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Pain Management for Chronic Back Pain

Dr. Sanjay Sharma 89% (304 ratings)
Fellowship in Interventional Pain management , Diploma in Anesthesia, DA, MBBS
Pain Management Specialist, Jaipur
Pain Management for Chronic Back Pain

Back pain may occur due to various reasons. Chronic back pain is the one that remains for 12 weeks or more than that even after the cause of the pain has been treated. There are several ways of treating chronic back pain. Its treatment depends upon the nature of injury or the actual underlying cause of the pain.

The treatment for back pain has been listed below:

  1. Short-term methods: Initially, people use short-term remedies for tackling back pain. Over-the-counter painkillers and home remedies are used to cure the patient. This might show useful results within six weeks.
  2. Continue movement: Although traditionally, patients with back pain were advised to take complete bed rest. However, doctors today are of the opinion that patients should not take complete bed rest. The patient should try to move around a bit. It may be hurting first, but slowly it will heal the pain. One can take up brisk walking for best results.
  3. Painkillers: Patients are first prescribed to take paracetamol. However, some people take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for faster relief. There are stronger painkillers like codeine. But one must keep in mind that painkillers are not good for health. They have side effects. Long-term use of painkillers can cause damage to the kidneys. If these are not effective, the doctor might switch to muscle relaxant like diazepam.
  4. Hot and cold compress: Patients are advised to take hot or cold compress to get relief. A hot bath or compress with hot water can be useful. Otherwise, using ice pack can also produce effective results. Often, alternate hot and cold compress are advised to get rid of the pain.
  5. Change your sleeping style: The pain can be reduced to a great extent by changing one's sleeping pattern. Use pillows to change the sleep pattern.
  6. Exercise: The patient might have developed back pain due to faulty posture or obesity. In order to get rid of the pain, one must address these issues first. Shred the extra pounds b exercising the correct way to get cured of the pain.
  7. Acupuncture: It is a kind of treatment in which fine needles are put at different points of the body. This helps in reducing the pain.
  8. Oil massage: There are various kinds of massage techniques available. These improve the circulation of blood. This in turn, rejuvenates the muscles and bones by providing sufficient oxygen supply.
  9. Antidepressants: These are prescribed when painkillers don't show effective results. Tricyclic antidepressants (TCAs), such as amitriptyline are given to the patient. However, these are given in small doses.
  10. Stay calm and positive: It is important to have a positive frame of mind to get rid of the pain. One has to be patient and not lose hope while the treatment is on. If you wish to discuss any specific problem, you can consult a pain management specialist.
4104 people found this helpful

Pain Management For Chronic Back Pain - Know More!

Dr. Uttam Sidhaye 92% (229 ratings)
Fellowship in Pain Management, MD, MD - Anaesthesiology , MBBS , Observer post
Pain Management Specialist, Pune
Pain Management For Chronic Back Pain - Know More!

Back pain may occur due to various reasons. Chronic back pain is the one that remains for 12 weeks or more than that even after the cause of the pain has been treated. There are several ways of treating chronic back pain. Its treatment depends upon the nature of injury or the actual underlying cause of the pain.

The treatment for back pain has been listed below:

  1. Short-term methods: Initially, people use short-term remedies for tackling back pain. Over-the-counter painkillers and home remedies are used to cure the patient. This might show useful results within six weeks.
  2. Continue movement: Although traditionally, patients with back pain were advised to take complete bed rest. However, doctors today are of the opinion that patients should not take complete bed rest. The patient should try to move around a bit. It may be hurting first, but slowly it will heal the pain. One can take up brisk walking for best results.
  3. Painkillers: Patients are first prescribed to take paracetamol. However, some people take non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen for faster relief. There are stronger painkillers like codeine. But one must keep in mind that painkillers are not good for health. They have side effects. Long-term use of painkillers can cause damage to the kidneys. If these are not effective, the doctor might switch to muscle relaxant like diazepam.
  4. Hot and cold compress: Patients are advised to take hot or cold compress to get relief. A hot bath or compress with hot water can be useful. Otherwise, using ice pack can also produce effective results. Often, alternate hot and cold compress are advised to get rid of the pain.
  5. Change your sleeping style: The pain can be reduced to a great extent by changing one's sleeping pattern. Use pillows to change the sleep pattern.
  6. Exercise: The patient might have developed back pain due to faulty posture or obesity. In order to get rid of the pain, one must address these issues first. Shred the extra pounds b exercising the correct way to get cured of the pain.
  7. Acupuncture: It is a kind of treatment in which fine needles are put at different points of the body. This helps in reducing the pain.
  8. Oil massage: There are various kinds of massage techniques available. These improve the circulation of blood. This in turn, rejuvenates the muscles and bones by providing sufficient oxygen supply.
  9. Antidepressants: These are prescribed when painkillers don't show effective results. Tricyclic antidepressants (TCAs), such as amitriptyline are given to the patient. However, these are given in small doses.
  10. Stay calm and positive: It is important to have a positive frame of mind to get rid of the pain. One has to be patient and not lose hope while the treatment is on.
4144 people found this helpful

Interstitial Cystitis - Causes, Symptoms, Precautions And Its Treatments!

Dr. Radhika A (Md) 89% (13 ratings)
MD - Acupuncture, Diploma In Accupuncture, Advanced Diploma In Accupuncture
Acupuncturist, Delhi
Interstitial Cystitis - Causes, Symptoms, Precautions And Its Treatments!

What is Interstitial cystitis?

Interstitial cystitis is chronic inflammation of the bladder. It is a combination of uncomfortable bladder pressure, bladder pain and sometimes pain in your pelvis, which can range from mild burning or discomfort to severe pain.

Symptoms of Interstitial cystitis-

  • Discomfort or pain in the penis and scrotum
  • Chronic pelvic pain
  • A persistent, urgent need to urinate
  • Pain during sexual intercourse

Causes of Interstitial cystitis-

  • Abnormality of the bladder lining
  • Abnormalities of the immune system
  • Overactivity of nerve cells of the bladder

Risk factors of Interstitial cystitis-

Complications of Interstitial cystitis-

  • Reduced bladder capacity
  • Pain may interfere with social activities, work and other activities of daily life.
  • Emotional stress
  • Relationship troubles 

Diagnosis of Interstitial cystitis-

Diagnosis of Interstitial cystitis involves the following tests:

Precautions & Prevention of Interstitial cystitis-
There is no way to prevent interstitial cystitis. It can be reduced by avoiding the following foods or drinks:

  • Caffeine-containing beverages
  • High-acid citrus fruits
  • Spicy foods
  • Chocolate
  • Fermented foods
  • Alcohol

Treatment of Interstitial cystitis-

  • Homeopathic Treatment of Interstitial cystitis
  • Acupuncture & Acupressure Treatment of Interstitial cystitis
  • Psychotherapy Treatment of Interstitial cystitis
  • Conventional / Allopathic Treatment of Interstitial cystitis
  • Surgical Treatment of Interstitial cystitis
  • Dietary & Herbal Treatment of Interstitial cystitis
  • Other Treatment of Interstitial cystitis

Homeopathic Treatment of Interstitial Cystitis-

Homeopathic Treatment of Interstitial cystitis helps in relieving frequent, intense urges to urinate with cramping, burning pains. Some of the homeopathic remedies for treatment of interstitial cystitis are:

  • Stigmata
  • Berberis
  • Belladonna
  • Terebinth
  • Cantharis
  • Merc C

Acupuncture & Acupressure Treatment of Interstitial Cystitis-

In the Acupuncture Treatment of Interstitial cystitis, a practitioner places numerous thin needles in your skin at specific points on your body. This helps in relieving pain and other symptoms by rebalancing the flow of life energy. It also boosts the activity of your body’s natural painkillers.

Psychotherapy and Hypnotherapy Treatment of Interstitial Cystitis-

Psychotherapy and hypnotherapy can help in stress relief. They can help in better coping and early relief.

Conventional / Allopathic Treatment of Interstitial cystitis-

Allopathic Treatment of Interstitial cystitis involves the following medications:

Surgical Treatment of Interstitial cystitis-

Surgical Treatment of Interstitial cystitis involves the following surgeries:

  • Bladder augmentation
  • Fulguration
  • Resection

Dietary & Herbal Treatment of Interstitial cystitis-

  • Avoid carbonated beverages, caffeine
  • Avoid citrus products and food containing high concentrations of vitamin C

Other Treatment of Interstitial cystitis-

  • Easy stretching exercises may help reduce your interstitial cystitis symptoms.
  • Try methods such as visualization and biofeedback, and low-impact exercise
     

 

What Is Interstitial Cystitis ( Painful Bladder Syndrome)?

Dr. Satyajeet P Pattnaik 93% (412 ratings)
MBBS, MS- General Surgery, MCH- Urology, Fellowship Minimal Access Surgery
Urologist, Mumbai
What Is Interstitial Cystitis ( Painful Bladder Syndrome)?

Diagnosis -
The following may be helpful in diagnosing interstitial cystitis:

  • Medical history and bladder diary - Your doctor will ask you to describe your symptoms and may ask you to keep a bladder diary, recording the volume of fluids you drink and the volume of urine you pass.
  • Pelvic exam - During a pelvic exam, your doctor examines your external genitals, vagina and cervix and feels your abdomen to assess your internal pelvic organs. Your doctor may also examine your anus and rectum.
  • Urine test - A sample of your urine is analyzed for signs of a urinary tract infection.
  • Cystoscopy - Your doctor inserts a thin tube with a tiny camera (cystoscope) through the urethra, showing the lining of your bladder. Your doctor may also inject liquid into your bladder to measure your bladder capacity. Your doctor may perform this procedure, known as hydrodistention, after you've been numbed with an anesthetic medication to make you more comfortable.
  • Biopsy - During cystoscopy under anesthesia, your doctor may remove a sample of tissue (biopsy) from the bladder and the urethra for examination under a microscope. This is to check for bladder cancer and other rare causes of bladder pain.
  • Urine cytology - Your doctor collects a urine sample and examines the cells to help rule out cancer.
  • Potassium sensitivity test - Your doctor places (instills) two solutions — water and potassium chloride — into your bladder, one at a time. You're asked to rate on a scale of 0 to 5 the pain and urgency you feel after each solution is instilled. If you feel noticeably more pain or urgency with the potassium solution than with the water, your doctor may diagnose interstitial cystitis. People with normal bladders can't tell the difference between the two solutions.

Treatment -

No simple treatment eliminates the signs and symptoms of interstitial cystitis, and no one treatment works for everyone. You may need to try various treatments or combinations of treatments before you find an approach that relieves your symptoms.

  • Physical therapy - Working with a physical therapist may relieve pelvic pain associated with muscle tenderness, restrictive connective tissue or muscle abnormalities in your pelvic floor.
     
  • Oral medications - Oral medications that may improve the signs and symptoms of interstitial cystitis include:
    • Nonsteroidal anti-inflammatory drugs, such as ibuprofen (advil, motrin ib, others) or naproxen sodium (aleve), to relieve pain.
    • Tricyclic antidepressants, such as amitriptyline or imipramine (tofranil), to help relax your bladder and block pain
    • Antihistamines, such as loratadine (claritin, others), which may reduce urinary urgency and frequency and relieve other symptoms.
    • Pentosan polysulfate sodium (elmiron), which is approved by the food and drug administration specifically for treating interstitial cystitis. How it works is unknown, but it may restore the inner surface of the bladder, which protects the bladder wall from substances in urine that could irritate it. It may take two to four months before you begin to feel pain relief and up to six months to experience a decrease in urinary frequency.
       
  • Nerve stimulation - Sacral nerve stimulation.
  • Nerve stimulation techniques include:
    • Transcutaneous electrical nerve stimulation (tens. With tens, mild electrical pulses relieve pelvic pain and, in some cases, reduce urinary frequency. Tens may increase blood flow to the bladder. This may strengthen the muscles that help control the bladder or trigger the release of substances that block pain.
    • Electrical wires placed on your lower back or just above your pubic area deliver electrical pulses — the length of time and frequency of therapy depends on what works best for you.
    • Sacral nerve stimulation. Your sacral nerves are a primary link between the spinal cord and nerves in your bladder. Stimulating these nerves may reduce urinary urgency associated with interstitial cystitis.
    • With sacral nerve stimulation, a thin wire placed near the sacral nerves sends electrical impulses to your bladder, similar to what a pacemaker does for your heart. If the procedure decreases your symptoms, you may have a permanent device surgically implanted. This procedure doesn't manage pain from interstitial cystitis, but may help to relieve some symptoms of urinary frequency and urgency.
4 people found this helpful

Post-Herpetic Neuralgia Chronic Pain Management!

Dr. Snehal Panchal 86% (80 ratings)
MD,DNB, MBBS Bachelor of Medicine and Bachelor of Surgery, Fellowship In Pain Management
Pain Management Specialist, Mumbai
Post-Herpetic Neuralgia Chronic Pain Management!

The condition of persistent pain in the body, where an outbreak of the Varicella Zoster virus has caused Shingles, is termed as post-herpetic neuralgia. It is a debilitating complication of the herpes zoster virus. The blisters that occur in shingles develop a crust formation and neuralgia begins after these crusts are formed. It may also occur in people who do not produce the crustaceous lesions. A burning pain that is long-lasting, even after the rash and the blisters disappear, is observed. There is a criteria of the pain to be persistent for around three months for the confirmation of post herpetic neuralgia.

The cause of this condition is damage of the sensory nerves that can occur due to the movement of the reactivated Herpes Zoster virus from the nerves to the skin. In an individual affected with chickenpox, the infection can involve dorsal root ganglia, where the virus lies dormant. Under conditions like stress due to infection or in an immuno-compromised individual, after a period of time, reactivation of the virus takes place. This reactivation causes production of Shingles on the body. The dormant virus reaches the skin and reactivates to produce lesions.

With an increase in age, the chances of developing post-herpetic neuralgia also increase. It primarily affects older individuals in the age group of 60 to 70 years. Treatment is aimed at pain management and providing symptomatic relief, with improvement of the neuralgia over a period of time. Symptoms of this condition are limited to the area of shingles’ outbreak. Trunk is commonly affected on a unilateral site. It can also occur on face. Common symptoms include pain lasting 3 months or longer after healing of the shingles rash, allodynia, numbness over the affected area and itching. Even a slight touch of cloth over the affected area can cause alleviated pain to the individual. Disturbed sleep and development of clinical depression is usually associated with post herpetic neuralgia. The medications given for post herpetic neuralgia are aimed at pain relief and resolving of symptoms. Management of chronic pain can be brought about by the use of a combination of pain relieving drug classes.

Some commonly used drugs for treatment of post-herpetic neuralgia are as follows:

  1. Topical Agents: Numerous topical agents have been effectively used in the treatment of post-herpetic neuralgia. In patients with allodynia or an alleviated pain sensation, topical lidocaine patches are very effective. The nociceptive activity of small nerve fibers is decreased by use of Lidocaine. Also, the brush of clothing is avoided by the patch serving as a protective barrier itself. Another topical agent that has proved effective in pain relief is Capsaicin. Its clinical use is limited due to the burning sensation caused by its application. With regular use, however, the burning sensation gradually reduces. Capsaicin should be used for a minimum period of a month to aid pain relief. Low systemic absorption of the topical agents ensure few side effects caused by them.
  2. Antidepressants: The standard drug therapy for treatment of post-herpetic neuralgia include the use of antidepressant drugs. Drugs like Nortriptyline, Amitriptyline are the most commonly used drugs amongst the tricyclic antidepressants for pain relief in post-herpetic neuralgia. These drugs are however associated with various adverse effects like sedation and cardiac dysrhythmias. Other drug classes like Serotonin reuptake inhibitors are used in individuals with low tolerance to the tricyclic antidepressants. Depression symptoms are relieved by the use of this drug class. Specific relief of the chronic pain of post-herpetic neuralgia is not achieved much efficiently though.
  3. Anticonvulsants: Neuropathic pain can be relieved by many anticonvulsant drugs. Drugs like Pregabalin have lesser side effects and also require a lesser monitoring than previously used anticonvulsant drugs like Carbamazepine.
  4. Opioids: Long term use of opioids shows significant risks like sedation and mental clouding. These drugs are considered safe for use without causing cardiac or hepatic adverse effects. When opioids are prescribed, stool softeners and laxatives should also be given to avoid constipation. Other pain management protocol includes cryotherapy, ablation of the affected roots of nerve, anterolateral cordotomy and even the use of electrical nerve stimulation. The physician should evaluate the best suitable pain management option and provide treatment accordingly.

In case you have a concern or query you can always consult an expert & get answers to your questions!

4238 people found this helpful