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Abstract:

Migraine is a chronic inflammatory neurological disease which has progressive and episodic course. Poly unsaturated fatty acids are an important component of cell membrane phospholipids. The intake of this, specially omega 3 fatty acid rich foods related to decrease concentration of CRP, proinflammatory cytokines, eicosaniods and chemokines.

Introduction:

Migraine is a common chronic disease with nerve inflammation and dysfunction of the vascular endothelial cell. (1)The prevalence of a migraine is 17% in women and 7-8% in men. (2-4) Although the cause of migraine is still unknown, many factors involved in its pathogenesis include genetic factors, cerebral vasoconstriction, increased levels of glutamate in the attack phase, magnesium deficiency, monoaminergic pathway disorders, mitochondrial disorders, calcitonin gene-related peptide (CGRP) and neurogenic inflammation. (5) A large number of studies proved anti inflammatory and neuroprotective effects of omega 3 fatty acids.(6-7)

Neuro-inflammation: Only after disruption of blood brain barrier inflammatory mediators spread throughout brain tissue and cause wide spread inflammation. Immune cells produce active complement, cytokine, chemokines, IL, nitric oxide (NO), reactive oxygen species (ROS) and growth factors. These releasing substances have devastating effects on cells and cause of more damage.(8)

Anti- inflammatory and neuro protective role of omega 3 fatty acids:

DHA and EPA, PUFA which are part of omega 3 fatty acids. DHA and EPA, through the cyclooxygenase and lipoxygenase enzymatic pathway, cause production of Resolvins and related compounds with anti-inflammatory effects such as Protectine. Resolvin E1 (RvE1), Resolvin D1 (RvD1) and Protectin D1 evoke inhibition of migration of neutrophils from endothelial membrane. Some of the effects of omega-3 PUFA are related to modulation of the amount and types of eicosanoids which are made from omega-3 fatty acids.(10)

Another mechanism of PUFA is through PPAR-ϒ. The PPAR-Υ is a transcription factor that has anti-inflammatory function and can directly regulate the expression of inflammatory genes. It interferes with the activation of NFkB responsible for reducing the response of macrophages, decreasing phosphorylation  of  IkB (more NFkB activity) and production of TNF-α and IL-6.(11) Therefore, omega-3 fatty acids are remarkably effective in the treatment of inflammation and can be considered in the treatment of inflammatory pain.(9)

In rats, they studied PUFA significantly reduces oxidative stress and NO production in microglia and also having neuroprotective action.(11) The effects of sodium valproate and fish oil when both are given to patients with migraine, in combination or alone, the results showed that the significant reduction of duration, frequency, and severity of a headache has been observed in the group receiving the synergistic effect of fish oil and sodium valproate, as compared to the group receiving medication alone. Therefore, receiving sodium valproate with fish oil can control the severity of migraine disease more effectively than receiving sodium valproate alone.(12)

It has been shown that 2 months supplementation with 1 g of omega-3 fatty acids significantly decreased the frequency of headaches and also patients reported 74% reduction in the duration of their headache.(13)

Conclusion:

Omega 3 fatty acids, especially EPA, an alternative diatery supplementation therapy can be potentially important for neuroinflammatory as well autoimmune disorders.

REFERENCES:

  1. Robbins MS, Ailani J. Epidemiology, progression, prognosis, and comorbidity of trigeminal autonomic cephalalgias. In: Robbins M, Grosberg BM, Lipton R, Editors. Headache. New York, NY: John Wiley & Sons; 2013. p. 192-200.
  2. Hamed SA. The vascular risk associations with migraine: Relation to migraine          susceptibility and progression. Atherosclerosis 2009; 205(1): 15-22.
  3. Burch RC, Loder S, Loder E, Smitherman TA. The prevalence and burden of migraine and severe headache in the United States: Updated statistics from government health surveillance studies. Headache 2015; 55(1): 21-34.
  4. Lipton RB, Stewart WF, Diamond S, Diamond ML, Reed M. Prevalence and burden of migraine in the United States: Data from the American Migraine Study II. Headache 2001; 41(7): 646-57.
  5. Goua M, Mulgrew S, Frank J, Rees D, Sneddon AA, Wahle KW. Regulation of adhesion molecule expression in human endothelial and smooth muscle cells by omega-3 fatty acids and conjugated linoleic acids: Involvement of the transcription factor NF-kappaB? Prostaglandins Leukot Essent Fatty Acids 2008; 78(1): 33-43.
  6. De Caterina R, Madonna R, Massaro M. Effects of omega-3 fatty acids on cytokines and adhesion molecules. Curr Atheroscler Rep 2004; 6(6): 485-91.
  7. Sedighiyan M, Abdolahi M, Mohammadzadeh Honarvar N, Hosseini B, Djafarian K. Curcumin a novel agent targeting inflammatory pathways in obesity. Journal of Nutritional Sciences And Dietetics 2016; 2(5)
  8. Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr 2002; 21(6): 495-505.
  9. Xu ZZ, Zhang L, Liu T, Park JY, Berta T, Yang R, et al. Resolvins RvE1 and RvD1 attenuate inflammatory pain via central and peripheral actions. Nat Med 2010; 16(5): 592-7, 1p.
  10. Bazan NG, Molina MF, Gordon WC. Docosahexaenoic acid signalolipidomics in nutrition: Significance in aging, neuroinflammation, macular degeneration, Alzheimer's, and other neurodegenerative diseases. Annu Rev Nutr 2011; 31: 321-51.
  11.  Corsi L, Dongmo BM, Avallone R. Supplementation of omega 3 fatty acids improves oxidative stress in activated BV2 microglial cell line. Int J Food Sci Nutr 2015; 66(3): 293-9.
  12. Tajmirriahi M, Sohelipour M, Basiri K, Shaygannejad V, Ghorbani A, Saadatnia M. The effects of sodium valproate with fish oil supplementation or alone in migraine prevention: A randomized single-blind clinical trial. Iran J Neurol 2012; 11(1): 21-4.
  13. Harel Z, Gascon G, Riggs S, Vaz R, Brown W, Exil G. Supplementation with omega-3 polyunsaturated fatty acids in the management of recurrent migraines in adolescents. J Adolesc Health 2002; 31(2): 154-61.

Nerve Pain: how to manage?

What is Nerve Pain?

Nerve pain or neuropathic pain is a condition where there is pain because of nerve damage. It is characterized not only by pain, but also numbness, tingling, burning sensations and weakness that arise out of nerve damage. This pain is more common in the feet and the hands.

What are the common causes of nerve pain?

Diabetes is one of the most common causes, other causes are injuries, infections, slip disc and prolonged exposure to certain toxins etc.

How can you treat nerve pain?

Nerve pain can be the points that have been mentioned below:

  1. Topical Painkillers: Don’t have much role: These are also dangerous because we never measure the amount we apply on skin. These pain killers is absorbed through skin and produce same side effects like when it is taken orally.  

Certain over the counter ointments and creams can help relieve nerve pain. These medications act as local anaesthetics, Capsaicin, a derivative of chili peppers, is one of the major ingredients used in these medicines.

  1. Painkillers: Over the counter painkillers such as diclofenac, ibuprofen, aspirin and acetaminophen do not really work well for severe pain of the nerves.
  2. Anti-neuropathic medicines: Some anti-depressants, some anti-convulsant helps in reducing the neuropathic pain. Pregabalin, Gabapentin, Amitriptyline and some other similar medicines are of real help.
  3. Physical Therapy: Physical Therapy can sometimes help. Particularly transcutaneous electrical nerve stimulation is of definite help in neuropathic pain.
  4. Interventional Pain Management:
    • Sympathetic nerve block like stellate ganglion block, lumbar sympathetic block are very helpful in certain types of neuropathic pain.
    • Gasserian ganglion block is helpful in trigeminal neuralgia, one of the most severe nerve pain.
    • Spinal cord stimulation is one procedure like cardiac pace maker which is of immense help when all other options has failed. This is also called spinal cord pace maker.

Heat and cold therapy in pain

Both heat and cold can relief pain, know which and how to use these:

Most diseases, minor or major, acute or chronic, trauma or infection, there is one common factor - that is pain. Not only we should treat the disease, but also care the pain. For this in addition to analgesics, the most inexpensive and easily available modes of pain management are application of heat and cold. We should know the specific instances where heat and cold should be used as listed below.

Heat: Some of the common modes to heat therapy are: heat pads, warm baths/shower,  liquid paraffin system, hot water bottles, or warm oils. Heat acts by improving blood circulation and nutritional supply to the affected parts of the body and is best suited for stiff joints and muscle pain. 

Some common ways to apply heat:

  1. A warm shower or bath will ease morning stiffness and pain.
  2. Apply a heating pad on the painful/stiff areas up to 20 minutes - we must use optimal, tolerable heat to avoid skin burns.
  3. Wrap the affected area for 15 to 20 minutes with a moist heat pad.
  4. Warm mineral oils can be applied to the painful joints of hands and legs. We can keep it in place for 15 to 20 minutes before washing it off.
  5. For pain in hand and leg/foot joints, warm liquid paraffin wax can be applied.

Some common ways to apply cold:

Contrary to heat therapy, cold therapy acts by reducing blood flow to the paiful area and numbing the nerve endings, thereby reducing the transmission of pain signal. It works well for acute pain cases like fresh injuries and post-exercise trauma & inflammation.

  1. A cold wrap with ice cubes can be applied to the affected painful area for about 15 to 20 min. It can be repeated if needed.
  2. Alternately, a wet towel can be put in a plastic bag and kept in the freezer for 15 minutes and then used as a cold pack.
  3. The affected joint can be dipped in a bucket of ice-water.
  4. Cold gel packs are available at medical stores - they won't leak, will stay cold longer (when kept in refrigerator) and can be easily wrapped around a joint.

Both heat and cold works in pain, but as rule cold is got acute/recent/injury patients, whereas heat to be applied in chronic cases. Never apply heat in trauma or injury cases.

Pain in heel & foot

Author: Gautam Das

The foot and heels are the most load bearing components of our body which take most of the weight when walking, running, exercising or even standing up. The heels are especially vulnerable part which can face trauma and pain.

Causes for heel & foot pain:

  1. Planter Fasciitis: One of the commonest cause, Pain is felt more in the morning at morning after awaking up.
  2. Tarsal Tunnel Syndrome: Like carpal tunnel syndrome, it is not uncommon. Inflamed ligament at ankle compress post tibial nerve.
  3. Radicular pain or radiculopathy: In slip disc and sciatica when L5 or S1  nerve root is compressed or inflamed, patient may feel heel or ankle pain.
  4. Sprains or strains of foot: after any trauma including over exercise can produce ligaments injury and pain.
  5. Fractures: Stress or hairline fractures are not uncommon.
  6. Achilles tendinopathy & bursitis: It is the tendinous part of calf muscle which is attached to calcaneal bone. It can be injured or inflamed.
  7. Arthritis: Spondyloarthritis and gouty arthritis both are very common causes of heel and foot pain.

Treatments:

  1. Change of shoes: Shoes with soft sole are recommended.
  2. Physical Therapy: Shockwave or laser therapy may help.
  3. Ice packs: Cold compress and cold therapy reduces edema of inflamed ligaments of nerve and helps in reducing pain.
  4. Pain relief medications: Sometimes analgesics or adjuvants medicines are helpful.
  5. Interventional pain management: When all other options failed, interventional pain management is needed. Local steroid injection or, Platelet rich plasma injection can cure.
  6. Surgery: In extremely rare situations surgery may be needed.

It is however, advisable to visit a pain specialist doctor.

Knee pain management

Author: Gautam Das

Knee joints not only carry our body weight, it helps us to stand, sit, walk & run. Our knee joint is made up of three bones, femur, patela and tibia. Like there are buffers at the end of tables and chairs made up of tough rubber or plastic, end of our bones are covered with cartilages. This cartilage prevents friction between bones.

What is osteoarthritis?

It’s a disease where there is decay of cartilages at the end of bones. Cartilage surface becomes irregular, thickness of cartilage is reduced and gap between two bones are reduced. Reasons of osteoarthritis are age, body weight, family predisposition & trauma. Osteoarthritis is manifested as pain after exertion with cracking sounds particularly climbing up or down the stairs.

How should we treat osteoarthritis?

Early osteoarthritis can be treated with body weight reduction, exercises and medicines. But advanced osteoarthritis needs knee joint replacement surgery. But, Platelet rich plasma or PRP injection is a breakthrough in medical treatment of osteoarthritis of knee where cartilage can grow. Visco-supplementation & Radio-frequency procedures are other options.

What is Platelet rich plasma or PRP injection?

There are some growth factors inside our body which helps us to repair damaged tissues. This growth factors are mostly inside platelets. These platelets can be concentrated and injected at knee. This is also called regeneration therapy because it prevents further decay and repair decayed cartilage.

Steps of PRP injection:

  • About 30 ml of patient’s own blood is taken in a container containing anticoagulant, which do not allow the blood to clot and keep it fluid.
  • Then it is centrifuged in special machine that is capable of spin in high speed with temperature control.
  • Blood is taken and platelet part is separated which accumulate at the middle part.
  • This platelet part of blood is then injected inside knee under ultrasound guidance after injecting local anesthetic at injection site. 

Dos & don’ts after PRP injection:

  • If there is pain, swelling or heat at knee apply ice, and take pain medicines as advised by doctor.
  • Don’t apply hot fomentation, don’t stand or walk too much or lift heavy items, particularly on first 2 days.