pain management in ehlers danlos syndrome – 2015

Download Pain management in Ehlers Danlos Syndrome – 2015

Post on 12-Feb-2017

216 views

Category:

Documents

3 download

Embed Size (px)

TRANSCRIPT

  • PainmanagementinEhlersDanlosSyndrome 2015

    PradeepChopra,MDDirector,PainManagementCenter,

    AssistantProfessor,BrownMedicalSchool,RhodeIslandAssistantProfessor(Adjunct),BostonUniversityMedicalCenter

    painri@yahoo.comwww.painri.com

    PradeepChopra,MD 1

  • Disclosureanddisclaimer

    Ihavenoactualorpotentialconflictofinterestinrelationtothispresentationorprogram

    Thispresentationwilldiscussofflabelusesofmedications

    Discussionsinthispresentationareforageneralinformationpurposesonly.Pleasediscusswithyourphysicianyourownparticulartreatment.ThispresentationordiscussionisNOTmeanttotaketheplaceofyourdoctor.

    PradeepChopra,MD 2

  • Introduction

    TrainingandFellowship,HarvardMedicalschool

    PainMedicinespecialist AssistantProfessor BrownMedicalSchool,RhodeIsland

    Specialinterestincomplexpainconditions

    PradeepChopra,MD 3

  • Atypicalevaluationwithmetakesanywherebetween5hoursto6hours.

    Iamgoingtotrymybesttosqueezeallthatin1hour

    PradeepChopra,MD 4

  • TypesofpaininEDS

    PradeepChopra,MD 5

  • TypesofpaininEDS

    Mechanicalpainorstructuralpain(Nociceptivepain)

    Inflammatorypain Nervepain Musclepain. Headaches

    PradeepChopra,MD 6

  • Jointsense

    ProprioceptionThebodysabilitytosensemovement

    ofthejointsandtheirposition

    PradeepChopra,MD 7

  • Proprioception Jointsense

    Thebrainconstantlygetsinformationfromthejointsastotheexactpositionofthelimbsinspace.

    Ithelpsuswalk,useourarms,maintainourposturewithouttippingover.

    Protectsourjointsfromoverextendingandourmusclesfromoverstretching

    EDS poorproprioception.Klutzy

    PradeepChopra,MD 8

  • Proprioception

    Reallyimportanttoworkonimprovingproprioception.

    EDSerslearntoprotectandavoidinjurytotheirjointsproperlybynotoverextendingthem.

    PradeepChopra,MD 9

  • Proprioceptionexercises

    Juggling Balanceboardorwobbleboard Storkstanding(standononeleg) Standuppaddleboard(SUP) Sittingonexerciseball Exerciseinwater walking,treadingbutNOswimming

    PradeepChopra,MD 10

  • 11

  • Compressiongarments,taping

    PradeepChopra,MD 12

    http://betterchiropractic.com/2011/09/therapeutictapingkinesiology

    tape/

  • Neuromusculartaping(Kinesio)

    PradeepChopra,MD 13

  • Kinesiotapingmechanism

    Mimicsthesuperficiallayerofskin after10minutesyoucannotfeelit

    Designedtostretch Porous allowsfordryingeasily.Youcantakeashowerwithiton

    Theadhesiveisappliedinawavelikepatterntomimicthequalitiesoffingerprints.

    PradeepChopra,MD 14

  • Fingerprintpattern

    PradeepChopra,MD 15

  • Kinesiotapingmechanism

    Thetapestimulatesthesensorsintheskinaswemove improvesproprioception

    Helpsreduceswelling

    PradeepChopra,MD 16

  • Kinesiotaping uses

    Reducespain Improvesmovementpatterns Relaxesmuscles Stabilizesjoints Supportsweakjoints Reducesswelling

    PradeepChopra,MD 17

  • Kinesiotapinghelpfulfor

    Neck Upperback Lowerback SIjoints,muscles Wrist Shoulders Knees Anklesandfeet

    PradeepChopra,MD 18

  • Kinesiotaping EDSknee Acombinationoftwostripsof

    25cminlengthand2.5cminwidthalongthecollateralligament(sidesoftheknee)using50%tapetensionapplieddistally(furthest)toproximal,ahorizontaltapebelowthepatella25cminlengthand2.5cminwidthappliedwith25%tensionandlastlyaYtape30cminlengthand5cminwidthcutwith5cmininitialbaseappliedlaterallytothepatellawithnotapetension.

    Ther Adv Musculoskelet Dis.2015Feb;7(1):310.doi:10.1177/1759720X14564561PMCID:PMC4314299Theeffectsofneuromusculartapingongaitwalkingstrategyinapatientwithjointhypermobilitysyndrome/EhlersDanlossyndromehypermobilitytypeFilippoCamerota,ManuelaGalli,VeronicaCimolin,corresponding authorClaudiaCelletti,AndreaAncillao,DavidBlow,andGiorgioAlbertiniAuthorinformation

  • TapingforlowerbackinEDS

    Twotapesof25cminlengthand5cmwidthappliedwithnotensiontothetape,laterallytothespinefromtheintergluteal foldtothelastdorsalvertebrawiththepatientmaintainalumbarflexionat45degreesinastandingpositionduringthecompleteapplication

    Ther Adv Musculoskelet Dis.2015Feb;7(1):310.doi:10.1177/1759720X14564561PMCID:PMC4314299Theeffectsofneuromusculartapingongaitwalkingstrategyinapatientwithjointhypermobilitysyndrome/EhlersDanlossyndromehypermobilitytypeFilippoCamerota,ManuelaGalli,VeronicaCimolin,corresponding authorClaudiaCelletti,AndreaAncillao,DavidBlow,andGiorgioAlbertiniAuthorinformation

  • HeadachesandneckpaininEDS

    PradeepChopra,MD 21

  • Headachesandneckpain

    Headachesmaybecausedbyneckpain Headachesmaybefrom

    insidethehead(Migraines)or outside(chronicdailyheadachesortensiontypeheadaches)

    Treatmentforbothisdifferent

    PradeepChopra,MD 22

  • PradeepChopra,MD 23

  • Causesofheadaches1

    1. ArnoldChiarimalformation2. Cervicogenic HA frommuscles3. TMJdysfunction(akaCraniofacialpain)4. Vision blurry5. POTS/Dysautonomia6. TetheredCordsyndrome7. Trigeminalneuralgia8. SpontaneousCSF(Cerebrospinal)leak

    PradeepChopra,MD 24

  • Causesofheadaches2

    7. Instabilityoftheneck Cranio CervicalInstability)

    8.Atlanto axialhypermobility9.Cervicalfacetjointarthritis(jointsinthe

    spine)10.Occipitalneuralgia(nervesinthebackofthehead)11.Sinusitis

    PradeepChopra,MD 25

  • Chiarimalformation..connecting

    Lowerbrainstemsymptoms: Nausea Dysphagia Throattightness Sleepapnea Shortnessofbreath Palpitations Facepain Doublevision Syncope(fainting)

    PradeepChopra,MD 26

  • TMJPain

    TemporoMandibularJointDysfunction

    PradeepChopra,MD 27

  • PradeepChopra,MD 28

  • TMJPain

    Verycloselyrelatedtoneckissues Clickingnoises Clenching,grinding Painwithchewing Difficultyopeningmouthwide(eatinganapple)

    Jawlockingup

    PradeepChopra,MD 29

  • TriggerpointsforTMJointpain

    PradeepChopra,MD 30

  • Temporomandibularjointdysfunction(TMJ)

    Presentin70% Treatment:avoidexcessivemouthopening,cautionwhenyawning,

    orthodontistspecializinginTMJ Avoidoverthecountermouthguards

    PradeepChopra,MD 31

  • KinesiotapingforTMJ

    32Kenzo Kase,WallisJim,Kase Tsuyoshi.ClinicalTherapeuticapplicationsoftheKinesiotapingmethod.3rd

    Edition..2013KinesioIP;LLC

  • Neckpain

    PradeepChopra,MD 33

  • Neckpainandheadaches

    Themostcommoncauseofneckpainisposture

    Chinpokingforwardposition Correctioniseasy. Beforelookingatotherreasons,correctthisfirst

    Thereareotherreasonslikecervicalinstability,Chiarimalformationetc theseneedtobeaddressed

    PradeepChopra,MD 34

  • Pokingchinposture

    PradeepChopra,MD 35

  • Headforwardorpokingchinposture

    Thisposturecancausepaininthejaws(TMJ),face,upperback,neck

    Blurryvision(POTS,EDS,Chiari)

    Laptops BrainFog(POTS,Chiari,

    MCAS)

    PradeepChopra,MD 36

  • Pokingchinposture/Forwardheadposition

    Shortensthemusclesinthebackoftheheadandneck

    Weaknessofmusclesinfrontofneck(flexors)

    PradeepChopra,MD 37

  • Managingneckpainandheadachesfrompoorposture

    Placeindexfingerinfrontofchinandpushbackheadgentlytillearsareinlinewithshoulders

    Largemonitor Postitnoteonmonitortoremindyou Visioncorrection ManagePOTS

    PradeepChopra,MD 38

  • Differenttypesoftapingforneckpainandheadaches.

    PradeepChopra,MD 39

  • Wristsandfingers

    PradeepChopra,MD 40

  • Musclesofthehand

    Thesmallmusclesofthehandarestressedtocompensateforhypermobility

    Smallintrinsicmusclesfatigueeasily short,painfreesessions

    PradeepChopra,MD 41

  • TheEDSwayofholdingapen

    PoorproprioceptionmakesEDSersgripapenwithasmanyfingersaspossible

    Theyholdthepenverytight

    Putsabnormalpressureonthemusclesandjointsofthehandandwrist

    PradeepChopra,MD 42

  • Handsandwristpain

    Damagetothe1st thumbjoint(1st CMCjoint) Holdpentootightly(poorproprioception) Fingerlesscompressionglove Foampaddedpen(Ableware) Splintingforsubluxations Pleasedonotvoluntarysublux fingersandthumbstoshowoff

    PradeepChopra,MD 43

  • Densefoampadding(Ableware)orwrapafoampaddedtape

    Fatpensarenothelpful

    Compressionhalffingergloves

    PradeepChopra,MD 44

  • Thumbpain

    Itsthe1st CMCjoint Hyperextensionofthisjointiscommon

    Splintshouldstabilizethejointbutnot crossthewristcrease(soasnottointerferewithwristmovements)

    PradeepChopra,MD 45

  • Musclesofthehand proprioceptiontraining

    Weightbearinginneutralposition eyesopen,eyesclosed

    Maytakemonthsbutdoesmakethejointsmorestableandligamentstaut

    Goalshouldbetodecreasefatigueandincreaseproprioception wrapcoban,foampadetc.forpens.But retraintoapplyappropriateamountsofpressure.

    PradeepChopra,MD 46

  • Splintingandbracesingeneral

    Bracesmaintainjointinneutralposition Avoidhyper extension Braceshelpwithjointpositionawareness(proprioception)

    Graduallydecreasetheiruseasyougainstrength

    Kinesiotapingisagoodoption

    PradeepChopra,MD 47

  • BreathingdifficultiesinEDS

    Mayfeellikerunningoutofbreath,needtotakedeeperbreaths,workingtobreathe

    Italmostfeelslikeonehastotakeabreathvoluntarily

    Thereareproprioceptorreceptorsinthemusclesofthechest,jointsoftheribs.

    Compressionshirt Tapingovertheribs.

    PradeepChopra,MD 48

  • CompressiongarmentforbreathingdifficultiesinEDS

    PradeepChopra,MD 49

  • FeetandanklesinEDS

    PradeepChopra,MD 50

  • Paininlowerhalfofthebody

    Payattentiontofeetandankles. Ifthefeetanda

Recommended

View more >