News from
www.DrLamb.com April 10/00
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Answers in this newsletter to your questions on....
Cold Temperatures
PMS and chronic pain
L-Tryptophan
Limbs Falling Asleep
Anxiety and Chronic Pain
Cold Temperatures
Many of our readers have asked for my opinion about cold and dampness with
respect to chronic pain and arthritis.
It has been my experience that cold and damp temperatures aggravate both
myofascial pain syndromes and arthritis. Although various studies have been
performed studying the affect of barometric pressures and temperature affect on
arthritis, headache and other pain syndromes, much of the resulting information
is mixed. My personal belief is that colder and damp
temperatures increase the tension of muscle shortening and spasm, particularly
in the neck area.
It is for this reason that I generally recommend the use of heat
as an adjunctive therapy in myofascial pain syndromes. Heat applied to a joint
may make an acute arthritis worse, however, heat applied to the muscles
contributing to joint compression (that surround the joint) may actually help
the acute compression arthritis. Applying cold to the immediate joint can be
helpful, however, the cold may cause more muscle spasm.
L-Tryptophan
Many of our readers have asked for my opinion about L-Tryptophan with respect to
chronic pain and arthritis.
L-Tryptophan is a chemical precursor for Serotonin in the body, also known as
5-hydroxy-tryptophan or 5HT. Serotonin is the major neurotransmitter
within the brain and is typically lowered in people who are depressed and suffer
from chronic pain syndromes of almost any kind including fibromyalgia and back
pain.
Sleep disruption is common to those who are depressed and suffer
fibromyalgia and other pain syndromes. Many physicians, including myself, find
that serotonin will help some people sleep better thereby aiding in decreasing
many chronic pain syndromes. The
dose of prescription can vary widely from 500 mg to 6 grams or even higher (6000
mg). I personally do not use L-Tryptophan as a first line treatment, however, I
have had some patients respond well to the treatment.
Of course, one should discuss this option with their
doctor.
Limbs Falling Asleep
Many of our readers have asked for my opinion about their arms or legs falling
asleep.
Most people will experience, on occasion, the numbness or tingling of an arm or
leg, especially while sitting, laying or sleeping. In most people, this
represents a temporary and usually only partial nerve compression at a discreet
location in their body. Usually the problem gradually improves over seconds or
minutes once moving about.
Rarely, limb numbness and tingling may be a sign of
circulatory problems in a limb but the numbness or tingling would typically
occur with increasing activity, like walking. This vascular problem would
typically occur in the legs and in older people or long-term diabetics and
smokers. There should also be a greatly decreased pulse in the affected limb. I
should add that neuropathy or
nerve compression or disease would also get worse with activity. Carpal tunnel
syndrome, sciatica, fibromyalgia and ulnar neuritis are just a few singular or
multiple neuropathies that get worse with activity and all are very common.
Anxiety and Chronic Pain
Many of our readers have asked for my opinion about how anxiety may aggravate or
perpetuate chronic pain.
Anxiety and depression are very common problems in our modern society. In fact,
the numbers and percentages seem to be increasing. Part of the explanation of an
increasingly depressed or anxious society is the fact that both doctors and
society are better at recognizing the problem.
Depression is gradually being accepted in society as a medical problem and
rightly so. However, It would also appear that our modern lifestyle with pagers,
just on time delivery, E-mail, Cell phones, and double-booked scheduling is also
contributing to an actual increase in anxiety and depression.
It has been shown in numerous studies that there is an association between
chronic pain and anxiety and depression. It has been my long-standing opinion
that chronic pain is probably a major contributor to the anxiety and depression
associated with most pain syndromes, including fibromyalgia.
There are biochemical changes in the brain that contribute to a chemical depression or anxiety. These changes appear to be driven by
chronic pain or neuropathy. I also believe, however, that anxiety and depression
will aggravate pain syndromes by altering sleep patterns and increasing muscle
tension and scarring.
I frequently add a little Inderal (propranolol) 10 to 20
mg twice daily to help block the adrenaline surges associated with chronic pain.
Check with your doctor, as Inderal can aggravate asthma and depression. On the
other hand, I have found that low doses of Inderal can improve depression and anxiety in fibromyalgia.
PMS and Chronic Pain
Many of our readers have asked for my opinion about the affect of a menstrual cycle upon chronic pain.
PMS or premenstrual syndrome is simply the collection of symptoms and signs
(hence syndrome) usually one week before the period. PMS and menstrual
dysfunction, unfortunately is anything but simple. I am not a gynecologist,
however, my general approach is that anything that increases muscles tension and
spasm and decreases sleep can aggravate and even cause a pain syndrome. Menstrual dysfunction certainly falls into this category.
I find it is important to get help if a women’s cycles are physically and
emotionally disruptive. Search to find a gynecologist who is actively passionate
and compassionate about gynecological issues. A web site I recommend that might
be of some help is that of Dr. Larry Komer, MD found
at www.drkomer.com. Proper management of
hormonal issues may make your pain issues that much smaller.
Consult your doctor, and keep long and strong.
Questions?
Send an
email to
pain@drlamb.com
Watch for upcoming announcements on:
*A new priority medical consultation service with Dr.
Lamb.
*Special pain prescription medication soon to be available over the internet.
*Vitamin and supplements selected for specific pain conditions
Dr. Lamb's Stretching & Pain Videos
www.stretch-doctor.com
The information contained in this newsletter is the opinion of Dr.
G.
Blair Lamb M.D. C.C.F.P. and should not be used as personal medical
advice. Everyone is encouraged to see their own
healthcare professional to review what is best for them.
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