Dr. Mike Evans of St. Michael’s Hospital in downtown Toronto published an extensive must-watch video for anyone taking, considering, or giving care to a patient on opioids. The video answers a lot of questions about these type of pain-killing drugs, and the pitfalls that can be associated with treatment.
Dr. Evans mentions that before you try opioids, consider trying other methods of managing your pain. As a pain clinic in Toronto, we see a number of patients come in with chronic pain conditions who considered opioids but instead started seeing our Osteopath or Chiropractor for manual therapies, acupuncture, etc. They also discuss nerve block interventions with our Anesthesia-trained pain management physicians. For many of Allevio’s chronic pain patients, the options they discovered and improvement they say saw kept them from starting opioids in the first place.
If you have, or care for, someone with chronic pain, drugs are not the only answer. Please watch this video, post it and pass it on to those you know who have pain-related complications and may use opioids. The background and advice in it is very worthwhile.
Radiculopathy is a set of conditions where a nerve does not work (and send pain signals to the brain) properly. With this type of a condition, the problem with the nerve may be localized close to the spine, but the pain or sensation of pain can radiate from that place through the where the nerve ends (such as through an arm or down a leg). The image shows where the pain may be felt through the arm.
Neuropathic pain and Radiculopathy can come from pressure through a ruptured disc, degenerative bone conditions, arthritis or other injuries that put pressure on the nerve roots. In middle-aged people however, normal degenerative changes in the discs can cause pressure on nerve roots.
Neck And Arm Pain is an infographic put together by Mount Sinai hospital in New York, and it’s worth looking at.
While not specific to neuropathic pain, the poster points out several important points and tips:
Exercise and keep your weight under control, but don’t strain your neck or do anything too aggressive.
And of course, see your doctor if your pain lasts longer than 8 weeks, you experience neck or back pain along with pain across other extremities, you have numbness or tingling, or if your muscles aren’t responding as they normally do.
At Allevio Pain Management in Toronto, our physicians can help you understand and decide your best course of actions, and should a procedure make sense, they have specific tools to help them make sure the procedure is done properly. Be very careful when you have any work done to your neck or spine that is being done properly by specialists, and that they are using proper tools to help them.
Allevio Pain Management sees a number of people with a common condition called plantar fasciitis. Plantar fasciitis has garnered quite a few nicknames (Basketball Heel, Runner’s Heel and Jogger’s Heel to name a few) and is presently becoming better known through its most famous patient: basketball-loving President of the United States, Pres. Barak Obama.
But what is plantar fasciitis? And what can you do to treat it?
Plantar fasciitis is one of the most common causes of foot and heel pain. It’s not the same as a heel spur or flat feet. Plantar fasciitis is an inflammation of the plantar fascia which is the ligament that connects your heel bone to your toes. The fascia acts like a shock absorber for the foot. Overuse can cause the fascia to tear resulting in inflammation and pain.
The pain is typically caused by chronic irritation of the arch of the foot when excessively strained. The most familiar symptom of plantar fasciitis is a stabbing pain felt in the bottom of your foot near the heel. This pain is usually worse with the first few steps in the morning or after long sedentary periods.
Plantar fasciitis is common and treatable in most cases. People who are on their feet for long periods of time (servers, cashiers, athletes, nurses, police, fire, ambulance, military personnel, etc.) are more likely to suffer from plantar fasciitis at some point in their life, and statistics show it tends to affect middle-aged men and women more than any other age group.
How do you know if you have plantar fasciitis? You’re always better off to check with your doctor. Your expert be able to tell by checking pain points in your feet. Once diagnosed, there are a variety of ways to treat the condition.
As with most sites of inflammation, icing and resting the area is important. Treatment will vary depending on the severity of your condition. Your doctor may recommend you see an allied healthcare provider like a physiotherapist, chiropractor or osteopath. The various health practitioners you can see will depend on your condition. The more chronic the plantar fasciitis, the more likely it is you will need multiple treatments.
The healing route you take is ultimately your choice with the end goal of relieving your pain. A physiotherapist, chiropractor and osteopath all provide hands-on evaluation (with a detailed look at your medical history) and a treatment plan to eliminate and prevent future inflammation. Both a physiotherapist and chiropractor can provide laser, shockwave or ultrasound treatments, kinesiotaping, manual adjustment and stretching. Custom orthotics may also be prescribed as a way to correct your foot’s natural posture. An osteopath will assess the interaction of your overall structure and functioning to see if the way you walk/run are having an effect. Treatment may also include some imaging (X-ray, CT) if further intervention is needed.
Lastly, if you suffer from chronic plantar fasciitis and you’ve had little success with various treatments, your doctor may recommend you to see a pain specialist. An anaesthesiologist or physiatrist who specialize in pain management will be able to determine whether certain pain therapies could work in conjunction with physical therapies or alone. Platelet-Rich Plasma therapy (PRP) is one treatment that has been proven to help sufferers of chronic plantar fasciitis. PRP is a therapy that utilizes a patient’s own blood, enriched with platelets to stimulate a healing response within a damaged tissue or joint.
There are several ways to easily prevent plantar fasciitis from happening to you. Make sure you’re always wearing supportive shoes when active or standing for long periods of time. Put some variety into your daily sport or activity. Low impact sports like cycling or swimming will take the pressure off your feet. Simple stretching of your arches and legs will help keep muscles nimble allowing for greater range of motion. Lastly, ask your doctor or treating healthcare practitioner if orthotics are right for you. Wearing orthotics everyday can help support your foot in the right position to prevent plantar fasciitis from coming back.
Now that summer is in full swing, people of all ages are coming out of hibernation and naturally becoming more active, engaging in various sports the summer months allow us to enjoy.
This year, with the added fascination of the FIFA World Cup causing mass infatuation with soccer (called football in many other parts of the world), our interest in trying new sports this season is certainly on the rise.
When done safely, engaging in exercise of any kind can offer individuals health benefits. However, those who do not take care to prepare, practice and play properly are at a higher risk of injury.
The most common injuries resulting from sports or exercise involve the musculoskeletal system which include muscles, bones, and their associated tissues, like cartilage.
Common injuries include:
Sprains and Strains
Achilles Tendon Injuries
Common Summer Injuries: Causes and Symptoms
1. Sprains and Strains
A sprain involves stretching or tearing of a ligament. A ligament is a band of connective tissue that allows one end of a bone to join with another. Sprains can occur when you fall or get hit knocking the joint out of position, causing the supportive ligament to be stretched or worse, completely torn.
Of all parts of the body that are prone to this injury, sprained ankles, sprained knees and sprained wrists are the most common.
A sprain can cause tenderness, pain, and occasional bruising. The area may become swollen, leaving individuals unable to move the joint or limb affected. Injured areas may also feel loose or unstable.
A strain involves twisting, pulling or tearing of a muscle or tendon, which is the cord of tissue that connects your muscles to your bones. This injury usually does not involve any contact from an object or force, but is caused rather from overstretching or overcontraction of muscles or tendons. A strain can cause pain, muscle spasms and sometimes even loss of strength and function to the affected muscle or tendon.
2. Knee Injuries
The knee is the largest joint in the body, and because of its anatomical location, it has to sustain significant impact, weight, flexion,and extension. Daily activities such as walking, running, jumping, and bicycling all add to the wear and tear of this great joint.
Knee injuries can be painful and limit an individual’s ability to function. Some knee injuries are severe causing bone bruising or damage to the cartilage or ligaments that support and provide cushion to the knee. Injuries like these are commonly the result of direct impact to, or twisting of the knee joint.
Common knee injuries include torn ACL (Anterior Cruciate Ligament) and MCL (Medial Collateral Ligament), torn or sprained meniscus and a dislocated or fractured kneecap (patella).
3. Compartment Syndrome
Some muscles in the body, along with the nerves a nd blood vessels that provide signals and nourishment to them, are enclosed in a compartment made up of a tough membrane called a fascia.
When a muscle suffers inflammation due to an injury, it can fill up the space inside the compartment where it is held, causing the surrounding nerves and blood vessels to become compressed. This interferes with proper functioning and can sometimes cause further damage to the muscle itself. This syndrome can result from a single or repetitive hits to the area, or in some cases from chronic overuse, like long distance running.
4. Shin Splints
The term shin splint refers to a sharp and long-lasting pain felt along the tibia, the long bone located along the front of the lower leg (also known as the shin bone). Pain found along the outside front part of the lower leg, including the shin and ankle is referred to as anterior shin splints. Pain that occurs on the inner bone where it meets the calf muscle, is called medial shin splints.
Shin splints occur primarily in runners and are usually the result of incorrect or overuse of the lower leg, improper stretching, overtraining, frequent running or jumping on hard surfaces, and running in shoes that have improper support. These injuries occur more frequently in individuals who have flat (overpronated) feet.
5. Achilles Tendon Injuries
Injuries to the achilles tendon are often reported to be extremely painful and are the result of a stretch, tear or irritation to the tendon. The achilles tendon connects the calf muscle to the back of the heel.
The most common cause of an achilles tendon injury is from a degenerative condition caused by aging or overuse, known as tendonitis. When a tendon becomes weakened it is possible for it to rupture, causing severe pain. These injuries are also common in individuals who do not exercise regularly or stretch properly before engaging in a sport or activity and in individuals who engage in jumping sports, such as football and basketball.
There are two types of fractures: An acute fracture, a broken bone caused by a one-time injury and a stress fracture, caused by repetitive strain endured by the bone over a long period of time.
An acute fracture can be further broken down as simple or compound. A simple fracture is a clean break that involves little damage to the surrounding tissue, where as a compound fracture causes a break in the skin with little damage to the surrounding tissue. An acute fracture that causes a break in the skin is considered an emergency as there is a high risk for infection.
Stress fractures primarily occur in the legs and feet and are most often endured by athletes who compete in sports that require long bouts of running, jumping, or high impact activities such as gymnastics, or track and field. Running creates two to three times the force of a person’s body weight on their lower limbs. A contributing factor to the stress fractures that occur.
Signs and symptoms of a fracture include tenderness and swelling at the site along with pain that increases with weight bearing activity.
Two bones come together to form a joint. When these two bones become separated, the joint becomes dislocated. A dislocated joint is usually considered an emergency requiring immediate medical treatment. The joint must be relocated as soon as possible before inflammation sets in and makes it more difficult. It is always best to have a medical professional relocate the joint to ensure proper positioning.
Dislocation of the hand and shoulder joints are the most common, followed by the knee and elbow.The most common sports where dislocations occur are contact and high-impact sports such as football, basketball, soccer and lacrosse.
If you feel you have suffered an injury, do not try and work through the pain. If you feel any pain or discomfort performing a certain motion, activity or sport, stop engaging in it as it can possibly cause further injury. Seek medical treatment if necessary, but if you are able to treat the injury at home, the RICE method is used to help relieve pain and inflammation and helps to speed the healing process.
The RICE Method
Follow these four steps immediately after an injury occurs and continue for at least 48 hours. If the pain or symptoms worsen, it is advisable to seek medical attention.
Rest: Reduce the amount of regular exercise or activity as necessary. In some cases, the use of a walking aid, like crutches or a cane, may help to reduce the amount of weight placed on the injured area. If you are using an aid, use it on the uninjured side to help relieve weight on the injured side.
Ice: Apply an ice pack to the injured area for a maximum of 20 minutes, four to eight times daily. If you don’t have a cold pack, use a bag of crushed ice but make sure to wrap it in a slightly dampened towel. The dampness will conduct cold while the towel prevents a cold injury and potential frostbite. Ice should never have direct contact with skin.
Avoid using heat directly after an injury, as this tends to increase the amount of internal bleeding and swelling to the affected area. Heat is best used in the later stages of healing to help relieve muscle tension and help promote relaxation.
Compression: Compression of an injured area has been known to help reduce the amount of swelling. Elastic wraps, special boots, air casts, and splints can all be used to aid compression. A healthcare provider should help you decide which device to use as an ill fitting device can cause further damage.
Elevation: If possible, keep the injury elevated on a pillow, above the level of the heart to help with the reduction of swelling. For instance, if you have injured your knee, lie comfortably on your back with your leg supported in the air.
TheRICE method is just a starting point in injury treatment. There are other treatments your doctor or healthcare provider can recommend or administer to facilitate healing. It is always best to seek advice from your healthcare provider to ensure the best possible treatment.
There has been increasing pressure on Canada from the U.S. to align their rules on prescription narcotics to help alleviate the abuse and the eventual trickle effect of contraband drugs making their way across the border.
Health Canada recently released a notice of intent to change parameters for not only the highly addictive OxyContin but for all prescription narcotics. This change would make Canada’s one of the strictest anti-abuse systems in the world and great leap in the right direction.
Last year, the U.S. banned a particular form of OxyContin and is still finding it in more than 10 different states. This data comes from a drug-abuse researcher who collects data from a crowdsourcing website where users plugin particulars on the drugs they’ve purchased.
The recent stir of information on opioid abuse comes along with at study recently published in Monday’s edition of the journal Addiction. Researchers revealed a 242% increase in deaths related to opioid abuse in young adults ages 24-35 over a 20 year span. (More details in this related post)
We remain professionally disappointed with drug manufacturers who continue to produce a drug killing what is now 1 in 8 young Ontario residents and is also a lethal contraband substance in the United States. Ontario deserves to be recognized as a centre of excellence for patient care and ethical pracitce, and not as the source for this type of obviously avoidable controversy. We look forward to the outcomes of the proposal being put forth by Health Canada.
A new study revealing a major increase in deaths caused by the abuse of opioids and prescription narcotics, has been published in the Addiction journal and is also available online through the ICES Website.
The researchers reviewed 5935 opioid-related deaths in Ontario between 1991 and 2010. The overall rate of opioid-related mortality increased by 242% between 1991 (12.2 per 1,000,000 Ontarians) and 2010 (41.6 per 1,000,000 Ontarians; P < 0.0001). By 2010, nearly one of every eight deaths (12.1%) among individuals aged 25–34 years was opioid-related. Tara Gomes, scientist at the Li Ka Shing Knowledge Institute at St. Michael’s Hospital, the Institute for Clinical Evaluative Sciences and author of the study, states the findings can likely be attributed proportionately to the rest of Canada.
The demographics examined are not those typically treated for chronic pain. As such, it appears the problem remains with accessibility to the drug and its abuse by youths, not with the drug itself when used for short term, post-operative pain for example.
Health Minister Rona Ambrose, along with Health Canada is planning to curb abuse of narcotics by insisting drug companies make all opioids tamper-proof so addicts cannot easily crush the drugs for snorting or injecting.
Gomes notes opioids can be effective when used appropriately. The study highlights the importance of consultation with a doctor when using narcotics for any reason.
As council member, he will sit on the board of directors for the College and will have an active role in helping to develop policy and standards that affect the daily practice for kinesiologists.
“This new role is an exciting opportunity for me as I see it as a step to make progressive changes for the practice of kinesiology in Ontario. I see exercise as a valuable and empowering tool that directly affects every aspect of a person’s health and I feel I have a responsibility to share the information that I have learned,” says Gennady.
Gennady works at Allevio Toronto as an osteopath and registered kinesiologist. With over 17 years of experience, his expertise lies in looking at the whole person to determine the cause of their pain and the varying ways to treat it. Treatment involves both hands-on clinical treatment as well as patient education so patients can manage their pain at home.
Allevio is proud to support Gennady and every member of our paramedical team who tirelessly demonstrate excellence in their respective fields. Gennady will be representing the city of Toronto and the regional municipality of York as council member for the next 3 years.
Congratulations Gennady! We look forward to seeing your enthusiasm come through in your new role.
Centres for Complex Diabetes Care (CCDC) provide expert short-term case management to diabetic patients over the age of 18 with cumulative, complex problems requiring more intensive treatment measures. The CCDC uses a coordinated approach to diabetes management from a single access point, connecting patients to various services and programs the patient may require for their health needs.
Specialized teams of endocrinologists, nurse practitioners, registered nurses, registered dietitians, social workers, pharmacists and chiropodists (foot care specialists) help patients manage their diabetes through:
Specialized medical interventions
Management and stabilization of blood sugar
Diet planning and nutritional counselling
Insulin administration and monitoring
Counselling and mental health support
Management and monitoring of related cardiovascular health concerns
Foot and wound care
The CCDC team works closely with the patients’ primary care provider (a family physician) to ensure additional support for diabetes management through education, specialized training and mentoring. The patient-centred, goal-specific model links patients with the necessary services across the health care and social service systems to effectively manage their condition.
Who Can Be Referred?
To be referred, the client must be 18 years of age or older with Type 1 or Type 2 diabetes and have one or more of the following:
Multiple episodes of inadequate glycemic control and/or significant co-morbidities impacting glycemic control;
Barriers in accessing healthcare, serious mental health issues, mobility issues, frail or elderly, and other issues compromising determinants of health;
Recurrent emergency department visits or hospitalizations; and
Individuals with diabetes complexities that would benefit from an inter-professional team who is able to provide collaborative client care between multiple healthcare providers.
Diabetes and Chronic Pain
Allevio is very pleased to be able to work together with CCDCs across the province, and specifically with the North York General CCDC to be able to support patients with both diabetes and chronic pain. Allevio Pain Management helps many patients that have diabetic neuropathy, also known as diabetic neuropathic pain, through various treatments and our team works with CCDCs to meet the needs of diabetic patients.
Ontario has six CCDCs in the following regions:
Central West : William Osler Health System – (Phone) 905-494-2260 (Fax) 905-595-2863
Northwestern Ontario: Thunder Bay Regional Health Sciences Centre – (Phone) 807-684-6663 (Fax) 807-684-5928
Central : North York General Hospital – (Phone) 416-635-2575 (Fax) 416-635-2601 *Referral forms can be downloaded by visiting the CCDC’s website at www.nygh.on.ca/diabetes or clients can use the e-referral process.
Mississauga Halton : Trillium Health Centre – (Phone) 905-848-7545 (Fax) 905-804-7955
Central East : Central EastCommunity Care Access Centre – (Phone) 905-430-3308 x.5458 (Fax) 905-430-8682
CBC Reporter Susana da Silva has written an important article which will be a first in a series focused on Chronic Pain. The article is noteworthy because it focuses on an important part of any chronic pain practice: Education and understanding.
This article looks at the struggles Susana faced with her father’s un-diagnosed neuropathic pain condition and how a lack of education meant a very long and hard struggle to diagnose the problem.
Like Susana’s father, many of our chronic pain patients come to Allevio after being referred to a number of different facilities. Others also come because another specialist has identified their symptoms and thought that the pain-relief procedures Allevio offers may help them.
Allevio Pain Management’s chronic pain clinic in Toronto has programs being developed to help patients and physicians better understand chronic pain. Allevio also offers continuing medical education to physicians whenever we can.
We will be posting the other articles in the series as they become available. We hope that all of our readers are continually asking the tough questions and seeking the right answers in the area of chronic pain.
London’s Dr. Patricia Morley-Forester will be speaking on local CBC radio stations across the country on Monday April 28th, with a focus on discussing chronic pain in Canada. Dr. Patricia Morley-Forster is a Professor of Anesthesiology at Schulich Medicine & Dentistry, University of Western Ontario and a thought and practice leader in the area of chronic pain. Tuning in will be worthwhile for patients, their caregivers, and physicians.
Here’s a list of the times that Dr. Pat Morley-Forester will be speaking on local CBC stations, please take a look and tune in!
6:50 Charlottetown – Island Morning Matt Rainnie – Host Twitter: @islandmorning
7:00 Sudbury – Morning North Markus Schwabe – Host Twitter (show): @MorningNorth Twitter (host): @cbcmarkus
7:20 Cape Breton (Sydney) – Information Morning Steve Sutherland – Host Twitter: @InfoMorningCB
7:40 Winnipeg – Information Radio Terry MacLeod/Marcy Markusa – Host Twitter: @CBCInfoRad
7:50 Regina – The Morning Edition Host: Sheila Coles Twitter handle: @sheilacolescbc
8:10 Kelowna – Daybreak South Chris Walker – Host Twitter: @cbckelowna