Ask The Expert
I recently had a shoulder injury. My primary care doctor said the joint is inflamed, and recommended I see a pain management physician for joint injections. Can you explain inflammation and what a joint injection is?
Inflammation can be caused within a joint and to its surrounding structures (ligaments, tendons, muscles…). Inflammation is common after overuse, trauma, and inflammatory conditions such as arthritis.
Inflammation is one of the body’s first reactions when an area is injured. When the body sustains injury, white blood cells and other inflammatory mediators go to the injured site and protect the body from infection while helping to heal the damaged area. This process causes inflammation and often pain.
Inflammatory symptoms within a joint may include redness, pain, stiffness, loss of range-of-motion and skin that is warm to the touch. If the inflammation is mild enough, it can be treated with over-the-counter medications such as non-steroidal anti-inflammatory drugs (NSAIDs), like ibuprofen. It is important to make sure that inflammation is the source of your pain, instead of infection. Infection can also cause many of the same symptoms and if suspected, blood work will probably be ordered. Your physician will have to determine if your pain is due to inflammation and may request imaging (MRI, CT scan…) to better see the painful area.
Joint injections are performed when your pain is severe and is not assisted by over the counter medications and physical therapy. Joint injections are a safe and effective procedure that many pain management physicians use regularly. Joint injections utilize corticosteroids, which work actively to reduce inflammation and help alleviate pain. The procedure is simple, and consists of sterilizing the area, numbing the skin, placing the needle within the joint (which may be assisted by x-ray guidance), and injecting the medication into the painful joint. Since the injection will be going into a painful area, it is advised to ice the area and be aware that you may be tender in that area for up to two days after your injection. Physical therapy exercises are often used to increase the mobility of the inflamed area and prevent the injury from recurring.
What treatment options are available for those who suffer from fibromyalgia?
Fibromyalgia is a difficult disease – difficult to diagnose, difficult to treat, and difficult to live with. Many with fibromyalgia find that they are in constant, all-over pain, and that there seems to be limited resources to help them with their painful condition.
While predominately seen in women ages 30-50, fibromyalgia can actually affect anyone, of any age. This painful condition is characterized by tenderness seen in the extremities, neck and back, and most specifically at “tender points” in these regions. A fibromyalgia patient may experience stiffness, and may experience pain from minimal stimuli such as clothing brushing against the skin, or someone bumping into them in a hallway. From these seemingly insignificant stimuli, a fibromyalgia patient can experience excruciating pain, where most people would just feel the sensation. Those with fibromyalgia will also generally experience depression, anxiety and sleep deprivation. However, it will be noticed that inflammation is not usually present.
Fibromyalgia was once believed to be an inflammatory condition, but no inflammatory markers have been identified as causative. Some believe fibromyalgia is related to an active or previous infection with a bacteria or a virus. This has also not been shown to be a definitive reason for fibromyalgia. The current thinking is that fibromyalgia is a central nervous system (CNS) imbalance of some sort. Fibromyalgia is a complex condition and ongoing research is looking into the reasons that certain people suffer from this disease.
The treatment can be particularly difficult, but we now have three FDA approved medications for fibromyalga: Lyrica®, Cymbalta®, and Savella®. These medications are believed to regulate central nervous system imbalances. Physicians will also often prescribe anti-depressants, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen (the most popular brand name is Tylenol ®), and muscle relaxants. However, these medications are often not completely effective in treating pain caused by fibromyalgia. Opioid medications (morphine, Vicodin, Percocet…) have never been shown to help those who suffer from fibromyalgia and are typically avoided.
Additional treatments are also used by physicians and might include physical therapy and acupuncture. Patients can also empower themselves by taking action toward living with less pain. Exercise is highly recommended for fibromyalgia patients, especially yoga and exercises that can be performed in a pool. Even if a fibromyalgia patient is having a particularly bad day, a “fibro-flare” in consideration of their pain, they are still encouraged to perform their daily exercise routine. It has been shown that even taking a simple walk can help a fibromyalgia patient immensely. Another simple and minimally invasive treatment for pain caused by fibromyalgia is the use of a TENS unit. Known as transcutaneous electrical nerve stimulation, this is a device that is used on the skin and can be used at home once a patient has been trained to use the device in the office.
In addition, those who suffer from fibromyalgia have found that prayer, meditation and looking for support from friends and family members have benefitted them greatly.
Dr. Troy McJunkin
