Tuesday, May 31, 2005

Pain in legs and feet

Today is Memorial Day, and as we give thanks to those who give of themselves to keep us safe, it is time to also discuss ways of helping those of us who are aging “feel better”. I don’t know about you, but the aging process sometimes results in aches and pains over and above what the doctors say we should feel at this point in our lives. AND, knowing that we only have about 15 minutes with the doctor, how best to get him/her to know what is going on? Also, what does the latest research show about managing pain now that Vioxx and Bextra have been taken off of the market?

Someone close to me sent me an email that I am adding to my blog so that as I answer one person, perhaps the information might help others, and trigger additional useful information from those of you with additional solutions.

Now for the questions:
“What are some effective ways to control common age related ailments? I have "issues" as they say with my lower back, cervical spine, knees and ankles. Most advice from doctors has been unhelpful at best, wrong at worst. The most valuable information has come from physical therapists, as most of my problems are mechanical. Whenever I see any knee Surgeon, all they want to do is operate, and I do not want that. Some suggestions, please?”

First of all, the better you can describe your symptoms and the SPECIFIC impact that the symptoms have on your normal daily activities, the better you will be able to communicate with your Doctors. For this I suggest something that I call a “Symptom Impairment Matrix”. It looks something like this.

NOTE: I haven't figured out how to import a chart into this format yet!

Part of Body (column #1)
How Impacted (column #2)
How Impact Impairs Normal Daily Living; How Currently Alleviate Pain (column #3)
Feet (goes in column #1)
Ø My feet are always cold; they always tingle like when they awaken from being asleep. Ø My feet often ache; the ankles, the toes, the arch all ache. (goes in column #2)
Ø The coldness of the feet I manage by wearing socks all of the time. Nothing appears to work for the tingles, and this symptom is like a dull headache that will not go away. It is distracting, at best, and makes me avoid walking, at the worst of times.Ø When the feet ache like this, it is usually in the afternoon, after I have been walking or standing for over an hour. I usually take OTC (Over The Counter) pain medicine, but this doesn’t seem to help much. When the pain is very bad, I need to sleep at night with pillows under my legs to see if that will help.
Legs (knees too) (goes in column #3)


ETC. As you can see, it is very important to be specific. It is impossible to be too detailed, and to list too much information. The better you can describe what is going on with you, the better your Doctor(s) can assist you.

Next, let us talk about pain medicine. Since I only described feet above, I’ll limit this example to pain medications that might alleviate these feet problems. They are, however, the same medications that might just help with the legs and knee pains. Note: This information is provided for information purposes only. Only your Doctor can determine if this, or any other medicine is appropriate for you. By providing information, we are only assisting you with options that can be discussed with your Doctor for appropriate care.

Antispastic analgesic (in trigeminal neuralgia)
Baclofen (BAK-loe-fen) is used to help relax certain muscles in your body. It relieves the spasms, cramping, and tightness of muscles caused by medical problems such as multiple sclerosis or certain injuries to the spine. Baclofen does not cure these problems, but it may allow other treatment, such as physical therapy, to be more helpful in improving your condition.

Baclofen acts on the central nervous system (CNS) to produce its muscle relaxant effects. Its actions on the CNS may also cause some of the medicine's side effects. Baclofen may also be used to relieve other conditions as determined by your doctor.[1]

1.What is gabapentin (Neurontin)?
Gabapentin is an anticonvulsant that is chemically unrelated to any other anticonvulsant or mood regulating medication.
2. When was gabapentin approved for marketing in the USA and for what indications may it be promoted?
Gabapentin received final approval for marketing in the USA on 30 December 1993 and is labeled only for use as an anticonvulsant. It is also widely used to treat individuals suffering from many kinds of pain problems, tremors, restless legs syndrome, hot flashes associated with menopause, and various psychiatric disorders.
3. Is a generic version of gabapentin available?
Generic forms of gabapentin are available in the USA as the manufacturer no longer has patent protection.
4. How does gabapentin differ from other mood stabilizing drugs?
Gabapentin differs from other mood stabilizing drugs in two major ways:
1. Gabapentin is sometimes effectiveness for patients who have failed to respond to antidepressants or mood stabilizers;
2. Gabapentin's relatively benign side-effect profile.[2]
Neurontin has a growing multitude of medical studies showing it effective for off-label illnesses such as:
Reflex Sympathetic Dystrophy (RSD),
brain injury,
essential tremors,
sleep dysfunction,
Interstitial Cystitis,
refractory GU tract pain,
agitation secondary to dementia,
muscle cramps,
inflammatory injuries,
phantom limb pain
cocaine dependence
neuropathic pain,
Shoulder-Hand Syndrome,
hemifacial spasms,
peripheral neuropathy,
the pain, nystagmus, and spasticity of Multiple Sclerosis (MS),
trigeminal neuralgia,
prophylaxis and for acute migraines,
for pain secondary to epidural fibrosis,
acute and postherpetic neuralgia (Shingles),
acute pain from Herpes Simplex,
post-operative pain,
myofascial pain (MPS),
radiation myelopathy,
cancer pain
Restless Leg Syndrome (RLS),
Lou Gehrig's Disease (ALS) (but not its progression),
Periodic Leg Movement (PLM),
chronic pain not already mentioned here,
Bipolar Disorder,
social phobias,
somatiform pain with depression,
mood disorders,
both situational and clinical depression,
and it was concluded in one study that gabapentin (Neurontin) "represents a novel class of antihyperalgesic agents" (pain medications) and millions of us have proven that. [3]

Hopefully, this information will be of assistance. We welcome additional information and questions from others.

[1] Welcome to MedlinePlus, a goldmine of good health information from the world's largest medical library, the National Library of Medicine. Health professionals and consumers alike can depend on it for information that is authoritative and up to date. MedlinePlus has extensive information from the National Institutes of Health and other trusted sources on over 700 diseases and conditions.
[2] The information provided here and below about the various “off-label” illnesses treated by Neurontin has been gleaned from various websites.
[3] Any information provided should not be interpreted as a substitute for physician evaluation or treatment. Users are advised to seek the advice of a health care professional and practitioner. Users are advised to rely on their own training, education and experience.


Blogger Carolyn said...

Hi! Carolyn here. I had a comment from my friend, via email, about the value of this information, and wanted to share it with you.

"The info was very useful. I am keeping data for the chart in preparation for my next physical, and will discuss meds at that time.
Thanks, very much, for your help."

Now, this friend, does not know how to use a blog. I'm certain that the rest of you are more adept, so let's hear some comments and/or questions!

3:15 PM  

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