Hope Center

Comprehensive Pain Management
Centre


Experience Life Without Pain


Fight The Pain

CONDITIONS TREATED

  • 1. BACK PAINA) DISC PROLAPSE
    B) FACET JOINT ARTHROPATHY
    C) SPONDIOLYSTHESIS

     2. SACROILIAC JOINTPAIN
     3. NECK AND SHOULDER PAIN
     4. HEADACHE
     5. MIGRAINE
     6. TRIGEMINAL NEURALGIA
     7. MYOFASCIAL PAINS
     8. ARTHRITIC PAINS
     9. FIBROMYALGIA
    10. COMPLEX REGIONAL PAIN SYNDROME
    11. CANCER PAIN

    BACK PAINThe key to understanding back pain is to understand the cause of the pain and then treat is accordingly.
    Back and neck pain is the price human beings pay for poor posture, prolonged sitting, repeated bending, and other stresses placed on the lower back and neck.. Discs are soft, rubbery pads, which act as shock absorbers between the hard bones (vertebrae) of the spinal column. The discs between the vertebrae allow the back to flex or bend.

    Disc herniation is normally a further development of a previously existing disc "protrusion", a condition in which the outermost layers of the annulus fibrosus is still intact, but can bulge when the disc is under pressure.A spinal disc herniation is a medical condition affecting the spine due to trauma, lifting injuries, or idiopathic (unknown) causes, in which a tear in the outer, fibrous ring (annulus fibrosus) of an intervertebral disc allows the soft, central portion (nucleus pulposus) to bulge out beyond the damaged outer ring. Most minor herniations heal within several weeks. Anti-inflammatory treatments for pain associated with disc herniation, protrusion, bulge, or disc tear are generally effective. Severe herniations may not heal on their own and may require surgical intervention.

    The condition is widely referred to as a slipped disc, but this term is not medically accurate as the spinal discs are fixed in position between the vertebrae and cannot "slip"

    Majority of spinal disc herniation cases occur in lumbar region (95% in L4-L5 or L5-S1). The second most common site is the cervical region (C5-C6, C6-C7). The thoracic region accounts for only 0.15% to 4.0% of cases. Herniations usually occur posterolaterally, where the annulus fibrosis is relatively thin and is not reinforced by the posterior or anterior longitudinal ligament. In the cervical spinal cord, a symptomatic posterolateral herniation between two vertebrae will impinge on the nerve which exits the spinal canal between those two vertebrae on that side.
  • Cervical Cervical disc herniations occur in the neck, most often between the fifth & sixth (C5/6) and the sixth and seventh (C6/7) cervical vertebral bodies. Symptoms can affect the back of the skull, the neck, shoulder girdle, scapula, shoulder, arm, and hand. The nerves of the cervical plexus and brachial plexus can be affected.
  • Lumbar Lumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, anal/genital region and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected and cause the patient to experience a numb, tingling feeling throughout one or both legs and even feet or even a burning feeling in the hips and legs.
  • TreatmentIn the majority of cases, spinal disc herniation doesn't require surgery. A study on sciatica, that after 12 weeks, 73% of patients showed reasonable to major improvement without surgery.

    Initial treatment usually consists of non-steroidal anti-inflammatory pain medication (NSAIDs), but the long-term use of NSAIDs for patients with persistent back pain is complicated by their possible cardiovascular and gastrointestinal toxicity. An alternative often employed is the injection of cortisone into the spine adjacent to the suspected pain generator, a technique known as “epidural steroid injection”. Epidural steroid injections "may result in some improvement in radicular lumbosacral pain when assessed between 2 and 6 weeks following the injection, compared to control treatments." Complications resulting from poor technique are rare.

    Ancillary approaches, such as rehabilitation, physical therapy, anti-depressants, and, in particular, graduated exercise programs, may all be useful adjuncts to anti-inflammatory approaches.
  • LumbarLumbar disc herniations occur in the lower back, most often between the fourth and fifth lumbar vertebral bodies or between the fifth and the sacrum. Symptoms can affect the lower back, buttocks, thigh, anal/genital region and may radiate into the foot and/or toe. The sciatic nerve is the most commonly affected nerve, causing symptoms of sciatica. The femoral nerve can also be affected and cause the patient to experience a numb, tingling feeling throughout one or both legs and feet or a burning feeling in the hips and legs.

    Non-surgical methods of treatment are usually attempted first, leaving surgery as a last resort. Pain medications are often prescribed as the first attempt to alleviate the acute pain and allow the patient to begin exercising and stretching. There are a variety of other non-surgical methods used in attempts to relieve the condition after it has occurred, often in combination with pain killers.

    TREATMENT1. Patient education on proper body mechanics
    2. Physical therapy, to address mechanical factors, and may include modalities to temporarily relieve pain (i.e. traction, electrical stimulation, massage)
    3. Non-steroidal anti-inflammatory drugs (NSAIDs)
    4. Oral steroids (e.g. prednisone or methylprednisolone)
    5. Weight control
    6. Tobacco cessation
    7. Lumbosacral back support
    8. Epidural steroid injection- An epidural steroid injection is performed to help reduce the inflammation and pain associated with nerve root compression. Nerve roots can be compressed by a herniated disc, spinal stenosis, and bone spurs. When the nerve is compressed it becomes inflamed. This can lead to pain, numbness, tingling or weakness along the course of the nerve. This is called radiculopathy. The goal of the epidural steroid injection is to help lessen the inflammation of the nerve root.

    The epidural space is located above the outer layer surrounding the spinal cord and nerve roots. An epidural steroid injection goes into the epidural space, directly over the compressed nerve root.


  • Epidural steroid injection with injection needle visible in the epidural space using a fluoroscope
  • OZONE NUCLEOLYSIS- A shot of ozone and oxygen may prove to be a safe, effective and less invasive way to relieve the pain of a herniated disk . Ozone discectomy is done under local anaesthesia and the patient goes home after a short recovery on the same day. Ozone therapy due to its good results, non-invasiveness and lack of major complications compared to other methods (microsurgery, endoscopic discectomy, percutaneous discectomy, conventional open surgery) make this therapy the treatment of choice.

  • PERCUTANEOUS DISCECTOMY- The discectomy is performed through a cannula inserted through the back into the center of the vertebral disc under local anaesthetic using a stylet. After the position of the stylet is confirmed to be correct using AP and Lateral X-ray views it is removed leaving the cannula in place. The disc material may be removed using surgical tools such as the Dekompressor or traditional manual surgical tools; however the manual instruments require a larger cannula and more disruption to the surrounding structures. Both the automated and manual percutaneous discectomy procedures produce similar results and reduction in disc height and pressure on the nerves to result in pain reduction.

  • 9. ENDOSCOPIC DISCECTOMY- Non Traumatic Discectomy is different from open lumbar disc surgery because there is no traumatic back muscle dissection, no bone removal, and no large skin incision. The risk of complications from scarring, blood loss, infection, and anaesthesia that may occur with conventional surgery are drastically reduced or eliminated with this procedure. Non Traumatic Discectomy was invented to be an effective treatment for herniated discs while avoiding these risks.
  • 10. LUMBAR LAMINECTOMY
          FACET JOINT ARTHROPATHY
    Arthritis of the lumbar facet joints can be a source of significant low back pain. Aligned on the back of the spinal column, the facet joints link each vertebra together. Articular cartilage covers the surfaces where these joints meet. Like other joints in the body that are covered with articular cartilage, the lumbar facet joints can be affected by arthritis.

    Normally, the facet joints fit together snugly and glide smoothly, without pressure. If pressure builds where the joint meets, the cartilage on the joint surfaces wears off, or erodes.

    Each segment in the spine has three main points of movement, the intervertebral disc and the two facet joints. Injury or problems in any one of these structures affects the other two. As a disc thins with aging and from daily wear and tear, the space between two spinal vertebrae shrinks. This causes the facet joints to press together.

    Facet joints can also become arthritic due to a back injury earlier in life. Fractures, torn ligaments and disc problems can all cause abnormal movement and alignment, putting extra stress on the surfaces of the facet joints.
    The body responds to this extra pressure by developing bone spurs. As the spurs form around the edges of the facet joints, the joints become enlarged. This is called hypertrophy. Eventually, the joint surfaces become arthritic. When the articular cartilage degenerates, or wears away, the bone underneath is uncovered and rubs against bone. The joint becomes inflamed, swollen, and painful.
  • TREATMENT-  NONSURGICAL
    1 Medicine. Non steroidal anti-inflammatory drugs
    2 Physical therapy
    3 Facet joint injection- Facet joint injections usually have two goals: to help diagnose the cause and location of pain and also to provide pain relief:

    • Diagnostic goals: By placing numbing medicine into the joint, the amount of immediate pain relief experienced by the patient will help confirm whether the joint is the source of pain. If complete pain relief is achieved while some of the facet joints are numb it means those joints are likely to be the source of pain.

    • Pain relief goals: Along with the numbing medication, a facet joint injection also includes injecting time-release cortisone into the facet joints to reduce inflammation, which can often provide long term pain relief. The procedure may also be called a facet block, as its purpose is to block the pain.

    4. Radiofrequency neurotomy (also called radiofrequency ablation or lesioning) is a minimally invasive procedure that can provide lasting relief to those suffering from facet joint pain.

    Benefits of radiofrequency ablation include:
     Pain relief for up to 2 years
     Significant and longer lasting pain relief compared to steroid injections
     Low complication and morbidity rates
     Appreciable pain relief compared to surgery: Nearly half of back pain sufferers are not helped by surgery
     Greater range of motion
     Lower use of analgesics
     Improved quality of life
     Short recovery time

    . C) SPONDIOLYSTHESIS- Spondylolisthesis is the anterior or posterior displacement of a vertebra or the vertebral column in relation to the vertebrae below

  • TREATMENT- Patients with less severity are initially offered conservative treatment consisting of activity modification, chiropractic treatment, pharmacological intervention, and a physical therapy consultation. Anti-inflammatory medications (NSAIDS) in combination with acetaminophen can be tried initially.

    If severe radicular component is present, a short course of oral steroids such as Prednisone or Methylprednisolone can be considered.

    Chiropractic treatments and physical therapy can evaluate and address postural and compensatory movement abnormalities such as hyperlordosis and hip flexor and lumbar paraspinal tightness. The majority of these patients also present with chronically tight hamstrings. Physical modalities such as thermal treatment, electrical stimulation and lumbar traction can help with reactive muscle spasm, but typically are of short therapeutic duration when done in isolation, and should be coupled with therapeutic exercise.

    Epidural steroid injections, either interlaminar or transforaminal, performed under fluoroscopic guidance can help with severe radicular (leg) pain.
  • NECK OR SHOULDER PAIN- Neck pain is a common complaint. Neck muscles can be strained from poor posture — whether it's leaning into your computer at work or hunching over your workbench at home. Wear-and-tear arthritis also is a common cause of neck pain.

    Rarely, neck pain can be a symptom of a more serious problem. Medical attention should be sought if neck pain is accompanied by numbness or loss of strength in arms or hands or there is shooting pain into the shoulder or down the arm.

    Neck pain can result from a variety of causes, including: • Muscle strains. Overuse, such as too many hours hunched over a steering wheel, often triggers muscle strains. Even such minor things as reading in bed or gritting your teeth can strain neck muscles.
    • Worn joints. Just like all the other joints in your body, your neck joints tend to undergo wear and tear with age, which can cause osteoarthritis in your neck.
    • Nerve compression. Herniated disks or bone spurs in the vertebrae of the neck can take up too much space and press on the nerves branching out from the spinal cord.
    • Injuries. Rear-end auto collisions often result in whiplash injuries, which occur when the head is jerked backward and then forward, stretching the soft tissues of the neck beyond their limits.
    • Diseases. Neck pain can sometimes be caused by diseases, such as rheumatoid arthritis, meningitis or cancer.

  • HEADACHE-
    A Headache is defined as a pain in the head or upper neck. It is one of the most common locations of pain in the body and has many causes.
    Headaches have numerous causes. There are three major categories of headaches:
    1. primary headaches
    2. secondary headaches
    3. cranial neuralgias, facial pain, and other headaches

  • MIGRAINE-Migraine is a chronic neurological disorder characterized by recurrent moderate to severe headaches often in association with a number of autonomic nervous system symptoms. Typically the headache is unilateral (affecting one half of the head) and pulsating in nature, lasting from 2 to 72 hours. Associated symptoms may include nausea, vomiting, photophobia (increased sensitivity to light), phonophobia (increased sensitivity to sound) and the pain is generally aggravated by physical activity. Up to one-third of people with migraine headaches perceive an aura: a transient visual, sensory, language, or motor disturbance which signals that the headache will soon occur Occasionally an aura can occur with little or no headache following it.

    Migraines are believed to be due to a mixture of environmental and genetic factors. About two-thirds of cases run in families Fluctuating hormone levels may also play a role: migraine affects slightly more boys than girls before puberty, but about two to three times more women than men. Propensity for migraines usually decreases during pregnancy. The exact mechanisms of migraine is not known. It is, however, believed to be a neurovascular disorder. The primary theory is related to increased excitability of the cerebral cortex and abnormal control of pain neurons in the trigeminal nucleus of the brainstem.

    Initial recommended management is with simple analgesics such as ibuprofen and acetaminophen (also known as paracetamol) for the headache, an antiemetic for the nausea, and the avoidance of triggers. Specific agents such as tryptans or ergotamines may be used by those in whom simple analgesics are not effective.

  • TRIGEMINAL NEURALGIA
    Trigeminal neuralgia is a chronic pain condition that affects the trigeminal nerve, which carries sensation from face to brain. If you have trigeminal neuralgia, even mild stimulation of face such as from brushing teeth or putting on makeup may trigger a jolt of excruciating pain.

    There may initially be short, mild attacks, but trigeminal neuralgia can progress, causing longer, more frequent bouts of searing pain. Trigeminal neuralgia affects women more often than men, and it's more likely to occur in people who are older than 50.

    Because of the variety of treatment options available, having trigeminal neuralgia doesn't necessarily mean you're doomed to a life of pain. Trigeminal neuralgia symptoms may include one or more of these patterns:

    • Occasional twinges of mild pain
    • Episodes of severe, shooting or jabbing pain that may feel like an electric shock
    • Spontaneous attacks of pain or attacks triggered by things such as touching the face, chewing, speaking and brushing teeth
    • Bouts of pain lasting from a few seconds to several seconds
    • Episodes of several attacks lasting days, weeks, months or longer some people have periods when they experience no pain
    • Pain in areas supplied by the trigeminal nerve, including the cheek, jaw, teeth, gums, lips, or less often the eye and forehead
    • Pain affecting one side of your face at a time
    • Pain focused in one spot or spread in a wider pattern
    • Attacks becoming more frequent and intense over time

    Trigeminal neuralgia treatment usually starts with medications, and many people require no additional treatment. However, over time, some people with the condition may stop responding to medications, or they may experience unpleasant side effects. For those people, injections or surgery provide other treatment options.

    If your condition is due to another cause, such as multiple sclerosis, your doctor will treat the underlying condition.

    MedicationsMedications to lessen or block the pain signals can be taken .

    • Anticonvulsants. Doctors usually prescribe carbamazepine (Tegretol, Carbatrol, others) for trigeminal neuralgia, and it's been shown to be effective in treating the condition. Other anticonvulsant drugs that may be used to treat trigeminal neuralgia include oxcarbazepine (Trileptal). Other drugs, including clonazepam (Klonopin) and gabapentin (Neurontin, Gralise, others), also may be used.

    If the anticonvulsant you're using begins to lose effectiveness, your doctor may increase the dose or switch to another type. Side effects of anticonvulsants may include dizziness, confusion, drowsiness, double vision and nausea. Carbamazepine can trigger a serious drug reaction in some people.

    • Antispasmodic agents. Muscle-relaxing agents such as baclofen (Gablofen, Lioresal) may be used alone or in combination with carbamazepine. Side effects may include confusion, nausea and drowsiness.
  • NON SURGICAL • Glycerol injection. During this procedure, a needle is inserted through your face into an opening in the base of the skull. The needle is guided into the trigeminal cistern, a small sac of spinal fluid that surrounds the trigeminal nerve ganglion — where the trigeminal nerve divides into three branches — and part of its root. A small amount of sterile glycerol is injected, which damages the trigeminal nerve and blocks pain signals. This procedure often relieves pain. However, some people have a later recurrence of pain, and many experience facial numbness or tingling

    • Radiofrequency thermal lesioning. This procedure selectively destroys nerve fibres associated with pain. While you're sedated, your doctor inserts a hollow needle through your face and guides it to a part of the trigeminal nerve that goes through an opening at the base of your skull.

    Once the needle is positioned. an electrode is inserted through the needle which sends a mild electrical current through the tip of the electrode. You'll be asked to indicate when and where you feel tingling.

    When the part of the nerve involved in your pain is located, then the electrode is heated until it damages the nerve fibres, creating an area of injury (lesion). If your pain isn't eliminated, your doctor may create additional lesions. Radiofrequency thermal lesioning usually results in some temporary facial numbness after the procedure.

    Surgery In trigeminal neuralgia surgery, surgeons' goals are to stop the blood vessel from compressing the trigeminal nerve or to damage the trigeminal nerve to keep it from malfunctioning. Damaging the nerve often causes temporary or permanent facial numbness, and with any of the surgical procedures, the pain can return months or years later.

    Surgical options for trigeminal neuralgia include:
    • Microvascular decompression. This procedure involves relocating or removing blood vessels that are in contact with the trigeminal root.

    During microvascular decompression, your doctor makes an incision behind the ear on the side of your pain. Then, through a small hole in your skull, your surgeon moves any arteries that are in contact with the trigeminal nerve away from the nerve, and places a pad between the nerve and the arteries. If a vein is compressing the nerve, your surgeon may remove it. Doctors also may cut part of the trigeminal nerve (neurectomy) during this procedure.

    Microvascular decompression can successfully eliminate or reduce pain most of the time, but pain can recur in some people. Microvascular decompression has some risks, including small chances of decreased hearing, facial weakness, facial numbness, double vision, a stroke or other complications. Most people who have this procedure have no facial numbness afterward.

    • Gamma Knife radio surgery. In this procedure, a surgeon directs a focused dose of radiation to the root of your trigeminal nerve. This procedure uses radiation to damage the trigeminal nerve and reduce or eliminate pain. Relief occurs gradually and may take several weeks. Gamma Knife radio surgery is successful in eliminating pain for the majority of people. If pain recurs, the procedure can be repeated. Because Gamma Knife radio surgery is effective and safe compared with other surgical options, it is becoming widely used and may be offered instead of other surgical procedures.
    Other procedures may be used to treat trigeminal neuralgia, such as a rhizotomy. In a rhizotomy, your surgeon destroys nerve fibres, which causes some facial numbness.

  • MYOFASCIALPAINMyofascial pain syndrome is a chronic pain disorder. In myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain.

    Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension.

    While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens.

    Treatment for myofascial pain syndrome typically includes medications, trigger point injections or physical therapy. No conclusive evidence supports using one therapy over another. Discuss your options and treatment preferences with your doctor. You may need to try more than one approach to find pain relief.

    Medications Medications used for myofascial pain syndrome include:

    • Pain relievers. Over-the-counter pain relievers such as ibuprofen and naproxen may help some people. Or your doctor may prescribe stronger pain relievers. Some are available in patches that you place on your skin.

    • Antidepressants. Many types of antidepressants also can help relieve pain. For some people with myofascial pain syndrome, amitriptyline appears to reduce pain and improve sleep.
    • Sedatives. Clonazepam helps relax muscles affected by myofascial pain syndrome. It must be used carefully because it can cause sleepiness and can be habit-forming.

    Therapy A physical therapist can devise a plan to help relieve your pain based on your signs and symptoms. Physical therapy to relieve myofascial pain syndrome may involve:

    • Stretching. A physical therapist may lead you through gentle stretching exercises to help ease the pain in your affected muscle. If you feel trigger point pain when stretching, the physical therapist may spray a numbing solution on your skin.

    • Massage. A physical therapist may massage your affected muscle to help relieve your pain. The physical therapist may use long hand strokes along your muscle or place pressure on specific areas of your muscle to release tension.

    • Heat. Applying heat, via a hot pack or a hot shower, can help relieve muscle tension and reduce pain.

    • Ultrasound. This type of therapy uses sound waves to increase blood circulation and warmth, which may promote healing in muscles affected by myofascial pain syndrome.

    Needle procedures Injecting a numbing agent or a steroid into a trigger point can help relieve pain. In some people, just the act of inserting the needle into the trigger point helps break up the muscle tension. Called dry needling, this technique involves inserting a needle into several places in and around the trigger point. Acupuncture also appears to be helpful for some people who have myofascial pain syndrome.
  • ARTHRITIS Arthritis affects the musculoskeletal system, specifically the joints. It is the main cause of disability among people over fifty-five years of age in industrialized countries. Arthritis is not a single disease - it is a term that covers over 100 medical conditions. Osteoarthritis (OA) is the most common form of arthritis and generally affects elderly patients. Some forms of arthritis can affect people at a very early age.

    FIBROMYALGIA Fibromyalgia is a disorder characterized by widespread musculoskeletal pain accompanied by fatigue, sleep, memory and mood issues. The causes of fibromyalgia are unclear. They may be different in different people. Fibromyalgia may run in families. There likely are certain genes that can make people more prone to getting fibromyalgia and the other health problems that can occur with it.

    There is most often some triggering factor that sets off fibromyalgia. It may be spine problems, arthritis, injury, or other type of physical stress. Emotional stress also may trigger this illness. The result is a change in the way the body "talks" with the spinal cord and brain. Levels of brain chemicals and proteins may change. For the person with fibromyalgia, it is as though the "volume control" is turned up too high in the brain's pain processing centres.

    Fibromyalgia is most common in women, though it can occur in men. It most often starts in middle adulthood, but can occur in the teen years and in old age. Younger children can also develop widespread body pain and fatigue.

    You are at higher risk for fibromyalgia if you have a rheumatic disease (health problem that affects the joints, muscles and bones). These include osteoarthritis, lupus, rheumatoid arthritis, or ankylosing spondylitis.
  • COMPLEX REGIONAL PAIN SYNDROMEComplex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury, if any.

    The cause of complex regional pain syndrome isn't clearly understood. Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible.

    Signs and symptoms of complex regional pain syndrome include:
    • Continuous burning or throbbing pain, usually in your arm, leg, hand or foot
    • Sensitivity to touch or cold
    • Swelling of the painful area
    • Changes in skin temperature — at times your skin may be sweaty; at other times it may be cold
    • Changes in skin colour, which can range from white and mottled to red or blue
    • Changes in skin texture, which may become tender, thin or shiny in the affected area
    • Changes in hair and nail growth
    • Joint stiffness, swelling and damage
    • Muscle spasms, weakness and loss (atrophy)
    • Decreased ability to move the affected body part

    Symptoms may change over time and vary from person to person.

    Medications Doctors use various medications to treat the symptoms of complex regional pain syndrome.

    • Pain relievers. Over-the-counter (OTC) pain relievers, such as aspirin, ibuprofen and naproxen may ease pain and inflammation. Your doctor may prescribe stronger pain relievers if OTC ones aren't helpful. Opioid medications may be an option. Taken in appropriate doses, they may provide acceptable control of pain.

    • Antidepressants and anticonvulsants. Sometimes antidepressants, such as amitriptyline, and anticonvulsants, such as gabapentin (Neurontin), are used to treat pain that originates from a damaged nerve (neuropathic pain).

    • Corticosteroids. Steroid medications, such as prednisone, may reduce inflammation and improve mobility in the affected limb.

    • Bone-loss medications. Your doctor may suggest medications to prevent or stall bone loss, such as Alendronate and Calcitonin.

    • Sympathetic nerve-blocking medication. Injection of an anaesthetic to block pain fibres in your affected nerves may relieve pain in some people.

    Therapies • Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.

    • Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.

    • Physical therapy. Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.

    • Applying heat and cold. Applying cold may relieve swelling and sweating. If the affected area is cool, applying heat may offer relief.

    • Topical analgesics. Various creams are available that may reduce hypersensitivity, such as lidocaine or a combination of ketamine, clonidine and amitriptyline.

    • Physical therapy. Gentle, guided exercising of the affected limbs may help decrease pain and improve range of motion and strength. The earlier the disease is diagnosed, the more effective exercises may be.

    • Transcutaneous electrical nerve stimulation (TENS). Chronic pain is sometimes eased by applying electrical impulses to nerve endings.

    • Biofeedback. In some cases, learning biofeedback techniques may help. In biofeedback, you learn to become more aware of your body so that you can relax your body and relieve pain.

    • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord results in pain relief.

    Recurrences of complex regional pain syndrome do occur, sometimes due to a trigger such as exposure to cold or an intense emotional stressor. Recurrences may be treated with small doses of antidepressant or other medication.
  • CANCER PAIN People with cancer often feel severe or constant pain. The pain they experience depends on the type of cancer they have, the stage the disease is at, and the therapy they receive. Approximately 25% to 50% of people with cancer complain of pain at the time of diagnosis, and up to 75% of people with cancer complain of pain as the cancer progresses.

    Cancer pain can be defined as a complex sensation that reflects both damage to the body and the body's response to the damage. Although doctors agree that controlling cancer pain is a high priority, pain isn't always understood or treated properly. This is often because of unfounded fears about people with cancer becoming addicted to painkillers.

    There is currently no effective way to control cancer pain in almost 90% of people. Pain control is extremely important, not only for people suffering from advanced cancer, but also for those whose condition may remain stable for years to come.




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