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Central Pain Syndrome: causes, symptoms, and treatment

March 5th, 2009

Introduction: Central pain syndrome is a neurological condition caused by damage to or dysfunction of the central nervous system (CNS), which includes the brain, brainstem, and spinal cord. This syndrome can be caused by stroke, multiple sclerosis, tumors, epilepsy, brain or spinal cord trauma, or Parkinson’s disease. The character of the pain associated with this syndrome differs widely among individuals partly because of the variety of potential causes. Central pain syndrome may affect a large portion of the body or may be more restricted to specific areas, such as hands or feet. The extent of pain is usually related to the cause of the CNS injury or damage. Pain is typically constant, may be moderate to severe in intensity, and is often made worse by touch, movement, emotions, and temperature changes, usually cold temperatures. Individuals experience one or more types of pain sensations, the most prominent being burning. Mingled with the burning may be sensations of “pins and needles;” pressing, lacerating, or aching pain; and brief, intolerable bursts of sharp pain similar to the pain caused by a dental probe on an exposed nerve. Individuals may have numbness in the areas affected by the pain. The burning and loss of touch sensations are usually most severe on the distant parts of the body, such as the feet or hands. Central pain syndrome often begins shortly after the causative injury or damage, but may be delayed by months or even years, especially if it is related to post-stroke pain.

Symptoms: Central pain syndrome is characterized by a mixture of pain sensations, the most prominent being a constant burning. The steady burning sensation is sometimes increased by light touch. Pain also increases in the presence of temperature changes, most often cold temperatures. A loss of sensation can occur in affected areas, most prominently on distant parts of the body, such as the hands and feet. There may be brief, intolerable bursts of sharp pain on occasion.

Treatment: Pain medications often provide little or no relief for those affected by central pain syndrome; however, some antidepressants and anticonvulsants can be useful in treating central pain syndrome. Doctors recommend people with the condition be sedated and the nervous system kept quiet and as free from stress as possible.

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Pelvic pain and its causes and Symptoms

March 4th, 2009

What is pelvic pain?

Pelvic pain is a general term that health care providers use to describe pain that occurs mostly or only in the lower abdomen area.  It may be steady pain, or pain that comes and goes.  In some cases the pain may be severe and might get in the way of daily activities. In other cases, the pain might be dull and occur only during the menstrual cycle.  Pelvic pain also describes pain that occurs during sexual intercourse.

What Causes Pelvic Pain?

In general, pelvic pain signals that there might be a problem with one of the organs in your pelvic area: uterus, ovaries, fallopian tubes, cervix, vagina, urinary tract, lower intestines, or rectum.  Or the pain might be a symptom of infection.  Sometimes pelvic pain can be caused by muscular and skeletal problems. There are some common health conditions that are often associated with pelvic pain, including:

  • Vulvodynia – describes chronic pain or discomfort of the vulva (the external female genitalia). Vulvodynia can cause burning, stinging, irritation, or rawness of the vulva.  The type of pain can be different for each woman.  Pain may move around or always be in the same place. It can be constant, or come and go.
  • Endometriosis – occurs when tissues that usually line a woman’s uterus instead grow outside the uterus.  These tissues often grow on the surfaces of organs in the pelvis or abdomen, where they are not supposed to grow.  The two most common symptoms of endometriosis are pain and infertility.
  • Uterine Fibroids – are the most common, non-cancerous tumors in women of childbearing age.  The fibroids are made of muscle cells and other tissues that grow within and around the wall of the uterus.  Symptoms can include heavy or painful periods, pain during sex, and lower back pain, among others.

Possible causes of pelvic pain in both men and women may also include:

  • Bladder disorders
  • Sexually transmitted diseases
  • Kidney infection or kidney stones
  • Intestinal disorders
  • Nerve conditions
  • Hernia
  • Pelvis disorder
  • Broken pelvis
  • Psychogenic pain
  • Appendicitis

Possible causes of pelvic pain in women only may include:

  • Ectopic pregnancy
  • Miscarriage
  • Pelvic inflammatory disease
  • Ovulation
  • Menstrual cramps
  • Ovarian cysts or other ovarian disorders
  • Fibroids
  • Endometriosis
  • Uterine cancer
  • Cervical cancer

What Symptoms Suggest a Problem?

  • Menstrual cramps
  • Menstrual pain
  • Vaginal bleeding, spotting or discharge
  • Painful or difficult urination
  • Constipation or diarrhea
  • Bloating or gas
  • Blood seen with a bowel movement
  • Pain during intercourse
  • Fever or chills
  • Pain in the hip area
  • Pain in the groin area

Pelvic Pain Diagnosis

To determine what is causing pelvic pain, your doctor will first ask you several questions about your symptoms and past medical problems. He or she will also perform a physical exam and may offer you tests to determine what is causing your pain. Other tests that may be given include:

  • Blood and urine tests
  • Pregnancy tests in females of reproductive age
  • Vaginal or penile cultures to check for sexually transmitted diseases such as gonorrhea and/or Chlamydia
  • Abdominal and pelvic X-rays
  • Bone density screening (special type of X-ray to determine the strength of bone)
  • Diagnostic laparoscopy (procedure allowing a direct look at the structures in the pelvis and abdomen)
  • Hysteroscopy (procedure to examine the uterus)
  • Stool guaiac test (checking a stool sample for presence of microscopic blood)
  • Lower endoscopy (insertion of a lighted tube to examine the inside of the rectum and part or all of the colon)
  • Ultrasound (test that uses sound waves to provide images of internal organs)
  • CT scan of the abdomen and pelvis (scan that uses X-rays and computers to produce an image of a cross-section of the body)

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Children’s Migraine Headache Symptoms, Causes, and treatment

February 28th, 2009

Types of children’s migraines

  • Migraine with aura: This type of migraine, also known as classic migraine, is characterized by a visual aura followed by a unilateral (one-sided), throbbing headache, which may later spread to both sides. It lasts from half an hour to 48 hours.
  • Common migraine: Common migraines lack an aura. Migraine without aura in children is traditionally described as a recurring (happening over and over), bilateral (two-sided) headache disorder with a throbbing and/or pulsating pain quality, moderate-to-severe intensity, and severe stomach symptoms. Common accompanying symptoms in children are irritability and paleness with dark circles under the eyes. In younger children, the pain is more often on both sides and around the eyes and temples. Migraine without aura occurs in 60-85% of migrainous children.
  • Chronic migraine: Persons with chronic migraine have headache attacks at least 15 days of every month for at least 2 months. Chronic migraine may affect up to 4% of teenage girls and 2% of teenage boys.
  • Status migrainosus: This is a severe form of migraine headache in which the attack is continuous over 72 hours. People who have such an attack usually have a history of migraine. In those who vomit, rehydration (restoring adequate fluid levels) is often the necessary first step.
  • Complicated and variant migraines: These are classified as migraines because they often have the same triggers. They are brief, recurrent, episodic disorders that are made worse by physical activity and relieved by deep sleep or typical antimigraine medications. 
    • Complicated and variant migraines cause some of the same symptoms as typical migraines, including pain, stomach problems, autonomic symptoms (for example, abnormal sweating, changes in pupil size), neurologic symptoms (for example, tingling, numbness, weakness), and changes in mood or emotion. These benign (relatively harmless) disorders are frightening because they often seem to be life-threatening emergency situations.
    • Migraine equivalents are underrecognized and underreported expressions of childhood migraine. They are often forerunners of the typical migraine, and complicated and variant migraines occasionally alternate with typical migraines.

    Migraine without aura (formerly called a common migraine):

    The child must have experienced at least five attacks meeting the following criteria:

             a. headache lasts from four to 72 hours—duration decreased to two hours in children less than 15 years old

             b. two of the following characteristics

                                                       i.                  unilateral (meaning on one side of the head)

                                                     ii.                  pulsating

                                                    iii.                  moderate to severe intensity

                                                    iv.                  aggravated by physical activity (becomes worse with physical activity)

    c. associated problems with the headache

                                                      v.                  nausea or vomiting

                                                    vi.                  photophobia or phonophobia (abnormal sensitivity to light or sound)

    Migraine with aura (formerly called a classic migraine):

    An aura is a sensation of light or warmth that is caused by the nervous system and may precede a migraine. Visual changes are the most common aspect of an aura and may include flashing lights, double vision, partial vision loss, zig-zag lines, or size distortions. The aura also may cause tingling in an arm or leg or a peculiar smell; weakness in an arm or leg or an inability to speak; or even abdominal pain.

    The child must have experienced at least two attacks meeting the following criteria: 

    a.       one or more reversible auras

    b.       gradual development of the aura over more than four minutes

    c.       no aura lasts more than 60 minutes

    d.       headache follows the aura within 60 minutes

     

    Migraine Headache in Children Causes

    The exact cause(s) of migraine headaches is unknown. Some migraines are thought to be due a temporary deficiency of the brain chemical serotonin. Many of the drugs effective in treating migraines target this chemical. Some migraineurs know that their headaches are triggered by something they eat or drink or do. Most know who they are and what it is. The most common triggers are alcohol, chocolate, cheese, nuts, shellfish, Chinese food, sugar, and caffeine. Migraines most likely have several trigger factors and multiple internal causes. Although many migraine disorders do not develop until middle age, early recognition of migraine risk factors may help a child adopt a healthy lifestyle.

    Migraine Headache in Children Symptoms

    A headache may be a symptom of a benign (relatively harmless) condition, or it may be a life-threatening symptom. A person’s medical history and physical examination results are often enough to identify or rule out serious underlying problems or conditions.

    Since there is no specific diagnostic test for migraine headache, doctors make the diagnosis through medical history, physical examination findings, and clinical judgment. When considering a diagnosis of migraine headache, doctors will ask about a child’s medical history, previous tests, allergies, and current and previous medications. Children will be asked to describe how the headache feels (for example, throbbing, pounding, squeezing, pressing, pulsating, aching, burning, stabbing, dull). They will also be asked about the headache’s location, timing, severity, causal events (for example, concussion, falling down), duration, and whether any relatives have migraine headaches. Other common symptoms include sensitivity to light and sound, tenderness in the scalp, usually where the pain is most severe, and a strong desire to lie down.

     

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    Posted in Headache, Pain Diagnosis/Symptoms

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