Orthopedic Care and Consultation
US FDA has approved a novel neurostimulation device with motion sensor technology for the treatment of chronic back and/or leg pain.
The device is called AdaptiveStim With RestoreSensor and built by Medtronic. It uses an implantable pacemaker-like device to interrupt pain signals, transforming them into a tingling sensation instead of pain.
The manufacturer says in a press release [Read more...]
Cochrane Database of Systematic Reviews has reported that topical nonsteroidal anti-inflammatory drugs may be safe and effective for acute musculoskeletal conditions in adults
The use of topical NSAIDs vary in different countries.In theory they have potential to provide pain relief without associated systemic adverse events.”
Recent report published on June 16,2010 has evaluated the evidence from randomized, double-blind, controlled trials of the efficacy and safety of topically applied NSAIDs for relief of acute pain. [Read more...]
Persistent pain after orthopaedic trauma is every troublesome and is a common phenomenon. Despite physical healing, some individuals continue to have persistent pain and disability and a reduced capacity for functioning.
A lot of research has been done to determine the factors responsible for persistent pain following injury.
Earlier studies suggested that factors other than the physical injury are important in the development of persistent pain.
A recent study involving 168 participants between 18-64 years evaluated the association between a range of biopsychosocial factors and the presence of persistent pain, pain severity, and pain interfering with normal work activities in a cohort of patients after of non-life-threatening orthopaedic injuries.
The study found that high initial pain, external attributions of responsibility for the injury, and psychological distress are factors that strongly predict persistent pain, pain-related work disability, and pain severity.
The study has been recently published in Journal of Pain.
Mirror box therapy was originally developed for the relief of Phantom Limb Pain, but has been proven in the treatment of stroke rehabilitation, and complex regional pain syndrome, as well as for hand and foot rehabilitation following an injury or surgery.
A mirror box is a box with two mirrors in the center (one facing each way), invented and uses the principle of visual feedback to alleviate limb pain.
In this, the patient places the good limb into one side, and the stump into the other. The patient then looks into the mirror on the side with good limb and sees the reflection of good limb in place of stump. Because the subject is seeing the reflected image of the good hand moving, it appears as if the phantom limb is also moving.
Through the use of this artificial visual feedback it becomes possible for the patient to “move” the phantom limb, and to unclench it from potentially painful positions.
Studies have found that use of the mirror box can eliminate the remapping associated with phantom limb pains.
Ketamine is a potent anesthetic that has been used as an experimental and controversial treatment for Complex Regional Pain Syndrome.
This was conceptualized by neurologist Dr Robert J. Schwartzman
The basis for using it to treat CRPS may reside in its strong ability to block N-methyl D-aspartate (NMDA) receptors.There is sufficient evidence to suggest that a intense or prolonged painful stimulus causes an extraordinary release of glutamate from peripheral nerve fibers that carry pain information.
This glutamate stimulates NMDA receptors on second-order neurons that produce the phenomena central sensitization.
Thus it seems reasonable that by blocking NMDA receptors, one might also be able to block cellular mechanisms supporting windup and central sensitization. [Read more...]
Pain management program aims at providing pain relief and restoration of normal function of part of body/individual. Pain relief is provided by either pharmacological methods or interventions.
Physiotherapy as the word itself indicates is a therapy wherein pain relief and mobilization is provided by physical means like heat and cold, traction, manipulation and electrical stimulation. This therapy is an useful adjunct to conventional methods to provide pain relief and restoration of normal function. [Read more...]
Complex regional pain syndrome is a chronic progressive disease characterized by severe pain, swelling and changes in the skin in the involved region. Depending on presence or absence of nerve involvement it can be on of the two types.
Type I
It was formerly known as reflex sympathetic dystrophy, Sudeck’s atrophy, reflex neurovascular dystrophy or algoneurodystrophy. This type does not have a demonstrable nerve lesions.
Type II
It was formerly known as causalgia and is associated with obvious nerve damage.
Exact cause of this syndrome is not known. Injury and surgery are known predisposing factors but cases can occur without these factors too. wrist fractures and are quite commonly associated with CRPS.
Contents
Clinical Presentation
The symptoms of complex regional pain syndrome are usually spread beyond the original area of injury.It may involve the entire limb and sometimes other limb too.
The most common complaint is that of overall are burning and shooting pain. The pain is continuous and may be aggravated by emotional stress. [Read more...]
Also called myofascial trigger points, trigger points are hyperirritable spots in skeletal muscle that are associated with palpable nodules in taut bands of muscle fibers. It is believed that palpable nodules are small contraction knots and a common cause of pain.
Pressing the trigger point may cause local tenderness, referred pain, or local twitch response.
The trigger points frequently cause pain that frequently radiates from these points of local tenderness to broader areas, sometimes quite faraway from these points. In spite of being accepted them as a different entity, enough diagnostic criteria and cause of there origin is not known
The term “trigger point” was coined in 1942 by Dr. Janet Travell.
Cold therapy has been used for relief of pain since ancient times. In recent years, it is being used in the form of ice packs, vapocoolant sprays and ice massage.
It is most useful in acute musculoskeletal pain associated with sports injures or trauma.
Whenever cold stimulus (ice pack) is applied to skin, it melts and removes heat from tissues. This leads to vasoconstriction (The blood vesseles get constricted, their lumen and their capacity to carry blood increases), reduction of nerve conductivity (As a result the nerve becomes less sensitive), reduction of muscle spasm and spasticity. Once the cold stimulus is taken off, the temperature of the area reaches normal level by vasodilatation. [Read more...]
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