All posts by Abbie

Children

People seeking information or support related to chronic pain in children may find some of the following resources helpful.

Books

— “Conquering Your Child’s Chronic Pain: A Pediatrician’s Guide for Reclaiming a Normal Childhood,” by Lonnie Zeltzer and Christina Blackett Schlank (HarperResource, 2005). Zeltzer is a pain specialist at UCLA. This book — one of the few for laypeople on chronic pain in children — includes contact information for pediatric pain centers in the United States and around the world.

— “Young People and Chronic Illness: True Stories, Help and Hope,” by Kelly Huegel (Free Spirit Publishing, 1998). A book for teens and preteens. While not specific to chronic pain, it covers a lot of the relevant issues — how to talk to friends; how to deal with parents and doctors, etc.

Online Resources

— American Pain Foundation. The Baltimore-based nonprofit advocacy group works to advance pain research, treatment and education. Its Web site includes dozens of links related pain in children. www.painfoundation.org, 888-615-PAIN (7246) or 410-783-7292.

— American Pain Society. While this professional group gears its information primarily to doctors and caregivers, some material is also helpful for the general public. Information includes how doctors should assess children with chronic pain and how pain in children should be treated. www.ampainsoc.org (pediatric info is at www.ampainsoc.org/advocacy/pediatric.htm), 847-375-4715.

— The American Council for Headache Education. This nonprofit offers information for children and families about pediatric headaches at www.achenet.org/kids. 856-423-0258.

— Cancer Pain Management in Children, www.childcancerpain.org. This site, sponsored by the Texas Cancer Council and Texas Children’s Hospital, is geared to professionals treating cancer pain in children, but is also suitable for parents and older children.

Support Group

— Growing Pains: Teen Discussion/Support Group. This support group for teens is sponsored by the American Chronic Pain Association. www.theacpa.org, 800-533-3231.

CRPS treatment with ketamine

From a press release: Thirty-three patients with unrelenting CRPS (Complex Regional Pain Syndrome, also known as Reflex Sympathetic Dystrophy – RSD) were treated using this novel approach developed by Dr. Graeme E. Correll, BE, MBBS, in Mackay, Queensland, Australia. Pain relief and the duration of this relief appeared impressive. After only one treatment, there was complete relief in 76% (25) of the group. 54% of the patients remained free of pain for more than three months, 31% for more than six months. Although the relief of pain did not last indefinitely, it was noted that following a second treatment given to 12 of the patients, the outcome was improved. In this retreated group 58% remained pain free for more than a year and almost 33% experienced relief for over three years.

Angie’s Pain

It all started as a normal TMJ problem. My jaws would pop & click w/ wide opening, yawning, etc.
Over about 2 years it progressed very quickly into “internal derangement w/out reduction”. I’ve done physical therapy, bite splints ( soft & hard ), biofeedback, imagery, soft diet, liquid diet, Advil, Tylenol, Aleve, about 10 different RX NSAID’s. After all the O-T-C Nsaid’s & Rx Nsaid’s, I now have an ulcer. Then I moved onto trigger point injections weekly, occipital nerve blocks weekly. Percocet 10’s, 3/day.
OxyContin 20mgs, 2/day, Duragesic Patches, 75mcg’s, one patch/ 72 hrs., MS Contin 30mgs, 2/day.
And now currently I take Methadone 15mgs, 2/day, w/ 60 Lortab 10/500mgs for breakthrough pain.

DEPRESSION

If you are feeling suicidal now, please stop long enough to read this.
www.metanoia.org/suicide

Call 1-800-SUICIDE in the U.S.
Teenagers, call Covenant House NineLine, 1-800-999-9999

beyondblue is a national, independent, not-for-profit organisation working to address issues associated with depression, anxiety and related substance misuse disorders in Australia.
https://www.beyondblue.org.au/

The National Institute of Mental Health (NIMH) is part of the National Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services.
https://www.nimh.nih.gov/publicat/depression.cfm

Wikipedia definition: Major depressive disorder
https://en.wikipedia.org/wiki/Clinical_depression

TeensHealth
https://kidshealth.org/teen/your_mind/mental_health/depression.html

Online Screening (University of Michigan Psychiatric Emergency Room)
734-936-5900
https://www.depressioncenter.org/screening/

Biological Psychiatry
https://www.journals.elsevierhealth.com/periodicals/bps

Centers for Medicare & Medicaid Services (CMS)
https://www.cms.hhs.gov/

Cyberonics, Inc.
https://www.cyberonics.com/

DBSA (Depression and Bipolar Support)
https://www.dbsalliance.org

DepressionForums.org
https://www.depressionforums.org/

depression-guide.com
https://www.depression-guide.com/vagus-nerve-stimulation.htm

DepressioNet.com
https://www.depressionet.com.au/

Dr. Ivan’s DEPRESSION CENTRAL
https://www.psycom.net/depression.central.html

Drug Digest
https://www.drugdigest.org/DD/Interaction/ChooseDrugs/1,4109,,00.html

Elsevier
https://www.elsevier.com/wps/find/homepage.cws_home

HealingWell.com
https://www.healingwell.com/depression/

Manufacturer and User Facility Device Experience Database – (MAUDE)
https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfMAUDE/search.cfm

McMan’s Depression and Bipolar Web
www.mcmanweb.com/

Medicare
https://www2.medicare.gov/default.asp

Mood Garden
https://www.moodgarden.org/forum/index.php?sid=079571636247373d57e310ff96529f36

NARSAD raises money from donors around the world and invests it directly in the most promising research projects in mental health.
https://www.narsad.org/

Neurotransmitter.net
https://www.neurotransmitter.net/index.html

NIH (National Institutes of Health) – Clinical Trials
https://www.clinicaltrials.gov/

PsychEducation.org
https://www.psycheducation.org/index.html

Quackwatch
https://www.quackwatch.org/

Remedyfind
https://www.remedyfind.com/

The Dr. Bob Home Page
https://www.dr-bob.org/

The Infinite Mind public radio show
https://www.lcmedia.com/mindprgm.htm

The Trouble With Spikol
https://trouble.philadelphiaweekly.com/

U.S. Food and Drug Administration
Center for Devices and Radiological Health / CDRH
https://www.fda.gov/cdrh/index.html

U.S. National Library of Medicine
https://www.nlm.nih.gov/

Vagus Nerve Stimulation.com
www.vagusnervestimulation.com

VNSdepression.com
https://www.vnsdepression.com

VNS for Depression
https://health.groups.yahoo.com/group/vns-for-depression/

Welcome to AMA Physician Select
https://dbapps.ama-assn.org/aps/amahg.htm

Rise Up in Darkness
The book was “Darkness Visible: A Memoir of Madness.” Its dramatic arc was simple. In 1985, Mr. Styron got sick, got worse, went to the hospital and got better. In recollecting and studying his pain, Mr. Styron illuminated the disease for others.
https://www.nytimes.com/2006/11/07/opinion/07tue2.html?_r=1&th&emc=th

Living Life to the Full – helping you to help yourself
https://www.livinglifetothefull.com/

MINDBRAIN – support forum for people with psychiatric disorders
https://www.mindbrain.proboards51.com

Botulinum toxin injection

Botulinum toxin injection is used to treat dystonia, a neuromuscular disorder that produces involuntary muscle contractions, or spasm, that affects muscles that control movement in the eyes, neck, face, voice box, or the smooth muscle in the bladder. The goal of the therapy is to reduce muscle spasm and pain.

This potent neurotoxin is produced by Clostridium botulinum, a bacterium that causes food poisoning (botulism). There are seven known types of C. botulinum toxin, but only types A (Botox) and B (Myobloc) are used as medical treatments.

Botulinum toxin has proven to be useful in the treatment of many forms of dystonia, including the following:

blepharospasm, forceful involuntary closure of the eyelids
strabismus, misalignment of the eyes hemifacial spasm, sudden contraction of the muscles on one side of the face spasmodic torticollis, or cervical dystonia, muscle spasm in the neck that causes the head to turn to one side, and sometimes forward or backward oromandibular dystonia, continuous spasms of the face, jaw, neck, tongue, larynx, and in severe cases, the respiratory system urinary retention, severe inability to urinate that requires catheterization spasmodic dysphonia, spasm of the vocal cords that causes sudden disruption of speech stuttering, repetitions of parts of words and whole words, long pauses, elongated sounds voice tremor, quavering vocalization.

Neurons generate new nerve endings that reactivate the dystonia, so improvement is not long lasting, and treatment is usually repeated every 3 to 4 months. Physical or occupational therapy usually is undertaken to stretch and restore normal muscle function. Some patients develop antibodies to the toxin over time, rendering the treatment ineffective.

Side Effects

This is a safe and effective treatment when given in very small amounts by a qualified neurologist. Some patients experience temporary weakness in the group of muscles being treated. For example, ptosis (drooping eyelid) can develop after treating blepharospasm. Flu-like symptoms develop in some, but rarely.

Epidural Steroid Injection

Overview

Epidural injection is the administration of medication into the epidural space. It is used to treat swelling, pain, and inflammation associated with neurological conditions that affect nerve roots, such as a herniated disk and radiculopathy.

Epidural injections may be painful and produce uncertain results. Studies show that epidural injection may provide short-term pain relief for patients when conservative treatments have failed.

Anatomy

The brain is covered by three membranes (dura, arachnoid, and pia), called the meninges that extend through the base of the skull and surround the entire spinal cord. The spinal cord travels down the entire length of the spinal column through the spinal canal. The epidural space is located between the dura and the interior surface of the spinal canal and contains veins, arteries, and fat. Epidural injection is the injection of medication into the epidural space.

Procedure

Epidural injection is usually given in an outpatient setting. An anesthesiologist usually administers the injection, but some neurosurgeons, orthopedic surgeons, and neurologists are also qualified to perform this procedure.

A mild sedative and a local anesthetic may be given prior to the procedure to relax the patient and numb the injection site. Medications, usually an anesthetic such as bupivacaine (Marcaine?) or a muscle relaxant, and a corticosteroid such as methylprednisolone (Medrol?), are injected directly into the epidural space. (The injection is commonly called a cortisone shot.)

Effectiveness

Approximately 30% to 70% of people who receive an epidural injection benefit from it. Some patients notice improvement within hours of the injection; others improve over a number of days; and others experience no improvement with the treatment. In some cases, two or three injections are given over weeks or months.

Complications

Complications resulting from an epidural injection are rare. Possible conditions that may develop following the procedure include infection (e.g., epidural abscess), bleeding into the epidural space, and headache caused by a cerebrospinal fluid leak. Approximately 2% of patients experience side effects from the corticosteroid, such as mild fluid retention.

Lumbar Epidural Steroid Injection:

Your physician may refer you for a procedure called an Lumbar Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves include:

  1. Pain in the lower back
  2. Pain down one or both legs
  3. Numbness or tingling of your legs or feet
  4. Weakness in one or both legs or feet

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area of your lower back called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) we will suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

EPIDURAL STEROID INJECTIONS work very well for most people with the above problems. While it will not cure everyone, this procedure can be extremely helpful to relieve the pains caused by “pinched nerves”.
If you have questions about this procedure, please discuss them with your anesthesiologist.

Here are some commonly asked questions and answers:

  1. Will this injection cure my problem?

    Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.

  2. Are you going to give me a shot in my back!?!

    Yes. This is the best and easiest approach to the Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. As stated above, by using the Epidural Space the medicine can soak into the nerves very easily without a direct injection into the nerve itself.

  3. I only have pain in my leg. Why are you giving me a shot in the back?

    As stated, the nerves which supply feeling to your legs come from the spinal cord in your lower back. The site of irritation of this nerve is usually in the lower back where the nerve leaves the spinal canal or backbone. Your Doctor referred you for this treatment because he feels this may be the source of your problem.

  4. Is this procedure safe? What are the risks?

    As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:

    1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
    2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self limiting (it doesn’t last long) and does not usually occur with the second or third injection.
    3. Post-spinal Headache: Occasionally the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
    4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.


  5. Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

    No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.

Cervical Epidural Steroid Injections:

Your physician may refer you for a procedure called a Cervical Epidural Steroid Injection. This procedure is used to treat swollen and inflamed spinal nerve roots often referred to as a “pinched nerve.” The spinal nerves come from the spinal cord and exit the backbone to provide sensation to different parts of the body. Occasionally something rubs or irritates these nerves where they exit the backbone causing them to be swollen and inflamed. The source of irritation may be a ruptured, herniated, or bulging disc. Another source may be Spinal Stenosis, where arthritis of the spine, bone growth, or hardening of the ligaments begins to close the openings in the spine through which these nerves exit. Common problems associated with this inflammation of the spinal nerves in the neck or cervical spine include:

  1. Pain in the neck or shoulders
  2. Pain down one or both arms
  3. Numbness or tingling of your shoulders, arms, or hands
  4. Weakness in one or both shoulders, arms, or hands

Your symptoms may include some or all of the above problems. Your physician may treat these symptoms with oral medications and/or physical therapy or exercise. Another method for treating this condition is called an EPIDURAL STEROID INJECTION. This technique involves an injection of a steroid into an area in the back of your neck called the epidural space. The epidural space extends through the spinal canal from your head to your tailbone. The spinal nerves pass through the epidural space and are therefore bathed in this steroid (a solution of anti-inflammatory medicine). After the procedure you will be asked to reduce your activities at home for 24 to 48 hours to allow the medicine a chance to do its work. Within a few days after the injection, the medicine should reduce the swelling and inflammation of these nerves and thereby reduce your symptoms.

You will probably be asked to return two weeks after your first injection. If all of your pain or numbness has been relieved, you will not need another shot at that time. Most often, however, the first injection will relieve most, but not all of your pain or numbness. At that time (2 weeks after the first injection) your anesthesiologist may suggest a second EPIDURAL STEROID INJECTION. Occasionally you may require a third injection two weeks after the second one. After a series of three injections, you should probably wait six months before starting another series of injections.

EPIDURAL STEROID INJECTIONS work very well for most people with the above problems. While it will not cure everyone, this procedure can be extremely helpful to relieve the pains caused by “pinched nerves”.
If you have questions about this procedure, please discuss them with your anesthesiologist.

Here are some commonly asked questions and answers:

  1. Will this injection cure my problem?

    Although this procedure may give excellent pain relief, it will not fix the source of the “pinched nerve”. However, by reducing the inflammation of the nerve and with the help of some exercises provided by your orthopedist or physical therapist, you should have months to years of freedom from pain. And although you may have to return for a repeat series of Epidural Steroid Injections in future years, many people prefer this treatment than having surgery to repair the defect.

  2. Are you going to give me a shot in the back of my neck?

    Yes. As noted above, in this instance the nerves involved are located in the cervical spine. This is the best and easiest approach to the Cervical Epidural Space. We do not inject anything directly into the spinal nerves or spinal cord. By using the Epidural Space, the medicine can soak into the nerves very easily without a direct injection into the nerve itself.

  3. I only have pain in my arm. Why are you giving me a shot in the neck?

    As stated, the nerves which supply feeling to your arms and hands come from the spinal cord in your neck (the cervical spine). The site of irritation of this nerve is usually in the cervical spine where the nerve leaves the spinal canal or backbone. Your Doctor referred you to us because he feels this may be the source of your problem.

  4. Is this procedure safe? What are the risks?

    As with any procedure, there are always certain risks involved with injections. Epidural Steroids have proven to work very well and carry very low risks of injury. However, anytime you receive a shot there is a minimal risk of complications. It is rare that these complications ever cause a significant problem. The following are some, but not all of the possible complications:

    1. Bleeding or Infection at the site of the injection: Minimal bleeding is not uncommon, but it is extremely rare that this is a significant problem
    2. Pain during or after injection: This is not a common problem, but may occur when there is significant swelling and irritation of the nerve root prior to the injection. This is usually self-limiting (it doesn’t last long) and does not usually occur with the second or third injection.
    3. Post-spinal Headache: Occasionally, the needle enters the dura (the membrane that covers the spinal fluid and nerves). This is called a “wet tap”. This does not occur very often, but when it does, the patient gets a particular type of headache. As stated, this is an uncommon occurrence and there is a treatment for this type of headache when it occurs.
    4. Reaction to medications or nerve injury: Reactions to the medications can occur but are quite unusual. Injuries to nerves or nerve roots are possible, but extremely rare.
  5. Will these steroids cause my muscles to increase like the athletes that take illegal steroids?

    No. These steroids are anti-inflammatory agents, not the anabolic steroids like athletes use.


Recent post

Ever Have A Bad Epidural?
Submitted by gregg on 15 May 2010 – 10:41pm