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Family Medicine (Expert Forum)
Nightmares and joint pain.
Questions in the Family Medicine forum are answered by Dr. J.M. Keyes. Topics covered include general health issues, adolescence, babies, child health, eating disorders, fitness, immunizations and vaccines, infectious diseases, medical tests and procedures, and senior health.
Nightmares and joint pain.
by sinnequan, Nov 19, 2001 12:00AM
i am 29 years old and seem to have some kind of health trouble all the time.currently, i am going to a physical therapist for what my doctor thinks is bursitis (though both my joint and right buttock hurt) but my right sholder blade hurts too. i am also taking protonix after abdominal pain could not be diagnosed.... well, for the past month and a half i have been having terrible nightmares almost EVERY night.they are VERY vivid- and i dread going to sleep because of this.right now i am taking 5 mg of paxil, 200 mg of celexa (which doesn't help), 40 mg of protonix--and calcium and prenatal vitamins (i don't plan on becoming pregnant). i am REALLY scared about my nightmares--i have a psychiatric history of depression and hypochondria (i am convinced i have bone cancer right now)-- should i see a neurologist about these nightmares?what is the likely hood i have an undiagnosed illness causing these nightmares? do nightmares usually mean something serious??? please help me.
Doctor's Answer
by Forum-M.D.-DT, Nov 20, 2001 12:00AM
After reading your question carefully, I can tell you that I suspect, without a doubt, that you are dealing with a problem with chronic Anxiety. My first thought is why 5mg of Paxil? This is a very low dose and as you will read within the content of this response, there are treatments for anxiety. Paxil is one of them and I would recommend speaking with your doctor about a "regular" dose of Paxil (20mg/day). You also have symtpoms of Fibromyalgia and Irritable Bowel Syndrome. Both of which are common in patients with chronic anxiety. My feeling is this ... controlling your anxiety will, in addition to helping to reduce nightmares, will help you "feel" better in general.
Anxiety is a common emotional state causing feelings of worry, apprehension, or uneasiness. Physical symptoms may be present as well. These include increases in heart rate and breathing rate, tremulousness, sweating or fatigue. We all experience stress or anxiety at some time or another in our lives. It’s a normal part of life. However, when this stress or anxiety affects the ability to function in every day life, it is time for some changes to be made. This week we will discuss both medical and non-medical ways of relieving these all too uncomfortable feelings.
Generalized Anxiety Disorder (GAD)
Anxiety can be divided into 3 main classes. Generalized anxiety disorder, panic attacks and social phobias. While these may be considered distinct, in many cases a person with GAD will commonly have a history of panic attacks and/or social phobias as well.
GAD is present in about 5% of the population. It is more common in women than men and usually is gradual in onset, most often beginning during childhood or adolescence.
There are many symptoms associated with GAD and there are also many conditions the doctor examining the patient must consider when evaluating the anxious or “stressed” patient.
Symptoms which may indicate GAD
1. Restlessness or feeling “keyed up”
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep Disturbances (trouble falling or staying asleep)
Physical Signs with may indicate GAD
1. Clammy hands
2. Dry mouth
3. Urinary frequency
4. Nausea, diarrhea or stomach pains
5. Sweating
6. Headaches
7. Dizziness
8. Rapid heart beat
Some medical conditions the doctor should consider
1. Irritable bowel syndrome
2. Gastritis
3. Asthma or Emphysema
4. Migraine headache
5. Thyroid disease
6. Diabetes
7. Heart disease and cardiac arrhythmias
8. Menopause
9. Drug reactions
10. Excessive alcohol or caffeine use
With a thorough examination (with blood and urine test) your doctor will be able to rule out most common medical causes for anxiety. An EKG, chest Xray and possibly further examination of the intestinal tract may be needed in some cases.
Treating Stress and Anxiety without medication
Stress! With our busy lives and schedules this seems to become a more and more common underlying problem in the majority of patients coming to the doctor’s office.
Stress can worsen hypertension, diabetes and the body produces more cholesterol under stress. Stress also increases the amount people smoke and drink alcohol and those under stress are less likely to exercise regularly.
Exercise: Certainly exercise burns calories and fat and builds muscle but it also RELIEVES TENSION! Getting onto and sticking with a regular exercise routine (as little as 30 minutes of walking 3 times a week) may do wonders for helping relieve stress and anxiety. Also, learn to stretch your muscles. Important muscle groups to consider include the neck, arms, legs, and back particularly if you sit at a desk for much of the day.
Well balanced diet: More fruits and vegetables, grains, and low in fats and sugars. Also avoiding caffeine, nicotine and alcohol tremendously helps reduce once feeling of “stress.”
Get enough sleep: Most adults need at least 6 hours of sleep each night. Usually getting 7 or 8 hours is most beneficial at helping relieve stress and improve symptoms of anxiety.
Avoid large meals, sugar or caffeine for at least 4 hours before going to bed.
Know your body: Learning the physical signs your body gives you when you are beginning to feel stress. These may include neck stiffness, headache, fatigue, rapid heartbeat, irritability, anger, worry or difficulty concentrating. Know what causes you stress. Is it arguments, being late, having to wait, meeting new people, your work environment, loud noise or traffic? In some cases you may be able to avoid the stress or alter the situation, if not learn some relaxation techniques and practice them.
Learning how to relax
Deep Breathing: When the stressful situation arises try this. Breathe in slowly through your nose and exhale through your mouth. Take long deep slow breaths while telling yourself “relax” with each breath. Do this for 10 breaths .. or longer if necessary. This helps increase oxygen delivery to the bloodstream and eases muscle tension.
Relaxation techniques: Countless books have been written on this subject alone however consider this technique to help you relax. This is beneficial if done daily or before bed and is usually helpful for many with insomnia.
Sit in a quiet room where you won’t be interrupted and get comfortable. Close your eyes and beginning with your toes focus on each muscle relaxing. First your toes, then your feet, your ankles and so on. Take slow breaths through your nose and exhale through your mouth and imagine yourself in the most relaxed setting that comes to mind. Depending on the situation, do this for 5 minutes, 10 minutes or longer if possible.
Cognitive therapy: This usually involves working with a therapist to learn to recognize situations causing worry and negative thinking. Patients are challenged to modify negative thinking with positive thoughts and substitute realistic alternatives to “worry.”
People with anxiety tend to overestimate danger and underestimate their ability to control that perceived danger.
Medications to consider:
Medication is very helpful with the treatment of Generalized Anxiety Disorder. If you and your doctor feel as though medication may be necessary to help you control your symptoms of anxiety, keep working on diet, exercise, proper sleep and relaxation techniques while on the medication.
Buspirone (Buspar): An excellent medication for treatment of Generalized Anxiety Disorder. Patients may not notice improvement of symptoms for 2-3 weeks after beginning the medication however this medication is not addictive (like benzodiazepines – noted below). Potential side effects with Buspirone include nausea, headache, dizziness and nervousness.
Benzodiazepines: This class includes medications such Xanax, Ativan and Valium. These medications have a moderately high potential for addiction and therefore should be used with caution. Additionally they have many side effects including drowsiness, headache, confusion, dry mouth, stomach upset, problems with coordination and may cause (or worsen) depression. They have a fast onset however and may be quite beneficial for control of symptoms of anxiety if used short term.
Antidepressants – Selective Serotonin Reuptake Inhibitors (SSRI)
This class includes medications such as Prozac, Celexa, Luvox, Zoloft and Paxil. While most of these medications are indicated for depression, Paxil has been shown to be somewhat more beneficial in the treatment of GAD. They carry the potential for side effects such as nausea, dry mouth, headache, fatigue, constipation and sexual dysfunction.
Venlafaxine (Effexor): The extended release formulation of Effexor (EffexorXR) has been approved by the FDA for treatment of GAD. This is a highly effective medication for treatment of GAD and is not addictive. It does have a slight potential to increase blood pressure and may include other potential side effects such as dry mouth, dizziness, nausea, fatigue, nervousness, tremor, sexual dysfunction, sweating and decreased appetite.
If you have symptoms of stress or anxiety, see your doctor to make sure you have no underlying medical condition that could be causing your symptoms. Once medical etiologies have been ruled out, working on exercise, proper diet, proper sleep, relaxation techniques and in some cases the use of medication will be of great value to you. In many cases, consultation with a therapist will also be of great benefit.
You may want to print this up and bring it to your next doctor's visit. Listen, many, many, many people have come into my office with a variety of symptoms which, ultimatly, resolve once the anxiety is resolved. I really suspect this would be the case with you as well.
To answer one of your questions, NO, nightmares do NOT mean anything serious medically .. BUT they are quite common in untreated (or undertreated) anxiety disorders.
I wish you well and hope this information will be beneficial.
Dean M. Tomasello, M.D.
Anxiety is a common emotional state causing feelings of worry, apprehension, or uneasiness. Physical symptoms may be present as well. These include increases in heart rate and breathing rate, tremulousness, sweating or fatigue. We all experience stress or anxiety at some time or another in our lives. It’s a normal part of life. However, when this stress or anxiety affects the ability to function in every day life, it is time for some changes to be made. This week we will discuss both medical and non-medical ways of relieving these all too uncomfortable feelings.
Generalized Anxiety Disorder (GAD)
Anxiety can be divided into 3 main classes. Generalized anxiety disorder, panic attacks and social phobias. While these may be considered distinct, in many cases a person with GAD will commonly have a history of panic attacks and/or social phobias as well.
GAD is present in about 5% of the population. It is more common in women than men and usually is gradual in onset, most often beginning during childhood or adolescence.
There are many symptoms associated with GAD and there are also many conditions the doctor examining the patient must consider when evaluating the anxious or “stressed” patient.
Symptoms which may indicate GAD
1. Restlessness or feeling “keyed up”
2. Being easily fatigued
3. Difficulty concentrating or mind going blank
4. Irritability
5. Muscle Tension
6. Sleep Disturbances (trouble falling or staying asleep)
Physical Signs with may indicate GAD
1. Clammy hands
2. Dry mouth
3. Urinary frequency
4. Nausea, diarrhea or stomach pains
5. Sweating
6. Headaches
7. Dizziness
8. Rapid heart beat
Some medical conditions the doctor should consider
1. Irritable bowel syndrome
2. Gastritis
3. Asthma or Emphysema
4. Migraine headache
5. Thyroid disease
6. Diabetes
7. Heart disease and cardiac arrhythmias
8. Menopause
9. Drug reactions
10. Excessive alcohol or caffeine use
With a thorough examination (with blood and urine test) your doctor will be able to rule out most common medical causes for anxiety. An EKG, chest Xray and possibly further examination of the intestinal tract may be needed in some cases.
Treating Stress and Anxiety without medication
Stress! With our busy lives and schedules this seems to become a more and more common underlying problem in the majority of patients coming to the doctor’s office.
Stress can worsen hypertension, diabetes and the body produces more cholesterol under stress. Stress also increases the amount people smoke and drink alcohol and those under stress are less likely to exercise regularly.
Exercise: Certainly exercise burns calories and fat and builds muscle but it also RELIEVES TENSION! Getting onto and sticking with a regular exercise routine (as little as 30 minutes of walking 3 times a week) may do wonders for helping relieve stress and anxiety. Also, learn to stretch your muscles. Important muscle groups to consider include the neck, arms, legs, and back particularly if you sit at a desk for much of the day.
Well balanced diet: More fruits and vegetables, grains, and low in fats and sugars. Also avoiding caffeine, nicotine and alcohol tremendously helps reduce once feeling of “stress.”
Get enough sleep: Most adults need at least 6 hours of sleep each night. Usually getting 7 or 8 hours is most beneficial at helping relieve stress and improve symptoms of anxiety.
Avoid large meals, sugar or caffeine for at least 4 hours before going to bed.
Know your body: Learning the physical signs your body gives you when you are beginning to feel stress. These may include neck stiffness, headache, fatigue, rapid heartbeat, irritability, anger, worry or difficulty concentrating. Know what causes you stress. Is it arguments, being late, having to wait, meeting new people, your work environment, loud noise or traffic? In some cases you may be able to avoid the stress or alter the situation, if not learn some relaxation techniques and practice them.
Learning how to relax
Deep Breathing: When the stressful situation arises try this. Breathe in slowly through your nose and exhale through your mouth. Take long deep slow breaths while telling yourself “relax” with each breath. Do this for 10 breaths .. or longer if necessary. This helps increase oxygen delivery to the bloodstream and eases muscle tension.
Relaxation techniques: Countless books have been written on this subject alone however consider this technique to help you relax. This is beneficial if done daily or before bed and is usually helpful for many with insomnia.
Sit in a quiet room where you won’t be interrupted and get comfortable. Close your eyes and beginning with your toes focus on each muscle relaxing. First your toes, then your feet, your ankles and so on. Take slow breaths through your nose and exhale through your mouth and imagine yourself in the most relaxed setting that comes to mind. Depending on the situation, do this for 5 minutes, 10 minutes or longer if possible.
Cognitive therapy: This usually involves working with a therapist to learn to recognize situations causing worry and negative thinking. Patients are challenged to modify negative thinking with positive thoughts and substitute realistic alternatives to “worry.”
People with anxiety tend to overestimate danger and underestimate their ability to control that perceived danger.
Medications to consider:
Medication is very helpful with the treatment of Generalized Anxiety Disorder. If you and your doctor feel as though medication may be necessary to help you control your symptoms of anxiety, keep working on diet, exercise, proper sleep and relaxation techniques while on the medication.
Buspirone (Buspar): An excellent medication for treatment of Generalized Anxiety Disorder. Patients may not notice improvement of symptoms for 2-3 weeks after beginning the medication however this medication is not addictive (like benzodiazepines – noted below). Potential side effects with Buspirone include nausea, headache, dizziness and nervousness.
Benzodiazepines: This class includes medications such Xanax, Ativan and Valium. These medications have a moderately high potential for addiction and therefore should be used with caution. Additionally they have many side effects including drowsiness, headache, confusion, dry mouth, stomach upset, problems with coordination and may cause (or worsen) depression. They have a fast onset however and may be quite beneficial for control of symptoms of anxiety if used short term.
Antidepressants – Selective Serotonin Reuptake Inhibitors (SSRI)
This class includes medications such as Prozac, Celexa, Luvox, Zoloft and Paxil. While most of these medications are indicated for depression, Paxil has been shown to be somewhat more beneficial in the treatment of GAD. They carry the potential for side effects such as nausea, dry mouth, headache, fatigue, constipation and sexual dysfunction.
Venlafaxine (Effexor): The extended release formulation of Effexor (EffexorXR) has been approved by the FDA for treatment of GAD. This is a highly effective medication for treatment of GAD and is not addictive. It does have a slight potential to increase blood pressure and may include other potential side effects such as dry mouth, dizziness, nausea, fatigue, nervousness, tremor, sexual dysfunction, sweating and decreased appetite.
If you have symptoms of stress or anxiety, see your doctor to make sure you have no underlying medical condition that could be causing your symptoms. Once medical etiologies have been ruled out, working on exercise, proper diet, proper sleep, relaxation techniques and in some cases the use of medication will be of great value to you. In many cases, consultation with a therapist will also be of great benefit.
You may want to print this up and bring it to your next doctor's visit. Listen, many, many, many people have come into my office with a variety of symptoms which, ultimatly, resolve once the anxiety is resolved. I really suspect this would be the case with you as well.
To answer one of your questions, NO, nightmares do NOT mean anything serious medically .. BUT they are quite common in untreated (or undertreated) anxiety disorders.
I wish you well and hope this information will be beneficial.
Dean M. Tomasello, M.D.
It is wonderful to have a physician truly understand the effects and stress! Wish there were more doctors like you.
Catherine
Dean M. Tomasello, M.D.