If you suffer from chronic pain of any kind, it is important for you to know that it is associated and linked with your emotions. Other than your physical activities and personal relationships getting hampered, unwanted feelings like resentment, stress and frustration are also common. These emotions and feelings are capable of making your chronic pain condition more worse. 

The Relationship between your mind and body: Your mind and body work together and cannot be separated. Your mind controls all your thoughts and also affects the way in which pain is controlled or perceived by the body. Pain and the fear of pain may lead you to avoid activities. This may reduce your physical strength and cause disruption in the functioning of your body.

Stress: Stress affects your body both physically and emotionally. It may lead to an increase in your blood pressure, breathing rate, heart rate and muscle tension may also occur. These may lead to fatigue, appetite changes and sleep disruption. Stress also causes depression, anxiety, make you dependent on drugs and make you dependent on other people.

Depression: Depression is common among chronic pain patients. Chronic pain can make cases of existing depression much more worse and the existing pain is also worsened. There are chances of developing depression from chronic pain if depression runs in your family or genes. 

Symptoms of Depression are as follows:

Feeling sad, angry, worthless and hopeless frequently
Lack of energy
Lack of interest in regular activities
Difficulty in sleeping
An increase or decrease in appetite, which may lead to major weight gain or weight loss
Difficulty with concentration
Having suicidal thoughts and thoughts about dying or harming oneself
How to Handle your Emotions during Chronic Pain: A common therapy, which people with chronic pain undertake is called Cognitive Behavioural therapy. You should seek the help of a therapist. In this therapy, you will learn about thinking in a positive way instead of drowning in negative thoughts. Your fear of pain will be reduced and you will learn how to strengthen important relationships. You will be able to develop a sense of freedom from chronic pain. 

If your chronic pain occurs due to an accident or emotional trauma, you may be assessed for post-traumatic stress disorder (PTSD) by your healthcare provider. Many patients suffering from PTSD cannot deal with their pain until the emotional stress is dealt with. If you feel depressed and cannot control your emotions, you need to consult a doctor.

Chronic Pain - Is it Linked to Our Emotions?

Why does PAIN occur? Understand the Mechanism of Pain

Pain is an unpleasant and distressing physical sensation caused by disease or injury, which induces hurt and anxiety in those suffering from it.
There are many different manifestations of pain, ranging from short term (acute pain) to long term (chronic pain). Other classifications include pain in the internal organs (visceral pain), injured tissue (inflammatory pain), nerves (neuropathic pain), etc.

The reason for the occurrence of pain depends on the cause and kind of pain being experienced. In most cases, pain acts as a warning sign that the body has been afflicted by a disorder of some sort, which may have arisen due to internal sickness or external wounding. Acute pains are generally cured on their own through rest or simple medication. Chronic pains, on the other hand, are more complicated in nature and the treatment requires more elaborate diagnosis.

The mechanism of pain

Pain is an extremely personal and subjective experience and affects each individual to varying degrees. The pain signals, which can arise in any part of the body, travel through the spinal cord to the brain along thousands of specialized nerves and nerve fibres. In the brain, it is processed in the centres associated with anxiety, emotions, memory, appetite, etc. Signals and pain inputs are then returned from the brain to the spinal cord, which may heighten or diminish pain.

In some cases, pain may also be induced by damage to the brain and spinal cord, which happens after a stroke.
A constant barrage of pain signals may cause the cells at the end of nerve fibres to become over-sensitized. This is known as 'wind-up' and is one of the most common causes of chronic pain that occurs even though the root of the problem has been identified and treated.

The causes and effects of pain differ from case to case depending on the signals received by the brain and its interpretation. It affects the individual's day to day activities and if persistent, can also have a harmful impact on mental health and psychosis. Pain is always handled, diagnosed and treated differently in all patients by drawing out the best possible solution to the problem.





Why does PAIN occur? Understand the Mechanism of Pain

Shoulder pain can be a persistent dull and nagging sensation in the upper arm or shoulder area. It can be easily differentiated from neck pain as it is related to the movement of shoulders i.e. it will increase and decrease with shoulder movements, especially overhead activities. The other signs to identify shoulder pain is if your shoulder movements are reduced.

If you find it difficult to scratch / wash your back, comb your hair or reach your back pocket, it clearly shows you are suffering from shoulder pain. Shoulder pain can happen due to various reasons, it varies from person to person depending on the activities he/she is involved in, for e.g. sports, manual job etc. It can be a single major injury or multiple small injuries due to repetitive usage patterns. Also, degenerative changes in various parts of the shoulder can lead to shoulder pain.

In case of middle to old age, injuries that can cause shoulder pain are:

    Biceps Tendonitis
    Acromio-clavicular Joint arthritis
    Scapular Dyskinesia
    Trapezitis
    Suprascapular nerve entrapment In young age, injury due to sports or gym activity can cause shoulder pain
    Superior labral anterior/posterior (SLAP tear)lesion

Also, traumatic or repeated dislocations of shoulder can cause shoulder pain due to:

    Bankart lesion

Diagnose Shoulder Pain

Shoulder pain can be diagnosed only after thorough history taking and clinical examination. However, some imaging studies can be very helpful like:

    X-rays: Through an x-ray one can view the shoulder in many different views.
    Ultrasound: With an ultrasound, you can also check the damaged caused to the tendons and muscles of the shoulder but the quality of reporting depends upon the expertise of the doctor.
    MRI: MRI gives a clear picture of the shoulder as it shows everything related to a shoulder joint that is joints, vessels, tendons and muscles that too from different angles.
    Diagnostic Arthroscopy: A surgical procedure often used by orthopaedic surgeons to diagnose and treat issues inside a joint. Arthroscopy has the big advantage that one can use it to diagnose as well as treat at the same time.

Treatment for Various Types of Shoulder Pain

    For Shoulder Impingement or Rotator Cuff tear: Give rest to the shoulder for a few days only Dedicated Physiotherapy Protocol Bursal injections If these fail then, (Surgery)Arthroscopic sub-acromial decompression If Cuff tear is found, then one can go for Arthroscopic/Mini-open repair
    Labral Lesions: For anterior Labral lesions (Bankart's) following anterior shoulder dislocation then surgery in the form of Arthroscopic Bankart's repair is the only option to reduce risk of recurrence and degeneration.

SLAP Lesions

    Pain relief and physiotherapy as first step If this fails then following surgical options are available
    Arthroscopic debridement or repair of labrum
    Biceps tenotomy or tenodesis

Arthritis

In this case, the joint is already destroyed and has to be resurfaced for pain relief and to maintain ROM. If Rotator cuff muscles are working, then Shoulder resurfacing hemiarthroplasty (preferred in young people), that has a life of 10 to 15 years, Total shoulder replacement (preferred in middle aged to old people) has a life of 10 to 15 years. But, if rotator cuff muscle are not working then Reverse Geometry Shoulder replacement is recommended, that has a life of 10 years.

It is always advisable to get yourself diagnosed properly in case of shoulder pain as management changes depending on clinical situations. Neglecting shoulder conditions can lead to bigger problems later on.

Always remember 'a stitch in time saves nine'

Shoulder Pain: Causes, Diagnoses & Treatment

Joint pains or muscles cramps are the usual suspects when it comes to leg pain. Joint pains are usually a symptom of arthritis, a common occurrence during old age. Leg muscles are mostly affected by muscle cramps. From an ayurvedic point of view, all pains are caused by the vata dosha.

What are doshas?
The doshas define the natural inclination of the body and they comprise the three main energies that affect your health and well-being. The three doshas are pitta, vata and kapha. Thus in ayurveda, pain is caused when the doshas are vitiated. In ayurveda, ama is the name given to the toxic materials in the body that are caused by improper indigestion. Therefore, pain occurs when there is too much ama build-up in your body.

Useful herbs for treating leg pain
1. Clove- it provides instant relief from pain, especially if they are due to muscle cramps. Apply clove oil in a poultice over the affected area.
2. Ginger- since ginger has great painkiller properties, it can be added to a regular diet to deal with chronic leg pain.
3. Liquorice- muscle aches can be treated with liquorice roots infused in water overnight.
4. Madhuca- applying madhuca oil over leg pains, especially if they are due to rheumatism, then it can give great results.
5. Pepper- pepper aids in proper blood circulation by helping dilating the superficial blood vessels.

Dietary regulations for leg pain
To help with chronic leg pain, leafy vegetables, green vegetables, vitamin c-rich foods, plantains that are rich in potassium, magnesium and calcium must be consumed. Coffee and chocolate must be avoided at all costs. The consumption of water cannot be stressed enough as one of the leading causes of leg pain is dehydration of insufficient fluids in the body. Water helps flush out the toxins in the body, thus getting rid of the vitiated doshas.

Ayurvedic treatment for leg pain
For external use, mahanarayana tailam is extremely effective. Warming the oil before application will give best results.
For internal use, simhanada guggulu, a mild laxative, laxmi vilas rasa and pratapa lankeshwara rasa are prescribed.

Top 5 Ayurvedic Remedies for Leg Pain - Effective Tips

In most cases, pain anywhere in the body can be explained as a symptom of some other problem, but sometimes, there is no reason for abdominal pain. This type of pain is known as chronic functional abdominal pain. This is a gastrointestinal disorder that cannot be explained through X-ray or laboratory findings. It can be triggered by altered sensitivity to nerve impulses in the brain and gut. People suffering from this condition are often so debilitated by the pain that it becomes the central focus of their life.

This condition cannot be cured, but with proper treatment, it can be managed so that it does not affect the quality of your life. The aim of treatment for this condition is to control the symptoms and improve functioning. When it comes to treating this condition, the patient s relationship with his or her doctor plays an important role as the condition cannot be proven through any form of testing and it has a great psychological effect on the person. Regular checkups are also a key to managing this condition effectively.

The first step towards achieving this is to identify possible emotional and situational triggers. Maintaining a journal that records these experiences can help with this. Further treatment is usually either through psychological treatment or antidepressants.

Psychological treatment is based on the understanding that the brain can block pain by diverting attention elsewhere. Nerve impulses that travel from the abdomen to the brain must pass through a type of  gate  that is controlled by nerve impulses generated by the brain. When these impulses close the gates, pain is blocked while when these gates are open, the pain can be magnified. Psychological treatment for chronic functional abdominal pain can be in the form of relaxation techniques, imagery, hypnosis and cognitive behavioral therapy. While relaxation techniques such as meditation and hypnosis help a person shift focus from the pain, cognitive behavioral therapy teaches a person how to change thoughts and perceptions in order to control the pain.

Antidepressants can also act as pain relievers. This form of medication stimulates the production of brain signals that close the  gates  of nerve transmissions. This blocks the pain but can take several weeks to be effective. Some people may experience side effects such as drowsiness and nausea and hence should never be taken without a doctor s supervision. In some cases, antidepressants may also be combined with cognitive behavioral therapy or medication to regulate bowels.

Ways to Treat Chronic Functional Abdominal Pain!

Leg bypass surgery is needed when the patient suffers from peripheral artery disease. PAD is a very common condition in elderly people, where the rate of flow of blood to the limbs (in this case, the legs) is reduced due to narrowing of the blood vessels.

Causes and risk factors-

The narrowing of the blood vessels occurs due to excess calcium accumulation and fat deposits in the walls of the arteries. The following are the risk factors of PAD-

  Age (60 years and above)
  Smoking
  Diabetes

The condition may be life-long or can last for years.

Symptoms that indicate you might need a leg bypass surgery-

The following are the signs and symptoms of PAD, which suggest you should consider having a leg bypass surgery-

  Pain in the legs, especially when walking
  Pain in the buttocks
  A sore on a foot/leg that does not seem to heal
  Thinning of the skin on the legs
  Loss of hair on the legs
  Tingling, weakness, or numbness in the legs
  One or both the feet/legs may feel cold
  The feet or legs may appear bluish, pale, or dark reddish in colour

You should get yourself checked by a specialist in the initial stage, or else the condition may get worse and affect your day-to-day activities.

Vascular surgery for PAD in the legs:

Vascular surgery is a surgical sub-specialty, which manages vascular system disorders- disorders of the veins, arteries, and lymphatic circulation- by surgical reconstructions, minimally invasive procedures, and medical therapies.

The most commonly used surgical procedure is the leg bypass surgery. The surgery aims to reroute the supply of blood around an obstructed artery in one of the legs.

How is leg bypass surgery performed?

The surgeon performs leg bypass surgery using a graft (usually made of plastic tube) to bypass or replace the blocked portion of the artery. On some occasions, the graft may be a vein or blood vessel taken from the patient s body (usually, the other leg).

During the surgery, the surgeon will first administer anaesthesia so that you are not able to feel pain or discomfort. He/she will make an incision over the portion of the blocked artery. After carefully removing the skin tissues, the surgeon will place clamps on each side of the narrowed artery and sew the grafts in place. The surgeon will ensure that the flow of blood in your lower extremity (legs) is good. An arteriogram (an X-ray of the arteries/blood vessels) is recommended to make sure that the graft is working fine after the leg bypass surgery.

For most people, leg bypass surgery helps improve the flow of blood in the arteries. The prognosis is better if underlying medical conditions like diabetes are controlled.

Leg Bypass - Treating It Through Vascular Surgery!

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