Coping Articles - Pain Management
RSD and the Eyes
RSD AND THE EYES, MY EXPERIENCE
Message from Keith
Many people ask about my personal experience with RSD and the eyes, which is how my RSD started. Unfortunately there is not much information out there concerning RSD and the eyes. Dr Hooshmand wrote a puzzle on it but I have yet to see any real studies on it or any in-depth articles on RSD and the eyes. In 1974, when I was 14, I developed an eye disease called Uveitis. Very soon after this disease started, I was hit in the nose by a baseball while I was pitching, and it shattered the bone. I know, it‘s a big target, lol. Of course they had to set it and I wore a nose cast for a few months, yes there IS such a thing and it ain‘t pretty. It covers the nose and both cheekbones. It was a wonderful look let me tell you, especially as a High School Freshman, no one worries how they look as a teenager do they? Hmmmm.
Very soon after I broke my nose I started to have severe burning pain in both eyes, especially the left side, as if they were two burning hot coals instead of eyes. If someone came to now and explained the pain that way of course I could tell him it sounds like RSD. It was constant severe pain and my vision was also affected adversely by light, causing me to wear dark glasses a lot of the time and during the worst of times forcing me to sit in a darkened room. This, the nose fracture, we found out later looking back; was the onset of my RSD. Way back in 1974.
My vision had gone to from 20/20 to 20/450 in my left eye and 20/200 in my right. Needless to say this made doing everything much more difficult. Reading and schoolwork were very tough, as was playing sports, but I refused to let it stop me. Not so much out of bravery but out of a desperate need to feel like a "normal" teenager. I know there are a lot of teens out there with RSD who can relate to most of what I was saying. I didn‘t realize at the time that memory problems, concentration difficulties, etc., were part and parcel of the disease that I didn‘t even know I had. I saw all sorts of specialists, all of whom told my parents that burning pain was NOT a symptom of Uveitis and said I was making it up for attention. Fortunately for me my parents never once doubted what I was saying and feeling. I know how lucky I am on that score. Then my sister got the same eye disease but fortunately she did not have the burning pain of RSD. This only served to reinforce the specialist‘s opinion that I was making up the burning pain. (my sister has since had Drs confirm that about the same time her uveitis started, she developed relapsing/remitting MS), I can‘t tell you how often I wished that those "specialists" could feel what I was feeling, if only for a few minutes. Then we would see if they thought it was in my head!
Over the years they got my vision to improve to 20/40 in my right eye and about 20/250 in my left. I had cataract surgery and a cornea transplant eventually but it did not improve the vision. They said it was sort of like putting a brand new blanket over a pile of rocks. And none of these things made the burning less. It actually seemed to make it worse, which now I understand was due to the fact that surgery in or around the RSD site can worsen the RSD. Bright light, overcast days, time on the computer etc., all can make it worse. There are days when I have flares just in the eyes.
Does this sound like anyone else out there? Unfortunately I would imagine so. The eye pain has never subsided and of course the RSD spread after I broke my back in 1985 and the subsequent surgery caused scar tissue which then pressed on the sciatic nerve; causing the RSD to start in my left foot on June 10th, 1992. By April of 1993 it had spread full body or "systemic". So I have had CRPS for over three decades. Yet I still remember how it felt to grow up as a teenager and then a college student with it. That is why the kids on RSDHopeKids and the teens on RSDHope Teen Corner mean so much to me. I have been where they are but had no one else to talk to.
I have found a couple of other people who have RSD in the eyes. It seems to be pretty rare. I thank God for that because, despite having RSD full body, and as excruciatingly painful as that is ... the pain of RSD in the eyes is beyond anything I have ever experienced. It is truly beyond description. Understand that I don't mean to diminish anyone else's pain by saying that. The pain ANY and EVERY RSD patient experiences, no matter how widespread or localized it is, is horrible. It seems to stretch us to our limits. But I have learned that that old expression, "God never gives us more than he thinks we can handle" is a lousy one. A better one is Mother Theresa's answer to that, "I just wish God didn't trust me so much".
In March of 2003 I had the Low-dose Ketamine Infusion treatment, the Awake Technique, done in Arizona by Dr Ronald Harbut. This is the method that is done over a period of four or five days in-hospital and so far has the highest success rate of all the ketamine treatment methods. It was amazing. I didn't expect much going in since I had had this awful disease for almost 30 years at that point, and it was full body, but we wanted to give it a try and he had had pretty good success. I was blessed with 85% relief from my RSD pain and allodynia (sensitivity to touch) !
It didn't affect my Fibromyalgia, degenerative disc disease, failed back syndrome, etc., but we did not expect it to. We were thrilled with what it did to the RSD. Unfortunately the eyes got no relief at all. They even got worse over the next couple of years. By February of 2005 the relief I had gotten from the treatment had dropped to about 50%. At this time we are contemplating doing a second ketamine treatment, which should occur sometime in early or mid 2007. (I since had a second treatment in April of 2007).
Since we began American RSDHope my family and I have talked to tens and tens of thousands of RSD patients and our website is now approaching 7,000,000 visitors! (when we stopped the counter in early 2011 it had gone beyond 13 million). It is vital at any age to have someone else who knows what the pain and problems are.
Remember, CRPS affects EVERYONE in the family. It is a wonderful feeling to know that even though our bodies aren‘t perfect, we still can be full of wonderful qualities that we don‘t see but others see in us. Never give up on life just because you have CRPS. There are so many things you can still do, even if you end up on disability; from volunteering at your local animal shelter to working with kids struggling to read, you name it. There are organizations to suit every interest out there all screaming for volunteers who would love to have you come and help for as little as an hour a week even.
Peace, it is all we seek,
Keith Orsini
Message from Keith
Many people ask about my personal experience with RSD and the eyes, which is how my RSD started. Unfortunately there is not much information out there concerning RSD and the eyes. Dr Hooshmand wrote a puzzle on it but I have yet to see any real studies on it or any in-depth articles on RSD and the eyes. In 1974, when I was 14, I developed an eye disease called Uveitis. Very soon after this disease started, I was hit in the nose by a baseball while I was pitching, and it shattered the bone. I know, it‘s a big target, lol. Of course they had to set it and I wore a nose cast for a few months, yes there IS such a thing and it ain‘t pretty. It covers the nose and both cheekbones. It was a wonderful look let me tell you, especially as a High School Freshman, no one worries how they look as a teenager do they? Hmmmm.
Very soon after I broke my nose I started to have severe burning pain in both eyes, especially the left side, as if they were two burning hot coals instead of eyes. If someone came to now and explained the pain that way of course I could tell him it sounds like RSD. It was constant severe pain and my vision was also affected adversely by light, causing me to wear dark glasses a lot of the time and during the worst of times forcing me to sit in a darkened room. This, the nose fracture, we found out later looking back; was the onset of my RSD. Way back in 1974.
My vision had gone to from 20/20 to 20/450 in my left eye and 20/200 in my right. Needless to say this made doing everything much more difficult. Reading and schoolwork were very tough, as was playing sports, but I refused to let it stop me. Not so much out of bravery but out of a desperate need to feel like a "normal" teenager. I know there are a lot of teens out there with RSD who can relate to most of what I was saying. I didn‘t realize at the time that memory problems, concentration difficulties, etc., were part and parcel of the disease that I didn‘t even know I had. I saw all sorts of specialists, all of whom told my parents that burning pain was NOT a symptom of Uveitis and said I was making it up for attention. Fortunately for me my parents never once doubted what I was saying and feeling. I know how lucky I am on that score. Then my sister got the same eye disease but fortunately she did not have the burning pain of RSD. This only served to reinforce the specialist‘s opinion that I was making up the burning pain. (my sister has since had Drs confirm that about the same time her uveitis started, she developed relapsing/remitting MS), I can‘t tell you how often I wished that those "specialists" could feel what I was feeling, if only for a few minutes. Then we would see if they thought it was in my head!
Over the years they got my vision to improve to 20/40 in my right eye and about 20/250 in my left. I had cataract surgery and a cornea transplant eventually but it did not improve the vision. They said it was sort of like putting a brand new blanket over a pile of rocks. And none of these things made the burning less. It actually seemed to make it worse, which now I understand was due to the fact that surgery in or around the RSD site can worsen the RSD. Bright light, overcast days, time on the computer etc., all can make it worse. There are days when I have flares just in the eyes.
Does this sound like anyone else out there? Unfortunately I would imagine so. The eye pain has never subsided and of course the RSD spread after I broke my back in 1985 and the subsequent surgery caused scar tissue which then pressed on the sciatic nerve; causing the RSD to start in my left foot on June 10th, 1992. By April of 1993 it had spread full body or "systemic". So I have had CRPS for over three decades. Yet I still remember how it felt to grow up as a teenager and then a college student with it. That is why the kids on RSDHopeKids and the teens on RSDHope Teen Corner mean so much to me. I have been where they are but had no one else to talk to.
I have found a couple of other people who have RSD in the eyes. It seems to be pretty rare. I thank God for that because, despite having RSD full body, and as excruciatingly painful as that is ... the pain of RSD in the eyes is beyond anything I have ever experienced. It is truly beyond description. Understand that I don't mean to diminish anyone else's pain by saying that. The pain ANY and EVERY RSD patient experiences, no matter how widespread or localized it is, is horrible. It seems to stretch us to our limits. But I have learned that that old expression, "God never gives us more than he thinks we can handle" is a lousy one. A better one is Mother Theresa's answer to that, "I just wish God didn't trust me so much".
In March of 2003 I had the Low-dose Ketamine Infusion treatment, the Awake Technique, done in Arizona by Dr Ronald Harbut. This is the method that is done over a period of four or five days in-hospital and so far has the highest success rate of all the ketamine treatment methods. It was amazing. I didn't expect much going in since I had had this awful disease for almost 30 years at that point, and it was full body, but we wanted to give it a try and he had had pretty good success. I was blessed with 85% relief from my RSD pain and allodynia (sensitivity to touch) !
It didn't affect my Fibromyalgia, degenerative disc disease, failed back syndrome, etc., but we did not expect it to. We were thrilled with what it did to the RSD. Unfortunately the eyes got no relief at all. They even got worse over the next couple of years. By February of 2005 the relief I had gotten from the treatment had dropped to about 50%. At this time we are contemplating doing a second ketamine treatment, which should occur sometime in early or mid 2007. (I since had a second treatment in April of 2007).
Since we began American RSDHope my family and I have talked to tens and tens of thousands of RSD patients and our website is now approaching 7,000,000 visitors! (when we stopped the counter in early 2011 it had gone beyond 13 million). It is vital at any age to have someone else who knows what the pain and problems are.
Remember, CRPS affects EVERYONE in the family. It is a wonderful feeling to know that even though our bodies aren‘t perfect, we still can be full of wonderful qualities that we don‘t see but others see in us. Never give up on life just because you have CRPS. There are so many things you can still do, even if you end up on disability; from volunteering at your local animal shelter to working with kids struggling to read, you name it. There are organizations to suit every interest out there all screaming for volunteers who would love to have you come and help for as little as an hour a week even.
Peace, it is all we seek,
Keith Orsini
Living With Insomnia: Get a Good Night's Sleep
When Pain Interrupts Your SleepWebMD Feature
By Elizabeth Shimer Bowers
Reviewed By Michael J. Breus, PhD
Whether it’s from a sore lower back or throbbing tooth, pain is hard enough to deal with in the light of day. But pain at night that robs you of your much-needed sleep can be downright exhausting.
“An individual simply cannot get comfortable to fall asleep due to the discomfort of pain,” says Frank. J. Falco, MD, who specializes in pain management and sleep problems in Newark, Del. Plus, pain causes anxiety, which disrupts sleep even more.
In addition to preventing a person from falling asleep, pain also results in difficulty stayingasleep. And once pain keeps you awake one night, it is likely to do the same thing again and again. Pain-related insomnia gets worse over time.
If pain keeps you up, take comfort in knowing you are not alone. According to the National Sleep Foundation, two out of three people with chronic pain have trouble sleeping.
Many types of pain can interrupt sleep, from the chronic pain of arthritis to the acute pain that follows surgery.
“But no matter what the cause, it is the intensity and quality of the pain, not necessarily the type, that determines the impact on a person’s quality of life, including sleep,” says Falco, who heads Mid-Atlantic Spine and Pain.
The Relationship Between Pain and Sleep“Pain is a sensation you feel when nerves are stimulated to an intense degree,” says Tracey Marks, MD, an Atlanta-based psychiatrist. Marks is author of Master Your Sleep: Proven Methods Simplified. “This stimulation activates the brain, which keeps you awake.”
Some of the ways pain causes insomnia include the following:
Pain at night disrupts sleep architecture.
“You need a certain amount of each stage of sleep to feel rested and for proper memory,” Marks says. These stages include light sleep, deep sleep, and REM (rapid eye movement) sleep. “We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. This reduced sleep -- in particular, shortened REM -- may increase sensitivity to pain.
Pain affects sleep position.
Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).
Sleep deprivation makes you more sensitive to pain.
A study in the April 2009 issue of Sleep Journal showed that normal, healthy individuals are more sensitive to pain when they are low on rest. The reasons why aren’t known for sure. “Some research studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines,” Marks says.
Pain medications interrupt sleep. Unfortunately, some of the medications prescribed for pain, such as codeine and morphine, can cause insomnia. These opioid pain medications can cause apnea, brief pauses in breathing, during sleep. “Therefore, people who take these kinds of medications for chronic pain are at a higher risk for sleep problems,” Falco says.
People with chronic pain may have trouble exercising. Lack of exercise leads to weight gain. Excess weight then restricts exercise, which leads to more pounds gained. “This vicious cycle can lead to sleep apnea, which prevents a restful night’s sleep,” Falco says.Article continues ... read parts two and three by clicking here
By Elizabeth Shimer Bowers
Reviewed By Michael J. Breus, PhD
Whether it’s from a sore lower back or throbbing tooth, pain is hard enough to deal with in the light of day. But pain at night that robs you of your much-needed sleep can be downright exhausting.
“An individual simply cannot get comfortable to fall asleep due to the discomfort of pain,” says Frank. J. Falco, MD, who specializes in pain management and sleep problems in Newark, Del. Plus, pain causes anxiety, which disrupts sleep even more.
In addition to preventing a person from falling asleep, pain also results in difficulty stayingasleep. And once pain keeps you awake one night, it is likely to do the same thing again and again. Pain-related insomnia gets worse over time.
If pain keeps you up, take comfort in knowing you are not alone. According to the National Sleep Foundation, two out of three people with chronic pain have trouble sleeping.
Many types of pain can interrupt sleep, from the chronic pain of arthritis to the acute pain that follows surgery.
“But no matter what the cause, it is the intensity and quality of the pain, not necessarily the type, that determines the impact on a person’s quality of life, including sleep,” says Falco, who heads Mid-Atlantic Spine and Pain.
The Relationship Between Pain and Sleep“Pain is a sensation you feel when nerves are stimulated to an intense degree,” says Tracey Marks, MD, an Atlanta-based psychiatrist. Marks is author of Master Your Sleep: Proven Methods Simplified. “This stimulation activates the brain, which keeps you awake.”
Some of the ways pain causes insomnia include the following:
Pain at night disrupts sleep architecture.
“You need a certain amount of each stage of sleep to feel rested and for proper memory,” Marks says. These stages include light sleep, deep sleep, and REM (rapid eye movement) sleep. “We normally go through four to six cycles of these stages per night. But if pain wakes you up, you spend too much time in light sleep,” she explains. This reduced sleep -- in particular, shortened REM -- may increase sensitivity to pain.
Pain affects sleep position.
Certain types of pain, such as arthritis pain and orthopedic pain, may prevent you from getting comfortable at night, says Reena Mehra, MD, of University Hospitals Case Medical Center in Cleveland. The medical director of adult sleep services says joint and muscle pain usually results in problems staying asleep (called sleep maintenance insomnia) rather than falling asleep (called sleep onset insomnia).
Sleep deprivation makes you more sensitive to pain.
A study in the April 2009 issue of Sleep Journal showed that normal, healthy individuals are more sensitive to pain when they are low on rest. The reasons why aren’t known for sure. “Some research studies show that sleep deprivation causes increased production of inflammatory chemicals in the body called cytokines,” Marks says.
Pain medications interrupt sleep. Unfortunately, some of the medications prescribed for pain, such as codeine and morphine, can cause insomnia. These opioid pain medications can cause apnea, brief pauses in breathing, during sleep. “Therefore, people who take these kinds of medications for chronic pain are at a higher risk for sleep problems,” Falco says.
People with chronic pain may have trouble exercising. Lack of exercise leads to weight gain. Excess weight then restricts exercise, which leads to more pounds gained. “This vicious cycle can lead to sleep apnea, which prevents a restful night’s sleep,” Falco says.Article continues ... read parts two and three by clicking here
HOW ARE PAIN MANAGEMENT DOCTORS DIFFERENT FROM OTHER HEALTHCARE PROVIDERS?
06/07/2007
WHAT IS PAIN MANAGEMENT?
Santhosh A. Thomas, D.O.
Medical Director, Westlake Spine Center, Cleveland Clinic, Westlake, Ohio
If you or a loved one live with pain everyday, a pain management doctor may be able to offer treatments to help reduce discomfort. Here you can learn how pain management doctors are different from other health care providers. For many pain patients, these specialists are truly special!
Did you know that more than 86 million Americans suffer pain? Or that about 80% of Americans will suffer at least one episode of back pain in their lifetimes? Back pain is a common complaint and a leading reason people seek medical care. There are many causes of acute or chronic back pain such as back strain, spinal stenosis, and osteoarthritis. But how is back pain treated? What happens if pain doesn't go away? To help answer those questions and others, this article provides information about many aspects of pain management including:
Most often, pain is classified as being either acute or chronic. Broader definitions and examples follow.
Acute pain may begin suddenly and is often described as feeling sharp. It is likened to the body's warning system signaling something is wrong. Most times, acute pain is quickly resolved, although by definition it may last 3 to 6 months. Patterns of recovery from acute pain are usually predictable and aid in developing a treatment plan. Pain specialists realize it is important to control acute pain to prevent it from becoming chronic. Causes of acute pain include:
Chronic pain affects people physically and emotionally. Physical symptoms include muscle tension, loss of mobility, lack of energy and appetite. The emotional affects can be similarly devastating and include depression, anger and anxiety. Causes of chronic pain can include:
Myofascial pain is caused by painful trigger points that develop in a muscle or a group of muscles. A trigger point is a locally sensitive and tender area in a muscle or where a muscle and fascia (band-like tissue encasing muscle) meet. Myofascial pain may cause 'referred pain' because when a trigger point is pressed the pain may be felt elsewhere. This pain may be chronic and described as nagging, burning, aching or stabbing.
Psychogenic pain presents as real physical pain caused by a psychological problem. This means the pain is caused by the patient's mental or emotional issues.
Radicular pain, or radiculitis, is caused by inflammation of a spinal nerve root. Other associated terms are 'cervical radiculitis' or 'lumbar radiculitis' meaning the pain originates from a cervical (neck) or lumbar (low back) spinal nerve. Sciatica is a commonly used term to describe pain that descends into the leg. Different disorders can cause spinal nerve compression, inflammation and pain. A spinal tumor or cyst, disc herniation, spinal stenosis and osteoarthritis can cause radiculitis.
Somatic pain is caused by bodily injury or other event affecting the pain receptors in the skin, ligaments, muscles, bones, or joints. This pain may be chronic and is sometimes associated with cancer.
Visceral pain is caused by internal organs that are damaged or injured.
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