Pain Management

		TENS (Transcutaneous Electrical Nerve Stimulation): is one example of this approach. A small device sends a mild electric current through your skin. While TENS is simple and painless, the evidence that it helps with nerve pain is mixed. Given that it has very low risks, your doctor may recommend giving it a try.
		PENS (Percutaneous Electrical Nerve Stimulation): also called as Electroacupuncture delivers electrical stimulation to the nerves through acupuncture needles.
		RTMS (Repetitive Transcranial Magnetic Stimulation): uses magnets to send electrical impulses into the brain. While evidence is limited, studies suggest that PENS and rTMS could help with nerve pain.

Other methods of electrical stimulation are more complex and require surgery. For instance, spinal cord stimulation involves implanting a device in the body that sends out electrical impulses to the spinal cord. For deep brain stimulation (DBS), a surgeon would implant electrodes in the brain. Generally, doctors only use these invasive approaches when everything else has failed.

What Are the Most Common Causes of Abdominal Pain?

Whether it is a mild stomach ache, sharp pain, or stomach cramps, abdominal pain has numerous causes. These include:

		Indigestion
		Constipation
		Stomach "flu"
		Menstrual cramps
		Food poisoning
		Food allergies
		Gas
		Lactose intolerance
		Ulcers
		Pelvic inflammatory disease
		Hernia
		Gallstones
		Kidney stones
		Endometriosis
		Crohn's disease
		Urinary tract infection
		Gastroesophageal reflux disease (GERD)
		Appendicitis

What Symptoms of Abdominal Pain Are Cause for Concern?

If your abdominal pain is severe or if it is accompanied by any of the following symptoms, contact your doctor as soon as possible:

		Fever
		Inability to keep food down for several days
		Inability to pass stool, especially if you are also vomiting
		Vomiting blood
		Bloody stools
		Difficulty breathing
		Painful or unusually frequent urination
		The pain occurs during pregnancy
		The abdomen is tender to the touch
		The pain is the result of an injury to the abdomen in the previous days
		The pain lasts for several days

These symptoms can be an indication of an internal problem that requires treatment as soon as possible.

How Is the Cause of Abdominal Pain Determined?

Because there are so many potential causes of abdominal pain, your doctor will perform a thorough physical exam, discuss with you the type of symptoms you are experiencing, and ask you several related questions about the pain you are feeling. These questions may include:

		What type of pain are you experiencing? Is the pain throughout your abdomen or is it confined to a particular area?
		Where in your abdomen does the pain seem to be located?
		What type of pain are you experiencing? Is it stabbing and severe? Is it a dull ache?
		When does the pain occur? Always? More often in the morning or at night? If the pain comes and goes, about how long does it last each time? Does it occur after eating certain types of foods or after drinking alcohol? During menstruation?
		How long have you had this pain?
		Does the pain also radiate into your lower back, shoulder, groin, or buttocks?
		Are you currently taking any medications or herbal supplements?
		Are you pregnant?
		Does any activity such as eating or lying on one side relieve the pain?
		Have you been injured recently?

Once an initial evaluation has been completed, your doctor may have you undergo some tests to help him or her diagnose your pain. These may include stool or urine tests, blood tests, barium swallows or enemas, an endoscopy, X-ray, ultrasound, or CT scan.

How Is Abdominal Pain Treated?

Treating abdominal pain depends on its cause. This can range from medications for inflammation, GERD, or ulcers, to antibiotics for infections, to changes in personal behavior for abdominal pain caused by certain foods or beverages. In some cases such as appendicitis and a hernia, surgery is necessary.

What Causes Myofascial Pain?

Myofascial pain may develop from a muscle injury or from excessive strain on a particular muscle or muscle group, ligament or tendon. Other causes include:

		Injury to muscle fibers
		Repetitive motions
		Lack of activity (such as having a broken arm in a sling)

What Are the Symptoms of Myofascial Pain?

Myofascial pain symptoms usually involve muscle pain with specific "trigger" or "tender" points. The pain can be made worse with activity or stress. In addition to the local or regional pain associated with myofascial pain syndrome, people with the disorder also can suffer from depression, fatigue and behavioral disturbances.

How Is Myofascial Pain Diagnosed?

Trigger points can be identified by pain that results when pressure is applied to an area of a person's body. In the diagnosis of myofascial pain syndrome, two types of trigger points can be distinguished:

		An active trigger point is an area of extreme tenderness that usually lies within the skeletal muscle and which is associated with a local or regional pain.
		A latent trigger point is a dormant (inactive) area that has the potential to act like a trigger point. It may cause muscle weakness or restriction of movement.

How Is Myofascial Pain Treated?

Medications such as non-steroidal  anti-inflammatories, acetaminophen or opioids may be used to treat myofascial pain. Medications for sleep, depression or muscle spasm are sometimes used, as well. Non-drug treatments may include

		Physical therapy: "Stretch and spray" technique: This treatment involves spraying the muscle and trigger point with a coolant and then slowly stretching the muscle.
		Massage therapy: Trigger point injection In some chronic cases of myofascial pain, combinations of physical therapy, trigger point injections, and massage are needed.

Causes of Hip Pain

These are some of the conditions that are most likely to cause hip pain:

		Arthritis . Arthritic conditions such as osteoarthritis and rheumatoid arthritis are among the most common causes of hip pain, especially in older adults.  Arthritis leads to inflammation of the hip joint and the breakdown of the cartilage that normally cushions your hip bones. The pain gradually gets worse as the arthritis progresses. People with arthritis also feel stiffness and have reduced range of motion in the hip.
		Hip fractures. Fractures of the hip are a particular problem in elderly people. With age, the bones can become weak and brittle. Weakened bones are more likely to fracture during a fall.
		Bursitis . Inflammation of the small, fluid-filled sacs (called bursae) that protect muscles and tendons is usually due to repetitive activities that overwork or irritate the hip joint.
		Tendinitis . Tendons are the thick bands of tissue that attach bones to muscles. Tendinitis is inflammation or irritation of the tendons. It's usually caused by repetitive stress from overuse.
		Muscle or tendon strain. Repeated activities can put strain on the muscles, tendons, and ligaments that support the hips. When these structures become inflamed from overuse, they can cause pain and prevent the hip from functioning normally.
		Cancers. Tumors that start in the bone (bone cancer) or that spread to the bone can cause pain in the hips, as well as in other bones of the body.
		Avascular necrosis (also called osteonecrosis). This condition occurs when blood flow to the hip bone is reduced and the bone tissue dies as a result. Although it can affect other bones, avascular necrosis most often occurs in the hip. It can be caused by a hip fracture or dislocation, or from the long-term use of high-dose steroids (such as prednisone), among other causes.

Symptoms of Hip Pain

Depending on the condition that's causing your hip pain, you might feel the discomfort in your:

		thigh
		inside of the hip joint
		groin
		outside of the hip joint
		buttocks

Sometimes pain from other areas of the body, such as the back or groin (from a hernia), can radiate to the hip.You might notice that your pain gets worse with activity, especially if it's caused by arthritis. Along with the pain, you might have reduced range of motion. Some people develop a limp from persistent hip pain.

Hip Pain Relief

If your hip pain is caused by a muscle or tendon strain, osteoarthritis, or tendinitis, you can usually relieve it with an over-the-counter pain medication such as Tylenol or a nonsteroidal anti-inflammatory drug such as Motrin or Aleve.Rheumatoid arthritis treatments also include prescription anti-inflammatory medications such as corticosteroids, or disease-modifying anti-rheumatic drugs (DMARDs) like methotrexate and sulfasalazine.Another way to relieve hip pain is by holding ice to the area for about 15 minutes a few times a day. Try to rest the affected joint as much as possible until you feel better.If you have arthritis, exercising the hip joint with low-impact exercises, stretching, and resistance training can reduce pain and improve joint mobility. For example, swimming is a good non-impact exercise for arthritis. Physical therapy can also help increase your range of motion.When osteoarthritis becomes so severe that the pain is intense or the hip joint becomes deformed, a total hip replacement (arthroplasty) may be a consideration. People who fracture their hip sometimes need surgery to fix the fracture or replace the hip.Call your health care provider if your pain doesn't go away, or if you notice swelling, redness, or warmth around the joint. Also call if you have hip pain at night or when you are resting.

Get medical help right away if:

		The hip pain came on suddenly.
		A fall or other injury triggered the hip pain.
		Your joint looks deformed or is bleeding.
		You heard a popping noise in the joint when you injured it.
		The pain is intense.
		You can't put any weight on your hip.

What Are the Symptoms of Sciatica?

Common symptoms of sciatica include:

		Pain in the rear or leg that is worse when sitting
		Burning or tingling down the leg
		Weakness, numbness, or difficulty moving the leg or foot
		A constant pain on one side of the rear
		A shooting pain that makes it difficult to stand up

Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.For some people, the pain from sciatica can be severe and debilitating. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control.

What Causes Sciatica?

Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine. Additional common causes of sciatica include:

		Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
		Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
		Spondylolisthesis (a condition in which one vertebra slips forward over another one)
		Pregnancy Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.

What Is Fibromyalgia Syndrome?

A syndrome is a set of symptoms. When they exist together, they imply the presence of a specific disease or a greater chance of developing the disease. With fibromyalgia syndrome, the following symptoms commonly occur together:

		anxiety or depression
		decreased pain threshold or tender points
		incapacitating fatigue
		widespread pain

Women are 10 times more likely to get this disease than men. Most of them are women ranging in age from 25 to 60.

What Are Fibromyalgia Symptoms?

Fibromyalgia causes you to ache all over. You may have symptoms of crippling fatigue -- even on arising. Specific tender points on the body may be painful to touch. You may experience swelling, disturbances in deep-level or restful sleep, and mood disturbances or depression.Your muscles may feel like they have been overworked or pulled. They'll feel that way even without exercise or another cause. Sometimes, your muscles twitch, burn, or have deep stabbing pain.Some patients with fibromyalgia have pain and achiness around the joints in the neck, shoulder, back, and hips. This makes it difficult for them to sleep or exercise. Other fibromyalgia symptoms include:

		abdominal pain
		anxiety and depression
		chronic headaches
		difficulty maintaining sleep or light sleep
		dryness in mouth, nose, and eyes
		fatigue upon arising
		hypersensitivity to cold and/or heat
		inability to concentrate (called "fibro fog")
		incontinence
		irritable bowel syndrome
		numbness or tingling in the fingers and feet
		stiffness

Fibromyalgia can cause signs and feelings similar to osteoarthritis, bursitis, and tendinitis. However, while the pain of bursitis or tendinitis is localized to a specific area,  pain and stiffness with fibromyalgia are widespread.

Treatment for Fibromyalgia

There is no fibromyalgia cure. And there is no treatment that will address all of the fibromyalgia symptoms. Instead, a wide array of traditional and alternative treatments has been shown to be effective in treating this difficult syndrome. A treatment program may include a combination of medications, exercises -- both strengthening and aerobic conditioning -- and behavioral techniques.The FDA has approved three drugs to treat fibromyalgia: Lyrica, Cymbalta, and Savella.

Alternative Treatments for Fibromyalgia?

Alternative therapies, can help manage the symptoms of fibromyalgia. For instance, therapeutic massage manipulates the muscles and soft tissues of the body and helps ease deep muscle pain. It also helps relieve pain of tender points, muscles spasms, and tense muscles. Similarly, myofascial release therapy, which works on a broader range of muscles, can gently stretch, soften, lengthen, and realign the connective tissue to ease discomfort.Moderate aerobic exercise at least two or three times a week, also treatments, such as hypnosis, acupuncture, therapeutic massage, and chiropractic manipulation for pain relief. Along with alternative therapies, it's important to allow time each day to rest and relax. Relaxation therapies -- such as deep muscle relaxation or deep breathing exercises -- may help reduce the added stress that can trigger fibromyalgia symptoms. Having a regularly scheduled bedtime is also important. Sleep is essential to let the body repair itself.

What Causes Neck Pain?

Causes of neck pain include:

		Abnormalities in the bone or joints
		Trauma
		Poor posture
		Degenerative diseases
		Tumors
		Muscle strain

What Causes Shoulder Pain?

The shoulder is a ball and socket joint with a large range of movement. Such a mobile joint tends to be more susceptible to injury. Shoulder pain can stem from one or more of the following causes:

		Strains from overexertion
		Tendonitis from overuse
		Shoulder joint instability
		Dislocation
		Collar or upper arm bone fractures
		Frozen shoulder
		Pinched nerves (also called radiculopathy)

How Are Neck and Shoulder Pain Diagnosed?

		X-rays: Plain X-rays can reveal narrowing of the space between two spinal bones, arthritis-like diseases, tumors, slipped discs, narrowing of the spinal canal, fractures and instability of the spinal column.
		MRI: Magnetic resonance imaging is a noninvasive procedure that can reveal the detail of neural (nerve-related) elements, as well as problems with the tendons and ligaments.
		Myelography/CT scanning: Sometimes used as an alternative to MRI.
		Electrodiagnostic Studies: Electromyography (EMG) and nerve conduction velocity (NCV) are sometimes used to diagnose neck and shoulder pain, arm pain, numbness and tingling.

How Are Neck and Shoulder Pain Treated?

The treatment of soft tissue neck and shoulder pain often includes the use of anti-inflammatory medication such as ibuprofen (Advil or Motrin) or naproxen (Aleve or Naprosyn). Pain relievers such as acetaminophen (Tylenol) may also be recommended. Depending on the source of pain, drugs like muscle relaxers and even antidepressants might be helpful. Pain also may be treated with a local application of moist heat or ice. Local corticosteroid injection is often helpful for arthritis of the shoulder. For both neck and shoulder pain movement,  exercises may help. For cases in which nerve roots or the spinal cord are involved, surgical procedures may be necessary.

What Are the Symptoms of Tennis Elbow?

Symptoms of tennis elbow include:

		Pain slowly increasing around the outside of the elbow. Less often, pain may develop suddenly.
		Pain is worse when shaking hands or squeezing objects.
		Myelography/CT scanning: Sometimes used as an alternative to MRI.
		Pain is made worse by stabilizing or moving the wrist with force. Examples include lifting, using tools, opening jars, or even handling simple utensils such as a toothbrush or knife and fork.

Who Gets Tennis Elbow?

Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50, although people of any age can be affected. Although tennis elbow commonly affects tennis players, it also affects other athletes and people who participate in leisure or work activities that require repetitive arm, elbow, wrist, and hand movement, especially while tightly gripping something. Examples include golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly-line workers.

How Is Tennis Elbow Diagnosed?

Tennis elbow cannot be diagnosed from blood tests and rarely by X-rays. Rather, it is usually diagnosed by the description of pain you provide to your doctor and certain findings from a physical exam. Since many other conditions can cause pain around the elbow, it is important that you see your doctor so the proper diagnosis can be made. Then your doctor can prescribe the appropriate treatment. Tennis elbow usually is successfully treated by medical means -- such as physical therapy, forearm bracing to rest the tendons, topical anti-inflammatory gels, topical cortisone gels, and  cortisone injections. It only rarely requires surgery. The type of treatment prescribed for tennis elbow will depend on several factors, including age, type of other drugs being taken, overall health, medical history, and severity of pain. The goals of treatment are to reduce pain or inflammation, promote healing, and decrease stress and abuse on the injured elbow.

How Is Pain and Inflammation Reduced in Tennis Elbow?

To reduce the pain and inflammation of tennis elbow, try:

		Rest and avoid any activity that causes pain to the sore elbow.
		Apply ice to the affected area.
		Take nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen.
		Cortisone-type medication may be put on topically by you or injected into the sore area.

To help lessen the continued stress and abuse on tennis elbow:

		Use the proper equipment and technique in sports and on the job.
		Use of a counter-force brace, an elastic band that wraps around the forearm just below the injured elbow (tendon) may help to relieve pain in some people.
		Avoid tight gripping, overuse of the wrist.
		Pay attention to the movements that cause pain.

Carpal Tunnel Syndrome - Treatment
The goal of treatment for carpal tunnel syndrome is to allow you to return to your normal function and activities and to:

		Address other health conditions if they are making your symptoms of carpal tunnel syndrome worse.
		Reduce any inflammation of tissues in the wrist that puts pressure on the median nerve.
		Determine the causes of your carpal tunnel symptoms. You can then identify whether there are activities for you to avoid or do differently and ways you can help prevent the condition.
		Prevent nerve damage and loss of muscle strength in your fingers and hand.

Treatment for carpal tunnel syndrome is based on the seriousness of the condition, whether there is any nerve damage, and whether other treatment has helped. Treatment options include treatment without surgery (nonsurgical treatment) or with surgery.

		If treated early, carpal tunnel symptoms usually go away with nonsurgical treatment.
		If your symptoms are mild, with occasional tingling, numbness, weakness, or pain, 1 to 2 weeks of home treatment are likely to relieve your symptoms.
		If home treatment does not help, or if your symptoms are more severe (including the loss of feeling in your fingers or hand, or the inability to perform simple hand movements such as holding objects or pinching), have your doctor examine you and recommend treatment.

Nonsurgical treatment
If your symptoms are not severe, expect your doctor to recommend nonsurgical treatment to see whether symptoms improve. Nonsurgical treatment includes:

		Evaluating any other medical problems that might contribute to carpal tunnel syndrome, and changing your treatment for those problems if needed.
		Changing or avoiding activities that may be causing symptoms, and taking frequent breaks from repetitive tasks.
		Wearing a wrist splint to keep your wrist straight, usually just at night. Using nonsteroidal anti-inflammatory drugs (NSAIDs) to relieve pain and reduce inflammation. Although studies have not shown NSAIDs to be effective for carpal tunnel syndrome, they may help relieve your symptoms.
		Learning ways to protect your joints as you go through your daily activities.

In some cases, oral corticosteroids or corticosteroid injections into the carpal tunnel may be considered if other methods to reduce inflammation do not work.

Surgical treatment
Surgery is sometimes recommended when other treatment has not helped, if a carpal tunnel condition has continued for a long time, or if there is nerve damage or the risk of nerve damage. Surgery involves cutting the ligament that forms the roof of the carpal tunnel. This relieves the pressure on the median nerve, which eases or ends the symptoms of carpal tunnel syndrome.

Corticosteroids for Carpal Tunnel Syndrome
Generic Name:

		betamethasone
		methylprednisolone

Although corticosteroids come in oral (tablets or syrup) form, injections (shots) are most commonly used for treating carpal tunnel syndrome.

		How It Works: Corticosteroids relieve inflammation.
		Why It Is Used: Corticosteroids are given to relieve inflammation due to carpal tunnel syndrome when other forms of treatment (such as rest, using a wrist splint, or using anti-inflammatories) have not helped relieve pain.
		When it should not be used (contraindications): Corticosteroids should not be given to children, nor to women who are pregnant or breast-feeding.

Sudden (acute) Injury
An acute injury may occur from a direct blow, a penetrating injury, or a fall, or from twisting, jerking, jamming, or bending a limb abnormally. Pain may be sudden and severe. Bruising and swelling may develop soon after the injury. Acute injuries include:

		Bruises. After a wrist or hand injury, bruising may extend to the fingers from the effects of gravity. See a picture of a bruise (contusion)
		Injuries to ligaments. See a picture of a torn thumb ligament as in skier's thumb.
		Injuries to tendons, such as mallet finger.
		Injuries to joints (sprains).
		Pulled muscles (strains).
		Broken bones (fractures), such as a wrist fracture
		Dislocations.
		Crushing injury, which can lead to compartment syndrome.

Overuse Injuries
Overuse injuries occur when too much stress is placed on a joint or other tissue, often by "overdoing" an activity or repeating the same activity. Overuse injuries include the following:

		Carpal tunnel syndrome is caused by pressure on a nerve (median nerve) in the wrist. The symptoms include tingling, numbness, weakness, or pain of the fingers and hand. See a picture of carpal tunnel syndrome.
		Tendon pain is actually a symptom of tendinosis, a series of very small tears (microtears) in the tissue in or around the tendon. In addition to pain and tenderness, common symptoms of tendon injury include decreased strength and movement in the affected area.
		De Quervain's disease can occur in the hand and wrist when tendons and the tendon covering (sheath) on the thumb side of the wrist swell and become inflamed. See a picture of de Quervain's disease.

Treatment
Treatment for a finger, hand, or wrist injury may include first aid measures; medicine; "buddy-taping" for support; application of a brace, splint, or cast; physical therapy; and in some cases, surgery. Treatment depends on:

		The location, type, and severity of the injury.
		How long ago the injury occurred.
		Your age, health condition, and activities (such as work, sports, or hobbies).

Pain killers from your kitchen(Home Remedies)
Ayurveda, the science of life was the first system which advocated the ‘Food is Medicine’ concept. In every context of physiology to pathology and prognosis, Ayurveda talks about the quality of food and its good and bad effects.


Here, we take a look at Ayurveda’s top 11 pain killers – which I should call the ‘Top 10 Kitchen pain killers’ as all of them can be found on your kitchen shelf and are currently very well validated by the modern medical system.