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The case of the bad placebo
What Is It?
Arthritis involves inflammation of the joints that causes pain and swelling. Although many people believe arthritis is a disease of old age, various forms of arthritis can affect just about anyone at any age. When arthritis occurs in children younger than age 16, it is called juvenile arthritis. According to the Arthritis Foundation, about 300,000 children in the United States have some form of the disease.
The most common forms of juvenile arthritis are:
- Juvenile idiopathic arthritis (formerly called juvenile rheumatoid arthritis) – This is the most common form of juvenile arthritis. Juvenile idiopathic arthritis is thought to be an autoimmune disease, which means that, for unknown reasons, the body's immune system attacks some of its own tissue the same way it would react against a foreign invader such as a virus or bacteria. In juvenile idiopathic arthritis, the lining of the joint (called synovial membrane) becomes inflamed and enlarged, limiting movement and causing pain and tenderness. Enzymes released by the inflamed membranes cause further damage by eroding the bone and cartilage. This type of joint and bone damage can cause problems in a growing child. If the growth areas of the bones are affected, the bones may grow at different rates so that one bone may develop abnormally in shape or size. The result could be, for example, that one leg might be permanently shorter than the other.
There are several subcategories of juvenile idiopathic arthritis, including:
Oh, my aching jaw
Diagnosing the underlying cause of jaw, mouth, and face pain is crucial to getting relief.
Sometimes, it's a dull painful ache on the side of your face. In other cases, you may feel a sharp pain accompanied by a popping or clicking noise when you chew. Or you may have a problem biting down.
While these various symptoms were once commonly grouped together under the umbrella of temporomandibular joint problems, casually abbreviated as TMJ, today we know that there are different underlying reasons for mouth, jaw, and face pain — what doctors call orofacial pain — and not all of them are caused by problems with the temporomandibular joint itself.
Doctors’ pain pill prescribing habits at odds with current guidelines
Research we're watching
Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.
Image: © robeo/Getty Images
Can alternative treatments help with painful fibroids?
Ask the doctors
Q. I have uterine fibroids and am experiencing some pain and discomfort from them. Are there any alternative treatments that I can use to help manage my symptoms?
A. If you are experiencing anemia, severe pain, or difficulty with urinating that may be due to fibroids, it's important to seek the advice of a doctor. However, there are some pain management options other than medications or surgery that may help relieve symptoms related to fibroids. These strategies haven't been proven to relieve pain from fibroids, but The National Center for Complementary and Integrative Health, in a 2017 review of complementary approaches to chronic pain, found they have some promise in helping other types of chronic pain, specifically lower back pain. These include acupuncture, an alternative medicine treatment that uses small needles applied at specific sites on the body to relieve chronic pain; yoga, a type of low-impact exercise that includes a series of postures and breathing techniques; relaxation techniques, such as deep breathing and mindfulness (a practice that encourages staying focused on the present moment); tai chi, originally practiced as a form of self-defense, which incorporates slow, deliberate movements and deep breathing exercises; and massage performed by a massage therapist.
When is it time for a knee replacement?
Q. I have osteoarthritis. My right knee is especially painful and stiff. How do I know when the time is right for knee replacement surgery?
A. Timing is key. If you get the procedure too soon, you might not see enough improvement to make the surgery worth it. In addition, the younger you are when you have knee replacement surgery, the greater the chances it will not last and another surgery may be needed. But if you wait too long, you may subject yourself to unnecessary pain and disability.
Giving steroid injections a shot
They can offer temporary pain relief, but are they right for you?
If you're battling with a flare-up of arthritis, bursitis, or tendinitis, you may find relief from an injection of cortisone (a type of steroid).
"People turn to injections when conservative treatments like over-the-counter and prescription pain medication or physical therapy no longer work, and their pain begins to interfere with quality of life," says Dr. Rob Shmerling, clinical chief of rheumatology at Harvard-affiliated Beth Israel Deaconess Medical Center.
Don’t take back pain sitting down
Some conditions can be aggravated by sitting, so after the initial pain subsides, aim to move more, not less.
Sitting down is supposed to be a way to relax after a long day on your feet. But for many women, sitting for any length of time is painful. It aggravates pain in the back instead of relieving it.
If this sounds like you, the problem could be one of several common conditions, says Dr. Steven J. Atlas, an associate professor of medicine at Harvard Medical School.
Bedsores (Decubitus Ulcers)
What Is It?
Bedsores, also called pressure ulcers or decubitus ulcers, are areas of broken skin that can develop in people who:
- Have been confined to bed for extended periods of time
- Are unable to move for short periods of time, especially if they are thin or have blood vessel disease or neurological diseases
- Use a wheelchair or bedside chair (a hospital chair that allows a patient to sit upright next to the bed)
Bedsores are common in people in hospitals and nursing homes and in people being cared for at home. Bedsores form where the weight of the person's body presses the skin against the firm surface of the bed.
Carpal Tunnel Syndrome
What Is It?
In the wrist, nerves and tendons pass through a space called the carpal tunnel.
Because the carpal tunnel is somewhat narrow, a major nerve called the median nerve that passes through this tight space, can become irritated or compressed. Carpal tunnel syndrome is a combination of numbness, tingling, pain and weakness in the hand caused by compression of the median nerve in the carpal tunnel.
What Is It?
A hernia occurs when part of an internal organ or body part protrudes through an opening into an area where it shouldn't. A hiatal hernia is named for the hiatus, an opening in the diaphragm between your chest and your stomach. Normally, the esophagus (the tube that carries food to the stomach) goes through this opening. In a hiatal hernia, part of the stomach and/or the section where the stomach joins the esophagus (called the gastroesophageal junction) slips through the hiatus into the chest.
There are two types of hiatal hernias:
- Sliding — A part of the stomach and the gastroesophageal junction slip into the chest. Sliding hiatal hernias are common, especially in smokers, overweight people and women older than 50. These hernias are related to naturally occurring weaknesses in the tissues that normally anchor the gastroesophageal junction to the diaphragm and to activities or conditions that increase pressure within the abdomen. These activities or conditions include persistent or heavy coughing, vomiting, straining while defecating, sudden physical exertion and pregnancy.
- Paraesophageal — The gastroesophageal junction remains in its proper place, and a fold of the stomach slips into the chest, pinched between the gastroesophageal junction and the diaphragm. Of the two types of hiatal hernias, paraesophageal hernias are more likely to cause severe symptoms.
Sliding hiatal hernias may not cause any symptoms, or they may cause heartburn that is worse when you lean forward, strain or lie down. There may be chronic belching and, sometimes, regurgitation (backflow of stomach contents into the throat).
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