Pain Management

knee Pain

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:28:00 +0000

Are your knees aching from a sudden injury, or have your symptoms developed gradually over time? A common physical complaint, knee pain can occur at any age and may interfere with many aspects of life, from participation in sports to simply getting up from a chair and walking. Any part of the knee — bones, cartilage, muscles, ligaments, and tendons — can be damaged by disease (such as arthritis) or injury.

Knee Pain Causes and Prevention

Knees suffer injury more often than any other joint. Often described as a simple hinge, the knee is actually quite complicated — it moves in six directions, which allows us to do a lot of different movements, but also increases the knee's chance of injury.

Knee Pain Diagnosis
What's causing your knee pain? When you see your doctor about a potential knee injury, the diagnostic process is most likely to begin with a complete medical history and physical examination of the knee. You may also undergo an X-ray, MRI, ultrasound, or other test to help determine the extent of knee damage.

Knee Pain Treatment
People with knee pain have many traditional treatment options, including medications, physical therapy, and surgery. There are also many complementary and alternative therapies that can help control knee pain.

Living With Knee Pain
Besides getting the right diagnosis and treatment, a few simple adjustments can make living with knee pain more manageable. Staying active and eating a healthy diet will also help promote healing.

Do Age and Hip Pain Always Go Together?

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:17:00 +0000

It's not written in stone that your hips will give out on you as you age. Learn how to avoid hip pain as you get older.

Common wisdom holds that as you age, you are destined to face a multitude of ills, including hip pain and possibly hip replacement surgery. In fact, hip replacement surgeries do increase after age 65.
Yet this does not have to be your future, say orthopedic surgeons. There are steps you can take to reduce the likelihood of hip pain and surgery as you age.
Hip Pain: It’s Not Inevitable
“Most people don’t get old and wear out. The hip joint is one of the best mechanically designed things that we’ve got,” says Steven Stuchin, MD, director of orthopedic surgery at the Hospital for Joint Diseases of New York University Medical Center and associate professor at NYU School of Medicine in New York City. “The hip is a round ball in a round socket, and nothing is better equipped to deal with stress and motion. For most, hip pain is not a product of aging — it is a product of injury or disease.”
One possible reason that the numbers of hip replacement surgeries appears to skyrocket as people age is that after age 65, Medicare coverage makes long-awaited joint replacement surgeries possible — an individual may have been coping with hip pain for years without insurance to cover the surgery.

Hip Pain: A Matter of Time
It is true that the longer you live, the greater the incidence of arthritis,” says Thomas Parker Vail, MD, professor and chairman of orthopedic surgery at the University of California, San Francisco. “Your risk of having arthritis is greater, partly related to genetics, partly related to injury, partly related to factors that we don’t completely understand about why joints deteriorate.”
Dr. Vail says that as people age, their cartilage, which acts as the cushion between bones that allows them to move freely in a joint, loses its ability to hold water. “It’s the water that cartilage contains that allows it to act like a shock absorber. Cartilage can begin to wear down just like any other shock absorber. When the cartilage wears down, becomes thinner, and loses its mechanical resiliency, that leads to inflammation and fluid in the joint — all of which is perceived as being uncomfortable,” explains Vail. If this process continues, the perfectly designed ball and socket do not match or move as well as they did in earlier years. Yet Vail and Stuchin both stress that many people in their 80s have no hip pain at all.
Hip Pain: Limiting the Risk Factors
Although hip pain may be related to factors beyond your control, like genetic inheritance or structural problems from birth, there are several steps you can take to reduce your risk of hip pain:

Maintain a healthy weight throughout your life. A review of charts from 305 adults between 18 and 59 years old found that obesity significantly increased the likelihood of having a total hip or total knee replacement.
Protect the health of your bones. Developing osteoporosis, a condition in which the bones become weakened through loss of calcium, can lead to hip pain as a result of fractures and falls. Stay active, eat calcium-rich foods, and get recommended levels of vitamin D throughout your life to help maintain strong bones.
Learn about fall prevention. Falls are more likely as you age for a number of reasons, ranging from loss of balance to the side effects of medications. Seek advice for preventing falls at home and at work.
Seek medical help early. Whether your hip pain is due to arthritis or a repetitive stress injury from sports, talk to your doctor. She can help you make a plan to manage your hip pain.

Hip Pain: Are Lifestyle Choices to Blame?
A change in lifestyle, not age alone, is probably what led to hip pain for Joan O’Connor, a 62-year-old small business owner in San Francisco with osteoarthritis. For most of her working life, she held a desk job; then several years ago she decided to open a home decor and antiques store.
“When I changed my job and started my own business, I became much more active physically, climbing a ladder, carrying stuff. I would come home after work and my joint was so painful. I had no idea what was going on,” says O’Connor. Walking through the uneven streets of San Francisco didn’t help — two falls in a year led her to try acupuncture, chiropractic interventions, and, eventually, a total hip replacement.
Understanding how age, weight, and other factors may influence your hip pain can help you make decisions about preventing it or, if you experience it, seeking care early.

Hip Pain and Arthritis: Get the Facts

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:14:00 +0000

Hip pain is commonly due to arthritis. Find out how arthritis causes wear and tear on the hip joints and can even lead to hip replacement.

Arthritis is a frequent cause of hip pain and hip replacement. Yet the term arthritis actually covers a number of different conditions, such as osteoarthritis, rheumatoid arthritis, and psoriatic arthritis.
Hip Pain and Osteoarthritis
“The most common type of arthritis is osteoarthritis, so-called ‘wear and tear arthritis,’” says Thomas Parker Vail, MD, professor and chairman of orthopedic surgery at the University of California, San Francisco.
Osteoarthritis is caused by the gradual wearing down of cartilage in a joint, which can lead to inflammation of joint lining. It can also be due to an injury to the joint, sometimes referred to as “traumatic arthritis.”
Risk factors for osteoarthritis include:

Aging
Obesity
Damage or trauma to the joint
Structural problems with the joint
Having rheumatoid arthritis

Symptoms of osteoarthritis develop slowly, beginning with stiffness or soreness in your hip or hips and eventually becoming painful enough to prevent you from doing normal activities, such as walking or climbing stairs.
Look out for any of these symptoms:

Pain in the inner thigh, buttock, or groin area
Pain in your outer thigh down to your knee
Tendency to limp

Hip Pain and Rheumatoid Arthritis
“There are other conditions like rheumatoid arthritis in which inflammation rather than the wear and tear instigates pain. It may be an immune system response that causes the deterioration characteristic of this kind of joint pain,” explains Dr. Vail, who notes that this is often seen at its most extreme in children who have juvenile rheumatoid arthritis.
Rheumatoid arthritis (RA) is a chronic disease that affects the entire body, not just your hips. It begins with a swelling of the lining of joints, called the synovial lining, and progresses to the deterioration of bone and cartilage.
One way to tell the difference between RA and osteoarthritis is to note whether you have pain in only one or two joints (such as your hips) or whether you feel it in other joints, including your knuckles, knees, and shoulders. If you feel pain in many joints, that indicates more of a systemic problem as opposed to the wear and tear of osteoarthritis, says Vail.
The cause of RA is not fully understood, although researchers believe that an abnormal response of the body’s immune system contributes to the disease. Research also points to the possibility that RA’s cause lies in your genes or even infections. Women are particularly at risk. They are two to three times more likely than men to develop RA and are most vulnerable in the year after giving birth.
Symptoms of RA include:

Pain developing in joints on both sides of the body, like the same knuckle on the right hand as on the left
Swelling of the affected joints
Tiredness
Morning stiffness
Soreness after sitting for a long time
Weakness
Muscle pain
Anemia
Unusual lumps, especially on elbows, called rheumatoid nodules

Early diagnosis of RA is critical to preserving your quality of life, so see a doctor as soon as you become concerned about joint pain.

Five Common Causes of Hip Pain in Women

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:11:00 +0000

Hip pain in women can be caused by wear and tear, overuse, and a few other sources. Women may be able to use anti-inflammatories for their hip pain.

When you tell your doctor your hip hurts, the first thing he should do is confirm that your hip is actually the problem. Women might say they have hip pain, but what they may mean is they have pain in the side of the upper thigh or upper buttock, or they may be experiencing lower back pain, says Stephanie E. Siegrist, MD, an orthopedic surgeon in Rochester, N.Y., and spokeswoman for the American Academy of Orthopaedic Surgeons. Hip pain is often felt in the groin or on the outside of the hip directly over where the hip joint (a ball-and-socket joint) is located.
Five Common Causes of Hip Pain in Women
When a female patient comes to Dr. Siegrist complaining of hip pain, she considers the patient's age, build, and activity level. If the patient is a thin 20-year-old runner or a heavy, sedentary 80-year-old grandmother, “the possibilities at the top of my list will be different,” she says.

Among the most common causes of hip pain in women are:

Arthritis. The most common cause of chronic hip pain in women is arthritis, particularly osteoarthritis, the wear-and-tear kind that affects many people as they age. “The ball-and-socket joint starts to wear out,” Siegrist says. Arthritis pain is often felt in the front of your thigh or in the groin, due to stiffness or swelling in the joint.
Hip fractures. Hip fractures are common in older women, especially those with osteoporosis (decreased bone density). A woman over age 65 has a one in five chance of experiencing a hip fracture. Symptoms of a hip fracture include pain when you straighten, lift, or stand on your leg. Also, the toes on your injured side will appear to turn out, a sign that can aid your doctor’s preliminary diagnosis.
Tendinitis and bursitis. Many tendons around the hip connect the muscles to the joint. These tendons can easily become inflamed if you overuse them or participate in strenuous activities, leading to hip pain in women. One of the most common causes of tendinitis at the hip joint is iliotibial band syndrome — the iliotibial band is the thick span of tissue that runs from the outer rim of your pelvis to the outside of your knee. Runners are prone to iliotibial band injuries. Another common cause of hip pain in women is bursitis, says Marc Philippon, MD, an orthopedic surgeon in Vail, Colo. Fluid-filled sacs called bursae cushion the bony part of the hip that is close to the surface. Like the tendons, these sacs can become inflamed from irritation or overuse, he says. If the sacs are inflamed and you move the hip joint, you will feel pain. Your hip can hurt when you get up from a chair, climb stairs, walk, and even drive.
Hernia. In the groin area, femoral and inguinal hernias — sometimes referred to as sports hernias — can cause anterior (frontal) hip pain in women. Pregnant women can be susceptible to inguinal hernias because of the added pressure on the wall of their abdomen.
Gynecological and back issues. “Hip pain in women can have gynecological causes,” Siegrist says. “It’s important not to just assume that the pain is caused by arthritis, bursitis or tendinitis. Depending on your age and other health issues, the pain in your hip could be coming from some other system.” Endometriosis (when the uterus lining grows somewhere else) can cause pelvic tenderness, which some women describe as hip pain. Pain from the back and spine also can be referred and felt around the buttocks and hip, Siegrist says. Sciatica, a pinched nerve, can cause pain in the back of the hip — the pain from sciatica can start in your lower back and travel down to your buttocks and legs.

Hip Pain: What Do Your Symptoms Mean?

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:06:00 +0000

When you visit your doctor to find out what you should do about your hip pain, she will probably ask you to describe the kind of pain you are experiencing. Hearing about your symptoms of hip pain will help her determine the cause of your discomfort.
“The first question is, where does the hip hurt?” says Steven Stuchin, MD, director of orthopedic surgery at the Hospital for Joint Diseases of New York University Medical Center and associate professor at the NYU School of Medicine in New York City.
Many people are confused about where their hip really is. “Pain that involves the hip joint is usually in the groin, right where your leg meets your body," Dr. Stuchin says. "The hip joint is in the groin and you can feel it as low as your knee, in the front of your leg down the thigh.”
Here are some common hip pain complaints and their symptoms.
Arthritis: With arthritis-based hip pain, it hurts to move your legs. That includes walking, climbing stairs, and bending down to pick things up. There are many reasons arthritis could be causing your hip pain:

Osteoarthritis can occur after an injury or infection causes damage to the hip joint.
Hip dysplasia, a problem with the formation of your hip, can cause early hip arthritis.
Rheumatoid arthritis causes an inflammatory immune response that affects all your joints.

Piriformis syndrome: With piriformis syndrome, moving the leg out or back from the body causes pain in the buttocks and lower back. “Your hip has some very powerful muscles. Among them is the piriformis,” explains Stuchin. “The piriformis is in the back of the hip and helps rotate the leg outwards.”

The sciatic nerve is just behind it; in some people, the nerve goes between the tendons of the piriformis muscle. When the muscle pulls, it acts like a pincer on the nerve, causing the pain you feel, explains Stuchin.
Snapping hip: A patient might tell her doctor: “When I move my leg, I feel a pop in my hip at the top of my thigh.” The snapping sound is a tendon, explains Stuchin. Some people are born with a tendon that “snaps” over the top of the femur, the bone that makes up your thigh. “As your leg moves, if that sheath of stuff catches on that bony projection, you’ll get a ‘snap.’”
Stress fracture of the femoral neck: A stress fracture of the femoral neck starts as a dull ache in the groin and gets progressively worse. The femoral neck is the region between the ball at the top of your femur (thigh bone) that moves in the socket of your pelvis bone and the rest of the femur. This can also feel like a pulled muscle, but unlike a muscle, it won’t respond to taking a break from exercise. There are two common reasons for a stress fracture to this area:

A fall
A repetitive stress injury as a result of vigorous exercise

Trochanteric bursitis: A patient might tell his doctor: “It’s painful to lie on my hip and at other times, I feel pain on the outside of that hip and upper thigh.” Trochanteric bursitis is an inflammation of the bursae, the fluid filled sacs that act as a cushion, located over the greater trochanter (a bony prominence next to the femoral neck).
If these hip pain descriptions do not perfectly explain your hip pain, don’t worry. Through the right diagnostic tests, your doctor probably still will be able to help identify and treat your pain.

Hip Pain

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 13:05:00 +0000

Hip pain can make everyday tasks, including getting in and out of a car or walking up a flight of stairs, nearly impossible. Hip pain can affect people of all ages and be caused by injuries to the hip joints or muscles, or by conditions such as tendinitis, bursitis, or osteoarthritis.

Hip Pain Causes and Prevention

Arthritis is one of the most common causes of hip pain, but other conditions can also cause sharp pain in the hip area, including sciatica, tendinitis, osteoporosis, or infection. Fracture is another serious cause of hip pain. Staying in shape with the right diet and exercise, especially stretching, can help lessen the risk of hip problems.

Hip Pain Causes and Prevention
Arthritis is one of the most common causes of hip pain, but other conditions can also cause sharp pain in the hip area, including sciatica, tendinitis, osteoporosis, or infection. Fracture is another serious cause of hip pain. Staying in shape with the right diet and exercise, especially stretching, can help lessen the risk of hip problems.

Hip Pain Diagnosis
Have you been slowing down lately because of soreness, stiffness, or pain in your hip? Because hip pain can be due to a number of different causes, the first step toward diagnosing hip pain is to discuss your medical and health history with your doctor. You may also undergo different tests, such as blood work, X-rays, or MRIs.
- Getting a Hip Pain Diagnosis
- Taking Hip Pain Seriously
- Tracking the Symptoms of Hip Arthritis
- Snap, Pop, or Grating in a Hip
- Hip Pain Treatment
  It's important to get an accurate diagnosis to get the right treatment for hip pain. In most cases, the first remedies used to treat hip pain usually include rest, exercises, and an over-the-counter or prescription pain medication. Physical therapy and assistive devices can also help. But if conservative management doesn't do the trick, hip replacement surgery may be needed.
  - 6 Moves for Hip Pain
  - Non-Surgical Treatment for Hip Pain
  - Physical Therapy After Hip Surgery
  - Treating Hip Pain With Acupuncture

Childcare

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 12:55:00 +0000

Child Care Centers

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 12:54:00 +0000

Child Care Centers care for children in groups. All states require centers to be licensed. The definition of licensed child care varies by state or territory.
Licensing does not insure quality but it does set minimum health, safety and caregiver training standards which centers must maintain. All states inspect centers at least once a year.
Parents choose centers because they believe that larger groups, multiple caregivers and state inspections make programs safer for their children and make the arrangement more dependable. They respect the reputation of the child care program or the institution sponsoring the program.
Many parents believe that more staff, space, equipment, toys and organized activities provide a better learning environment for their children.

5 Steps To Choosing Care

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 12:51:00 +0000

Start Early
Start looking as far in advance as you can. No matter what type of care you are considering - a child care center or care in someone else's home - finding the right child care option can take some time.
Make a Call
Begin your search by calling your local experts - your Child Care Resource and Referral (CCR&R) agency. CCR&Rs can give you the facts about child care, and a list of child care options in your area that may meet your needs. In addition to what is in this brochure, make sure to ask your CCR&R:

What are the licensing requirements in my area?
How can I get information about complaints and licensing violations?
Does my family qualify for any child care financial assistance programs?

Visit and Ask Questions
Visit the child care options you are considering. Find out about these key indicators of quality:

Adult to Child Ratio. Ask how many children there are for each adult. The fewer the children for each adult, the better for your child. You want your child to get plenty of attention. The younger your child, the more important this is. Babies need an adult to child ratio of no more than 1:4 (one adult for four infants), while four-year-olds can do well with a ratio of 1:10 (one adult for 10 children).
Group Size. Find out how many children are in the group. The smaller the group, the better. Imagine a group of 25 two-year olds with five adults, compared to a group of 10 with two adults. Both groups have the same adult to child ratio. Which would be calmer and safer? Which would be more like a family?
Caregiver Qualifications. Ask about the caregivers' training and education. Caregivers with degrees and/or special training in working with children will be better able to help your child learn. Are the caregivers involved in activities to improve their skills? Do they attend classes and workshops?
Turnover. Check how long caregivers have been at the center or providing care in their homes. It's best if children stay with the same caregiver at least a year. Caregivers who come and go make it hard on your child. Getting used to new caregivers takes time and energy that could be spent learning new things.
Accreditation. Find out if the child care provider has been accredited by a national organization. Providers that are accredited have met voluntary standards for child care that are higher than most state licensing requirements.The National Association for the Education of Young Children (NAEYC) and The National Association for Family Child Care (NAFCC) are the two largest organizations that accredit child care programs.

Make a Choice
Think about what you saw at each visit, and make the best choice for your child and family.
Stay Involved
The work isn't over when you find good care for your child. You and your child's caregiver are partners now.
Here are some ways to be involved:

Have parent-caregiver meetings regularly, and ask questions.
Offer to volunteer time when needed, like participating in clean up days, fixing broken toys.
Be there for your child's birthday party.
Visit your child at child care and read a book aloud.
Join in special events, like field trips, Career Day, Black History Month, or other holidays.

Even if you can't get time off from work during the day, you can still check in at drop-off and pick-up times. Ask the caregiver how things are going, and how your child is doing.
Visiting and participating in events at your child's provider sends a strong message. It tells your child and your child's caregiver that you think what your child is doing and learning is important.

Epidural steroid injections

noreply@blogger.com (Pain Management) — Sat, 13 Aug 2011 12:31:00 +0000

An epidural injection, or epidural steroid injection, may be used to help reduce the pain caused by a herniated disc, degenerative disc disease, or stenosis (cervical spinal stenosis or lumbar spinal stenosis). These spinal disorders often affect the cervical (neck) and lumbar (lower back) areas of the spine.
The medicine used in the injection is usually a combination of a local anesthetic (e.g. bupivacaine) and a steroid (e.g. triamcinolone). The technique and risks of the procedure are similar to those for standard epidural analgesia. The effects of an epidural steroid injection vary, but permanent benefit is unlikely.^[18] The technique is believed to work by reducing the inflammation or swelling, or both, of the nerves in the epidural space.
Some patients who have some residual pain after the first injection may receive a second or third epidural steroid injection. Patients who do not receive any relief from the first injection are unlikely to benefit from a second injection.

Kidney Stone and Symptoms

noreply@blogger.com (Pain Management) — Thu, 11 Aug 2011 19:46:00 +0000

A kidney stone, also known as a renal calculus (from the Latin ren, "kidney" and calculus, "pebble") is a solid concretion or crystal aggregation formed in the kidneys from dietary minerals in the urine. Urinary stones are typically classified by their location in the kidney (nephrolithiasis), ureter (ureterolithiasis), or bladder (cystolithiasis), or by their chemical composition (calcium-containing, struvite, uric acid, or other compounds). Kidney stones are a significant source of morbidity. 80% of those with kidney stones are men. Men most commonly experience their first episode between age 30–40 years, while for women the age at first presentation is somewhat later.
Kidney stones typically leave the body by passage in the urine stream, and many stones are formed and passed without causing symptoms. If stones grow to sufficient size (usually at least 3 millimeters (0.12 in) they can cause obstruction of the ureter. Ureteral obstruction causes postrenal azotemia and hydronephrosis (distension and dilation of the renal pelvis and calyces), as well as spasm of the ureter. This leads to pain, most commonly felt in the flank (the area between the ribs and hip), lower abdomen and groin (a condition called renal colic). Renal colic can be associated with nausea, vomiting, fever, blood in the urine, pus in the urine, and painful urination. Renal colic typically comes in waves lasting 20 – 60 minutes, beginning in the flank or lower back and often radiating to the groin or genitals. The diagnosis of kidney stones is made on the basis of information obtained from the history, physical examination, urinalysis, and radiographic studies. ultrasound examination and blood tests may also aid in the diagnosis.
When a stone causes no symptoms, watchful waiting is a valid option. For symptomatic stones, pain control is usually the first measure, using medications such as non-steroidal anti-inflammatory drugs (NSAIDs) or opioids. More severe cases may require surgical intervention. For example, some stones can be shattered into smaller fragments using extracorporeal shock wave lithotripsy (ESWL). Some cases require more invasive forms of surgery. Examples of these are cystoscopic procedures such as laser lithotripsy, or percutaneous techniques such as percutaneous nephrolithotomy. Sometimes, a tube (ureteral stent) may be placed in the ureter to bypass the obstruction and alleviate the symptoms.

kidney stones symptoms and signs?

While some kidney stones may not produce symptoms (known as "silent" stones), people who have kidney stones often report the sudden onset of excruciating, cramping pain in their low back and/or side, groin, or abdomen. Changes in body position do not relieve this pain. The abdominal, groin, and/or back pain typically waxes and wanes in severity, characteristic of colicky pain (the pain is sometimes referred to as renal colic). It may be so severe that it is often accompanied by nausea and vomiting. Kidney stones also characteristically cause blood in the urine. If infection is present in the urinary tract along with the stones, there may be fever and chills. Sometimes, symptoms such as difficulty urinating, urinary urgency, penile pain, or testicular pain may occur due to kidney stones.

How are kidney stones diagnosed?

The diagnosis of kidney stones is suspected by the typical pattern of symptoms when other possible causes of the abdominal or flank pain are excluded. Imaging tests are usually done to confirm the diagnosis. A helical CT scan without contrast material is the most common test to detect stones or obstruction within the urinary tract. Formerly, an intravenous pyelogram (IVP; an X-ray of the abdomen along with the administration of contrast dye into the bloodstream) was the test most commonly used to detect urinary tract stones, but this test has a greater risk of complications, takes longer, and involves higher radiation exposure than the non-contrasted helical CT scan. Helical CT scans have been shown to be a significantly more effective diagnostic tool than the IVP in the diagnosis of kidney or urinary tract stones.
In pregnant women or those who should avoid radiation exposure, an ultrasound examination may be done to help establish the diagnosis.

Treatment for kidney stones? How long does it take to pass a kidney stone?

Most kidney stones eventually pass through the urinary tract on their own within 48 hours, with ample fluid intake. Ketorolac (Toradol), an injectable anti-inflammatory drug, and narcotics may be used for pain control when over-the-counter pain-control medications are not effective. Intravenous pain medications can be given when nausea and vomiting are present.
Although there are no proven home remedies to dissolve kidney stones, home treatment may be considered for patients who have a known history of kidney stones. Since most kidney stones, given time, will pass through the ureter to the bladder on their own, treatment is directed toward control of symptoms. Home care in this case includes the consumption of plenty of fluids. Ibuprofen (Advil) may be used as an anti-inflammatory medication if there is no contraindication to its use. If further pain medication is needed, stronger narcotic pain medications may be recommended.
There are several factors which influence the ability to pass a stone. These include the size of the person, prior stone passage, prostate enlargement, pregnancy, and the size of the stone. A 4 mm stone has an 80% chance of passage while a 5 mm stone has a 20% chance. Stones larger than 9 mm-10 mm rarely pass without specific treatment.
Some medications have been used to increase the passage rates of kidney stones. These include calcium channel blockers such as nifedipine (Adalat, Procardia, Afeditab, Nifediac) and alpha blockers such as tamsulosin (Flomax). These drugs may be prescribed to some people who have stones that do not rapidly pass through the urinary tract.
For kidney stones that do not pass on their own, a procedure called lithotripsy is often used. In this procedure, shock waves are used to break up a large stone into smaller pieces that can then pass through the urinary system.
Surgical techniques have also been developed to remove kidney stones when other treatment methods are not effective. This may be done through a small incision in the skin (percutaneous nephrolithotomy) or through an instrument known as an ureteroscope passed through the urethra and bladder up into the ureter.

Pain management Articles

noreply@blogger.com (Pain Management) — Thu, 11 Aug 2011 19:31:00 +0000

What is Pain management
Low Back Pain
Heart-to-Heart: Beyond Pain
Kidney Stone and Symptoms
Hip Pain

Low back pain

noreply@blogger.com (Pain Management) — Thu, 11 Aug 2011 19:26:00 +0000

Low back pain (or lumbago, English pronunciation: /lʌmˈbeɪgoʊ/) is a common musculoskeletal disorder affecting 80% of people at some point in their lives. In the United States it is the most common cause of job-related disability, a leading contributor to missed work, and the second most common neurological ailment — only headache is more common.^[1] It can be either acute, subacute or chronic in duration. With conservative measures, the symptoms of low back pain typically show significant improvement within a few weeks from onset.

What is the anatomy of the low back?

The first step to understanding the various causes of low back pain is learning about the normal design (anatomy) of the tissues of this area. Important structures of the low back that can be related to symptoms there include the bony lumbar spine (vertebrae, singular = vertebra), discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
The bony lumbar spine is designed so that vertebrae "stacked" together can provide a movable support structure while also protecting the spinal cord from injury. The spinal cord is composed of nervous tissue that extends down the spinal column from the brain. Each vertebra has a spinous process, a bony prominence behind the spinal cord, which shields the cord's nervous tissue from impact trauma. Vertebrae also have a strong bony "body" (vertebral body) in front of the spinal cord to provide a platform suitable for weight bearing of all tissues above the buttocks. The lumbar vertebrae stack immediately atop the sacrum bone that is situated in between the buttocks. On each side, the sacrum meets the iliac bone of the pelvis to form the sacroiliac joint of the buttocks.
The discs are pads that serve as "cushions" between the individual vertebral bodies. They help to minimize the impact of stress forces on the spinal column. Each disc is designed like a jelly donut with a central softer component (nucleus pulposus) and a surrounding outer ring (annulus fibrosus). The central portion of the disc is capable of rupturing (herniating) through the outer ring, causing irritation of adjacent nervous tissue and sciatica as described below.
Ligaments are strong fibrous soft tissues that firmly attach bones to bones. Ligaments attach each of the vertebrae to each other and surround each of the discs.
The nerves that provide sensation and stimulate the muscles of the low back as well as the lower extremities (the thighs, legs, feet, and toes) exit the lumbar spinal column through bony portals, each of which is called a "foramen."
Many muscle groups that are responsible for flexing, extending, and rotating the waist, as well as moving the lower extremities, attach to the lumbar spine through tendon insertions.
The aorta and blood vessels that transport blood to and from the lower extremities pass in front of the lumbar spine in the abdomen and pelvis. Surrounding these blood vessels are lymph nodes (lymph glands) and tissues of the involuntary nervous system that are important in maintaining bladder and bowel control.
The uterus and ovaries are important pelvic structures in front of the pelvic area of women. The prostate gland is a significant pelvic structure in men. The kidneys are on either side of the back of the lower abdomen, in front of the lumbar spine.
The skin over the lumbar area is supplied by nerves that come from nerve roots that exit from the lumbar spine.

The majority of lower back pain stems from benign musculoskeletal problems, and are referred to as non specific low back pain; this type may be due to muscle or soft tissues sprain or strain,^[3] particularly in instances where pain arose suddenly during physical loading of the back, with the pain lateral to the spine. Over 99% of back pain instances fall within this category.^[4] The full differential diagnosis includes many other less common conditions.

Mechanical:
- Apophyseal osteoarthritis
- Diffuse idiopathic skeletal hyperostosis
- Degenerative discs
- Scheuermann's kyphosis
- Spinal disc herniation ("slipped disc")
- Thoracic or lumbar spinal stenosis
- Spondylolisthesis and other congenital abnormalities
- Fractures
- Leg length difference
- Restricted hip motion
- Misaligned pelvis - pelvic obliquity, anteversion or retroversion
- Abnormal Foot Pronation

Inflammatory:
- Seronegative spondylarthritides (e.g. ankylosing spondylitis)
- Rheumatoid arthritis
- Infection - epidural abscess or osteomyelitis

Neoplastic:
- Bone tumors (primary or metastatic)
- Intradural spinal tumors

Metabolic:
- Osteoporotic fractures
- Osteomalacia
- Ochronosis
- Chondrocalcinosis

Psychosomatic
- Tension myositis syndrome

Paget's disease

Referred pain:
- Pelvic/abdominal disease
- Prostate Cancer
- Posture

What is the treatment for low back pain?

So, how is low back pain treated? Well, as described above, the treatment very much depends on the precise cause of the low back pain. Moreover, each patient must be individually evaluated and managed in the context of the underlying background health status and activity level.
As has been highlighted by research presented at the national meeting of the American College of Rheumatology, a very important aspect of the individual evaluation is the patient's own perception of their particular situation. British researchers found that those who believed that their symptoms had serious consequences on their lives and that they had, or treatments had, little control over their symptoms were more likely to have a poor outcome. This research points out to physicians the importance of addressing the concerns and perceptions that patients have about their condition during the initial evaluations.
Finally, it should be noted that the conditions listed above are intended for general review. There are many other causes of back pain, including upper back pain, that have not been discussed.

Heart-to-Heart: Beyond Pain

noreply@blogger.com (Pain Management) — Thu, 11 Aug 2011 19:12:00 +0000

Heart-to-Heart: Beyond Pain

Listen to an 18-minute program on pain control that dispels common myths that many people -- including doctors -- have about pain medications. This segment explains how good pain management can help you keep going as best you can. But getting good pain management may be difficult due to poor physician training, concerns about drug addiction, and laws that can get in the way of needed pain medications. The extract is taken from the Heart-to-Heart: Caring for the Dying documentary series, which provides three hours of audio education on end-of-life care. [Audio requires Microsoft Media Player]

Videos

noreply@blogger.com (Pain Management) — Wed, 10 Aug 2011 10:18:00 +0000

Electrotherapy

Pain management

noreply@blogger.com (Pain Management) — Wed, 10 Aug 2011 09:34:00 +0000

Pain management (also called pain medicine; algiatry) is a branch of medicine employing an interdisciplinary approach for easing the suffering and improving the quality of life of those living with pain.^[1] The typical pain management team includes medical practitioners, clinical psychologists, physiotherapists, occupational therapists, and nurse practitioners.^[2] Pain sometimes resolves promptly once the underlying trauma or pathology has healed, and is treated by one practitioner, with drugs such as analgesics and (occasionally) anxiolytics. Effective management of long term pain, however, frequently requires the coordinated efforts of the management team.^[3]
Medicine treats injury and pathology to support and speed healing; and treats distressing symptoms such as pain to relieve suffering during treatment and healing. When a painful injury or pathology is resistant to treatment and persists, when pain persists after the injury or pathology has healed, and when medical science cannot identify the cause of pain, the task of medicine is to relieve suffering. Treatment approaches to long term pain include pharmacologic measures, such as analgesics, tricyclic antidepressants and anticonvulsants, interventional procedures, physical therapy, physical exercise, application of ice and/or heat, and psychological measures, such as biofeedback and cognitive behavioral therapy.

for more detail visit on http://en.wikipedia.org/wiki/Pain_management