Tag Archives: Chronic pain

Tinnitus

Definition:   Tinnitus is noise or ringing in the ears.It may be a the sensation of hearing ringing, buzzing, hissing, chirping, whistling, or other sounds. The noise can be intermittent or continuous, and can vary in loudness. It is often worse when background noise is low, so you may be most aware of it at night when you’re trying to fall asleep in a quiet room. In very rare cases, the sound beats in sync with your heart (pulsatile tinnitus)……..CLICK & SEE THE PICTURES 

A common problem, tinnitus affects about 1 in 5 people. Tinnitus isn’t a condition itself — it’s a symptom of an underlying condition, such as age-related hearing loss, ear injury or a circulatory system disorder.

Although bothersome, tinnitus usually isn’t a sign of something serious. Although it can worsen with age, for many people, tinnitus can improve with treatment. Treating an identified underlying cause sometimes helps. Other treatments reduce or mask the noise, making tinnitus less noticeable.

There are two kinds of tinnitus:

Subjective tinnitus is tinnitus only one can hear. This is the most common type of tinnitus. It can be caused by ear problems in the outer, middle or inner ear. It also can be caused by problems with the hearing (auditory) nerves or the part of your brain that interprets nerve signals as sound (auditory pathways).

Objective tinnitus is tinnitus the doctor can hear when he or she does an examination. This rare type of tinnitus may be caused by a blood vessel problem, an inner ear bone condition or muscle contractions.
Symptoms:
Tinnitus can be perceived in one or both ears or in the head. It is usually described as a ringing noise but, in some patients, it takes the form of a high-pitched whining, electric buzzing, hissing, humming, tinging or whistling sound or as ticking, clicking, roaring, “crickets” or “tree frogs” or “locusts (cicadas)”, tunes, songs, beeping, sizzling, sounds that slightly resemble human voices or even a pure steady tone like that heard during a hearing test and, in some cases, pressure changes from the interior ear. It has also been described as a “whooshing” sound because of acute muscle spasms, as of wind or waves. Tinnitus can be intermittent or it can be continuous: in the latter case, it can be the cause of great distress. In some individuals, the intensity can be changed by shoulder, head, tongue, jaw or eye movements.

Most people with tinnitus have some degree of hearing loss: they are often unable to clearly hear external sounds that occur within the same range of frequencies as their “phantom sounds”. This has led to the suggestion that one cause of tinnitus might be a homeostatic response of central dorsal cochlear nucleus auditory neurons that makes them hyperactive in compensation to auditory input loss.

The sound perceived may range from a quiet background noise to one that can be heard even over loud external sounds. The specific type of tinnitus called pulsatile tinnitus is characterized by hearing the sounds of one’s own pulse or muscle contractions, which is typically a result of sounds that have been created from the movement of muscles near to one’s ear, changes within the canal of one’s ear or issues related to blood flow of the neck or face.

Causes:
Prolonged exposure to loud sounds is the most common cause of tinnitus. Up to 90% of people with tinnitus have some level of noise-induced hearing loss. The noise causes permanent damage to the sound-sensitive cells of the cochlea, a spiral-shaped organ in the inner ear. Carpenters, pilots, rock musicians, street-repair workers, and landscapers are among those whose jobs put them at risk, as are people who work with chain saws, guns, or other loud devices or who repeatedly listen to loud music. A single exposure to a sudden extremely loud noise can also cause tinnitus...CLICK & SEE : 

A variety of other conditions and illnesses may lead to tinnitus and they are as follows:
*Blockages of the ear due to a buildup of wax, an ear infection, or rarely, a benign tumor of the nerve that allows us to hear (auditory nerve)

*Certain drugs — most notably aspirin, several types of antibiotics, anti-inflammatories, sedatives, and antidepressants, as well as quinine medications; tinnitus is cited as a potential side effect for about 200 prescription and nonprescription drugs.

*The natural aging process, which can cause deterioration of the cochlea or other parts of the ear

*Meniere’s disease, which affects the inner part of the ear

*Otosclerosis, a disease that results in stiffening of the small bones in the middle ear

*Other medical conditions such as high blood pressure, cardiovascular disease, circulatory problems, anemia, allergies, an underactive thyroid gland, and diabetes

*Neck or jaw problems, such as temporomandibular joint (TMJ) syndrome

*Multiple sclerosis

*Injuries to the head and neck

*External ear infection

*Acoustic shock

*Cerumen (earwax) impaction

*Middle ear effusion

*Superior canal dehiscence

*Sensorineural hearing loss

*Acoustic neuroma*Mercury or lead poisoning

*Neurologic disorders

*Temporomandibular joint dysfunction

*Giant cell arteritis

*Metabolic disorders like thyroid disease, hyperlipidemia, vitamin B12 deficiency, iron deficiency anemia, psychiatric disorders,diabetis

*Psychiatric disorders like depression, anxiety
Tinnitus can worsen in some people if they drink alcohol, smoke cigarettes, drink caffeinated beverages, or eat certain foods. For reasons not yet entirely clear to researchers, stress and fatigue seem to worsen tinnitus.

Diagnosis:
The basis of quantitatively measuring tinnitus relies on the brain’s tendency to select out only the loudest sounds heard. Based on this tendency, the amplitude of a patient’s tinnitus can be measured by playing sample sounds of known amplitude and asking the patient which they hear. The volume of the tinnitus will always be equal to or less than that of the sample noises heard by the patient. This method works very well to gauge objective tinnitus (see above). For example: if a patient has a pulsatile paraganglioma in their ear, they will not be able to hear the blood flow through the tumor when the sample noise is 5 decibels louder than the noise produced by the blood. As sound amplitude is gradually decreased, the tinnitus will become audible and the level at which it does so provides an estimate of the amplitude of the objective tinnitus.

Objective tinnitus, however, is quite uncommon. Often, patients with pulsatile tumors will report other coexistent sounds, distinct from the pulsatile noise, that will persist even after their tumor has been removed. This is generally subjective tinnitus, which, unlike the objective form, cannot be tested by comparative methods. However, pulsatile tinnitus can be a symptom of intracranial vascular abnormalities and should be evaluated for bruits by a medical professional with auscultation over the neck, eyes and ears. If the exam reveals a bruit, imaging studies such as transcranial doppler (TCD) or magnetic resonance angiography (MRA) should be performed.

The accepted definition of chronic tinnitus, as compared to normal ear noise experience, is five minutes of ear noise occurring at least twice a week. However, people with chronic tinnitus often experience the noise more frequently than this and can experience it continuously or regularly, such as during the night when there is less environmental noise to mask the sound.

Treatment:
Psychological:
The best supported treatment for tinnitus is a type of counseling called cognitive behavioral therapy (CBT) which can be delivered via the internet or in person. It decreases the amount of stress those with tinnitus feel. These benefits appear to be independent of any effect on depression or anxiety in an individual. Relaxation techniques may also be useful. A program has been developed by the United States Department of Veterans Affairs.

Medications:
There are no medications as of 2014 that are effective for tinnitus and, thus, none is recommended. There is not enough evidence to determine if antidepressants or acamprosate is useful. While there is tentative evidence for benzodiazepines, it is insufficient to support usage. Anticonvulsants have not been found to be useful.

Botulinum toxin injection has been tried with some success in cases of objective tinnitus (palatal tremor)

Others:
The use of sound therapy by either hearing aids or tinnitus maskers helps the brain ignore the specific tinnitus frequency. Although these methods are poorly supported by evidence, there are no negative effects, which makes them a reasonable option. There is some tentative evidence supporting tinnitus retraining therapy. There is little evidence supporting the use of transcranial magnetic stimulation. It is thus not recommended.

Alternative   Therapy :
Ginkgo biloba does not appear to be effective. Tentative evidence supports zinc supplementation and in those with sleep problems, melatonin. The American Academy of Otolaryngology, however, recommends against melatonin and zinc.

Doing YOGA EXERCISE daily with PRANAYAMA (specially Anuloma belome , Kapalabhati and Bhramari ) may help a lot to improve and sometimes cure totally.
Prognosis:
Most people with tinnitus get used to it over time; for a minority, it remains a significant problem.

Prevention:
Prolonged exposure to sound or noise levels as low as 70 dB can result in damage to hearing (see noise health effects). This can lead to tinnitus. Ear plugs can help with prevention.

Avoidance of potentially ototoxic medicines. Ototoxicity of multiple medicines can have a cumulative effect and can increase the damage done by noise. If ototoxic medications must be administered, close attention by the physician to prescription details, such as dose and dosage interval, can reduce the damage done.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
https://en.wikipedia.org/wiki/Tinnitus
http://www.mayoclinic.org/diseases-conditions/tinnitus/multimedia/tinnitus/
http://www.webmd.com/a-to-z-guides/understanding-tinnitus-basics

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New Norms to Ease Back Pain

An association of doctors has pencilled India’s first formal guidelines for pain diagnosis and treatment amid concern that Indian patients are either under-treated or over-treated for acute and chronic pain.

The Indian Society for the Study of Pain (ISSP) will release its pain management protocols for low back pain next week, to be followed later by protocols for other conditions, from headaches and neck and joint pain to pain related to cancer or trauma.

Limited surveys suggest that one in five patients in India with chronic pain do not find relief despite being under medical treatment, specialists in the ISSP said.

“We believe there is under-treatment, over-treatment, direct over-the-counter purchase of medicines by patients, and erratic treatment,” said Parmanand Jain, ISSP president and professor of anaesthesia at the Tata Memorial Hospital, Mumbai. “We’re hoping these pain management algorithms will improve this situation.”

The protocols, developed primarily for the medical community, will provide a well- defined sequence of diagnostic investigations and the line of treatment for specific conditions associated with acute or chronic pain.

Pain specialists are hoping the protocols will also help keep patients away from diagnostic procedures such as magnetic resonance imaging (MRI) scans, and even surgery, when they are not required.

Patients with low back pain are usually given mild painkillers and advised rest. If the pain doesn’t go away or gets worse and MRI scans show degenerative changes in the vertebral discs, it doesn’t mean surgery is required.

“Three out of four persons without any back pain may also show changes in MRI scans. So, the changes (in those with pain) may not be causing the pain at all,” said K. Jawahar Choudhury, senior pain management consultant at Apollo Hospital, Delhi.

As for over-treatment, many pain specialists believe the long-term abuse of painkillers is contributing significantly to the country’s burden of kidney disease.

But ISSP members concede that doctors in India are sometimes compelled to prescribe inappropriate treatment to cancer patients because morphine, a key pain-killer, isn’t easily available. The drug is distributed only through licensed clinics.

“We’ve been telling the narcotics control bureau to expand the distribution of morphine,” said Geeta Joshi, anaesthesiology professor at the Regional Cancer Centre, Ahmedabad. India’s per head consumption of morphine is 0.6mg, whereas the world and US figures are 5.93mg and 76mg, respectively.


Source
: The Telegraph ( Kolkata, India)

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Laser Therapy May Help Neck Pain

So-called low-level laser therapy (LLLT) entails using a laser‘s light — but not its fiercely concentrated heat — to stimulate tissue repair and ease pain.
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Doctors led by Roberta Chow of the Brain and Mind Research Institute at Australia‘s University of Sydney carried out an overview of 16 randomised trials that put this increasingly popular procedure to the test.

A total of 820 patients were enrolled in the trials, divided into groups that received either the therapy or a lookalike, dummy treatment. In five trials, patients given LLLT were around four times likelier to have reduced pain compared with a placebo, the paper found.

In the 11 other trials, for which there was a detailed analysis of pain symptoms, LLLT patients reported reductions of chronic pain by around 20 points on a scale of 100 points. The pain reduction continued for up to 22 weeks.

LLLT compares favourably with other drugs and other remedies for effectiveness and its side-effects are mild, says the study, which recommends that it be used in combination with an exercise programme.

Why LLLT works, though, is unclear. The authors suggest it could interfere with pathways of inflammation, muscle tiredness and the transmission of pain signals along nerves.

Between 10 and 24 percent of people suffer from chronic neck pain, inflicting a cost running into the hundreds of millions of dollars and highlighting the need for simple but effective treatent, the authors said.

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Source: The Times Of India

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Meditate Your Pain Away

Zen meditation – a centuries-old practice that helps people gain mental, physical and emotional balance – can keep pain at bay

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Universite de Montreal researchers.

According to a Psychosomatic Medicine study, Zen meditators have lower pain sensitivity both in and out of a meditative state compared to non-meditators. Along with Pierre Rainville, a professor and researcher at the Université de Montréal, Joshua A. Grant, a doctoral student in the Department of Physiology co-authored the paper.

The main aim of the study was to examine whether trained meditators perceived pain differently than non-meditators. “While previous studies have shown that teaching chronic pain patients to meditate is beneficial, very few studies have looked at pain processing in healthy, highly trained meditators. This study was a first step in determining how or why meditation might influence pain perception,” says Grant.

To reach the conclusion, the scientists recruited 13 Zen meditators with a minimum of 1,000 hours of practice to undergo a pain test and contrasted their reaction with 13 non-meditators. Subjects included 10 women and 16 men between the ages of 22 to 56.

The administered pain test was simple: A thermal heat source, a computer controlled heating plate, was pressed against the calves of subjects intermittently at varying temperatures. Heat levels began at 43 degrees Celsius and went to a maximum of 53 degrees Celsius depending on each participant’s sensitivity. While quite a few of the meditators tolerated the maximum temperature, all control subjects were well below 53 degrees Celsius.

Grant and Rainville noticed a marked difference in how their two test groups reacted to pain testing – Zen meditators had much lower pain sensitivity (even without meditating) compared to non-meditators. During the meditation-like conditions it appeared meditators further reduced their pain partly through slower breathing: 12 breaths per minute versus an average of 15 breaths for non-meditators.

“Slower breathing certainly coincided with reduced pain and may influence pain by keeping the body in a relaxed state. While previous studies have found that the emotional aspects of pain are influenced by meditation, we found that the sensation itself, as well as the emotional response, is different in meditators,” Grant said.

The ultimate result was that Zen meditators experienced an 18 per cent reduction in pain intensity.

Source:The Times Of India

Pain and Painkillers

Michael Jackson lived and died under the arc lights. Speculation attributes his sudden death to addiction to painkillers, disastrously fuelled by the purchasing power of his millions. He could buy schedule H drugs — which are available on prescription only — and pay for their expert administration.

Pain is universal and accounts for half the medical consultations worldwide. Since everyone wants instant relief, painkillers — also called analgesics — are the most commonly prescribed and purchased medications. They belong to several chemical groups and act by dulling unbearable pain. They do not, however, cure the disease that is the root of the problem.

This means that if the actual disease is not tackled, the pain is likely to reappear when the medication wears off. This leaves patients dissatisfied and they tend to shop around for doctors.

Pain is handled by several specialists such as neurologists, surgeons, rheumatologists, general physicians, anesthetists and dentists. A patient can have several prescriptions with unidentifiable “trade names” instead of chemical names.

In an attempt to obtain relief, he or she may take several medications together. Others may dispense with the medical profession altogether and purchase analgesics over the counter (OTC) from the friendly neighbourhood pharmacy.

In such a scenario, the quantity of drug consumed and dosage intervals are no longer scientific or within safe limits. About 25 per cent of patients overdoses and 56 per cent experiences side effects — by either taking more than the recommended dose, or taking it at intervals so short that the medication is not adequately metabolised in the body.

Gradually, the body may become so used to the painkillers that habituation sets in. The medications no longer provide relief. Higher and more frequent doses are needed until, eventually, toxic levels are reached.

Today, there are millions of people from all socio-economic strata, around the world, who have unknowingly become addicted to painkillers. They are unaware of the potentially dangerous and lethal side effects of these “harmless” medications.

Pain is defined medically as “an unpleasant sensory or emotional experience associated with actual or potential tissue damage.” It is a natural protective defence, which prevents bodily harm. Unfortunately, pain is not a tangible or measurable entity. It is as severe as the sufferer says it is.

Although pain is subjective, the degree of pain and tolerance to it are influenced greatly by social, cultural and religious factors. Egyptian queens delivered in “birthing” chairs in full view of the entire court, without any analgesic or anaesthetic, and not one of them changed their expression. It certainly was not because they were impervious to pain!

Most of the time, pain has a sudden, acute onset at a specific location in the body and is dull, burning, throbbing or stabbing. The cause — which may be an infection or injury — can usually be identified. The pain generally disappears quickly either with no treatment at all, or with simple measures such as hot or cold compresses and analgesics.

Problems set in when the pain becomes chronic, and occurs day after day, evolving into a disease entity which seems impossible to bear or cure. Around 20 to 30 per cent of the world’s population suffers from chronic pain. The commonest causes of chronic pain are low backache, arthritis, migraine and nerve pains.

If you are suffering from chronic pain,

*Ask your doctor for a diagnosis

*Make sure you are not receiving habit-forming or dangerous medications

*Check if your social or family problems are aggravating the symptoms

*Do not take more than the amount prescribed or change the frequency

Liniments and ointments may provide relief. They need to be combined with icepacks and moist heat.

Vibration can be applied by rubbing with the hand or with a machine operated by a physiotherapist. It stimulates nerve endings and the chemicals released interfere with those causing pain and block them

Acupuncture uses needles to stimulate certain nerves. It is believed to release beneficial chemicals which block those causing pain.

Acupuncture may cause the release of the body’s own natural opiate painkillers into the various areas of the nervous system.

 

Graded exercises and physiotherapy help by gradually strengthening the muscles overlying painful joints.

Nutritional supplements like curcumin (found in turmeric), glucosamine, chondroitin (found in cartilage) and omega-3 fatty acids (found in fish) can be added to the medication. They may help even though there is no clear-cut scientific evidence that they are beneficial.

When nothing seems to work, intravenous medication and anaesthesia can be used. This should be reserved for severe pain as occurs in cancer or after surgery. This can be dangerous and should not be administered on request.

The response to pain is a conditioned reflex. Tolerance increases with physical fitness. Exercise causes the release of chemicals from the large muscles of the body which help to withstand pain. EXERCISE REGULARLY  FOR A HEALTHY AND PAIN-FREE LONG LIFE .

Always keep in mind  MOST OF THE TIMES, CHEMICAL PAINKEELERS  AS ARE AVAILABLE IN THE MARKET  DO  MORE HARM TO OUR BODY SYSTEM  THAN  DOING ANY GOOD.SO, TRY TO AVOID THEM UNLESS IT IS ESSENTIAL TO  USE THEM.

Source:
The Telegraph  ( Kolkata, India)

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