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All posts by Kristine Brons

Why Botox may be the answer to your migraines.

Chronic migraines are a debilitating condition that affect a large population of people. They are headaches that come with other symptoms such as pain, nausea, vomiting, sensitivity to light and/or sound and visual changes. Living with chronic migraines means that you are having at least 15 or more headaches per month that last four hours or more, and of those 15 headaches, 8 headaches are considered migraines with the associated symptoms. When these headaches, with other symptoms occur, it is important to be evaluated by your doctor to rule out another pathological cause for the headaches. Imaging and labs may be performed to further evaluate these headaches. Typically, people start out with a low number of headaches and migraines each month and this increases over there years, which is when the chronic migraine diagnosis is given.

There are both acute and preventive treatments that are used for chronic migraines.

The acute treatment is taken to help decrease the pain associated from the headache or migraine once it has already started. These treatments can be taken from over the counter or prescribed by a physician.

Botox is an FDA approved preventive treatment for migraines when someone is having 15 or more headaches, with at least 8 migraines, per month. Botox is covered with insurance and patients should notice a different within approximately 1 month after starting treatment. The Botox ingredients work to block the pain nerves on the face that trigger the signal to the brain that brings on the migraine.  Optimal results would be that patients have an average of 2 or fewer headaches per month. This treatment should be repeated every 3 months in order to continue to receive optimal effects. Patient have found that staying on schedule with these treatments has significantly lessened the number of migraines, thus improving overall quality of life. Talk to your doctor if you suffer from chronic migraines and believe this would be a good option for you.

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Can Turmeric Help Arthritic Pain?

In the pain world today, we are always trying to find new ways to treat pain with fewer side effects and risks. One of the natural remedies known to help tame arthritic pain is Turmeric. Turmeric is a spice that is available in supplement form, but is also the main ingredient in widely used curry powder.

Turmeric has proven to reduce inflammation.

     The term arthritis means there is inflammation in a joint. Turmeric has properties that can reduce this inflammation, subsequently alleviating pain. It has been commonly used in Chinese and Indian medicine for years. New research reveals it is nearly compatible to Ibuprofen, without the increased side effects.

Talk with your provider if you are considering use this supplement.

    Although Turmeric is considered generally safe, it can pose a risk of GI side effects. Some nausea, vomiting, and diarrhea have been reported in individuals. In addition, it can act as a blood thinner. Therefore, it is important to talk with your provider if you are considering trialing this supplement to ensure it is appropriate.

In summary, Turmeric is in no way a “cure it all” method of pain relief. However, it could aid in providing better pain control for individuals who suffer from arthritic discomfort. Talk with your provider today if Turmeric is something you feel you could benefit from.

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Adding Aqua Therapy Can Help Improve Your Pain.

Here at Cahaba Pain, we try several types of interventions to help our patient that are experiencing pain. We use these methods in addition to medications, if applicable. One option that has shown benefit is hydrotherapy.

What is hydrotherapy?

Excellent question. Many people might know this better as aqua therapy. Basically, this is physical therapy but, in a heated pool and under the instruction of a physical therapist. Studies have shown an improvement in quality of life and decreasing pain in patients that have tried hydrotherapy for low back pain, knee pain, etc. (Yücesoy et al, 2019). The water helps lighten the strain on the joints and the back allowing the patient relief while exercising. Aqua therapy has also been shown to help patients lose weight, as well.

Making exercise a part of your everyday life improves your overall health.

Staying active in the setting of chronic pain is a challenge, to say the least. However, it is important to physical and mental health to exercise. It seems to be a cycle. Patients will hurt after activity, so they will not move to avoid this pain. A lifestyle of little to no movement or physical activity can lead to a life of more pain and depression. Aqua therapy can help with this struggle and break the cycle. Ask your provider about aqua therapy.

Emily Walker, CRNP

Yücesoy, H., Geçmen, I, Adigüzel, T, Karagülle, M, & Karagülle, K. M. (2019). International Journal of Biometeorology. Efficacy of balneological outpatient treatment (hydrotherapy and peloidotherapy) for the management of chronic low back pain: a retrospective study. Advanced online publication. doi: 10.1007/s00484-018-01668-9

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How smoking affects more than just your lungs.

There are some lifestyle choices that can increase pain in patients. Smoking, for instance, can intensify pain. Smokers tend to report higher pain scores and more impairments to daily functions than nonsmokers.
Smoking can also delay healing, worsen bone health, and weaken discs in the back. https://www.ncbi.nlm.nih.gov/pubmed/30192304 Along with these reasons, we also know that smoking causes significant harm to the lungs and increases the risk of various cancers.

How can I quit?

We all know smoking is bad for your body and those around you. How can I quit? We can work with you in this journey. The quitting process truly is a journey. It is a marathon and not a sprint. There are several tools to help. Medication, like nicotine patches and Chantix, are very helpful. Also, there are free apps available for download on your phone. We recommend counseling along with medication therapy. An accountability partner for encouragement, is always helpful.

Have you made the decision to quit?

Stopping smoking is a hard decision to make, but a step in the right direction for health and decreasing pain. If you are ready to quit smoking, please let us support you in taking that first step in this marathon.

Emily Walker, CRNP

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Treat Your Osteoarthritis Knee Pain.

Osteoarthritis in the knees can cause a significant amount of pain that can affect a person’s ability to perform normal activities of daily living. As the amount of joint fluid decreases, there is less cushion from the cartilage to protect the joint. This damage in the knee can cause a great deal of pain that slowly progresses with walking, bending, and sitting or lying for long period. Staying active with regular physical activity is vital for the muscle strength in protecting the joints. Maintaining a healthy weight is important to reduce the stress placed in the joints. Continued range-of-motion exercises improve the stiffness to keep the proper movement and flexibility.

What to do when conservative measures don’t help the pain?

When the conservative measures discussed above do not keep the pain under control and the mobility continues to worsen, another option to look at is having a steroid injected into to the joint. This can decrease the inflammation enabling the joint to move with less pain. The down falls to these steroid injections are that they do not provide long lasting relief and steroids themselves have side effects with long term use. Many people can also have contraindications with steroid use for other medical problems.

Hyalgan is an FDA approved treatment of pain for osteoarthritis.

When more conservative measures have failed to provide adequate pain relief and function hylagan is a great treatment. The fluid (or protection) that is in the joint decreases with worsening arthritis. Essentially, Hyalgan is used as a replacement fluid for this loss as it adds back in the “cushion”, thereby reducing the pain. The Hyalgan can be a three-week injection series or a one-time full dose. While this is not a permanent treatment or cure, it should provide at least six months or more of moderate to significant pain relief. If the series provides six months or more of pain relief, it can be repeated. This injection series should not interact with oral medications and should not have a systemic affect. Hyalgan is a safe choice for osteoarthritis pain. Watch our video on how these injections are done and talk to your doctor today if you feel that is could be right for you. https://cahabapain.com/procedure-simulations/#vm_A_c2aaee2b

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CBD oil – Too good to be true?

You may notice that everywhere you look you see cannabidiol (CBD) marketed in a variety of products including drugs, food, dietary supplements, cosmetics, pet food, and other animal health products. This oil is a derivative of the marijuana plant and promises to cure a whole host of ailments. Some of these include: Chronic pain, anxiety, depression, joint pain, fibromyalgia and the list goes on.

Lets look at the facts.

According to the CDC (Centers for Disease Control), CBD oil is currently not a regulated product. This means that manufacturers could add substances to the oil. The additives could make the product cheaper or even dangerous if used without physician supervision. There are many locations to obtain CBD oil including private entrepreneurs which have been known to provide the product, as well.

As of July 2019, the FDA (Food and Drug Administration) has only approved one type of CBD oil.

Epidiolex, for the treatment of seizures associated with two rare and severe forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. Otherwise, the FDA warns consumers that CBD oil products are not approved for the prevention, treatment, or cure of any disease.

In the setting of chronic pain, more scientific research is needed to study the risks and benefits of CBD oil. Please speak with your physician prior to using any CBD products.

Emily Walker, CRNP

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Not all arthritis is created equally.

     The term arthritis refers to inflammation in joints leading to increased pain. There are multiple types of arthritis with the most common being Osteoarthritis and Rheumatoid arthritis. While some symptoms such as joint pain and stiffness are present in both diseases, their cause, progression and treatment differ.

Osteoarthritis (OA) is commonly referred to a degenerative arthritis.

    The cause is usually secondary to wear and tear of the protective cartilage over the joint. Diagnosis can be made after review of x-rays, but is largely based on physical exam. There is currently not a cure. However, treatment is aimed at decreasing inflammation through anti-inflammatories and procedure-based interventions with steroids.

Rheumatoid Arthritis (RA) is an autoimmune disorder.

    This means the body’s own immune system attacks the joints. Diagnosis is commonly made after review of blood work that tests for a specific antibody. Multiple joints can be affected and may have associated systemic symptoms such as a muscle aches and fatigue. In addition, some patients experience signs and symptoms outside of their joints (skin, heart lungs, etc.) Treatment is similar to OA. However, other medications termed Biologics, are used to suppress the immune response and alleviate pain. Just as with OA, there is no current cure for RA. There are groups of physicians called Rheumatologists that specialize in auto-immune disorders such as Rheumatoid Arthritis and typically manage treatment.

Talk with your provider today about management of your arthritis and treatment options.

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NSAID use in Chronic Pain Management

Non-steroidal anti-inflammatory drugs (NSAIDS) are a common class of medications used to treat pain and fever. The most widely prescribed and over the counter formulations are Ibuprofen, Naproxen, Mobic, Diclofenac and Celebrex. These have been utilized for pain control for many years. Their role in decreasing inflammation has been proven to be beneficial in the management of acute pain, but also intermittently with chronic pain.

Risks of taking NSAIDs

     Although these medications serve as good alternative to opioid medications, they do pose a risk to your overall health. In 2005, the Food and Drug Administration released a black box warning on the risk of experiencing a stroke or heart attack with NSAID use. In 2015, they strengthened their stance on this risk due to evidence revealing a stronger correlation between the two. In addition, NSAIDs have also been known to increase an individual’s risk of bleeding.

Talk with your provider before starting a new medication

    Before starting you on an NSAID your provider will likely inquire about your previous medical history. Any individual with a history of a bleeding disorder, GI ulcer, previous heart attack/heart problems, or previous stroke will likely need to refrain from using these medications. If you are currently taking an NSAID and you answered yes to any of the above medications, it is important you discuss this with your provider.

Are NSAIDS the appropriate medication to help treat your pain?

     In summary, while NSAIDS are very useful for pain control they are not always appropriate for every patient. They are preferably utilized short term for acute pain flares and discontinued after this time. However, they are always outlier situations in which they may be used for a longer periods of time. If you are concerned about your current NSAID use and how you can decrease your risk of side effects talk with your provider today.

Natalie Chism, CRNP

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