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Managing Persistent Pain
How to treat symptoms of autoimmune diseases


Sept. 2017

Your immune system protects you from disease and infection, but if you have an autoimmune disease, your body attacks its own healthy cells by mistake. Autoimmune diseases can affect many parts of the body. For example, Crohn’s disease affects the gastrointestinal tract, colitis the colon, multiple sclerosis the central nervous system, lupus the joints and tissues, and fibromyalgia and complex regional pain syndrome can affect a number of areas of the body.

In fact, there are more than 80 types of autoimmune diseases, and some have similar symptoms, according to the American Chronic Pain Association. Getting diagnosed can be frustrating and stressful. In many people, the first symptoms are feeling tired and having muscle aches and a low fever. The diseases may also have flare-ups when they get worse. They also don’t usually go away, and sometimes severe pain is associated with them. Fortunately, the pain can be treated.

“We try to relieve pain, which also can lead to sleep difficulty and depression, with various treatment approaches, including pharmacological measures such as opioids, but this is just one category,” says Dr. Nileshkumar Patel, a pain specialist with Advanced Pain Management in Milwaukee. “We will also try other medications, such as antidepressants and anti-seizure medication, as well as nonopioids.”

When possible, physicians will recommend adjuvant or additional therapies, working with a team of other medical service providers. “We will try physical therapy, exercise programs, ultrasound and iontophoresis, in which electrical stimulation is used to deliver medication to the muscles,” Patel explains. At times, he adds, surgery may be recommended if appropriate.

Some individuals may find relief from alternative therapies; for example, joint pain and stiffness can be eased with acupuncture and massage.

People with rheumatoid arthritis frequently suffer from joint pain. A treatment that has been quite successful in relieving joint pain is radiofrequency ablation, according to Patel. “An electrical current produced by a radio wave is used to heat up a small area of nerve tissue, thereby decreasing pain signals from that specific area. It stuns the nerve and usually relief lasts 9 to 12 months,” he explains.

Patel is encouraged by the success of a new treatment he is using with some of his patients: high-frequency spinal cord stimulation. “Leads are placed in the back near the spine, sending electric pulses to disrupt the pain signals to the brain,” he says. This new technology improves upon low-frequency stimulators that essentially hide the pain with numbness. “The device was approved by the FDA last year,” he adds.

“I had one patient who was so desperate to be rid of her pain, she wanted to have her leg amputated. Fortunately, she was helped by some of the new technology,” Patel says. “People who did not have anywhere else to turn may get relief. It literally can be life-changing.”

Autoimmune Ailments Affect Oral Health

If you suffer from some autoimmune diseases like fibromyalgia or chronic fatigue syndrome, it’s likely you could also be suffering from temporomandibular joint disorder (TMD), affecting the jaw. TMD and bruxism — or teeth grinding — have been found in the majority of people with these illnesses. “Up to 85 percent of people with fibromyalgia also have TMD. There is a huge correlation between them,” says Dr. Jay Mackman of the TMJ Pain & Orofacial Treatment Centers of Wisconsin. 

Many people go from physician to physician to seek a diagnosis, Mackman says. “People may see seven to 10 other doctors — an ENT, neurologist, headache specialist and others — before they are referred to us,” he says. But once diagnosed, there is treatment available that may include physical therapy, nutritional recommendations and the use of stress reduction techniques, medications and trigger point injections. An acrylic appliance that fits over the teeth also can offer relief.

Individuals suffering from lupus, another autoimmune disorder, have problems with orofacial pain, Mackman adds. “The muscles tighten up, and we recommend they are fitted for a night guard, which they will wear for the rest of their life,” he says. “Help is available.”
— JoAnn Petaschnick


This story ran in the Sept. 2017 issue of: