transcutaneous

What is pain?

Pain is a signal in your nervous system that something may be wrong. It is an unpleasant feeling, such as a prick, tingle, sting, burn, or ache. Pain may be sharp or dull. It may come and go, or it may be constant. You may feel pain in one area of your body, such as your back, abdomen, chest, pelvis, or you may feel pain all over.

There are two types of pain:

• Acute pain usually comes on suddenly, because of a disease, injury, or inflammation. It can often be diagnosed and treated. It usually goes away, though sometimes it can turn into chronic pain.
• Chronic pain lasts for a long time, and can cause severe problems

What are pain relievers?

Pain relievers are medicines that reduce or relieve pain. There are many different pain medicines, and each one has advantages and risks. Some are over-the-counter (OTC) medicines. Others are stronger medicines, which are available by prescription. The most powerful prescription pain relievers are opioids. They are very effective, but people who take them are at risk of addiction and overdose.

Because of the side effects and risks of pain relievers, you may want to try non-drug treatments first. And if you do need to take medicines, also doing some non-drug treatments may allow you to take a lower dose.

What are some non-drug treatments for pain?

There are many non-drug treatments that can help with pain. It is important to check with your health care provider before trying any of them:

• Acupuncture involves stimulating acupuncture points. These are specific points on your body. There are different acupuncture methods. The most common one involves inserting thin needles through the skin. Others include using pressure, electrical stimulation, and heat. Acupuncture is based on the belief that qi (vital energy) flows through the body along paths, called meridians. Practitioners believe that stimulating the acupuncture points can rebalance the qi. Research suggests that acupuncture can help manage certain pain conditions.
• Biofeedback techniques use electronic devices to measure body functions such as breathing and heart rate. This teaches you to be more aware of your body functions so you can learn to control them. For example, a biofeedback device may show you measurements of your muscle tension. By watching how these measurements change, you can become more aware of when your muscles are tense and learn to relax them. Biofeedback may help to control pain, including chronic headaches and back pain.
• Electrical stimulation involves using a device to send a gentle electric current to your nerves or muscles. This can help treat pain by interrupting or blocking the pain signals. Types include
• Transcutaneous electrical stimulation (TENS)
• Implanted electric nerve stimulation
• Deep brain or spinal cord stimulation
• Massage therapy is a treatment in which the soft tissues of the body are kneaded, rubbed, tapped, and stroked. Among other benefits, it may help people relax, and relieve stress and pain.
• Meditation is a mind-body practice in which you focus your attention on something, such as an object, word, phrase, or breathing. This helps you to minimize distracting or stressful thoughts or feelings.
• Physical therapy uses techniques such as heat, cold, exercise, massage, and manipulation. It can help to control pain, as well as condition muscles and restore strength.
• Psychotherapy (talk therapy) uses methods such as discussion, listening, and counseling to treat mental and behavioral disorders. It can also help people who have pain, especially chronic pain, by
• Teaching them coping skills, to be able to better deal with the stress that pain can cause
• Addressing negative thoughts and emotions that can make pain worse
• Providing them with support
• Relaxation therapy can help reduce muscle tension and stress, lower blood pressure, and control pain. It may involve tensing and relaxing muscles throughout the body. It may be used with guided imagery (focusing the mind on positive images) and meditation.
• Surgery can sometimes be necessary to treat severe pain, especially when it is caused by back problems or serious musculoskeletal injuries. There are always risks to getting surgery, and it does not always work to treat pain. So it is important to go through all of the risks and benefits with your health care provider.

What is a rotator cuff?

Your rotator cuff is part of your shoulder joint. It's a group of muscles and tendons that holds the top part of your upper arm bone firmly in your shoulder socket. The rotator cuff keeps your shoulder stable when you move your arm in any direction.

What are rotator cuff injuries?

Rotator cuff injuries are common. Most of them are wear-and-tear injuries from doing the same arm movements over and over - especially reaching over your head. With time, the tissues in the rotator cuff break down, leading to these injuries:

• Tendinitis. The tendons in the rotator cuff connect your muscles to your shoulder bones. In tendinitis, the tendons become irritated and swollen from being pinched during shoulder movements.
• Bursitis. The bursa is a small, fluid-filled sac that pads the space between the rotator cuff and the bones of your shoulder. Bursitis happens when the muscle and bone rub the bursa too much. It swells with extra fluid, which causes pain
• Rotator cuff tears. Tears in a rotator cuff tendon can happen over time or suddenly from an injury, such as falling on an outstretched arm or lifting something heavy. A tear may go part way through a tendon (partial tear) or all the way through (full tear).

Who is more likely to develop a rotator cuff injury?

Anyone can develop a rotator cuff injury. But certain people are more likely to have one:

• People over age 40. Most rotator cuff injuries are from the wear and tear of aging. By age 80, most adults have tears.
• Athletes. Playing sports with repeated shoulder movements increases the risk of a rotator cuff injury, for example, tennis, swimming, and baseball - especially pitching.
• People in jobs that require a lot of reaching overhead or heavy lifting. Carpenters, construction workers, and painters are examples of workers who may be more likely to have rotator cuff problems.

What are the symptoms of rotator cuff injuries?

Rotator cuff injuries don't always cause pain. But when they do, the pain is often in the top part of your arm or shoulder. You may feel more pain when you:

• Lie down, especially on the injured shoulder
• Lift your arm or lower it to the front or side
• Reach behind your back

Other symptoms from a torn rotator cuff may include:

• Loss of strength in the arm
• Clicking or popping sounds when you move your arm

How are rotator cuff injuries diagnosed?

To find out if you have a rotator cuff injury, your health care provider:

• Will examine your shoulder. This includes checking the range of motion and where the pain is.
• Will test your arm and shoulder strength.
• May order imaging tests, such as x-rays, an ultrasound, or an MRI scan.

What are the treatments for rotator cuff injuries?

The best treatment for you depends on your age, how much your injury bothers you, and whether your injury was sudden or happened from wear and tear.

Treatments for rotator cuff injuries often include:

• Rest
• Putting ice or a cold pack on the sore area
• Pain relievers to lessen pain and swelling, such as ibuprofen or aspirin
• Physical therapy exercises to strengthen your shoulder and improve movement
• A corticosteroid shot into your shoulder joint if other treatments don't help with the pain

Treatments for rotator cuff tendinitis and bursitis may also include ultrasound therapy. Surgery may be an option if your shoulder doesn't feel better in 6 to 12 months.

Treatments for a torn rotator cuff may also include heat to the sore area or electrical stimulation of the nerves and muscles (transcutaneous electrical nerve stimulation, TENS).

You provider may suggest surgery if your tear is large or is from a recent injury, or symptoms last for 6 to 12 months.

When should I see a health care provider for shoulder pain?

If certain activities bother your shoulder, it's best to stop doing them and check with your provider. That's because early treatment can prevent mild rotator cuff injuries from becoming more serious later on. If you your arm feels weak right after a sudden injury to your shoulder, see your provider as soon as possible.

What are temporomandibular disorders (TMDs)?

Temporomandibular disorders (TMDs) are a group of more than 30 conditions that affect your temporomandibular joints (TMJs). You have two TMJs; one on each side of your jaw. They connect your lower jaw to your skull.

TMDs can cause problems in your jaw joint and your muscles that control jaw movement. These problems can include pain, stiffness, and trouble chewing.

There are three main types of TMDs:

• Disorders of your jaw joints
• Disorders of the muscles you use for chewing
• Headaches from a TMD

Many TMDs last only a short time and go away on their own. However, in some cases they can become chronic (long lasting)

What causes temporomandibular disorders (TMDs)?

Sometimes an injury to the jaw or TMJ can cause a TMD. But in most cases, the cause is not known.

Research suggests that certain factors may play a role in why a TMD starts and whether it will be long lasting:

• Genetics
• Psychological and life stressors
• How someone perceives pain

Who is more likely to develop a temporomandibular disorder (TMD)?

Anyone can develop a TMD, but it is more common in women than in men. It is most common in women between 35 and 44 years old.

What are the symptoms of temporomandibular disorders (TMDs)?

The symptoms of TMDs may include:

• Pain in the chewing muscles and/or jaw joint. This is the most common symptom.
• Pain that spreads to the face or neck.
• Jaw stiffness.
• Limited movement or locking of the jaw.
• Painful clicking or popping in your jaw joint when you open or close your mouth. However, clicking or popping without pain is common and is not a sign of a TMD.
• Tinnitus (ringing in the ears), hearing loss, or dizziness.
• A change in the way the upper and lower teeth fit together.

How are temporomandibular disorders (TMDs) diagnosed?

There is no standard test used to diagnose TMDs, and some other conditions can cause some similar symptoms. This can make TMDs hard to diagnose.

To find out if you have a TMD, your health care provider or dentist:

• Will take a detailed medical history, which includes asking about your symptoms. They will want to know:
  • Where the pain is
  • When you have it
  • What makes it better or worse
  • If it stays in one area or spreads to other parts of your body
  • If you have any other pain conditions such as headache or back pain
• Will examine your head, neck, face, and jaw for:
  • Tenderness
  • Jaw clicking or popping
  • Problems moving your jaw
• May order imaging studies such as an x-ray, MRI, or CT

What are the treatments for temporomandibular disorders (TMDs)?

For many people, the symptoms of TMD are temporary. To help you feel better, your provider or dentist may suggest that you:

• Eat soft foods.
• Apply heat or cold to the face and do some exercises to gently stretch and strengthen your jaw muscles.
• Take over-the-counter pain relievers, such as nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen.
• Stop clenching your jaw, chewing gum, and biting your nails.

If those do not help, your provider or dentist may suggest other treatments such as:

• Physical therapy
• Self-management and behavioral health approaches, which can include:
  • Cognitive behavioral therapy (CBT), a type of psychotherapy. It can help you identify negative thoughts and change them. It can also teach you coping skills.
  • Biofeedback, which involves using electronic devices to teach you to control certain body functions, such as your heartbeat, blood pressure, and muscle tension. For example, it can detect when you tighten your jaw muscles. You can learn how to recognize when this happens and then relax your muscles.
• Medicines such as:
  • Anti-anxiety medicines
  • Antidepressants
  • Anti-seizure medicines
  • Prescription pain relievers
• An intraoral appliance, which is a device that fits over your teeth. Types of intraoral appliances include oral splints and mouth guards. If you are going to use one, it's important to:
  • Know that there is not a lot of evidence that they improve TMD pain.
  • Make sure that the appliance you have is not designed to permanently change your bite.
  • Let your provider or dentist know if it makes your pain worse.
• Complementary treatments, which are treatments that are used along with mainstream medical care. There is limited evidence showing that they help with TMD symptoms. But some providers and dentists may recommend acupuncture and transcutaneous electrical stimulation (TENS). TENS involves using a device to send a gentle electric current to your nerves or muscles. It may help treat pain by interrupting or blocking the pain signals.

If you are still having severe symptoms from a TMD, your provider or dentist may suggest surgery, including implant surgery, or another procedure.

It's important to be careful, because sometimes surgery or another procedure may not work or may even make your symptoms worse. Before any surgery or other procedure, it is very important to get opinions from more than one provider and to completely understand the risks. If possible, get an opinion from a surgeon who specializes in treating TMDs.

NIH: National Institute of Dental and Craniofacial Research