hip pain Archives

A common link between pain and allergies

Do you have widespread pain? Do you also have allergy symptoms like itching, hives, or wheezing? Did you know that allergy symptoms and bodily pain are both symptoms of a common condition?

If any of these questions resonate with you, you could have Mast Cell Activation Syndrome (MCAS), a condition that causes both pain and allergy symptoms. MCAS is a common condition that may impact up to 17% of the population.

If you have never heard of MCAS, that’s because MCAS is a condition that is only gaining widespread recognition in the past decade or so through a recent boom in research. There are many doctors who are not familiar with MCAS, but as research grows on the condition, doctors are becoming aware of how and when to diagnose it.

If you have allergies and pain symptoms, you may have never thought about how these two seemingly unrelated symptoms might be a sign of a single condition. If you have MCAS, or think you might, we encourage you to learn more about a clinical trial opportunity we are holding at our clinic.

 

 

Share

Related posts

Sitting with your legs crossed may be contributing to your back pain

Think of some of the ways you sit. Whether taking a ride on the subway, waiting patiently at the doctor’s office, or sitting as a passenger in a car, the way we sit, especially for prolonged periods can have an effect on the pain we may experience in our low back.

 

 

 

 

 

 

 

For many of us, sitting with our legs crossed feels comfortable in the moment but have you ever considered how this can affect your back and cause pain? What happens to your spine and muscles when sitting with your legs crossed for an extended period of time? When considering good posture, a large component is keeping your spine neutral and avoiding positions that twist the spine or cause misalignment. When sitting with your legs crossed, your pelvis becomes tilted and unconsciously, we tilt our entire torso towards one side. There is a curvature towards one side in the low back which then creates problems in other areas of the spine. Naturally, with a tilt of the pelvis, the upper body will compensate by leaning the opposite direction to maintain balance. Working from the bottom up, pressure on the lumbar spine will cause curvature and misalignment in the thoracic spine. This places strain on the cervical spine to keep the head in the upright position.

 

Sitting with our legs crossed can also affect our muscles. There are two common sitting positions that we should be mindful of, knee over knee or foot over knee for a prolonged period can cause a tightness in the hamstrings, hip flexors and glute muscles. The iliopsoas, one of the major hip flexor muscles, is responsible for external rotation of the femur and an integral part in maintaining posture. This muscle may become strained due to contraction while the pelvis is tilted. You may notice soreness and tenderness in the low back and hip area. Similarly, sitting foot over knee can over time damage the muscles in the inner thigh. Most commonly, the sartorius muscle can become tight and cause discomfort when sitting with the calf over the knee. At the Norman Marcus Pain Institute, Iliacus and Psoas muscles on the hip can be treated for pain. As one of the most common muscles causing pain for patients, when treated, the Iliacus and other hip flexors can provide great relief for pain in the low back, buttock and groin.

Instead of sitting with crossed legs, sit in a chair with height necessary to place both feet flat on the floor. While sitting upright with your back against the chair, you may want to consider placing a cushion under your bottom that can add support to the low back.

References

Lee BJ, Cha HG, Lee WH. The effects of sitting with the right leg crossed on the trunk length and pelvic torsion of healthy individuals. J Phys Ther Sci. 2016 Nov;28(11):3162-3164. doi: 10.1589/jpts.28.3162. Epub 2016 Nov 29. PMID: 27942141; PMCID: PMC5140821.

Share

Related posts

Best Posture for Reading: How to alleviate back pain

There’s nothing better than snuggling into a good book. But are you experiencing back pain while sitting and reading for an extended period? Back pain can often be caused by improper posture. While reading, whether using a physical book or an electronic device, many people experience back pain in the neck and shoulder or in the low back. Here are some ways to alleviate back pain while reading.

Reading can cause strain on the neck and shoulders if there is a tilt in the neck to look down at your book or device. While sitting and reading, it’s important to place your reading material at eye level. Sitting with your head leaning forward and back hunched can cause hyperflexion of the cervical spine and lead to severe neck and back pain over time. It is best to use a stand that can be adjusted to the required height. Many have recommended raising your materials with your hand; however, this may also cause some strain on the neck and shoulders. While holding an object in front of you at eye level, either with one or both hands, your shoulder and neck muscles are in constant contraction to sustain this positioning. Even over a period of a few minutes, this can cause the muscles to spasm or cause intense strain. Using an adjustable stand will ensure that we can sit straight up, taking pressure off of the cervical spine.

The best posture for reading is sitting upright in a chair with lumbar support. Avoid sitting on a seat that lacks back support such as a stool or a bench. A chair with good ergonomics is one that supports the low back and provides an arm rest to place both elbows. Mentioned above, we want to avoid stiffness in the upper back and neck muscles. Placing your elbows on an arm rest that is low enough to support your arms without adding additional strain is ideal. A study examining the association of low back pain with cell phone use found that thoracolumbar kyphosis and lumbar lordosis (curvature in the spine causing a pelvis tilt) increased with prolonged sitting. Participants had a slouch and progressed spine curvature after sitting for longer than 30 mins. The study also found that those with pre-existing back pain had a significantly higher increase in lordosis and complained of more back pain. When sitting for longer than 30 minutes, take breaks. Sitting should be interrupted by standing breaks to keep blood flowing and reduce stiffness in muscles.

To summarize, here are some things we can do to minimize back pain while reading or using a device while sitting.

– Sit with back and arm support for your neck and shoulders

– Bring your reading material or device to eye level to avoid neck strain

– Take breaks and stand for a minute or so while sitting for more than 30 minutes

References

In TS, Jung JH, Jung KS, Cho HY. Spinal and Pelvic Alignment of Sitting Posture Associated with Smartphone Use in Adolescents with Low Back Pain. Int J Environ Res Public Health. 2021 Aug 7;18(16):8369. doi: 10.3390/ijerph18168369. PMID: 34444119; PMCID: PMC8391723.

Share

Related posts

How your sleeping position affects your back pain and neck pain

We all have different preferences when it comes to sleeping. Some of us are side sleepers while others may prefer to sleep on our backs. But there may be a few things to consider about your sleeping position that may be contributing to your back pain. Here are three ways to sleep to help prevent back pain and get a good night’s rest.

Sleeping on your side.

When laying on your side. Be sure to first support your head and neck. This can be done by placing as many pillows or supports as needed to keep the cervical spine neutral and the muscles surrounding it relaxed. These pillows or supports should be placed in the gap between the neck and the head, until the head is upright. Try to avoid raising your arm above your head as this may cause additional strain in the neck and shoulders. To keep the lumbar spine as neutral as possible, place a pillow between your knees. You may need to find a pillow that has enough support to hold the leg. This prevents the hips from rotating forward toward whichever side you are leaning on and helps to prevent rotation in the hips.

Sleeping on your back.

The recommendations for sleeping will be the same with slight adjustments for positioning. You must support your head and neck while sleeping on your back. This can be accomplished by placing your pillows in the gap between your neck and the bed while ensuring the top of the head is also lifted. This prevents an over extension of the cervical spine. Secondly, place a pillow under your knees to raise them slightly above the pelvis. This tilts the sacrum and the spine to neutral position.

Sleeping on your stomach/front.

A study on the relationship between sleep posture and spinal symptoms found that the prone sleeping position or sleeping on your front is the largest contributor back pain and poor quality of sleep. Although this sleeping position is not recommended for extended periods of time. If you need to sleep on your front, place a pillow under your hips to prevent curvature in the lower back. Additionally, a pillow should be placed under the ankles to provide comfort for the knees and avoid hyper extension of the hamstrings. Although it may be comfortable in the moment, raising a knee to either side may cause additional rotation in the sacrum and over time cause strain on the hip flexor muscles and muscles surrounding the spine.

To summarize, here are some ways you can avoid back pain while sleeping:

– Support your head and neck

– Avoid curvature in the back and rotation of sacrum for an extended period of time.

– Use pillows when necessary for additional comfort.

References

Cary D, Briffa K, McKenna L. Identifying relationships between sleep posture and non-specific spinal symptoms in adults: A scoping review. BMJ Open. 2019 Jun 28;9(6):e027633. doi: 10.1136/bmjopen-2018-027633. PMID: 31256029; PMCID: PMC6609073.

Cary D, Jacques A, Briffa K. Examining relationships between sleep posture, waking spinal symptoms and quality of sleep: A cross sectional study. PLoS One. 2021 Nov 30;16(11):e0260582. doi: 10.1371/journal.pone.0260582. PMID: 34847195; PMCID: PMC8631621.

Share

Related posts

Acetaminophen

The BMJ (what used to be called the British Medical Journal) just published an article stating that acetaminophen (ie Tylenol) has been found to provide no relief in low back pain (compared to a placebo). Acetaminophen was also related to a risk of having an abnormal liver test. The article included data from 13 randomized controlled trials (RCTs).

An RCT to evaluate a drug is a research study where one group of people receives the actual drug (in this case, acetaminophen) and the other group receives a placebo (a pill with no active ingredient, generally a sugar pill). Then, data is collected from both groups to see if either achieved any painTylenol relief. In this analysis, it shows that whether you receive acetaminophen or a sugar pill, you had the same amount of pain relief – meaning that active drug had no real pain relief effect.

Although most of the patients I see find no relief from acetaminophen, a small percentage of patients do, so don’t completely dismiss this drug when it comes to helping your pain. However, if you do take acetaminophen, make sure that you’re not taking too much. The FDA recommends taking less than 3000mg a day. This means if you’re taking Extra Strength Tylenol (500mg), you can only take 6 pills a day, or regular strength, 300mg, 10 pills a day. Higher amounts can lead to liver damage that could even be life-threatening.

Share

What To Do When Back Pain Causes Overdose?

“We don’t appreciate what we have until it’s gone.” If only we had a dime for every time we heard this. Perhaps the reason it is such a common expression is the simple truth in it. This certainly applies to our health, but specifically our backs. We probably all take our good health in vain, until something goes wrong. By the time we are in our forties over twenty percent of us experience some form of back pain. And what do we do when we experience pain? Well, unfortunately many people will turn to strong painkillers. This means opioids, morphine-like painkillers. And, while we have written about this topic in the past, there is something new on the horizon. Evzio, the brand name of injectable Naloxone, is a prescription medicine that can block the effects of morphine and related painkillers. Approved by the FDA in April 2014, it allows a patient to quickly treat themselves or be treated by a family member if the patient has overdosed on opioids.Evzio

In the past, Evzio was difficult to obtain due to its high cost. However, recently The Clinton Foundation announced that it has negotiated a lower price for Evzio (see NYT article). This will allow municipalities to more easily purchase this medication, making it more available to those who need it.

It is a sad reality that many people will turn, in desperation, to painkillers as an answer to their aching backs. We, at the Norman Marcus Pain Institute, only use opioids as a last resort. Our method of finding the source of the pain and treating it has eliminated back pain for thousands of patients.. Nevertheless, with the rise of overdoses each year, the increased availability of naloxone to non-medical personnel will allow lives to be saved.

 

 

Share

Is Bad Weather To Blame For Your Lower Back Pain?

A New York Times article Weather May Not Affect Back Pain, printed mid-July, cited a study showing that weather may not affect back pain. The purpose of the study was to explore the often-heard complaint from patients diagnosed with persistent pain related to muscles and bones (musculoskeletal pain) that weather changes cause an increase in pain. The study was based on an analysis of 993 patients who had seen their physician in 2011-2012 complaining of an episode of sudden back pain. These were not patients with a history of back pain.

So this article does not actually examine patients who already have back pain to see if the pain is increased with bad weather. In my practice, at NMPI, I have patients who can tell me a snowstorm is coming 3 days before it occurs. Although studies of the association between weather and pain are not uniformly supportive of the connection, a study done in 1995 of 558 patients with chronic pain found that 2/3 experienced an increase in pain and most of them prior to the occurrence of the bad weather.

bad weatherI have patients whose pain is so severe with bad weather that they can hardly get out of bed. Although there is no good scientific explanation for this association, some suggestions have been offered. When the barometric pressure falls, the air pressure in a painful joint may continue to be a little higher than the air pressure on the outside of the body, causing an increase in pain. Another explanation is that cold and/or inclement weather decreases the amount of time you are outside and active. Patients with musculoskeletal problems (i.e. muscle pain and arthritis) often feel worse with inactivity. In addition cold weather causes the blood vessels in the hands and feet to constrict, which can decrease the amount of available oxygen, resulting in increased muscle pain.

If your history indicates that bad weather causes an increase in your pain, it is likely that your flare up is most likely not an indicator of physical deterioration. Additional pain can be reasonably treated with increased medication for the brief period of weather related pain.

 

Share

From 1991 to 2009, the number of prescriptions written for the strongest pain medications tripled. These medications are collectively named opioids and include morphine, oxycodone, and hydrocodone.Opioids are a type of pain drug that may cause serious side effects. From 2005 to 2009, the number of emergency room visits for nonmedical use of prescribed pain medication doubled. Therefore, the states and federal governments are acting to try to limit the amount of pain medication being prescribed.

At NMPI, we focus on finding the most effective treatment to relieve our patients’ pain – without surgery, steroid injections, or heavy painkillers. However, when a patient complains of severe pain and is not responding well to other pain medications, stronger, prescription opioids will be given.

 
Pain pills blog-Norman Marcus Pain Institute-blogSome opioids, such as oxycodone, are often combined with Tylenol (acetaminophen) in one pill. Some examples of these combination drugs are Lorcet, Lortab, Norco, Vicodin (are all hydrocodone and acetaminophen), and Percocet (oxycodone and acetaminophen). Most often, severe pain is related to a condition that will improve over time. Ideally, all prescription pain medications should be given only while severe pain persists. Like any medication, there are risks and side effects:

 

• Opioids can make you drowsy – which raises the risk of falling and severe injury
• Opioids when mixed with alcohol, anti-anxiety medication, seizure medication, muscle relaxants, or sleep-aids can be deadly.
• Opioids cause constipation and can lower sex drive.
• Patients can become physically and psychologically dependent on opioids.
• Overtime a patient with chronic pain can develop a tolerance for the opioid and need a higher dosage.

Keep in mind that not all pain requires such strong medication, and most patients with pain can be managed with drugs such as acetaminophen (Tylenol) and aspirin-like drugs, called non-steroidal anti-inflammatory drugs (such as ibuprofen and Naproxen). When taken as directed, these less powerful drugs may be all that you need. (There are potential serious side effects with acetaminophen and NSAIDs, which I will discuss in a future blog.) For certain pains, some drugs are better than others. Sometimes we find that a drug we have been using may not actually be effective. A New York Times article on July 23, 2014 reported that for treating low back pain, acetaminophen was no better than a placebo.

Physicians have a responsibility to properly care for patients in pain. Some of these patients may appear to be at a higher risk to abuse opioids. Occasionally, patients complain of non-existent pain to obtain opioids for its mood-altering affect, called a “high.” The fact is that physicians who had been writing too many prescriptions for pain medication are now wary of prescribing any potentially habit-forming pain drugs. This has resulted in a decrease in emergency room visits for drug overdose and deaths from overdose, but it has also resulted in depriving many patients of medication they legitimately need to function normally.

At NMPI, when we treat patients in pain who have a history of drug abuse or who test positive on a written test to determine the risk of abuse, I believe that these two basic American traditions should be the guiding principles:

1. Innocent until proven guilty; and

2. In the words of Ronald Reagan, Trust but verify. Those patients who have problems or are at risk to not properly use pain medication need extra attention, not condemnation. They may be more difficult to treat, but that is why there are specialists to deal with complex pain problems.

Share

Stiffness is an important aspect of muscle pain

I recently saw George, a 48-year-old man, who suffered from pain, described as soreness in the thighs, neck, shoulders and arms, and tingling in his calves and shin. Sitting for more than two hours or sitting for more than 20 minutes would cause an increase in his pain.  Bending over also brought on his pain.

George had tried physical therapy on multiple occasions, and saw two neurologists, who could not find anything that would explain his pain.

When I examined him, I found him to be strong but very stiff. When he bent over, he was able to reach within 14 inches of the floor. When he lied on his back and lifted one leg up at a time, he was able to reach only 57 degrees (85 75 degrees is normal). Because he was so stiff, I decided to start a course of exercises that would help increase his range of motion.

Over the next few weeks, George learned all 21 of the Kraus-Marcus exercises, which he was advised to do every day. As he did the exercises, he noticed that his pain level was decreasing and wasn’t occurring as often as usual. When he was taught the last 7 exercises, he was able to bend over to within 9 inches of the floor, and could lift each leg to 80 degrees.

A month later, George reports a 90% decrease in his overall pain.  Sometimes we find that starting with the most conservative of treatments can prevent us from performing more costly and dangerous treatments. Very often, stiffness is an important aspect of one’s pain that can easily be found and treated!

 

 

Share

Low-Level Laser Therapy

One lesser-known but valuable tool for multiple painful conditions is the low-level laser.  The laser is a source of extremely pure, organized light, as opposed to something like a regular light bulb, which emits a scattered, disorganized light.  We can liken organized light to the sound of a flute playing a single note, and disorganized light to the sound of a stone rolling around in a tin can.  The laser is a non-painful treatment option that affects the local (near the area being treated) immune system, blood circulation, and the release of different chemicals that affect how we experience pain.

While it isn’t clear exactly how the laser helps a variety of painful conditions, there are two proposed means by which the laser improves pain:

  1. The light energy (called photons) is absorbed in the injured area and stimulates the production of Cytochrome C.  Cytochrome C is a protein involved in cell metabolism and energy.  When Cytochrome C is stimulated, it revs up the cell’s metabolism, and gives the cells more energy to heal the injured area.
  2. The light energy from the laser leads to the production of small amounts of singlet oxygen.  Singlet oxygen is a reactive form of oxygen, which means that it is very easy for this type of oxygen to take part in chemical reactions.  At high doses, singlet oxygen can be destructive, and has been used in cancer treatment to destroy cancerous cells.  At very low doses, singlet oxygen can increase the number of cells.  This may be one way the laser helps promote tissue repair.

The laser in a non-invasive, non-painful treatment option that can, in some cases, produce results immediately.  For pain that has been around for a long time, more than one treatment session is usually needed for best results.

Share

Related posts

How we perceive pain – nociceptors

We generally don’t think of muscles as a cause of pain. Sure, we know that after exercise or playing ball we can have muscle soreness, but when pain persists we often think it is coming from nerves, joints or the spine.  Believe it or not, muscles (and other soft tissue) are the most common reason for pains such as lower back pain, neck pain and shoulder pain.  The brain gets information from the body about pain from specialized nerves called nociceptors that respond to tissue damage. Trauma, overwork, and over-exercising cause low oxygen and too much acidity in the muscle. These changes, along with other chemicals that are produced when the muscle is damaged in any way, stimulate the nociceptor.  When a stimulus as strong enough it causes the nerve cell to produce an electrical impulse that is sent into the spinal cord and then up to the cortex, the part of the brain where we perceive pain.

There are actually more nociceptors in the muscle attachment sites (the ends of the muscle where it attaches to the tendon and the tendon attaches to the bone) than in the muscle tissue. That is why if you have pain originating in muscles you may be more aware of the pain close to a bone than in the middle of the muscle.

Any kind of injury releases substances from damaged muscle and surrounding tissue that stimulates the nociceptor. If the nociceptor gets enough stimulation it creates an electrical discharge which travels down the nerve and ends up in the spinal cord. Muscle nerves that have been stimulated repeatedly become more sensitive to additional stimulation. They are called sensitized nerves and they will more easily produce electrical activity with even non painful events such as any contraction to move the muscle. That is why when an injured muscle is used it may cause pain.  That is why if you have strained muscles for any reason you may feel pain from every day movement.  Nociceptors are key structures in the perception of pain.

Share

Related posts

NORMAN MARCUS PAIN INSTITUTE
30 East 40th Street - New York, NY 10016
Tel 212-532-7999 Fax 212-532-5957
Share
Help Desk Software