Researchers from the University of Michigan have found a link key between pain and one moleculespecific of the brain , one discovery which could result in new treatments for fibromyalgia , a common pain but disabling, with difficult treatment.
In patients with fibromyalgia , researchers found that pain decreased when the levels of the brain molecule glutamate decreased . The results of this study , which appears in the journal Arthritis and Rheumatism , may be useful for researchers to searching for new drugs to treat the fibromyalgia , say the authors .
“If these findings are replicated , investigators can conduct trials clinical therapy in fibromyalgia that could potentially use glutamate as a marker of response of disease ” , says the author Richard E. Harris, Ph.D. , Professor assistant of research in D ivisão of Rheumatology in D EPARTMENT of M edicina I nterna the F aculdade M edicina University of Michigan and researcher at C enter DEP earch F Adiga and D or C Ronica the University of Michigan .
The molecule of glutamate is one neurotransmitter , the which means that transmits information between the neurons of the system nervous . When the glutamate is released from one neuron , diffusesup through the space between the cells (synapses) , binds If thereceivers in the next neuron and causes the cell to become excited , or more active .
It was suspected that this molecule played one role in fibromyalgia , because studies earlier showed that some regions of the brain in patients with fibromyalgia seem to be highly elevated . One such region is the insula .
In studies of resonance magnetic functional imaging (fMRI) , researchers of the U-M had shown earlier that the insula displays activity increased in fibromyalgia , which means that neurons in these patients are more active in this part of the brain . The hypothesis of the team of A , Harris notes , that more activity among these neurons might be related to the level of glutamate in this region .
To measure the binding between the pain and glutamate , the researchers have used non – invasive examination of brain image, called spectroscopy of resonance magnetic of protons (H-MRS). H-MRS was performed once before and after they are applied four sessions of weekly of acupuncture or acupuncture “sham” .
Researchers used or acupuncture or acupuncture sham to reduce the symptoms of pain . The procedure sham involved the use of one device keen to prick the skin in order to mimic the sensations of acupuncture real .
After the four weeks of treatment , the pain clinic and experimental reported were reduced significantly .
More importantly , the reduction in both results of pain was linked to reductions in the levels of glutamate in the insula : patients with greater reduction of pain showed greater reductions in glutamate . This suggests that the glutamate may play one role in this disease and that potentially could be used as one biomarker of severity of the disease .
Because of the small number of participants in this study , further research must be conducted to verify the role of glutamate in fibromyalgia , Harris says .
The author Senior ‘s study was Daniel J. Clauw, MD , director of the center for research of fatigue and pain chronicle of A . Other authors were Richard H. Gracely, Ph.D. and He-Seong Kim , MD , of the U-M Department of Internal Medicine ; Pia C. Sundgren , MD , pH.d., YuxiPang, pH.d. e Myria Petrou, M.D., do U-M Departamento deRadiologia;Michael Hsu , MD , of the department of medical physics and rehabilitation ; A and Samuel A. McLean, MD , of the D EPARTMENT of M edicina emergency UM .
The funding study came from one purse D EPARTMENT the ANDxército , the National Institutes of Health and NIH C enter N ational for M edicina C omplementar and the lternativa .
What is the cause?
The cause is a great mystery, but doctors know that it is related to genetic factors and autoimmune reactions, but the origin is not known.In an autoimmune reaction the body’s defense system, which generally protects against infections, ends up attacking normal tissues by mistake and this causes an inflammatory reaction.
It is also known that this disease is more frequent in people with hormonal diseases like thyroid, for example. It also occurs in individuals who have the shoulder immobilized for a very long time or in people with cervical disc herniation. Frozen shoulder may also occur after a shoulder injury, surgery or fracture.
This problem happens with an inflammation in the tissue that covers the whole joint and as we have seen it can happen without any apparent cause. What is interesting, and what you should know is that there are 3 different phases and in each of them there is a different characteristic.
- Inflammatory phase – it is the first phase, occurs when the inflammation is just beginning, the patient feels a slight pain, but in a few days or weeks the pain begins to increase and becomes very strong limiting some movements. This phase can last up to 9 months;
- Stiffness phase – it is from this stage that comes the name of frozen shoulder, there is a progressive loss of shoulder movements, some people still feel pain at this stage, but it has less intensity. The sensation is of shorter shoulder, it is not possible to reach high places and happens the loss of rotating movements. This phase can last up to 12 to 18 months.
- Thawing phase – in the last phase the duration can vary a lot, the movement of the shoulder improves gradually, and in some cases there is the final loss of 15-20% of the movements. That is, in some cases the person has sequelae.
Diagnosis and treatment
To make the diagnosis is not complicated, the patient quickly seeks a doctor because of the pain that is often very large. Once the person is looking for the doctor the diagnosis can already be made and it is not complicated, in the consultation the doctor already does a physical examination and clinical history. The doctor also excludes the possibility of other diseases such as the rotator cuff injury.
The diagnosis is clinical and very simple, there is no need for any imaging method to complete the result of the problem. But of course some doctors ask for complementary tests like X-ray, MRI, ultrasound. These tests will rule out any other diseases that cause shoulder pain.
As soon as your doctor completes the diagnosis he or she is already on the treatment, there is no need for surgery, the treatment is simple and conservative. The problem is that the treatment of frozen shoulder or adhesive capsulitis is slow and therefore quite frustrating the patient. Patients improve, but the process may take a long time.
The first goal of treatment is to decrease inflammation and pain and even increase the range of motion of the shoulder. In most cases an anti-inflammatory is indicated to relieve the symptoms, physiotherapy is also indicated, in fact it is the main stage of the treatment , in this way the patient will recover the movement and the function of the shoulder more quickly.
The treatment is different for each person, it is necessary to analyze the patient’s situation to create a certain training program for him, usually they are directed in the sense of being able to relax the muscles and also decrease the inflammation. In some exercises heat is used in favor to help lengthen the joint capsule and shoulder muscle tissues.
In some cases the therapist passes exercises for the patient to do at home, that way the treatment is faster and the patient improves in a few months. About three to four months will see a significant improvement in shoulder movement and function.
Surgery is almost never needed, it will only be needed in more severe cases or if the patient is not showing improvement. Surgery is done at the right stage, the acute phase of inflammation should be avoided, leaving to do the surgery in the stiffening stage. The correct thing is to do at least three months of stretching before deciding to do the surgery, if your doctor has not waited this time and already indicated the surgery is better to stay alert.
There are also several types of surgical procedures and the doctor should observe the most appropriate for you. The most common and recommended is the so-called arthroscopic release procedure, it is done by arthroscopy and allows the thickened capsule to be released with that the movement improvement is immediate. After the surgery the patient also needs some care as to perform stretching intensively, alone or with the aid of physiotherapists.
As you have noted, the treatment and even the surgery is very quiet, so if you present the problem do not be afraid or apprehensive about the disease. This is a disease that often causes fear because of the pain and leaves the shoulder hard, but by doing the right treatment and seeking help early on you will realize that adhesive capsulitis is no seven-headed bug.
Keep an eye on our tips, they can help you a lot, you can also learn a little more and even advise a friend or relative who has symptoms. Be sure to comment by saying what you think and if there is any question.
What are the symptoms of low back pain?
The back injuries or back pain , tend to appear between 35 and 45 years in people who are still active, but are not in shape. The lesion can manifest itself in a variety of ways and affects the bottom of the dots more often. A back problem may present as a dull ache or a painful sting, or even present as a sensitivity to touch.
There may be stiffness in the lower back or else, the patient may feel pain and / or numbness radiating in the back and going toward the back.
A person can endure discomfort and back pain throughout the day, while others may feel good in the morning and begin to feel pain as the day passes. Some patients find that their back hurts more in certain positions, such as when they are bent, seated for a long period of time or walking.
What causes back pain
4 out of 5 people will experience back pain at some point in life. Poor body mechanisms (such as bending the waist when lifting some weight) are usually a contributor to various types of back pain. Sitting for a long period of time can also cause excessive pressure on the spine that results in injury.
Large numbers of people hurt their backs at work. Any occupation that involves bending, lifting, sitting, standing for too long, or repetitive movements can make you vulnerable to injury if you are not fit. At home, holding children or other heavy loads repeatedly or improperly can cause injury.
While many people blame their pain for a slippery, twisting or loading of some heavy load, back pain can usually be an accumulation of years of defective movements and minor irritations to the spine. Little flexibility and lack of form can be a major contributor to back pain.
What should I do when my back hurts
Avoid activities that may aggravate your pain. While your first instinct may be to go back to bed, recent research indicates that staying active can help in recovery from back pain. Rest and inactivity for more than two days may actually be harmful as it may lose strength, flexibility and endurance.
Try these first aids when you have back pain:
- Maintain physical activity, but be careful to avoid any movements that may aggravate back pain.
- Take anti-inflammatories
- Apply ice to the back for 15 to 20 minutes for one hour, three to five times a day, to reduce swelling, inflammation and pain.
- Proceed with low-impact exercises such as walking or water aerobics.
- When sleeping, find a comfortable position (maybe on the side with a pillow between your knees) and try to keep it
When should I see a doctor to treat the pain?
In 90% of the cases of people with acute back pain, the symptoms tend to disappear in a few weeks. Your midwife may recommend specific interventions that can speed recovery and may suggest measures to prevent injury.
If you are following the above recommendations and the pain does not subside after 4 or 5 days you should tell your doctor. In addition, you should inform your doctor immediately if you have pain radiating through the leg, difficulty in using limbs, lifting fingers, weakness in the ankles, difficulty in standing upright, loss of control of the bladder or bowel, tingling in the leg, difficulty in erection, infection or high fever. Although rare, back pain may indicate more serious problems, so any pain that is not gone should be reported to the doctor.
At first, your doctor can prescribe medications or an exercise program at home, or even transfer you to a physiotherapist for more intensive treatment. In some situations that back pain is not happening, you can also seek treatment with someone with more specialized training, such as a sports medicine doctor, a physiotherapist, a chronic pain specialist or even a spinal surgeon.
Why should I go through exams?
Your doctor may be able to diagnose the cause of your back pain by simply obtaining a detailed medical history and performing some physical exams. The doctor may question about your way of life, occupation, assess your pattern of movement and posture, and determine what you were doing when the pain arose.
For acute low back pain, x-rays and diagnostic studies are generally not helpful unless a serious accident or neurological problem has occurred. If there is a suspected disk injury, your doctor may order an MRI if your pain is not improving as expected.
What type of treatments are possible for back pain?
Your doctor may recommend that you see a physiotherapist, or a qualified personal trainer, who initiates an exercise regimen that speeds up recovery and prevents further injury. As acute pain subsides, a regimen of stretching, strengthening, and establishing exercises are critical to avoid future injury.
Those with persistent pain may find relief from cortisone injections or anesthetic nerve blockers. A small percentage of back problems require surgery.
With treatment for acute pain, you should notice some improvement after two weeks. If there is no improvement, change your treatment plan or consider another therapy. After 4 weeks without progress, exams are indicated. Keep in mind that back injuries require time and dedication to heal completely. The key to a successful treatment is good communication between patient, doctor, therapist and any other professional involved.
Can the pain come back?
If you simply face the pain and do not change the bad habits that led to the injury, the problem is likely to recur. Prevention is the key to back care, since once you have a problem with that, you’re four times more likely to suffer again in the future.
How to Prevent Low Back Pain
Strengthen and strengthen your abdominal muscles and legs to give you the most support and flexibility for your back. Exercises strengthen your trunk and lower extremities, which helps build support of the spine.
Learn to move safely. Bend your knees when lifting, never to your waist or back. Also, hold objects close to your waist. Articulate and do not twist when moving. When you have to get something, get closer or use a stool. If you are performing some task that requires repetitive motion, take breaks.
Evaluate your workplace in terms of the tasks performed and how they perform. Your chair should have good lumbar support if you sit for a long time. Always stretch and change position if you are sitting or standing all day. Organize your workplace-Telephone, computers, files, etc … -so that the movements of the head, shoulders, neck and arms are minimal. You should not have to bend forward on your work surface.
Maintain good body weight. When carrying excess weight, especially around the abdomen, the tensions of the muscles can put the spine into stress.
Learn relaxation techniques. Emotional stress causes the back muscles to become tense, which can result in painful spasms.
Wear comfortable shoes. Jumps higher than 1.5 inches throw the pelvis forward and may hurt the back. Your shoes should have good support and cushioning.