Summary: Migraine headaches are pretty common in children and adolescents, too. However, there are few treatment options in this age group, as FDA has approved very few drugs for treating migraine in children. It means that doctors often have to use some medications off-label. Studies suggest that untreated migraine in children may affect not only schooling but also brain development. Fortunately, an Israeli company has now developed a remote neurostimulation device that is even better than most commonly used medicines for migraine pain treatment in young adults.
Migraine headaches are pretty common in children and young adults. Studies show that migraine and cluster headaches even affect preschool children. In school-aged children, almost 10% may have migraine headaches, and these numbers may be pretty high for adolescent females.
Migraine headaches pose specific challenges in this age group, as they can disrupt education and affect development. Moreover, doctors find it quite challenging to manage such headaches due to a limited number of treatment options. Most drugs used to treat migraine in adults are not approved for use in children and young adults.
Therefore, doctors are left with few options, like prescribing over-the-counter medications that often fail to provide sufficient relief. Or doctors can prescribe migraine drugs like CGRP inhibitors off-label, which is not an ethical way to treat these headaches.
There is a reason why doctors often need to use unapproved drugs to treat migraine in children and young adults. Studies show that frequent migraine attacks may affect neurodevelopment. It may reduce the formation of ‘gray matter’ in different brain parts2.
Hence, doctors are faced with a dilemma. If they do not treat migraine, this would have a long-term negative impact on brain development. However, treating migraine with drugs not approved for use in young adults carries certain risks.
Thus, doctors think that there is an urgent need to find safer treatment options for managing migraine headaches in children and young adults, and it appears that there is one such way.
Of course, using devices to treat headaches have some distinct benefits, like lower risk of unforeseeable side effects. An Israeli medical tech company has developed a device called Nerivio as a new migraine treatment in both young and older adults.
It is a remote neuromodulation device. The device is worn on the upper arm and is controlled through a smartphone app. It generates electric impulses to stimulate nerves and thus disrupt migraine pain signals. Early studies have already shown that the device works, and it is pretty simple to use.
In a new study published in the journal Pain Medicine, researchers demonstrated that Nerivio is safe and effective for treating migraine headaches in adolescents. The latest study was done on 35 adolescents aged 12 to 17 living with migraines. It was a comparative study done for two months. Researchers compared the ability of the device to help with migraine headaches with over-the-counter drugs and oral triptans.
The findings of the study were quite encouraging. After two hours, 37% of patients reported complete pain relief compared to just 8.6% with medications. In addition, more than 80% of the patients reported some pain relief from the device compared to 57% with drug therapy.
Since the device was safe and did not cause any side effects, and was considerably better than medications, experts concluded that it could be used as a first-line treatment in young adults or adolescents. Moreover, the device is relatively inexpensive and a long-term investment. Finally, since it is an FDA-approved device, it is also covered by insurance.
Theranica, the company that produces these devices, is planning to check if their device can also help prevent migraine headaches. Not only that, the company plans to test the device for other chronic pain conditions in addition to migraine.
Summary: It has long been known that some drugs may cause headaches resembling migraines or cluster headaches. Even abusing painkillers like NSAIDs and opioids may cause headaches. However, a new study that analyzed the US FDA adverse event reporting system data found that immunosuppressants and immunomodulators also commonly cause headaches.
People are least likely to associate their headaches with medications that are intended to provide pain relief. However, studies show that many commonly used drugs to treat different pain conditions may become the source of headaches. Many of these drugs are used to treat inflammatory conditions and chronic pain. They might cause headaches that closely resemble migraine or cluster headaches. Thus, if you are one of those living with chronic pain or headaches, then it is vital to know more about the drugs that are often associated with headaches.
Early studies have shown that abusing painkillers may cause headaches. In addition, almost all painkillers, if abused, may increase pain sensation and cause headaches. Thus, people abusing NSAIDs, acetaminophen, opioids, and other analgesics are more likely to suffer from chronic migraine disorder. The risk is exceptionally high in those using these drugs for 10-15 days a month and for more than three months.
However, new studies suggest that the problem is worse than imagined. Even some of the new drugs used to treat inflammation, chronic pain, and autoimmune disorders may cause headaches. For example, drugs like monoclonal antibodies, immunomodulators, antivirals, and pulmonary artery dilators are commonly associated with chronic headaches. This new study was presented at the annual meeting of the American Headache Society.
For the study, investigators analyzed the US FDA data, which shows the possible side effects of various drugs. Additionally, it also maintains the side effects reported by clinicians. Thus, researchers say they were quite surprised to see how commonly immunosuppressants and immunomodulators were associated with headaches.
These drugs are often needed to treat severe health conditions, and many people need to use them regularly. Quite often, substituting these drugs is not an option. Moreover, it is worth understanding that the study only analyzed the reports of side effects. However, many cases go unreported. Thus, the real risk of headaches from these drugs might be much higher.
Interestingly enough, researchers also found that some drugs belonging to this class of drugs were much less likely to cause headaches. This has perplexed researchers, as it becomes really difficult to understand why some drugs in the same class cause headaches and others do not. For the study, researchers used US FDA adverse event reporting system data to investigate the reports of headaches caused by medications between 2018 to 2020. It is a website dedicated to pharmacovigilance. Thus, a website where doctors or patients may report adverse effects they experienced from drugs approved for clinical use.
They found that headaches were pretty common with apremilast, with 8672 reports. Other drugs affecting the immune system and commonly associated with headaches were adalimumab (5,357), tofacitinib (4,276), fingolimod (4,123), and etanercept (4,111)2. These drugs are often used to treat conditions like psoriasis, inflammatory bowel disease, and multiple sclerosis. But unfortunately, all these are difficult-to-treat conditions with fewer treatment options. Thus, quite often, changing the drug therapy is not an option.
Other drugs that the study found to be commonly associated with headaches were drugs used to treat hepatitis C, pulmonary hypertension, arthritis, and asthma. Of course, it is relatively simple to understand why some drugs, like those for pulmonary hypertension, cause headaches. Those drugs are also likely to affect other blood vessels, thus causing headaches. However, researchers still cannot explain why many other drugs cause headaches.
Investigators say that they understand that this is not the best way to understand the adverse effects of drugs. After all, many of these adverse effects were reported by individuals. Moreover, these are not findings of clinical studies, and such kinds of data sets do not provide highly reliable information. Nonetheless, researchers say that these findings are suggestive, and these issues require further scientific investigation.
Padda Institute Of Pain Management is one of the renowned pain treatment centers in St Louis that offer best medication for various types of headaches. The experts at Padda Institute provide headache treatments that are unique to a person’s needs. Schedule your appointment today!
Summary: Migraine is among the most difficult-to-treat headaches. Moreover, factors related to the worsening of migraine headaches differ. Many early studies have shown that higher omega-6 and low omega-3 intake are responsible for increased inflammation and a higher risk of different chronic disorders. A new study shows that reducing omega-6 fatty acids intake and, increasing omega-3 fatty acids intake, eating more fatty fish may considerably help ease migraine headaches. For some people, migraine can be highly debilitating, causing prolonged episodes of severe headaches. Even worse, some people do not respond well to drug therapy, thus experiencing frequent and prolonged migraine and neck pain. However, it is also not a secret that, in many instances, migraine is made worse by specific factors like changes in foods, climate, and more. There has been much research into migraine, but regretfully science does not fully understand what is the cause of migraine headaches in some individuals. There is a limited understanding of its pathogenesis. Hence, migraine headaches remain challenging to treat. Some people have a poor response to drug therapy. Of course, much research is happening, and migraine pain treatment is improving. There are now tens of drugs to treat migraine effectively in many people, and this includes even biologicals, neuromodulation, and light therapy. However, many of these treatments are expensive and tend to cause many side effects. Thus, there is a need to find more accessible and safer ways to prevent migraine headaches attacks, and it seems that dietary changes could be one of the ways. A new study funded by NIH found that increasing the intake of fatty fish may help reduce migraine headaches attacks, especially if a person also reduces the intake of vegetable oils concurrently1. This could be a pretty simple way to significantly reduce the risk of migraine attacks. Though it may not eliminate headaches, it can help. Moreover, these dietary measures are associated with better metabolic health. Many previous studies have recommended reducing the intake of vegetable oils rich in omega-6 fatty acids and increasing the intake of omega-3 fatty acids. This is because omega-6 fatty acids are not bad for the health; however, people are just consuming them in massive amounts, resulting in higher inflammation levels and, thus, a higher risk of certain disease conditions. On the other hand, increasing omega-3 intake and correcting the omega-3 to omega-6 intake ratio can help reduce inflammation and help prevent a range of metabolic disorders. These measures are quite good for reducing the risk of different chronic ailments. However, now the studies also show that such simple measures may help reduce episodes of migraine headaches. Surely, fatty fish is among the best dietary sources of omega-3 fatty acids. However, one may also increase their intake by increasing their intake of flaxseeds, chia seeds, and walnuts. Of course, these dietary changes would not eliminate migraine headaches, and benefits may vary. Nonetheless, it is quite a simple way to treat migraine headaches, and most people can use this approach to reduce the severity of their migraine headaches. Moreover, the benefits may be even greater when such dietary changes are combined with the right kind of drug therapy. These dietary imbalances are well known. Studies show that humans have evolved to consume more omega-3 fatty acids. This does not mean that they do not need omega-6 fatty acids. Omega-6 fatty acids or polyunsaturated fatty acids are also essential, and the body cannot produce them. However, humans consume omega-6 in large amounts, as they are abundant in most vegetable oils and processed foods. On the other hand, omega-3 intake in humans has become less over the centuries. Some of the dietary sources of omega-3 fatty acids are less accessible in different parts of the world. Studies suggest that boosting omega-3 fatty acids intake and reducing omega-6 fatty acids intake may reduce the risk of total headaches by 30% to 40%. Yes, that is a massive benefit, comparable to some expensive medications. At present, there are just a few moderately sized studies in this direction. There is a need to carry out a more extensive clinical trial to understand the role of dietary choices in migraine headaches. Moreover, many people living with migraines know that some foods cause worsening headaches. Padda Institute offers best treatment for migraines in the St Louis area. The team of specialists design a dedicated treatment suited to your needs.
Summary: Almost 40% of adults are living with chronic pain. However, many of them may progress to intractable pain. A kind of pain that would not benefit from traditional drug therapy and may require treatments like opioid therapy. Therefore, health experts think doctors and patients need to better understand intractable pain for a timely diagnosis of the condition. Studies suggest that some individuals are more likely to progress to intractable pain. Intractable pain is not something new, but its prevalence is increasing. Thus, many doctors see it as a distinct health condition. However, the term “intractable pain” is still not well recognized even in the medical world.
Studies show that almost 40% of people these days are living with chronic pains. Some may have musculoskeletal conditions, others post-surgical pain and other fibromyalgia. In some, chronic pain is quite severe and would not respond well to conventional therapy, including opioids. Such people are said to be living with intractable pain1.
Fortunately, now doctors realize to classify intractable pain as something different. It is a painful condition that is quite challenging to treat and often requires different treatment approaches. These are the individuals who might benefit from prolonged opioid use or procedures like a nerve block.
Therefore, now many states in the US are recognizing “intractable pain” as something different. Some states have passed the law recognizing this disease entity as a condition that justifies opioid prescription by doctors1.
Of course, not all people living with chronic pain are suffering from chronic pain. In most instances, doctors can help well by using conventional drug therapy. In addition, most would benefit significantly by using non-steroidal anti-inflammatory drugs. Nevertheless, some fail to respond to the treatment.
Studies suggest that some people are at a greater risk of intractable chronic pain. For example, one survey of 28 individuals living with intractable pain found that 20 of them were females. So, it means that the female gender is a significant risk factor for the condition.
Similarly, age is another risk factor. Young people are less likely to develop intractable pain, as they have good hormone status, and less likely to be living with chronic ailments. Thus, studies suggest that most people living with intractable pain were first diagnosed with the condition in their late 30s. The average age of people living with intractable pain is in the mid-fifties.
Moreover, intractable pain does not have a sudden onset. Most of these people are those who have been living with chronic pain for years. And, they remember quite clearly when their pain became intractable. This means that they started experiencing pain most of the time, and the usual treatment stopped helping them sufficiently.
Other signs found in those living with intractable pain is a decline in physical function in all cases, most require sleep medications, and they also report mental health issues. When it comes to laboratory findings, hormonal abnormalities, and high inflammatory markers, can be found in all the patients. In addition, one-third of these patients also have elevated blood glucose levels.
Further, it is worth understanding that those diagnosed with intractable pain have multiple health conditions. Thus, some common conditions they live with are adhesive arachnoiditis, Ehlers-Danlos syndrome, cervical neck neuropathy, reflex sympathetic dystrophy, interstitial cystitis, traumatic brain injury, rheumatoid arthritis, and stroke.
Researchers further studied the patients living with intractable pain. They found that apart from the above findings, 60% presented with a quad: constant pain, trouble sleeping, sugar craving, and cold hands and feet. Intractable pain is challenging to diagnose and manage, as most individuals with such pain are living with multiple health conditions. Moreover, most of these conditions are challenging to treat. Thus, in many, chronic pain progresses to intractable pain. For doctors, it is vital to identify when chronic pain has become intractable and provide treatment accordingly as ill-managed pain may cause worsening physical and mental health.
Summary: One-fifth of the US population is living with chronic pain, and some of them with high impact chronic pain. A new study shows that poorly managed chronic pain is a leading cause of faster cognitive decline, memory loss, and thus increased Alzheimer’s risk. Further investigation found that people with low socioeconomic status were particularly at risk due to healthcare disparities. The study also suggests that these health disparities may partially explain the higher prevalence of Alzheimer’s in black Americans. Hence, the study highlights the need for equal access to chronic pain treatment for various population groups.
Almost half of all adults may experience prolonged episodes of pain in their lifetime. However, data suggests that 20% of the population in the US continues to live with chronic pain at any given time, and these are massive numbers. Even worse, 8% of adults have high-impact chronic pain, and most have to live with it due to poor pain management.
Chronic pain is distressing, to say the least. However, in recent years, doctors have started to realize that chronic pain is also responsible for an increased risk of many chronic health disorders. For example, those living with poorly managed chronic pain are more likely to develop high blood pressure, heart disorders, depression, sleep disorders, and more. Now the new study suggests that chronic pain may be a risk factor for cognitive decline. This finding is especially relevant, considering the rise of dementia. Dementia is now among the leading causes of premature death and disability, affecting millions of lives.
The new study was published in the Journal of Alzheimer’s Disease. The study carried out detailed check-ups of 147 adults between the ages of 45 and 85. Researchers focused particularly on sociodemographic information and cognitive assessment and used MRI brain scans. They found that pain increased dementia risk, particularly in those with low education levels, low income, and thus with poor access to healthcare. In addition, they found that compared to those with better socioeconomic and education status, these individuals demonstrated 4% less gray matter. Thus, these findings were not merely subjective and were supported by objective data.
Of course, losing gray matter with aging is a common phenomenon. Early studies show that people gradually start losing gray matter as they age. This process generally begins in the 50s or 60s in different individuals. Generally, this decline is about half a percent each year. Thus, 3-4 percent equates to 6 to 8 years. It means that the brain of socially and economically deprived individuals age much faster. However, what is worrisome is that most people are diagnosed with conditions like Alzheimer’s in their 50s or later. This reduced gray matter in socially deprived individuals also suggests that they are at a greater risk of developing Alzheimer’s.
Researchers have also been focusing on how various stressors may contribute to an increased Alzheimer’s risk. For example, they found that the risk of developing dementia is almost twice as high in blacks compared to whites. Hence, this study found that this difference is not explained solely by genetics or ethnicity. Instead, it seems that health disparities are also an important contributing factor. These kinds of disparities lead to higher pain and stress exposure and thus resulting in faster brain aging, memory issues, and a greater risk of Alzheimer’s in blacks compared to whites.
Moreover, the study also suggests a relationship between pain intensity and brain aging. It appears that the risk of faster brain aging is proportionate to the pain intensity. It means that those with poorly managed chronic pain are more likely to develop dementia. This is not the first study. An early study that was done in 2017 also had similar kind of findings. It found that those older than 60 and living with chronic pain were more likely to see a sharp decline in their cognitive abilities.
However, there is some good news for those living with poorly treated chronic pain. A study in 2009 found that treating chronic pain well may even help reverse some of the changes in the brain. All these findings highlight the importance of managing chronic pain and providing sufficient relief.
Summary: Studies show that overdose-related deaths rose at an alarming rate of 30% between 2019 to 2020 in the US. However, data analysis shows overdose deaths affected Blacks and Indigenous Americans disproportionately. The increase in overdose deaths was exceptionally high in young black people. Further, it seems that fentanyl and fentanyl-laced drugs were the leading cause of overdose deaths.
Certain population groups in the US have historically been at a disadvantage. However, new data shows that drug overdose deaths are rising at an alarming and disproportionate rate among Black and Indigenous people in the US. Analysis of the report published by the Centers for Disease Control and Prevention shows that deaths due to drug overdose rose by 30% between 2019 to 2020, which is a massive increase.
However, as they say, the devil is in the details. On further analyzing the same report, one can see that drug overdose deaths affected Black and Indigenous people more severely. This new report shows a massive jump of 44% in overdose-related deaths among Black people. Things are also quite bad for American Indians and Alaska Native people. In this population group, the number of drug overdose-related deaths rose by 39%.
Researchers say that deaths among Indigenous people and Blacks outpaced those among white people. Thus, overdose-related deaths among white people rose by about 22% during the same period, which is significantly lower. Of course, one way to explain these differences is the pattern of substance abuse. Whites choose different kinds of drugs than Blacks or Indigenous Americans.
However, experts say that there are many reasons for such differences. For example, one of the significant causes of high mortality among specific population groups is treatment biases. Though a 30% increase in overdose deaths is already a historical landmark, there is more to it. It appears that the overdose issue affected younger Black people (15 to 24 years old) worse, with an almost 86% increase in overdose deaths. It means that in just one year, overdose deaths nearly doubled in this population group.
Not only that, overdose deaths were seven times higher in Black men older than 65 years old compared to white men, which is an unbelievably massive difference. Like many other reports, the study found that this difference was highest in the counties with the greatest socioeconomic disparities. Thus, for example, if the income gap in any county was less among various ethnic groups, then differences in overdose deaths also was lower.
Researchers say that income inequality between various racial groups seems to have the most significant impact since this leads to poor housing, lack of health insurance, limited access to treatment, and more.
When digging deep into the overdose death reports, experts also found that most of those who die do not get timely treatment for substance abuse or overdose. Thus, for example, data shows quite a low percentage of treatment for substance use among Blacks, with only one in 12 receiving any kind of treatment. Statistics were almost similar for disadvantaged populations like Hispanics and Indigenous people.
In the study, researchers noted a few other trends that may have practical implications. First, they found that most overdose deaths occurred due to illicitly produced fentanyl. Even in those with cocaine or methamphetamine overdose, fentanyl contamination appears to be a significant issue.
Hence, researchers say that tackling the illicit fentanyl supply is important for reducing overdose deaths in the US. Further, researchers recommend increasing access to substance abuse treatment and better access to medications like naloxone that can reverse opioid overdose. Additionally, better availability of fentanyl test strips would also help in understanding which drug contains fentanyl.
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Summary: Science has long known that emotional distress causes multiple physical signs due to stimulating the sympathetic nervous system, causing elevated body temperature, pulse rate, and blood pressure. Although these physical responses may be beneficial in the short run, helping initiate a fight or flight response. Still, they cause much harm in the long run, especially in those living with chronic issues like PTSD and panic disorders. In the new study, researchers discovered the neural circuit that causes these physical responses to stress, which may ultimately help find better treatments.
Mental health disorders are rising, especially emotional health disorders like PTSD and panic disorders. These conditions are known to cause physical signs, like increased heart rate, high blood pressure, increased stress response, and changes in body temperature.
If these altered physical responses remain unhandled, they might lead to changes in body function, increasing the risk of various chronic disorders. However, it is no secret that emotional disorders like anxiety, PTSD, and panic disorders tend to be chronic. Even if these conditions are treated with medications, relapses are common. Of course, there are many ways in which doctors treat both mental and physical signs of emotional disorders. Like they prescribe drugs that calm the brain and modulate emotions. But additionally, doctors also need to manage physical signs of emotional disorders and stress symptoms.
However, most of these treatments are far from adequate. For example, treating physical signs like increased heart rate and blood pressure using a specific drug helps. However, these drugs do not treat the underlying cause. Thus, a greater understanding of how emotional disorders lead to physical signs is needed. Needless to say, emotional responses develop deep inside the brain. Then there are circuits or pathways connecting it with brain centers responsible for controlling various body functions.
In the Nagoya University, Japan study, researchers found that stress responses start deep in the limbic system (area of the brain that controls emotions). From there, the signal travels to the dorsal peduncular cortex and the dorsal tenia tecta (DP/DTT), and then this signal is forwarded to the hypothalamus, causing different physical responses. Hypothalamus is like a junction box, connecting deep brain centers to other brain areas that control the sympathetic nervous system and motor system.
It seems that emotional responses mainly stimulate the sympathetic nervous system, which stimulates various body functions, causing high blood pressure, increase in temperature, and heart rate. Although short-term physical responses are the same, the same cannot be said about long-term responses. In the short run, these responses help mammals tackle certain issues and initiate the so-called fight or flight response.
However, the problem is that many people are living with chronic anxiety disorders these days. This means that this circuit responsible for controlling the physical responses to emotional issues remains switched on for days or even months. This continual stimulation of the pathway is the reason why many stress- related disorders, anxiety and panic attacks are increasing globally.
However, as the researchers noted, we can only treat or prevent these conditions if we have a better understanding of the underlying mechanism. Researchers carried out this experiment in lab mice to understand this whole neurocircuit. To confirm that this pathway plays a role in physical responses, they next impaired the connections of DP/DTT to the hypothalamus. This resulted in much less pronounced stress-induced physical responses.
Thus, the study confirmed that it is DP/DTT that is responsible for sending the signal to the hypothalamus and that DP/DTT-to-hypothalamus pathway plays an important role in physical responses to stress and anxiety. This is one of the first studies to identify the role of this particular pathway in stress responses.
Researchers from Nagoya University say that each such finding is a step forward and would help understand the “mind-body connection.” This would ultimately help doctors better treat conditions like PTSD and panic disorders and also help prevent chronic disorders caused by prolonged stress.
The short answer: most sources will tell you three to four injections a year in the same area, spaced at least six to twelve weeks apart. That ceiling is real and it is reasonable. But it is a practical guardrail built around cumulative steroid exposure — it is not a biological law, and it is not how the decision should actually be made.
The number of injections you need is based on your clinical need, and above all on how you responded to the first one. There is no particular magic in a series of three.
Corticosteroids are potent anti-inflammatory drugs. Injected near an inflamed nerve root or into an irritated joint, they can reduce swelling and interrupt a pain cycle that oral medication cannot reach. They are genuinely useful. They also have a dose-dependent cost: repeated steroid exposure at the same site is associated over time with weakening of local tendon, ligament and cartilage tissue, and repeated systemic absorption affects blood sugar, blood pressure and the body’s own cortisol production.
The three-or-four-per-year convention exists to cap that cumulative exposure. It is a sensible ceiling. What it is not is a schedule — and the difference matters, because a ceiling tells you when to stop, while a schedule tells you to keep going. Being told at your first visit that you will be having three injections is a booking convention, not a clinical finding. Nobody can know at injection one whether you will need injection two.
If the first injection gave you nothing at all, the odds that a second or third will help are slim. That is not a failure and it is not a dead end — it is diagnostic information. An injection placed correctly at a target that does not respond is telling you the target was probably wrong. The right next step is to re-examine the diagnosis, not to repeat the same injection and hope.
If the first injection helped — even partially, even briefly — that changes the calculation entirely. Partial relief means the target was right and the question becomes one of degree and durability. In that situation a repeat injection is reasonable, and there is evidence that repeating relatively early in people who responded can produce greater and longer-lasting relief than waiting a long interval.
So the two patients are not the same patient. One should probably not be injected again. The other might reasonably be injected sooner than a fixed calendar would allow. A standing series-of-three treats them identically, which is precisely the problem with it.
There are two separate reasons for the waiting interval, and they are often confused.
Corticosteroids are not painkillers and not anesthetics. The local anesthetic mixed into the injection can give you relief within hours, but that wears off and tells you very little. The steroid itself acts over roughly two to seven days. Judging the result before about two weeks have passed means judging it before the drug has finished doing whatever it is going to do.
Injected corticosteroid suppresses the hypothalamic–pituitary–adrenal (HPA) axis — the feedback loop governing your body’s own cortisol production. The most noticeable effects, including raised blood sugar and raised blood pressure, typically settle within 48 to 72 hours, but measurable HPA suppression can persist for three weeks or longer. Stacking injections inside that window means stacking systemic steroid effect, which matters a great deal if you are diabetic and matters to everyone eventually.
This is why the interval exists. It is not arbitrary caution, and it is also not a reason to wait six months when four weeks would serve you better.
Not all corticosteroid preparations behave the same way. Longer-acting formulations stay active at the site for longer and can buy more time between injections — but they also produce more prolonged systemic exposure and a higher chance of side effects. Shorter-acting preparations clear faster and have a better safety profile, at the cost of a shorter window of relief.
Which one is appropriate depends on the target, your medical history, and how many injections you have already had. Someone who has had several previous injections is a different prescribing problem from someone having their first. A frequency guideline that ignores which drug was used is not really a guideline.
Most of the advice you will find about “how often can I have a cortisone shot” is written about joints — a knee, a shoulder, a hip. That is where the concern about cartilage and tendon damage is most concrete, and where the three-per-year ceiling is most firmly established.
An epidural steroid injection places medication into the epidural space around an inflamed spinal nerve root rather than inside a joint. The cartilage concern does not apply in the same way, but the systemic and cumulative-exposure concerns do, and the response-driven logic above applies with even more force, because an epidural that produces no relief is a strong signal that the nerve root is not the source of your pain. For what the steroid is actually doing once it reaches the root, see why an inflamed nerve root burns, and what an epidural steroid injection actually does.
Injections into the sacroiliac joint, the hip joint, or trigger points each carry their own considerations. Asking “how many can I have” without saying where is asking an unanswerable question.
A defensible approach looks like this:
If you are being told the number before anyone has seen how you respond, you are being scheduled rather than treated.
Sometimes the honest answer is that injections have done what they can, and continuing to ask how many more you can have is asking the wrong question. Depending on the problem, the more useful conversation may be about genicular nerve blocks or genicular radiofrequency ablation for knee pain, viscosupplementation, other nerve blocks, shockwave therapy, spinal cord stimulation, or the metabolic and lifestyle factors that keep inflammatory pain going in the first place.
An injection that keeps being repeated because nothing else was offered is not a treatment plan.
Rarely sooner than about two weeks, because that is roughly how long it takes to judge whether the first one worked, and because HPA suppression from the first dose can persist for three weeks or longer. Many practitioners prefer six to twelve weeks between injections at the same site. The right interval for you depends on your response, the steroid used, and how many you have already had.
When a Piriformis Injection Does Not Work, That Is Still Information explains what that looks like.
It varies widely — from no useful relief at all to several months. A common range is around two to three months, but duration is not fixed and tends to be shorter with repeated injections at the same site. Duration is one of the things you should be recording, because it is a key input into whether repeating makes sense.
Steroid, Anesthetic, or Botox: What Goes Into a Piriformis Injection explains what that looks like.
Because repeated steroid exposure at the same site is associated over time with weakening of local tendon, ligament and cartilage tissue, and because systemic absorption raises blood sugar and blood pressure. None of that makes a well-indicated injection a bad idea. It makes an unlimited series of them a bad idea, which is exactly why the decision should be response-driven rather than scheduled.
That is the subject of Steroid, Anesthetic, or Botox: What Goes Into a Piriformis Injection.
Usually briefly. Most people resume normal activity within a day, but treating the injected area gently for the first day or two is sensible, and strenuous loading of a freshly injected joint or tendon is not. Follow the specific instructions you are given, since they differ by site.
The mechanism is covered in When a Piriformis Injection Does Not Work, That Is Still Information.
Usually, yes. We do not use sedation, so most patients drive themselves home. The exception is an injection that can leave a limb temporarily weak or numb — an epidural can — in which case wait until that has fully resolved before you drive. Ask before your appointment so you know which applies to you.
Steroid, Anesthetic, or Botox: What Goes Into a Piriformis Injection explains what that looks like.
The usual ceiling quoted for a single joint is three to four a year with at least six weeks between them, and many clinicians prefer longer. If a knee is needing injections at that rate, that is itself information — it is usually the point at which alternatives deserve a serious look rather than another shot.
That is the subject of When a Piriformis Injection Does Not Work, That Is Still Information.
Three a year is a reasonable ceiling and a poor plan. What should decide how often you are injected is your clinical need and your measured response to the last injection — not a number decided before anyone knew how you would do.
If you have been offered a standing series, or you have had several injections without anyone reassessing whether they are still helping, that is worth a second opinion. Contact the Padda Institute to have the question looked at properly.
This article is general information, not medical advice. Decisions about injection frequency should be made with the physician who has examined you and knows your history.
Summary: Experts say poorly treated pain may result in more severe complications than assumed earlier. It is known that poorly treated chronic pain causes an increase in blood pressure and cardiovascular issues. However, ill-treated chronic pain causes a constant increase in insulin, cortisol, and adrenalin, thus having broader adverse health effects. It is especially worth noticing that high cortisol causes changes in calcium metabolism, thus significantly increasing the risk of osteoporosis, arthritis, scoliosis, and other bone and joint disorders.
Data suggests that almost one-fifth of US adults are living with high-impact chronic pain. What is regretful is that most of these patients fail to get complete relief due to inadequate treatment. Even the rise of opioid addiction in the US has a lot to do with these chronic pains.
However, new studies suggest that pain is not just an unpleasant sensation. It is also about significant stress causing changes in the body and leading to serious complications. Acute pain causes acute stress with an increased adrenaline rush, high glucose, and changes in the autonomic nervous system. Most people would experience a sudden increase in heart rate and blood pressure.
Although the body can more or less counter acute stress, it is not made to handle chronic stress responses caused by chronic pain. Therefore, continuous pain, even if low grade, would result in chronic stress response, causing a negative impact on cardiovascular and endocrinal health.
Some of the complications associated with high-impact pain, whether acute or chronic, include:
Although science has long known about the above complications of severe pain, it is less aware of the long-term influences of pain on other body functions. Pain is an alarm signal that something is wrong in certain body parts, and something must be done. However, if this alarm keeps ringing, like in chronic pain, it may cause severe damage to the health.
The human body needs adequate rest and pain-free periods to revive and rejuvenate. However, trouble may ensue if it is not getting those essential pain-free hours. Quite often, it is challenging to treat underlying health conditions causing pain. Nonetheless, providing symptomatic relief is possible with the right kind of treatment. In addition, this can give the body a much-needed time to rejuvenate and revitalize.
Complications like osteoporosis, arthritis, and poor dental health, are more common among individuals living with chronic pain. However, till now, doctors did not realize that these issues may be due to chronic pain. New studies suggest that chronic pain causes more severe endocrinal changes than assumed earlier, thus leading to much graver changes in the body. Chronic pain is like an alarm that never shuts off, and thus body keeps releasing stress hormones like adrenalin, cortisol, and insulin (called big 3s). These hormones are pretty good at helping the body in times of emergency. They provide increased energy, help lower inflammation, and boost regenerative processes.
However, if these stress hormones remain continuously elevated, the body cannot cope. The body does not have infinite reserves. Over time, stress hormones like cortisol cause a decline in calcium levels in the body, causing dental health issues, joint disorders, and spine health problems. Many living with chronic pain may develop severe osteoporosis resulting in fragile bones, which become highly prone to fractures, and other issues. These people are at an increased risk of low back pain, arthritis, and more. However, things do not stop here, as high cortisol causes a decline in testosterone and estradiol levels. The decline in sex hormone levels may further cause havoc, causing poor health, mood issues, decreased sexual desire, anxiety, and more.
High cortisol means higher glucose, which causes an increase in insulin level, ultimately leading to insulin resistance or diabetes. It also causes a decline in vitamin D levels, low magnesium, and more. So as one can see that chronic and poorly treated pain can initiate severe stress responses leading to multiple complications. Here it is vital to understand how all body functions are interrelated. Therefore, experts suggest that doctors must carry out more extensive testing of patients living with chronic pain. In addition, doctors should not only focus on treating chronic pain but also its complications. Hence, doctors would need to test endocrine function, bone health, vitamin D levels, and more.
Summary: Researchers say that the traditional approach to treating low back pain must be changed. The conventional approach focuses too much on fixing something in the back. However, it neglects brain and spine communication. In the new study, researchers demonstrated that pain could be reduced by altering the thinking pattern of those living with CLBP. Chronic low back pain (CLBP) is the leading cause of chronic pain and disability globally. Despite much progress in medicine, it remains a significant problem. The traditional approach to managing CLBP is using anti-inflammatory drugs, painkillers like opioids, and even using invasive methods to repair degenerated disks. Doctors may also use various manipulations. Nonetheless, it appears that some patients do not respond well to various treatments. Even surgical correction fails to provide relief in many cases, which is why there is controversy around using such methods. Therefore, in recent years, researchers have started looking at CLBP a bit differently. They think, like any other chronic pain, low back pain is more complex. The pain occurs not merely due to some changes in the spinal cord. For example, fMRI studies confirm that the brains of those living with CLBP act differently. It means that we cannot ignore the role of the brain in such chronic pains. It means that CLBP is a complex problem occurring due to both changes in the spine and the brain. Moreover, the modern approach to the problem only makes things worse. It is no secret that those living with CLBP also live with different fears. They are hesitant to move their spine fully, fearing it will worsen their pain. Many such fears are fueled by medical recommendations. In CLBP, patients are often recommended to be careful about their spine. They are told to learn new ways of moving the spine, reducing stress on the spine. However, now researchers think that these recommendations might be making things worse. In addition, such recommendations might make problems chronic. It appears that in all the treatment approaches, one thing is missing. These treatment approaches do not realize that the brain plays a vital role in pain sensation. This is especially true for chronic conditions like CLBP. The new study published in the Journal JAMA confirms that focusing on the brain may help manage CLBP effectively. The new study was done on 276 patients randomly divided into two groups. One group, the intervention group, received graded sensorimotor retraining intervention (RESOLVE), which mainly included educating patients about low back pain, how to live with it, and assisting them with physical activities. Another group, the control group, received sham treatment using methods like diathermy or laser treatment. At the end of the study, researchers found that though both groups reported benefits at the end of the 18-week trial, but the benefit was more significant in the intervention group. This study demonstrated the importance of patient education and brain reprogramming in those living with the condition. Every researchers say that these findings are remarkable in many ways. In the intervention, researchers did not try to fix anything in the spine. Instead, the focus was on reprogramming the brain. As a result, it appears that the brains of those living with CLBP become more sensitive to pain. As researchers say that more extensive studies are needed to improve this treatment approach, so it can be used for managing low back pain. In addition, they say that if we want to help those living with CLBP, we need to alter how the brain and spine communicate. It is our mission to bring real hope and transformational change to patients who would otherwise be consigned to a lifetime of medications, doctor’s visits, and suffering. We expose misaligned incentives and return the power of health to the individual, we believe empowered individuals change their communities we use a combination of lifestyle intervention, medication management, and emerging scientific research to help our patients. When you are ready or have questions, reach out. The content provided herein is not intended to provide assessment, diagnosis, treatment, or medical advice; it also does not constitute provision of healthcare services. No information in this content should ever be considered as a substitute for advice from a healthcare professional, it is provided for thoughtful discussion, informational and educational purposes only.
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