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Phantom Pains

Although amputations are visible the phantom pains are not.  The exact cause of phantom pain is still unknown  but originates in the spinal cord and brain.  when a patient feels these pains, it can be seen in a MRI machine.    It is believed that it is a response from mixed signals from the brain.

When a amputation takes place, areas of the spinal cord and brain lose your input from the missing limb and adjust to this detachment in a unpredictable way.  It may send a message to your brain the pain is else where.   Because the sensory information is referred elsewhere-from a missing hand to a present cheek.  So when the cheek is touched its as the missing limb is present.  It is a version of tangled sensory wires.  Thus results in pain.

Phantom pain can be caused by damaged nerve endings, scar tissue at the site of amputation and the physical memory of pre-amputation pain.

Know your triggers, usually you can feel a tingle or some sensation before pain begins, Try to empty your bladder, don’t get constipated, drinking alcohol can add to the pain,  If you learn your triggers you may be able to stop them before they happen,  meditation, calming one self down can prevent the pain.  Number one trigger is Stress!  so if you can exercise, de stress, calm down, you may be able to find tricks by massaging the limb before bed to help prevent the pain or using a (tens) machine to the affected limb.

Treatments and drug

Acupuncture and Transcutaneous electrical nerve stimulation

(TENS), have been found to be effective treatment for those that don’t want to take oral medications.  Also more invasive options include injections or implanted devices .  This is usually a last resort.

Medications

Although no medications specifically for phantom pain exist, some drugs designed to treat other conditions have been helpful in relieving nerve pain.  Not every pain medication will work for every person’s pain.

Medications used in the treatment of phantom pain include:

  • Antidepressants. Tricyclic antidepressants may relieve the pain caused by damaged nerves. Examples include amitriptyline, nortriptyline (Pamelor) and tramadol (Conzip, Ultram).

    These drugs work by modifying chemical messengers that relay pain signals. Antidepressants may also help you sleep, which can make you feel better.

    Possible side effects include sleepiness, dry mouth, blurred vision, weight gain, and a decrease in sexual performance or desire.

  • Anticonvulsants. Epilepsy drugs — such as gabapentin (Gralise, Neurontin), pregabalin (Lyrica) and carbamazepine (Carbatrol, Epitol, Tegretol) — are often used to treat nerve pain. They work by quieting damaged nerves to slow or prevent uncontrolled pain signals.

    Side effects may include depression, anxiety, suicidal thoughts, irritability, and allergic reactions such as hives, fever and swelling.

  • Narcotics. Opioid medications, such as codeine and morphine, may be an option for some people. Taken in appropriate doses under your doctor’s direction, they may help control phantom pain
  • receotor antagonists. This class of anesthetics works by binding to the NMDA receptors on the brain’s nerve cells and blocking the activity of glutamate, a protein that plays a large role in relaying nerve signals.

    In studies, NMDA receptor antagonists ketamine and dextromethorphan were effective in relieving phantom pain. Side effects of ketamine include mild sedation, hallucinations or loss of consciousness. No side effects were reported from the use of dextromethorphan.

Noninvasive therapies

    • Nerve stimulation. In a procedure called transcutaneous electrical nerve stimulation (TENS), a device sends a weak electrical current via adhesive patches on the skin near the area of pain. This may interrupt or mask pain signals, preventing them from reaching your brain.

      Used properly, TENS is safe. To avoid an unintentional shock, don’t wear a TENS device in the shower or tub or turn it up too high.

    • Mirror box. This device contains mirrors that make it look like an amputated limb exists. The mirror box has two openings — one for the intact limb and one for the stump.

      The person then performs symmetrical exercises, while watching the intact limb move and imagining that he or she is actually observing the missing limb moving. Studies have found that this exercise may help relieve phantom pain.

    • Acupuncture. The National Institutes of Health has found that acupuncture can be an effective treatment for some types of chronic pain. In acupuncture, the practitioner inserts extremely fine, sterilized stainless steel needles into the skin at specific points on the body.

It’s thought that acupuncture stimulates your central nervous system to release the body’s natural pain-relieving endorphins. Acupuncture is generally considered safe when performed correctly.

Minimally invasive therapies

  • Injection. Sometimes injecting pain-killing medications — local anesthetics, steroids or both — into the stump can provide relief of phantom limb pain.
  • Spinal cord stimulation. Your doctor inserts tiny electrodes along your spinal cord. A small electrical current delivered to the spinal cord can sometimes relieve pain.
  • Nerve blocks. This method uses medications that interrupt pain messages between the brain and the site of the phantom pain.

Surgery

Surgery may be an option if other treatments haven’t helped. Surgical options include:

  • Brain stimulation. Deep brain stimulation and motor cortex stimulation are similar to spinal cord stimulation except that the current is delivered within the brain. A surgeon uses a magnetic resonance imaging (MRI) scan to position the electrodes correctly.

    Although the data are still limited, brain stimulation appears to be a promising option in selected individuals.

  • Stump revision or neurectomy. If phantom pain is triggered by nerve irritation in the stump, surgical resection or revision can sometimes be helpful. But cutting nerves also carries the risk of making the pain worse.

On the horizon

Newer approaches to relieve phantom pain include virtual reality goggles. The computer program for the goggles mirrors the person’s intact limb, so it looks like there’s been no amputation.

Along with this pain from amputation, a patient may experience grief of the loss of the limb amputated, also depression over the loss can be common,  Loss of activity, or ability to work, or function pre amputation.  So support from family and friends are a important part of the recovery of a amputee.

One patient told me the pain was so bad he wanted to cut his entire leg off or kill himself.   Life was not worth living.

 

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Understanding Anxiety Disorders by NIH

NIH News in Health
A monthly newsletter from the National Institutes of Health, part of the U.S. Depa

Understanding Anxiety Disorders
When Panic, Fear, and Worries Overwhelm
Illustration of a worried man standing apart from a circle of friends.

Many of us worry from time to time. We fret over finances, feel anxious about job interviews, or get nervous about social gatherings. These feelings can be normal or even helpful. They may give us a boost of energy or help us focus. But for people with anxiety disorders, they can be overwhelming.

Anxiety disorders affect nearly 1 in 5 American adults each year. People with these disorders have feelings of fear and uncertainty that interfere with everyday activities and last for 6 months or more. Anxiety disorders can also raise your risk for other medical problems such as heart disease, diabetes, substance abuse, and depression.

The good news is that most anxiety disorders get better with therapy. The course of treatment depends on the type of anxiety disorder. Medications, psychotherapy (“talk therapy”), or a combination of both can usually relieve troubling symptoms.

“Anxiety disorders are one of the most treatable mental health problems we see,” says Dr. Daniel Pine, an NIH neuroscientist and psychiatrist. “Still, for reasons we don’t fully understand, most people who have these problems don’t get the treatments that could really help them.”

One of the most common types of anxiety disorder is social anxiety disorder, or social phobia. It affects both women and men equally—a total of about 15 million U.S. adults. Without treatment, social phobia can last for years or even a lifetime. People with social phobia may worry for days or weeks before a social event. They’re often embarrassed, self-conscious, and afraid of being judged. They find it hard to talk to others. They may blush, sweat, tremble, or feel sick to their stomach when around other people.

Other common types of anxiety disorders include generalized anxiety disorder, which affects nearly 7 million American adults, and panic disorder, which affects about 6 million. Both are twice as common in women as in men.

People with generalized anxiety disorder worry endlessly over everyday issues—like health, money, or family problems—even if they realize there’s little cause for concern. They startle easily, can’t relax, and can’t concentrate. They find it hard to fall asleep or stay asleep. They may get headaches, muscle aches, or unexplained pains. Symptoms often get worse during times of stress.

People with panic disorder have sudden, repeated bouts of fear—called panic attacks—that last several minutes or more. During a panic attack, they may feel that they can’t breathe or that they’re having a heart attack. They may fear loss of control or feel a sense of unreality. Not everyone who has panic attacks will develop panic disorder. But if the attacks recur without warning, creating fear of having another attack at any time, then it’s likely panic disorder.

Anxiety disorders tend to run in families. But researchers aren’t certain why some family members develop these conditions while others don’t. No specific genes have been found to actually cause an anxiety disorder. “Many different factors—including genes, stress, and the environment—have small effects that add up in complex ways to affect a person’s risk for these disorders,” Pine says.

“Many kids with anxiety disorders will outgrow their conditions. But most anxiety problems we see in adults started during their childhood,” Pine adds.

“Anxiety disorders are among the most common psychiatric disorders in children, with an estimated 1 in 3 suffering anxiety at some point during childhood or adolescence,” says Dr. Susan Whitfield-Gabrieli, a brain imaging expert at the Massachusetts Institute of Technology. “About half of diagnosable mental health disorders start by age 14, so there’s a lot of interest in uncovering the factors that might influence the brain by those early teen years.”

Whitfield-Gabrieli is launching an NIH-funded study to create detailed MRI images of the brains of more than 200 teens, ages 14-15, with and without anxiety or depression. The scientists will then assess what brain structures and activities might be linked to these conditions. The study is part of NIH’s Human Connectome Project, in which research teams across the country are studying the complex brain connections that affect health and disease.

Whitfield-Gabrieli and colleagues have shown that analysis of brain connections might help predict which adults with social phobia will likely respond to cognitive behavioral therapy (CBT). CBT is a type of talk therapy known to be effective for people with anxiety disorders. It helps them change their thinking patterns and how they react to anxiety-provoking situations. But it doesn’t work for everyone.

Of 38 adults with social phobia, those who responded best after 3 months of CBT had similar patterns of brain connections. This brain analysis led to major improvement, compared to a clinician’s assessment alone, in predicting treatment response. Larger studies will be needed to confirm the benefits of the approach.

“Ultimately, we hope that brain imaging will help us predict clinical outcomes and actually tailor the treatment to each individual—to know whether they’ll respond best to psychotherapy or to certain medications,” Whitfield-Gabrieli says.

Other researchers are focusing on our emotions and our ability to adjust them. “We want to understand not only how emotions can help us but also how they can create difficulties if they’re of the wrong intensity or the wrong type for a particular situation,” says Dr. James Gross, a clinical psychologist at Stanford University.

We all use different strategies to adjust our emotions, often without thinking about it. If something makes you angry, you may try to tamp down your emotion to avoid making a scene. If something annoys you, you might try to ignore it, modify it, or entirely avoid it.

But these strategies can turn harmful over time. For instance, people with social phobia might decide to avoid attending a professional conference so they can keep their anxiety in check. That makes them lose opportunities at work and miss chances to meet people and make friends.

Gross and others are examining the differences between how people with and without anxiety disorders regulate their emotions. “We’re finding that CBT is helpful in part because it teaches people to more effectively use emotion regulation strategies,” Gross says. “They then become more competent in their ability to use these strategies in their everyday lives.”

“It’s important to be aware that many different kinds of treatments are available, and people with anxiety disorders tend to have very good responses to those treatments,” Pine adds. The best way to start is often by talking with your physician. If you’re a parent, talk with your child’s pediatrician. “These health professionals are generally prepared to help identify such problems and help patients get the appropriate care they need,” Pine says.

References:

The role of emotion and emotion regulation in social anxiety disorder. Jazaieri H, Morrison AS, Goldin PR, Gross JJ. Curr Psychiatry Rep. 2015 Jan;17(1):531. doi: 10.1007/s11920-014-0531-3. Review. PMID: 25413637.

Childhood antecedents and risk for adult mental disorders. Pine DS, Fox NA. Annu Rev Psychol. 2015 Jan 3;66:459-85. doi: 10.1146/annurev-psych-010814-015038. Review. PMID: 25559116.

Brain connectomics predict response to treatment in social anxiety disorder. Whitfield-Gabrieli S, Ghosh SS, Nieto-Castanon A, et al. Mol Psychiatry. 2015 Aug 11. doi: 10.1038/mp.2015.109. [Epub ahead of print]. PMID: 26260

Troubled by Anxiety?

If feelings of anxiety seem overwhelming or interfere with every-day activities:

See your family doctor or nurse practitioner.
The next step may be talking to a mental health professional. Consider finding someone trained in cognitive-behavioral therapy who is also open to using medication if needed. You may need to try several medicines before finding the right one.
Consider joining a self-help or support group to share problems and achievements with others.
Stress management techniques and mindfulness meditation may help relieve anxiety symptoms.

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What is the difference between Anxiety and Depression?

Dysthymia (dis-THIE-me-uh) is a mild but long-term (chronic) form of depression. Symptoms usually last for at least two years, and often for much longer than that. Dysthymia interferes with your ability to function and enjoy life.

With dysthymia, you may lose interest in normal daily activities, feel hopeless, lack productivity, and have low self-esteem and an overall feeling of inadequacy. People with dysthymia are often thought of as being overly critical, constantly complaining and incapable of having fun.

Symptoms

Dysthymia symptoms in adults may include:

  • Loss of interest in daily activities
  • Sadness or feeling down
  • Hopelessness
  • Tiredness and lack of energy
  • Low self-esteem, self-criticism or feeling incapable
  • Trouble concentrating and trouble making decisions
  • Irritability or excessive anger
  • Decreased activity, effectiveness and productivity
  • Avoidance of social activities
  • Feelings of guilt and worries over the past
  • Poor appetite or overeating
  • Sleep problems

Dysthymia symptoms usually come and go over a period of years, and their intensity can change over time. But typically symptoms don’t disappear for more than two months at a time. In general, you may find it hard to be upbeat even on happy occasions — you may be described as having a gloomy personality.

When dysthymia starts before age 21, it’s called early-onset dysthymia. When it starts after that, it’s called late-onset dysthymia.

When to see a doctor

It’s perfectly normal to feel sad or upset sometimes or to be unhappy with stressful situations in your life. But with dysthymia, these feelings last for years and interfere with your relationships, work and daily activities.

Because these feelings have gone on for such a long time, you may think they’ll always be part of your life. But if you have any symptoms of dysthymia, seek medical help. If not effectively treated, dysthymia commonly progresses into major depression. Sometimes, a major depression episode occurs in addition to dysthymia — this is called double depression.

Generalized Anxiety Disorder.

It’s normal to feel anxious from time to time, especially if your life is stressful. However, excessive, ongoing anxiety and worry that interfere with day-to-day activities may be a sign of generalized anxiety disorder.

It’s possible to develop generalized anxiety disorder as a child or an adult. Generalized anxiety disorder has symptoms that are similar to panic disorder, obsessive-compulsive disorder and other types of anxiety, but they’re all different conditions.

Living with generalized anxiety disorder can be a long-term challenge. In many cases, it occurs along with other anxiety or mood disorders. In most cases, generalized anxiety disorder improves with medications or talk therapy (psychotherapy). Making lifestyle changes, learning coping skills and using relaxation techniques also can help

Generalized anxiety disorder symptoms can vary. They may include:

  • Persistent worrying or obsession about small or large concerns that’s out of proportion to the impact of the event
  • Inability to set aside or let go of a worry
  • Inability to relax, restlessness, and feeling keyed up or on edge
  • Difficulty concentrating, or the feeling that your mind “goes blank”
  • Worrying about excessively worrying
  • Distress about making decisions for fear of making the wrong decision
  • Carrying every option in a situation all the way out to its possible negative conclusion
  • Difficulty handling uncertainty or indecisiveness

Physical signs and symptoms may include:

  • Fatigue
  • Irritability
  • Muscle tension or muscle aches
  • Trembling, feeling twitchy
  • Being easily startled
  • Trouble sleeping
  • Sweating
  • Nausea, diarrhea or irritable bowel syndrome
  • Headaches

There may be times when your worries don’t completely consume you, but you still feel anxious even when there’s no apparent reason. For example, you may feel intense worry about your safety or that of your loved ones, or you may have a general sense that something bad is about to happen.

Your anxiety, worry or physical symptoms cause you significant distress in social, work or other areas of your life. Worries can shift from one concern to another and may change with time and age.

Symptoms in children and teenagers

In addition to the symptoms above, children and teenagers who have generalized anxiety disorder may have excessive worries about:

  • Performance at school or sporting events
  • Being on time (punctuality)
  • Earthquakes, nuclear war or other catastrophic events

A child or teen with generalized anxiety disorder may also:

  • Feel overly anxious to fit in
  • Be a perfectionist
  • Redo tasks because they aren’t perfect the first time
  • Spend excessive time doing homework
  • Lack confidence
  • Strive for approval
  • Require a lot of reassurance about performance

When to see a doctor

Some anxiety is normal, but see your doctor if:

  • You feel like you’re worrying too much, and it’s interfering with your work, relationships or other parts of your life
  • You feel depressed, have trouble with drinking or drugs, or you have other mental health concerns along with anxiety
  • You have suicidal thoughts or behaviors — seek emergency treatment immediately

Your worries are unlikely to simply go away on their own, and they may actually get worse over time. Try to seek professional help before your anxiety becomes severe — it may be easier to treat early on.

 The good news is with both these disorders is there is help, it can be medications, meditation,Journaling,  behavior therapy, mindfulness, exercise, seeing a counselor.   You can live a life with these disorders.

 

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