Nerve pain (neuropathic pain) Archive

Ask the doctor

Q. My brother went to the emergency room because he thought he was having a heart attack. Instead, he was diagnosed with costochondritis. What is that?

A. Costochondritis is caused by inflammation of the cartilage between the ribs and the breastbone, called the costosternal joints (see illustration). This uncommon condition can trigger a stabbing, aching pain that's often mistaken for a heart attack.

Keeping your shoulder muscles flexible will help prevent injury.

The shoulder is the body's most complicated joint. It's where the ends of the collarbone, upper arm bone, and shoulder blade meet. And it's prone to arthritis (a wearing away of the cartilage between the bones), as well as tears or tendinitis (inflammation) in the rotator cuff — the group of tendons that helps you raise and rotate your arm. Shoulder pain can keep you from being able to raise your arms to get dressed, or reach up to a cupboard or out to a door.

But an easy way to stave off shoulder problems is to regularly stretch the muscles that support the joints. "The muscles need to be long and flexible to stay healthy. You're more vulnerable to injury when your shoulder muscles are tight and restricted," explains Clare Safran-Norton, clinical supervisor of rehabilitation services at Harvard-affiliated Brigham and Women's Hospital.

In the journals

Previous studies have shown a link between loss of smell among older adults and risk of death within a short period — often five years or less. Now, a report published online May 21, 2019, by Annals of Internal Medicine confirmed this increased risk of death over more than a decade, as well as identifying the leading causes of death.

Researchers gave smell identification tests to 2,289 adults ages 71 to 82 (about half of whom were men). They found that those who scored low on the smell test had a 46% higher risk of dying within 10 years, and 30% within 13 years, compared with those who had a stronger sense of smell.

Inside your wrist, a slick tunnel passes through the carpal bones. The nerves and tendons of the wrist pass through this space, called the carpal tunnel. One of these nerves, the median nerve, controls sensations in the palm side of the thumb, the index and middle fingers, and half of the ring finger. It also transmits the impulses to certain hand muscles that allow the fingers and thumb to move. Carpal tunnel syndrome occurs when this nerve becomes irritated or squeezed. Symptoms include numbness, tingling, pain, or weakness in the hand of the affected wrist.

Because the carpal tunnel starts out narrow, it doesn't take much to aggravate or compress the median nerve. A number of conditions can make a person more prone to carpal tunnel syndrome. These include:

Aquatic therapy can reduce pain and pressure while providing an effective workout.

When you're struggling with joint pain, gravity can make exercise an unpleasant experience. But exercising in water, also known as aquatic therapy, can change all that. "It enables you to do many of the same exercises you'd do on land without applying the same force on your joints," says Gayle Olson, a certified athletic trainer at the Sports Performance Center at Harvard-affiliated Massachusetts General Hospital.

The condition causes leg pain and fatigue that make activity difficult, but lifestyle changes can improve how you feel.

The occasional leg pain or stiffness is often not cause for concern, but if pain or fatigue develops after just a few minutes of walking or climbing stairs, it could be an early sign of peripheral artery disease (PAD).

"PAD not only interferes with an active lifestyle, but also can put you at higher risk for a heart attack and stroke," says Dr. Michael Belkin, chief of the Division of Vascular and Endovascular Surgery with Harvard-affiliated Brigham and Women's Hospital. "You can't cure PAD once it occurs, so you want to take measures to avoid it as much as possible."

Pain relief creams and ointments can get the medicine right to where it hurts, and the smell is often familiar and soothing. But do they work?

When something like a knee hurts, there's a natural tendency to rub it. And if it really hurts, most of us will think about popping a pain-relieving pill of some kind — acetaminophen (Tylenol) for starters, or perhaps one of the nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen (Advil, Motrin), or naproxen (Aleve, Naprosyn).

The CDC’s Guideline on Prescribing Opioids for Chronic Pain helps doctors and patients manage treatment at safe levels and avoid dependence. Any plan to taper medication dosage should be personalized to the patient’s needs.

News briefs

Many people use psychological techniques to help them cope with chronic pain. But which approach is best? A study published Jan. 31, 2019, in the journal Evidence-Based Mental Health offers insight. Researchers analyzed 21 randomized studies focusing on the effect of either cognitive behavioral therapy (CBT), to redirect pain-related thoughts and behaviors, or mindfulness-based stress reduction (MBSR), combining yoga and meditation to build awareness and acceptance of moment-to-moment experiences (including pain). The result: There was no clear winner. Both approaches reduced pain and depression and improved physical functioning compared with usual care or no care. The authors say the findings are important, since CBT is considered the go-to psychological technique for chronic pain. But MBSR should be considered as an additional tool, they suggest. Want to try it? Many hospitals, universities, and meditation centers offer MBSR programs. You can also search for MBSR videos and classes online.