Toe fracture

Toe fracture may occur in any of the bones of the toes. Minor fractures may only require rest, ice, and pain relievers; serious fractures can require foot immobilization and surgery. Any suspected fracture should be evaluated by a doctor.


Toe Sprain

Toe sprain may occur when jamming or stubbing of the toe damages the tendon or soft tissues of the toe. If no fracture is present, the pain and swelling of a toe sprain should subside within days.


Hallux Rigidus ( Toe Arthritis)

Hallux Rigidus ( Toe Arthritis) is a degenerative arthritis ( Osteoarthritis ) at the base of the big toe. Pain and stiffness of the joint, worsening over time, are symptoms. Treatment can include pain relievers and stretching exercises. Surgery may be needed in some cases.


Corns

Corns are thick buildups of tough skin on a point of irritation or pressure on the foot or toe. Corns often have a horn-like appearance.


Callus

Callus is a wider area of tough skin buildup on the toes or feet, in response to irritation or pressure. Calluses and corns are generally caused by poor-fitting footwear.

Treatment for corns and calluses include:

  Wear better-fitting shoes
  Use a pumice stone or other abrasive to wear down the extra skin


Sesamoid fracture

Sesamoid fracture is a fracture of small bones (sesamoids) that are embedded in tendons attaching to the big toe. Pain in and around the big toe is the main symptom.

Treatment for sesamoid fracture includes:

  Rest
  Ice
  Elevation
  Pain Relievers
  Immobilization of the toe and foot
Surgery may be needed for serious sesamoid fractures.


Pain on the Foot's Outer Edge

The fifth Metatarsal Bone (along the outer foot edge) is a commonly fractured bone in the foot. Pain, swelling, and bruising along the outer foot edge after an injury are symptoms.

Treatment for any Foot Fracture:

  Medical Attention
  Rest
  Ice
  Elevation
  X-Rays
  Pain Relievers
  Immobilization & Surgery for Foot Fractures


Foot Pain That's Anywhere or Everywhere

Neuropathy , or nerve damage in the feet, is most often caused by diabetes. Foot pain can be burning, stinging, or feel like electricity. Neuropathy foot pain can occur anywhere in the feet. Treatment for neuropathy focuses on the underlying cause, such as diabetes. Medications that act on nerves can also be helpful in reducing foot pain.  Trauma can mean anything from a major crush injury, to the repetitive damage caused by wearing poor-fitting shoes. The foot pain from trauma can occur anywhere on the feet.  Tendinitis is inflammation and irritation of tendons, the bands attaching muscles to bones. Tendons run along all the surfaces of the foot, and can cause foot pain in many different locations. Treatment for Tendinitis includes rest and pain relievers; sometimes steroid injections can help. Rarely is surgery necessary for foot pain caused by tendinitis.


Nerve Pain

Getting control of your nerve pain can be tough. However there are a lot of effective ways to treat it. These include medicines, like prescription pain relievers or anticonvulsants and antidepressants, as well as electrical stimulation and other techniques. So if you have nerve pain, whether it's caused by cancer, HIV, shingles, or another condition, take hope. Here's a rundown of the prescription treatments that your doctor might recommend.


Prescriptive Medicines for Nerve Pain 

There are several types of medication that help with nerve pain. However, not all of the ones listed here will necessarily work for your specific type of pain. The best choice for you depends on the cause of your pain, the severity, the potential side effects, and other factors.

  1. Anticonvulsants: The name might sound alarming, but some of these drugs can help people with nerve pain. In fact, they're often considered a first choice. These drugs were originally developed for people with epilepsy to control seizures. It turned out that their effects on the nervous system could also help dull pain. Side effects include drowsiness, dizziness, and nausea. Keep in mind that not all anticonvulsants will help. So your doctor will choose medicines that have been shown in studies to work on nerve pain.
  2. Antidepressants: Along with anticonvulsants, certain types of antidepressants can be the  first choice for treating neuropathic pain. Nerve pain specialists often recommend two major types.
  3. Tricyclic Antidepressants: have been used for decades. While they're not used to treat  depression as often now, they can play an important role in controlling nerve pain symptoms. Many studies have shown that they can help. These drugs can cause side effects, like dizziness, constipation, blurred vision, and upset stomach. They might not be safe for people with certain conditions, like heart problems.
  4. SNRIs (Serotonin & Norepinephrine Reuptake Inhibitors):are a newer type of antidepressant that seem to help with nerve pain. In general, these drugs have fewer side effects than tricyclic antidepressants. They might be safer for some, especially older people with heart problems. However, they might not be as effective as tricyclics in tackling nerve pain. Using antidepressants for nerve pain can have an added benefit, considering that chronic pain often coincides with depression. Chronic  pain can make a person depressed, and depression can often make the experience of chronic pain seem worse. So these drugs might help improve your mood as well as ease your discomfort. Of course, some people don't like the idea of taking antidepressants for their nerve pain because they worry taking antidepressants implies that the pain is just "in their heads." But that's not the case at all. It just happens that these drugs work with both conditions.
  5. Topical Treatments: Painkilling gels and lidocaine patches are another effective approach; you would apply them on a particularly painful area of skin. These work best with small, localized spots of pain. The side effects are minor and include skin irritation. 
  6. Painkillers:  For severe nerve pain, powerful opioid painkillers can help. Studies have found that for many types of nerve pain, they are as effective as anticonvulsants or antidepressants. Unlike other treatments for nerve pain, they also work very quickly. However, because of their side effects, many doctors only turn to these drugs when other treatments haven't worked. Opioid painkillers can cause constipation, stomach upset, and sedation. They also pose some risk of addiction and abuse, so it's important to use them exactly as your doctor recommends. Other painkillers like prescription doses of NSAIDs (NonSteroidal Anti-Inflammatory Drugs) might be helpful. But on the whole, those drugs don't seem to work well with nerve pain. 
  7. Combination Treatments: Your doctor might recommend that you use one or two of these treatments together - an approach called combination therapy. Many studies have shown that combining certain drugs - often an Anticonvulsant and an Antidepressant has a better effect on nerve pain than either medications alone.
  Watch out for Interactions. Before you start taking a new medicine, make sure your doctor knows about every other prescription drug, OTC medicine, supplement, and vitamin you use. You might want to write them all down and bring in the list to your appointment -- or even bring the pill bottles with you instead.
  Always follow your doctor's instructions for taking a new medicine. Make sure you understand how often you take it, how much you take, what time of day you should take it, and whether you should take it with or without food. Never stop using a prescription medicine without talking to your doctor first.
  Don't ignore side effects. Talk to your doctor about them. He or she might be able to alter the dose or change the medicine to resolve the problem.
 

Other Treatments for Nerve Pain

While medications are typically the first choice for neuropathic pain, some other approaches might help too. Here are some nondrug options.

  1. Electrical Stimulation: When you feel nerve pain, an electrical signal is being sent from a damaged nerve to your brain.  Some treatments for nerve pain work by sending out their own electrical impulses. These charges seem to interrupt or block the pain signals, reducing the pain you feel.

  TENS (Transcutaneous Electrical Nerve Stimulation): is one example of this approach. A small device sends a mild electric current through your skin. While TENS is simple and painless, the evidence that it helps with nerve pain is mixed. Given that it has very low risks, your doctor may recommend giving it a try.
  PENS (Percutaneous Electrical Nerve Stimulation): also called as Electroacupuncture delivers electrical stimulation to the nerves through acupuncture needles.
  RTMS (Repetitive Transcranial Magnetic Stimulation): uses magnets to send electrical impulses into the brain. While evidence is limited, studies suggest that PENS and rTMS could help with nerve pain.

Other methods of electrical stimulation are more complex and require surgery. For instance, spinal cord stimulation involves implanting a device in the body that sends out electrical impulses to the spinal cord. For deep brain stimulation (DBS), a surgeon would implant electrodes in the brain. Generally, doctors only use these invasive approaches when everything else has failed.


  2. Controlling Nerve Pain: Nerve pain can be hard to control. Some studies suggest that less than half of people with nerve pain are able to get sufficient pain relief.However, that doesn't mean you have to accept a life in pain. Experts believe that many of those people in pain could be helped. It's just that they aren't getting the proper treatment. They might be relying on medications that don't work. Or they might be getting the right drugs at the wrong dose.So if you're suffering with nerve pain and treatment isn't helping enough, don't give up hope. Instead, go back to your doctor and come up with a new approach. Or get a referral to an expert -- like a pain specialist or a neurologist.There are a lot of different ways to tackle nerve pain. If one approach doesn't work, others might. By working with an expert, and being persistent, you can find something that will help.
  3. Abdominal Pain: Just about everybody at one point or another will experience abdominal pain. Most of the causes are not serious and can be readily diagnosed and treated. However, pain can also be a sign of a serious illness. It's important to be able to recognize symptoms that are severe and know when to call a doctor.

What Are the Most Common Causes of Abdominal Pain?

Whether it is a mild stomach ache, sharp pain, or stomach cramps, abdominal pain has numerous causes. These include:

  Indigestion
  Constipation
  Stomach "flu"
  Menstrual cramps
  Food poisoning
  Food allergies
  Gas
  Lactose intolerance
  Ulcers
  Pelvic inflammatory disease
  Hernia
  Gallstones
  Kidney stones
  Endometriosis
  Crohn's disease
  Urinary tract infection
  Gastroesophageal reflux disease (GERD)
  Appendicitis


What Symptoms of Abdominal Pain Are Cause for Concern?

If your abdominal pain is severe or if it is accompanied by any of the following symptoms, contact your doctor as soon as possible:

  Fever
  Inability to keep food down for several days
  Inability to pass stool, especially if you are also vomiting
  Vomiting blood
  Bloody stools
  Difficulty breathing
  Painful or unusually frequent urination
  The pain occurs during pregnancy
  The abdomen is tender to the touch
  The pain is the result of an injury to the abdomen in the previous days
  The pain lasts for several days

These symptoms can be an indication of an internal problem that requires treatment as soon as possible.


How Is the Cause of Abdominal Pain Determined?

Because there are so many potential causes of abdominal pain, your doctor will perform a thorough physical exam, discuss with you the type of symptoms you are experiencing, and ask you several related questions about the pain you are feeling. These questions may include:

  What type of pain are you experiencing? Is the pain throughout your abdomen or is it confined to a particular area?
  Where in your abdomen does the pain seem to be located?
  What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache?
  When does the pain occur? Always? More often in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol? During menstruation?
  How long have you had this pain?
  Does the pain also radiate into your lower back, shoulder, groin, or buttocks?
  Are you currently taking any medications or herbal supplements?
  Are you pregnant?
  Does any activity such as eating or lying on one side relieve the pain?
  Have you been injured recently?

Once an initial evaluation has been completed, your doctor may have you undergo some tests to help him or her diagnose your pain. These may include stool or urine tests, blood tests, barium swallows or enemas, an endoscopy, X-ray, ultrasound, or CT scan.


How Is Abdominal Pain Treated?

Treating abdominal pain depends on its cause. This can range from medications for inflammation, GERD, or ulcers, to antibiotics for infections, to changes in personal behavior for abdominal pain caused by certain foods or beverages. In some cases such as appendicitis and a hernia, surgery is necessary.


Myofascial Pain

Myofascial pain syndrome (MPS) is a fancy way to describe muscle pain. It refers to pain and inflammation in the body's soft tissues.Myofascial pain is a chronic condition that affects the fascia (connective tissue that covers the muscles). Myofascial pain syndrome may involve either a single muscle or a muscle group. In some cases, the area where a person experiences the pain may not be where the myofascial pain generator is located. Experts believe that the actual site of the injury or the strain prompts the development of a trigger point that, in turn, causes pain in other areas. This situation is known as referred pain.

What Causes Myofascial Pain?

Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:

  Injury to muscle fibers
  Repetitive motions
  Lack of activity (such as having a broken arm in a sling)


What Are the Symptoms of Myofascial Pain?

Myofascial pain symptoms usually involve muscle pain with specific "trigger" or "tender" points. The pain can be made worse with activity or stress. In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder also can suffer from depression, fatigue and behavioral disturbances.


How Is Myofascial Pain Diagnosed?

Trigger points can be identified by pain that results when pressure is applied to an area of a person's body. In the diagnosis of myofascial pain syndrome, two types of trigger points can be distinguished:

  An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
  A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point. It may cause muscle weakness or restriction of movement.


How Is Myofascial Pain Treated?

Medications such as non-steroidal  anti-inflammatories, acetaminophen or opioids may be used to treat myofascial pain. Medications for sleep, depression or muscle spasm are sometimes used, as well. Non-drug treatments may include

  Physical therapy: "Stretch and spray" technique: This treatment involves spraying the muscle and trigger point with a coolant and then slowly stretching the muscle.
  Massage therapy: Trigger point injection In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed.

Hip Pain

The hip joint is designed to withstand repeated motion and a fair amount of wear and tear. This ball-and-socket joint -- the body's largest -- fits together in a way that allows for fluid movement.



Whenever you use the hip (for example, by going for a run), a cushion of cartilage helps prevent friction as the hip bone moves in its socket.Despite its durability, the hip joint isn't indestructible. With age and use, the cartilage can wear down or become damaged. Muscles and tendons in the hip can get overused. The hip bone itself can be fractured during a fall or other injury. Any of these conditions can lead to hip pain. If your hips are sore, here is a rundown of what might be causing your discomfort and how to get hip pain relief.

Causes of Hip Pain

These are some of the conditions that are most likely to cause hip pain:

  Arthritis . Arthritic conditions such as osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults.  Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that normally cushions your hip bones. The pain gradually gets worse as the arthritis progresses. People with arthritis also feel stiffness and have reduced range of motion in the hip.
  Hip fractures. Fractures of the hip are a particular problem in elderly people. With age, the bones can become weak and brittle. Weakened bones are more likely to fracture during a fall.
  Bursitis . Inflammation of the small, fluid-filled sacs (called bursae) that protect muscles and tendons is usually due to repetitive activities that overwork or irritate the hip joint.
  Tendinitis . Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It's usually caused by repetitive stress from overuse.
  Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When these structures become inflamed from overuse, they can cause pain and prevent the hip from functioning normally.
  Cancers. Tumors that start in the bone (bone cancer) or that spread to the bone can cause pain in the hips, as well as in other bones of the body.
  Avascular necrosis (also called osteonecrosis). This condition occurs when blood flow to the hip bone is reduced and the bone tissue dies as a result. Although it can affect other bones, avascular necrosis most often occurs in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.

Symptoms of Hip Pain

Depending on the condition that's causing your hip pain, you might feel the discomfort in your:

  thigh
  inside of the hip joint
  groin
  outside of the hip joint
  buttocks

Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.You might notice that your pain gets worse with activity, especially if it's caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.


Hip Pain Relief

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as Tylenol or a nonsteroidal anti-inflammatory drug such as Motrin or Aleve.Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, or disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine.Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better.If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.Call your health care provider if your pain doesn't go away, or if you notice swelling, redness, or warmth around the joint. Also call if you have hip pain at night or when you are resting.

Get medical help right away if:

  The hip pain came on suddenly.
  A fall or other injury triggered the hip pain.
  Your joint looks deformed or is bleeding.
  You heard a popping noise in the joint when you injured it.
  The pain is intense.
  You can't put any weight on your hip.

Sciatica

Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.

What Are the Symptoms of Sciatica?

Common symptoms of sciatica include:

  Pain in the rear or leg that is worse when sitting
  Burning or tingling down the leg
  Weakness, numbness, or difficulty moving the leg or foot
  A constant pain on one side of the rear
  A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.For some people, the pain from sciatica can be severe and debilitating. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control.


What Causes Sciatica?

Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine. Additional common causes of sciatica include:

  Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
  Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
  Spondylolisthesis (a condition in which one vertebra slips forward over another one)
  Pregnancy Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.

Fibromyalgia

Fibromyalgia is the most common musculoskeletal condition after osteoarthritis. Still, it is often misdiagnosed and misunderstood. Its characteristics include widespread muscle and joint pain and fatigue as well as other symptoms. Fibromyalgia can lead to depression and social isolation

What Is Fibromyalgia Syndrome?

A syndrome is a set of symptoms. When they exist together, they imply the presence of a specific disease or a greater chance of developing the disease. With fibromyalgia syndrome, the following symptoms commonly occur together:

  anxiety or depression
  decreased pain threshold or tender points
  incapacitating fatigue
  widespread pain

Women are 10 times more likely to get this disease than men. Most of them are women ranging in age from 25 to 60.


What Are Fibromyalgia Symptoms?

Fibromyalgia causes you to ache all over. You may have symptoms of crippling fatigue -- even on arising. Specific tender points on the body may be painful to touch. You may experience swelling, disturbances in deep-level or restful sleep, and mood disturbances or depression.Your muscles may feel like they have been overworked or pulled. They'll feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain.Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other fibromyalgia symptoms include:

  abdominal pain
  anxiety and depression
  chronic headaches
  difficulty maintaining sleep or light sleep
  dryness in mouth, nose, and eyes
  fatigue upon arising
  hypersensitivity to cold and/or heat
  inability to concentrate (called "fibro fog")
  incontinence
  irritable bowel syndrome
  numbness or tingling in the fingers and feet
  stiffness

Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. However, while the pain of bursitis or tendinitis is localized to a specific area,  pain and stiffness with fibromyalgia are widespread.


Treatment for Fibromyalgia

There is no fibromyalgia cure. And there is no treatment that will address all of the fibromyalgia symptoms. Instead, a wide array of traditional and alternative treatments has been shown to be effective in treating this difficult syndrome. A treatment program may include a combination of medications, exercises -- both strengthening and aerobic conditioning -- and behavioral techniques.The FDA has approved three drugs to treat fibromyalgia: Lyrica, Cymbalta, and Savella.


Alternative Treatments for Fibromyalgia?

Alternative therapies, can help manage the symptoms of fibromyalgia. For instance, therapeutic massage manipulates the muscles and soft tissues of the body and helps ease deep muscle pain. It also helps relieve pain of tender points, muscles spasms, and tense muscles. Similarly, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen, and realign the connective tissue to ease discomfort.Moderate aerobic exercise at least two or three times a week, also treatments, such as hypnosis, acupuncture, therapeutic massage, and chiropractic manipulation for pain relief. Along with alternative therapies, it's important to allow time each day to rest and relax. Relaxation therapies -- such as deep muscle relaxation or deep breathing exercises -- may help reduce the added stress that can trigger fibromyalgia symptoms. Having a regularly scheduled bedtime is also important. Sleep is essential to let the body repair itself.

Neck and shoulderpain

Neck and shoulderpain can be classified in many different ways. Some people experience only neck pain or only shoulder pain, while others experience pain in both areas.


What Causes Neck Pain?

Causes of neck pain include:

  Abnormalities in the bone or joints
  Trauma
  Poor posture
  Degenerative diseases
  Tumors
  Muscle strain

What Causes Shoulder Pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

  Strains from overexertion
  Tendonitis from overuse
  Shoulder joint instability
  Dislocation
  Collar or upper arm bone fractures
  Frozen shoulder
  Pinched nerves (also called radiculopathy)


How Are Neck and Shoulder Pain Diagnosed?

  X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
  MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements, as well as problems with the tendons and ligaments.
  Myelography/CT scanning: Sometimes used as an alternative to MRI.
  Electrodiagnostic Studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain, arm pain, numbness and tingling.


How Are Neck and Shoulder Pain Treated?

The treatment of soft tissue neck and shoulder pain often includes the use of anti-inflammatory medication such as ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn). Pain relievers such as acetaminophen (Tylenol) may also be recommended. Depending on the source of pain, drugs like muscle relaxers and even antidepressants might be helpful. Pain also may be treated with a local application of moist heat or ice. Local corticosteroid injection is often helpful for arthritis of the shoulder. For both neck and shoulder pain movement,  exercises may help. For cases in which nerve roots or the spinal cord are involved, surgical procedures may be necessary.

Tennis Elbow

"Tennis elbow" is a common term for a condition caused by overuse of arm, forearm, and hand muscles that results in elbow pain. You don't have to play tennis to get this, but the term came into use because it can be a significant problem for some tennis players.Tennis elbow is caused by either abrupt or subtle injury of the muscle and tendon area around the outside of the elbow.



Tennis elbow most commonly affects people in their dominant arm (that is, a right-handed person would experience pain in the right arm), but it can also occur in the nondominant arm or both arms.


What Are the Symptoms of Tennis Elbow?

Symptoms of tennis elbow include:

  Pain slowly increasing around the outside of the elbow. Less often, pain may develop suddenly.
  Pain is worse when shaking hands or squeezing objects.
  Myelography/CT scanning: Sometimes used as an alternative to MRI.
  Pain is made worse by stabilizing or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife and fork.


Who Gets Tennis Elbow?

Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50, although people of any age can be affected. Although tennis elbow commonly affects tennis players, it also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow, wrist, and hand movement, especially while tightly gripping something. Examples include golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly-line workers.


How Is Tennis Elbow Diagnosed?

Tennis elbow cannot be diagnosed from blood tests and rarely by X-rays. Rather, it is usually diagnosed by the description of pain you provide to your doctor and certain findings from a physical exam. Since many other conditions can cause pain around the elbow, it is important that you see your doctor so the proper diagnosis can be made. Then your doctor can prescribe the appropriate treatment. Tennis elbow usually is successfully treated by medical means -- such as physical therapy, forearm bracing to rest the tendons, topical anti-inflammatory gels, topical cortisone gels, and  cortisone injections. It only rarely requires surgery. The type of treatment prescribed for tennis elbow will depend on several factors, including age, type of other drugs being taken, overall health, medical history, and severity of pain. The goals of treatment are to reduce pain or inflammation, promote healing, and decrease stress and abuse on the injured elbow.


How Is Pain and Inflammation Reduced in Tennis Elbow?

To reduce the pain and inflammation of tennis elbow, try:

  Rest and avoid any activity that causes pain to the sore elbow.
  Apply ice to the affected area.
  Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
  Cortisone-type medication may be put on topically by you or injected into the sore area.

To help lessen the continued stress and abuse on tennis elbow:

  Use the proper equipment and technique in sports and on the job.
  Use of a counter-force brace, an elastic band that wraps around the forearm just below the injured elbow (tendon) may help to relieve pain in some people.
  Avoid tight gripping, overuse of the wrist.
  Pay attention to the movements that cause pain.

Carpal Tunnel Syndrome – Symptoms

The most common symptoms of carpal tunnel syndrome are tingling, numbness, weakness, or pain felt in the fingers or, less commonly, in the palm. Symptoms most often occur in the parts of the hand supplied by the median nerve: the thumb, index finger, middle finger, and half of the ring finger. If your little finger is not affected, this may be a sign that the condition is carpal tunnel syndrome, because the little finger is usually controlled by a different nerve than the thumb and other fingers. See a picture of areas affected in the hand



The median nerve supplies feeling to the skin of the thumb, index finger, middle finger, and half of the ring finger.The symptoms of carpal tunnel syndrome often occur in both hands, but symptoms are usually worse in one hand than the other. You may first notice symptoms at night. People with carpal tunnel syndrome can usually fall asleep, but pain or numbness may wake them up.

Mild carpal tunnel symptoms primarily affect the hand and sometimes the forearm, but they can radiate up to the shoulder. Symptoms include:

  Numbness or pain in your hand, forearm, or wrist that awakens you at night. (Shaking or moving your fingers may ease this numbness and pain.)
  Occasional tingling, numbness, "pins-and-needles" sensation, or pain. The feeling is similar to your hand "falling asleep."
  Numbness or pain that gets worse while you are using your hand or wrist, especially when gripping an object with your hand or bending (flexing) your wrist.
  Occasional aching pain in your forearm between your elbow and wrist.
  Stiffness in your fingers when you get up in the morning. With moderate or severe carpal tunnel symptoms, you may have numbness or reduced strength and grip in your fingers, thumb, or hand. It may be difficult to:
  Do simple hand movements, such as brushing your hair or holding a fork. You may accidentally drop objects.
  Pinch an object between your thumb and first finger (loss of pinch strength).
  Use your thumb while doing simple tasks such as opening a jar or using a screwdriver. With long-lasting carpal tunnel syndrome, the thumb muscles can get smaller and weaker (atrophy).Not all pain in the wrist or hand is caused by carpal tunnel syndrome. There are many other conditions with similar symptoms.


Carpal Tunnel Syndrome - Treatment
The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal function and activities and to:

  Address other health conditions if they are making your symptoms of carpal tunnel syndrome worse.
  Reduce any inflammation of tissues in the wrist that puts pressure on the median nerve.
  Determine the causes of your carpal tunnel symptoms. You can then identify whether there are activities for you to avoid or do differently and ways you can help prevent the condition.
  Prevent nerve damage and loss of muscle strength in your fingers and hand.

Treatment for carpal tunnel syndrome is based on the seriousness of the condition, whether there is any nerve damage, and whether other treatment has helped. Treatment options include treatment without surgery (nonsurgical treatment) or with surgery.

  If treated early, carpal tunnel symptoms usually go away with nonsurgical treatment.
  If your symptoms are mild, with occasional tingling, numbness, weakness, or pain, 1 to 2 weeks of home treatment are likely to relieve your symptoms.
  If home treatment does not help, or if your symptoms are more severe (including the loss of feeling in your fingers or hand, or the inability to perform simple hand movements such as holding objects or pinching), have your doctor examine you and recommend treatment.


Nonsurgical treatment
If your symptoms are not severe, expect your doctor to recommend nonsurgical treatment to see whether symptoms improve. Nonsurgical treatment includes:

  Evaluating any other medical problems that might contribute to carpal tunnel syndrome, and changing your treatment for those problems if needed.
  Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks.
  Wearing a wrist splint to keep your wrist straight, usually just at night. Using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help relieve your symptoms.
  Learning ways to protect your joints as you go through your daily activities.

In some cases, oral corticosteroids or corticosteroid injections into the carpal tunnel may be considered if other methods to reduce inflammation do not work.


Surgical treatment
Surgery is sometimes recommended when other treatment has not helped, if a carpal tunnel condition has continued for a long time, or if there is nerve damage or the risk of nerve damage. Surgery involves cutting the ligament that forms the roof of the carpal tunnel. This relieves the pressure on the median nerve, which eases or ends the symptoms of carpal tunnel syndrome.


Corticosteroids for Carpal Tunnel Syndrome
Generic Name:

  betamethasone
  methylprednisolone

Although corticosteroids come in oral (tablets or syrup) form, injections (shots) are most commonly used for treating carpal tunnel syndrome.

  How It Works: Corticosteroids relieve inflammation.
  Why It Is Used: Corticosteroids are given to relieve inflammation due to carpal tunnel syndrome when other forms of treatment (such as rest, using a wrist splint, or using anti-inflammatories) have not helped relieve pain.
  When it should not be used (contraindications): Corticosteroids should not be given to children, nor to women who are pregnant or breast-feeding.

Finger, hand, or wrist Pains

At one time or another, everyone has had a minor injury to a finger, hand, or wrist that caused pain or swelling. Most of the time our body movements do not cause problems, but it's not surprising that symptoms develop from everyday wear and tear, overuse, or an injury.
Finger, hand, or wrist injuries most commonly occur during:

  Sports or recreational activities.
  Work-related tasks.
  Work or projects around the home, especially if using machinery such as lawn mowers, snow blowers, or hand tools.
  Accidental falls.
  Fistfights.

The risk of finger, hand, or wrist injury is higher in contact sports, such as wrestling, football, or soccer, and in high-speed sports, such as biking, in-line skating, skiing, snowboarding, and skateboarding. Sports that require weight-bearing on the hands and arms, such as gymnastics, can increase the risk for injury. Sports that use hand equipment such as ski poles, hockey or lacrosse sticks, or racquets also increase the risk of injury. In children, most finger, hand, or wrist injuries occur during sports or play or from accidental falls. Any injury occurring at the end of a long bone near a joint may injure the growth plate (physis) and needs to be evaluated. Older adults are at higher risk for injuries and fractures because they lose muscle mass and bone strength (osteopenia) as they age. They also have more problems with vision and balance, which increases their risk of accidental injury. Most minor injuries will heal on their own, and home treatment is usually all that is needed to relieve symptoms and promote healing.

Sudden (acute) Injury
An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

  Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See a picture of a bruise (contusion)
  Injuries to ligaments. See a picture of a torn thumb ligament as in skier's thumb.
  Injuries to tendons, such as mallet finger.
  Injuries to joints (sprains).
  Pulled muscles (strains).
  Broken bones (fractures), such as a wrist fracture
  Dislocations.
  Crushing injury, which can lead to compartment syndrome.


Overuse Injuries
Overuse injuries occur when too much stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include the following:

  Carpal tunnel syndrome is caused by pressure on a nerve (median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See a picture of carpal tunnel syndrome.
  Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
  De Quervain's disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See a picture of de Quervain's disease.


Treatment
Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; "buddy-taping" for support; application of a brace, splint, or cast; physical therapy; and in some cases, surgery. Treatment depends on:

  The location, type, and severity of the injury.
  How long ago the injury occurred.
  Your age, health condition, and activities (such as work, sports, or hobbies).

Ayurvedic approach

Pain killers from your kitchen(Home Remedies)
Ayurveda, the science of life was the first system which advocated the ‘Food is Medicine’ concept. In every context of physiology to pathology and prognosis, Ayurveda talks about the quality of food and its good and bad effects.


Here, we take a look at Ayurveda’s top 11 pain killers – which I should call the ‘Top 10 Kitchen pain killers’ as all of them can be found on your kitchen shelf and are currently very well validated by the modern medical system.

  1. Fresh ginger to ease muscular pain: Ayurveda recommends 5 gm of fresh ginger or 2 gm dried ginger as part of diet to prevent and manage muscular and joint pains. Research from Denmark has proven ginger’s positive effects on reducing swelling and stiffness. They have very well documented the physiological results of ‘Gingerols’ which is effective for reducing all kinds of pain.
  2. Clove for toothache: Indians have always used the clove powder or oil to beat tooth ache and tooth-related problems. A team of researchers from the US have documented the effects eugenol – one of the active components from clove for its anesthetic and anti bacterial effects. They have also documented that the intake of 2 gm of clove powder improves cholesterol ratio, maintains the PH in the GI tract which in turn prevents all kinds of oral infections.
  3. Vinegar for heart burn: Did you know that Ayurveda was the first system to talk about preparing different kinds of Vinegars and its therapeutic and medical effects. Ayurveda recommends 30 ml of vinegar after a heavy meal to make digestion and metabolism smoother. One of the teams of the US Colon and Digestive Disease Center has documented the good results of vinegar especially the Apple cider one. They have found that mallic and tartaric acids are the components which help in the breakdown of harder, bigger food particles to smaller easily digestible ones.
  4. Garlic for earache: People from rural India would well be aware of this use of garlic. Traditionally, garlic is used to treat earaches. The practice is to pour 2 drops of warm garlic oil into the affected ear for 5-11 days till it is completely healed. In a study conducted by Mexican scientists, it is evident that the active ingredients of garlic like germanium, selenium and sulfur have positive physiological effects on pain causing chemicals secreted by common bacterial infection.
  5. Cherries for pain: Research has shown that anthocyanins, which are the active ingredients in cherries, have ten times more positive effect on reducing pain than common pain killers like Ibuprofen etc., and that too, without any side effects.
  6. Fish for stomach ailments: Most of us think that Ayurveda is a vegetarian system. But the truth is Ayurveda recommends as much non-vegetarian foods for better health. For example, for conditions like indigestion, irritable bowel syndrome, inflammatory bowel syndrome etc Ayurveda recommends as much as 200 gm of specified fish as diet. Ayurveda also opines that the waist size can very well be controlled by a fish diet. Modern research agrees that EPA and DHA, the powerful anti-inflammatory chemicals found in fish, are ten times more effective than the common corticosteroids.
  7. Buttermilk for PMS: Ayurveda recommends buttermilk for pre and post menopausal syndromes and menstrual pains. One of researches conducted in the Yale University has shown the positive results of buttermilk in treating gynaecological troubles. The calcium in buttermilk helps calm down the physical and psychological irritability caused during PMS.
  8. Reversing diabetic pain with turmeric: Ayurveda recommends the use of turmeric as a part of the diet to prevent the complications of diabetes and pain. One of the researches has shown the positive results of turmeric in healing pain in arthritis and fibromyalgia in diabetic patients.
  9. Salt to ease leg pain: As per research on the Internet, leg pain affects everyone irrespective of age, sex, region etc. As research has shown, salt’s anti-bacterial and anti-inflammatory properties, makes it effective against pain. Research from Stanford University shows that regular soaking of affected parts in warm salt water acts better than tropical pain killers and antibiotics.
  10. Honey for mouth sores: Ayurveda recommends honey gargle for mouth sores. Even as general practice, as part of ‘Dina Charya’ gargle with honey is recommended for better voice, improved speech and to prevent all types of oral inflammation and infections. A research conducted in the Dubai Medical center suggests that honey gargle heals mouth sores 47% better than any medicine or cream available in the market. Honey is extremely effective in reducing inflammation and improving tissue healing.
  11. Heal muscle cramps with tamarind juice: Ayurveda recommends tamarind juice to manage acute muscle cramps. An authentic research shows that potassium deficiency usually leads to muscle cramps and one out of four people over the age of 40 suffer from cramps. 50 ml of diluted tamarind juice is effective in bringing back the blood potassium levels, says research.

Ayurveda the science of life recommends called ‘Dina Charya’ – a daily regimen for the health and wellness of every individual, and for the society. Unfortunately, in this fast-paced life, we have lost the habit of following these practices. We lose out on their health benefits leading to ill health which results in intake of medicines. These remedies do not require much time, effort or cost. All that is required is to include them as a part of your diet or habit. Even though these remedies look simple, their benefits are priceless.

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