Health and Pain Mind

A headache or cephalalgia is pain anywhere in the region of the head or neck. It can be a symptom of a number of different conditions of the head and neck.  The brain tissue itself is not sensitive to pain because it lacks pain receptors. Rather, the pain is caused by disturbance of the pain-sensitive structures around the brain. Nine areas of the head and neck have these pain-sensitive structures, which are the cranium (the periosteum of the skull), muscles, nerves, arteries and veins, subcutaneous tissues, eyes, ears, sinuses and mucous membranes.

According to MediLexicon’s medical dictionary, Headache means “Pain in various parts of the head, not confined to the area of distribution of any nerve”. In fact, there are several different types of headaches. Headache is also known as Cephalalgia. Cephalalgia comes from the Greek kephale meaning “head”, and algos meaning “pain”. Some of the causes of headaches are benign while others can be medical emergencies.

Common types of headache:

Each of the links below goes to a medical dictionary definition on www.medilexicon.com.

• benign exertional headache
• bilious headache
• blind headache
• cluster headache
• coital headache
• drug-induced headache
• fibrositic headache
• histaminic headache
• Horton headache
• ice pick headache
• idiopathic stabbing headache
• medication-overuse headache
• migraine headache
• migraine without headache
• muscle contraction headache
• nodular headache
• organic headache
• posttraumatic headache
• reflex headache
• sick headache
• spinal headache
• symptomatic headache
• tension headache
• tension-type headache
• thunderclap headache
• vacuum headache
• vascular headache

Tension headaches:Also called chronic daily headaches or chronic non-progressive headaches, tension headaches are the most common type of headaches among adults and adolescents. These muscle contraction headaches cause mild to moderate pain and come and go over a prolonged period of time.

Migraines: The exact causes of migraines are unknown. A popular theory is that various triggers cause abnormal brain activity, which in turn causes changes in the blood vessels in the brain. This is called the neurovascular theory. Genetics plays a role in migraines and there are some forms of migraines that are associated with inherited abnormalities in certain parts of the brain. Migraine pain is moderate to severe, often described as pounding, throbbing pain. Migraine headaches can last from four hours to three days and usually occur one to four times per month. Migraines are associated with symptoms such as sensitivity to light, noise, or odors; nausea or vomiting; loss of appetite; and stomach upset or abdominal pain. When a child is having a migraine, he or she often looks pale, feels dizzy, has blurred vision, fever, stomach upset, along with the symptoms listed above.

A small percentage of children’s migraines include recurrent (cyclic) gastrointestinal symptoms, vomiting being the most common. Cyclic vomiting means that the symptoms occur on a regular basis — about once a month. These types of migraines are sometimes called abdominal migraines.

Mixed headache syndrome: Also called transformed migraines, mixed headache syndrome is a combination of migraine and tension headaches. Both adults and children experience this type of headache.

Cluster headaches: The least common — although the most severe — type of primary headache, the pain of a cluster headache is intense and may be described as having a burning or piercing quality that is throbbing or constant. The pain is so severe that most cluster headache sufferers cannot sit still and will often pace during an attack. The pain is located behind one eye or in the eye region, without changing sides. The term “cluster headache” refers to headaches that have a characteristic grouping of attacks. Cluster headaches occur one to three times per day during a cluster period, which may last two weeks to three months. The headaches may disappear completely (go into “remission”) for months or years, only to recur.

Sinus headaches: Sinus headaches are associated with a deep and constant pain in the cheekbones, forehead, or bridge of the nose. The pain usually intensifies with sudden head movement or straining and usually occurs with other sinus symptoms, such as nasal discharge, feeling of fullness in the ears, fever, and facial swelling.

Acute headaches:Seen in children, these are headaches that occur suddenly and for the first time and have symptoms that subside after a relatively short period of time. Acute headaches most commonly result in a visit to the pediatrician’s office and/or the emergency room. If there are no neurological signs or symptoms, the most common cause for acute headaches in children and adolescents is a respiratory or sinus infection.

Hormone headaches: Headaches in women are often associated with changing hormone levels that occur during menstruation, pregnancy, and menopause. Chemically induced hormone changes, such as with birth control pills, also trigger headaches in some women.

Chronic progressive headaches: Also called traction or inflammatory headaches, chronic progressive headaches get worse and happen more often over time. These are the least common type of headache, accounting for less than 5% of all headaches in adults and less than 2% of all headaches in kids. Chronic progressive headaches may be the result of an illness or disorder of the brain or skull.

For patients with pain who fail conservative therapies, simple to complex interventional therapies such as nerve blocks, epidural steroid injections, intraspinal drug administration, or trigger point injections may be helpful. These therapies are typically provided by anesthesiologists with advanced training in pain management.

Nerve Blocks and Epidural Steroid Injections
Nerve blocks can relieve pain by inhibiting the impulses that travel along specific nerves in the body. To achieve a block, the doctor usually injects a local anesthetic along the course of a nerve or nerves. Although this is called a “temporary” block, in the best outcome, pain relief lasts for a long time. In very selected cases, the doctor can inject a solution that damages the nerve and produces a more permanent block.

Sympathetic nerve blocks inhibit the nerves of the sympathetic nervous system, which are responsible for increasing heart rate, constricting blood vessels and raising blood pressure in response to stress. Sympathetic nerve blocks can be useful in treating some pains due to nerve damage, such as some types of complex regional pain syndrome (also called reflex sympathetic dystrophy or causalgia).

Blocks of somatic nerves can be targeted to any area of the body. In some cases, nerve blocks fail to provide pain relief, or provide only a brief respite.

Epidural steroids, administered through injection, can help to interrupt the passage of painful impulses through nerves.

Spinal Infusion
Intraspinal drug administration involves the delivery of low doses of analgesic drugs, such as morphine or clonidine, through a catheter inserted directly into the spine. This approach is used often to manage cancer pain.

Triggerpoint Injections

Acupuncture
Acupuncture is an ancient method for relieving pain and controlling disease, used in China for thousands of years. It appears to be effective for some patients with chronic pain.

Thin gold or metal needles, gently twirled for ten to twenty minutes, can be used to stimulate acupuncture points, which relieve pain in specific parts of the body (for example, a point on the leg targets stomach pain). Patients usually feel a tingling, warm sensation, similar to that of transcutaneous electrical nerve stimulation. Acupuncture points can also be stimulated with deep massage (acupressure), electric currents (electroacupuncture), or lasers.

The risk of side effects is low. Side Effects can include post-needling pain, bleeding, bruising, dizziness, fainting, and local skin reactions. Rarely, organ damage can occur with deep needling techniques. Infection because of inadequately sterilized needles is a hazard; disposable needles are recommended.

Acupuncture is not recommended for patients with serious blood clotting problems. Acupuncture should be used with caution by pregnant women.

Massage
Massage can be a useful addition to a pain management program, especially for patients who are bedridden.

Massage can:

	Stimulate blood flow
	Relax muscles that are tight or in spasm
	Promote a feeling of well-being

Muscles can be stroked, kneaded or rubbed in a circular motion. A lotion can reduce friction on the skin.

Massage is not recommended in cases of swollen tissue. It should be used in addition to, and not instead of, exercise by patients who can walk.

Transcutaneous electrical nerve stimulation (TENS) is a method of applying a gentle electric current to the skin to relieve pain. Studies have shown that it can be effective in certain cases of chronic pain.

A small box-shaped device, which patients can put in their pocket or hang on their belt, transmits electrical impulses through wires to electrodes taped to the skin in the painful area. Patients describe the sensation of TENS as buzzing, tingling or tapping.

The patient should experiment with the placement of the electrodes and the timing, intensity, amplitude and frequency of the electrical current to find the most effective setting. Pain relief usually lasts beyond the period when current is applied. TENS can become less effective at relieving pain over time.

TENS is usually safe and well tolerated. However, it is not recommended on inflamed, infected or otherwise unhealthy skin, over a pregnant uterus (except for obstetric pain relief), or in the presence of a cardiac pacemaker.

Therapeutic Exercise
Exercising is important because it can:

	Strengthen weak muscles
	Mobilize stiff joints
	Help restore coordination and balance
	Promote a sense of well-being
	Decrease anxiety and stress
	Keep the heart healthy
	Help maintain an appropriate weight

A physical therapist, exercise physiologist or certified athletic trainer can help patients get started safely and learn exercises designed specifically to target problem areas. Even bedridden patients can benefit from range-of-motion exercises.

Heat Therapy
Heat therapy can reduce pain, especially the pain of muscle tension or spasm. Sometimes patients with other types of pain benefit.

Heat therapy acts to:

	Increase the blood flow to the skin
	Dilate blood vessels, increasing oxygen and nutrient delivery to local tissues
	Decrease joint stiffness by increasing muscle elasticity

Heat should be applied for 20 minutes. Patients can use hot packs, hot water bottles, hot and moist compresses, electric heating pads, or chemical and gel packs carefully wrapped to avoid burns. Patients can also submerge themselves or the painful part in warm water.

Heat therapy is not recommended on tissue that has received radiation treatment. Pregnant women should avoid using hot tubs or any method that subjects the developing baby to prolonged heat.

Deep heat delivered to underlying tissue by short wave diathermy, microwave diathermy or ultrasound is also sometimes used to relieve pain. Deep heat should be used with caution by patients with active cancer and should not be applied directly over a cancer site.

Cold Therapy
Cold therapy, which constricts blood vessels near the skin, sometimes can relieve the pain of muscle tension or spasm. Other types of pain also benefit in some cases. It can also reduce swelling if applied soon after an injury.

Ice packs, towels soaked in ice water or commercially-prepared chemical gel packs should be applied for 15 minutes. Cold sources should be sealed to prevent dripping, flexible to conform to the body, and adequately wrapped to prevent irritation or damage to the skin.

Non-pharmacological treatments (treatments that do not rely primarily on medication to achieve their effect) offer a variety of approaches to pain relief. Most are non-invasive.

Simple, relatively safe non-pharmacological approaches include:

Physiatric Approaches
Non-invasive Stimulatory Approaches
Psychological Approaches
Complementary/Alternative Approaches

In most cases, these techniques should be used in addition to, not instead of, other approaches to pain relief.

More invasive non-pharmacological treatments include:

Anesthesiologic Approaches
Invasive Stimulatory Approaches
Surgical Approaches

Pharmacological Therapies (Medication)

	Non-opioid pain relievers
	Opioids
	Adjuvant medications (drugs whose primary purpose is not for pain but rather for other conditions)
	Topical treatments (drugs are applied directly to the skin, as a patch, gel, or cream) Because the effects of a medication can vary widely from person to person, treatment of pain needs to be tailored to fit each individual. Some patients may need to try many different kinds of treatments before they find the right balance between pain relief and side effects. Patients should be sure their doctors are aware of all medications they are taking, even for conditions unrelated to their pain or over-the-counter drugs such as aspirin. Many medications should not be taken together because they increase or decrease each other’s effects or produce new adverse reactions. Of course, the doctor should also be informed if the patient is pregnant or breast-feeding.

Many people with cancer experience pain. Thirty to 40 percent of patients in active cancer therapy and 70 to 90 percent of patients with advanced cancer report pain.

Cancer pain can be caused by:

	Tumors pressing on organs, nerves or bone
	Treatment such as surgery, chemotherapy or radiation
	Other conditions related to the cancer, such as stiffness from inactivity, muscle spasms, constipation and bedsores
	Conditions unrelated to the cancer, such as arthritis or migraine

In most cases, cancer pain can be controlled through relatively simple means. Doctors usually use medications, which are prescribed according to a plan that was first described by the World Health Organization and is called the Analgesic Ladder approach to cancer pain management.

Other ways to alleviate cancer pain include:

	Surgery, radiation or chemotherapy to shrink tumors causing pain
	Antibiotic therapy or drainage for pain caused by infection
	Psychological therapies, and social and spiritual support, to influence the perception of pain
	Other pain treatments

Beth Israel Medical Center, a major cancer care provider in New York City, has hundreds of cancer specialists in its network including top-rated surgeons, medical oncologists, physicians, radiation oncologists, radiologists, and oncology nurses.

Following are the definitions for terms commonly used in the diagnosis and treatment of arthritis.

Analgesic: Pain relief medication.

Arthralgia: Pain in the joints.

Arthritis: Inflammation of the joints. There are more than 100 kinds of arthritis.

Autoimmune: A process by which a person’s immune system attacks the body’s own tissues. Rheumatoid arthritis is an autoimmune disease.

Bacteria: Microscopic, one-celled organisms.

Cartilage: Firm, whitish substance at the ends of bones. It acts as the body’s “shock absorbers.”

Collagen: Substance making up the body’s connective tissues.? It gives cartilage its “bounce.”

Corticosteroid: Powerful steroid medication that reduces inflammation.

Glucosamine: An amino sugar occurring in vertebrate tissues including that of marine creatures, from which it’s harvested.

Glucosamine sulfate: A form of glucosamine that has been shown to reduce arthritis pain and rebuild damaged joints.

Gout: A painful inflammation primarily of the big toe, characterized by an excess of uric acid in the blood that leads to crystalline deposits in the small joints.

Ligament: A band of strong connective tissue that connects bones and holds organs in place.

Osteoarthritis: A type of arthritis in which cartilage wears out and joints become stiff and painful.

Prostaglandins: Hormone-like substances that play a part in inflammation.

Proteoglycans: Mortar-like substances made from protein and sugar that are the building blocks of cartilage.

Rheumatoid arthritis: A major form of the disease in which the body’s immune system attacks joints, causing hot, painful swelling and deformity.

The most prevalent form of arthritis in children is Juvenile Rheumatoid Arthritis (JRA), a disorder of the immune system that affects as many as 100,000 children in the United States alone. The three main types of JRA are pauciarticular JRA, which affects only a few joints and may cause eye inflammation; polyarticular JRA, which affects many joints, and systemic JRA, which affects many body parts, including internal organs and joints. While permanent damage to joints is less common in children than in adults, JRA can cause growth problems and joint inflammation and damage. Early diagnosis and treatment is important to control inflammation, relieve pain, prevent and control joint damage, and help young patients maintain their functional abilities.