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Nerve Pain: how to manage?

What is Nerve Pain?

Nerve pain or neuropathic pain is a condition where there is pain because of nerve damage. It is characterized not only by pain, but also numbness, tingling, burning sensations and weakness that arise out of nerve damage. This pain is more common in the feet and the hands.

What are the common causes of nerve pain?

Diabetes is one of the most common causes, other causes are injuries, infections, slip disc and prolonged exposure to certain toxins etc.

How can you treat nerve pain?

Nerve pain can be the points that have been mentioned below:

  1. Topical Painkillers: Don’t have much role: These are also dangerous because we never measure the amount we apply on skin. These pain killers is absorbed through skin and produce same side effects like when it is taken orally.  

Certain over the counter ointments and creams can help relieve nerve pain. These medications act as local anaesthetics, Capsaicin, a derivative of chili peppers, is one of the major ingredients used in these medicines.

  1. Painkillers: Over the counter painkillers such as diclofenac, ibuprofen, aspirin and acetaminophen do not really work well for severe pain of the nerves.
  2. Anti-neuropathic medicines: Some anti-depressants, some anti-convulsant helps in reducing the neuropathic pain. Pregabalin, Gabapentin, Amitriptyline and some other similar medicines are of real help.
  3. Physical Therapy: Physical Therapy can sometimes help. Particularly transcutaneous electrical nerve stimulation is of definite help in neuropathic pain.
  4. Interventional Pain Management:
    • Sympathetic nerve block like stellate ganglion block, lumbar sympathetic block are very helpful in certain types of neuropathic pain.
    • Gasserian ganglion block is helpful in trigeminal neuralgia, one of the most severe nerve pain.
    • Spinal cord stimulation is one procedure like cardiac pace maker which is of immense help when all other options has failed. This is also called spinal cord pace maker.

Heat and cold therapy in pain

Both heat and cold can relief pain, know which and how to use these:

Most diseases, minor or major, acute or chronic, trauma or infection, there is one common factor - that is pain. Not only we should treat the disease, but also care the pain. For this in addition to analgesics, the most inexpensive and easily available modes of pain management are application of heat and cold. We should know the specific instances where heat and cold should be used as listed below.

Heat: Some of the common modes to heat therapy are: heat pads, warm baths/shower,  liquid paraffin system, hot water bottles, or warm oils. Heat acts by improving blood circulation and nutritional supply to the affected parts of the body and is best suited for stiff joints and muscle pain. 

Some common ways to apply heat:

  1. A warm shower or bath will ease morning stiffness and pain.
  2. Apply a heating pad on the painful/stiff areas up to 20 minutes - we must use optimal, tolerable heat to avoid skin burns.
  3. Wrap the affected area for 15 to 20 minutes with a moist heat pad.
  4. Warm mineral oils can be applied to the painful joints of hands and legs. We can keep it in place for 15 to 20 minutes before washing it off.
  5. For pain in hand and leg/foot joints, warm liquid paraffin wax can be applied.

Some common ways to apply cold:

Contrary to heat therapy, cold therapy acts by reducing blood flow to the paiful area and numbing the nerve endings, thereby reducing the transmission of pain signal. It works well for acute pain cases like fresh injuries and post-exercise trauma & inflammation.

  1. A cold wrap with ice cubes can be applied to the affected painful area for about 15 to 20 min. It can be repeated if needed.
  2. Alternately, a wet towel can be put in a plastic bag and kept in the freezer for 15 minutes and then used as a cold pack.
  3. The affected joint can be dipped in a bucket of ice-water.
  4. Cold gel packs are available at medical stores - they won't leak, will stay cold longer (when kept in refrigerator) and can be easily wrapped around a joint.

Both heat and cold works in pain, but as rule cold is got acute/recent/injury patients, whereas heat to be applied in chronic cases. Never apply heat in trauma or injury cases.

Pain in heel & foot

Author: Gautam Das

The foot and heels are the most load bearing components of our body which take most of the weight when walking, running, exercising or even standing up. The heels are especially vulnerable part which can face trauma and pain.

Causes for heel & foot pain:

  1. Planter Fasciitis: One of the commonest cause, Pain is felt more in the morning at morning after awaking up.
  2. Tarsal Tunnel Syndrome: Like carpal tunnel syndrome, it is not uncommon. Inflamed ligament at ankle compress post tibial nerve.
  3. Radicular pain or radiculopathy: In slip disc and sciatica when L5 or S1  nerve root is compressed or inflamed, patient may feel heel or ankle pain.
  4. Sprains or strains of foot: after any trauma including over exercise can produce ligaments injury and pain.
  5. Fractures: Stress or hairline fractures are not uncommon.
  6. Achilles tendinopathy & bursitis: It is the tendinous part of calf muscle which is attached to calcaneal bone. It can be injured or inflamed.
  7. Arthritis: Spondyloarthritis and gouty arthritis both are very common causes of heel and foot pain.

Treatments:

  1. Change of shoes: Shoes with soft sole are recommended.
  2. Physical Therapy: Shockwave or laser therapy may help.
  3. Ice packs: Cold compress and cold therapy reduces edema of inflamed ligaments of nerve and helps in reducing pain.
  4. Pain relief medications: Sometimes analgesics or adjuvants medicines are helpful.
  5. Interventional pain management: When all other options failed, interventional pain management is needed. Local steroid injection or, Platelet rich plasma injection can cure.
  6. Surgery: In extremely rare situations surgery may be needed.

It is however, advisable to visit a pain specialist doctor.

Knee pain management

Author: Gautam Das

Knee joints not only carry our body weight, it helps us to stand, sit, walk & run. Our knee joint is made up of three bones, femur, patela and tibia. Like there are buffers at the end of tables and chairs made up of tough rubber or plastic, end of our bones are covered with cartilages. This cartilage prevents friction between bones.

What is osteoarthritis?

It’s a disease where there is decay of cartilages at the end of bones. Cartilage surface becomes irregular, thickness of cartilage is reduced and gap between two bones are reduced. Reasons of osteoarthritis are age, body weight, family predisposition & trauma. Osteoarthritis is manifested as pain after exertion with cracking sounds particularly climbing up or down the stairs.

How should we treat osteoarthritis?

Early osteoarthritis can be treated with body weight reduction, exercises and medicines. But advanced osteoarthritis needs knee joint replacement surgery. But, Platelet rich plasma or PRP injection is a breakthrough in medical treatment of osteoarthritis of knee where cartilage can grow. Visco-supplementation & Radio-frequency procedures are other options.

What is Platelet rich plasma or PRP injection?

There are some growth factors inside our body which helps us to repair damaged tissues. This growth factors are mostly inside platelets. These platelets can be concentrated and injected at knee. This is also called regeneration therapy because it prevents further decay and repair decayed cartilage.

Steps of PRP injection:

  • About 30 ml of patient’s own blood is taken in a container containing anticoagulant, which do not allow the blood to clot and keep it fluid.
  • Then it is centrifuged in special machine that is capable of spin in high speed with temperature control.
  • Blood is taken and platelet part is separated which accumulate at the middle part.
  • This platelet part of blood is then injected inside knee under ultrasound guidance after injecting local anesthetic at injection site. 

Dos & don’ts after PRP injection:

  • If there is pain, swelling or heat at knee apply ice, and take pain medicines as advised by doctor.
  • Don’t apply hot fomentation, don’t stand or walk too much or lift heavy items, particularly on first 2 days.