Excerpt from the
Handbook on the Late Effects of Poliomyelitis for Physicians and Survivors©

Pain

SPANISH

Pain can be due to any number of factors ranging from very benign to quite serious. Polio survivors who are experiencing pain should undergo a comprehensive medical evaluation to diagnose its cause. Pain is most often due to overuse of muscles, tendons, ligaments and/or joints, and primary interventions are directed at alleviating or eliminating the overuse factors.

Pain syndromes associated with the late effects of polio include muscle (myogenic) pain and cramping. Fasciculations, often described as a crawling sensation, are exacerbated by physical activity, stress and sometimes cold weather. Typically, myogenic pain and fasciculations will decrease or disappear entirely with rest (see Pacing, Conservation of Energy, Lifestyle Changes). Gentle stretching may be useful, but must be performed judiciously in situations when there is a greater functional benefit with tighter tendons (Gawne, 1997). Heat and gentle massage are useful adjunctive treatments as well. Fibromyalgia (see Fibromyalgia) and its associated pain have been noted to be more prevalent among polio survivors (Trojan & Cashman, 1995).

Strain injuries are not uncommon and affect the muscles, tendons, bursa and ligaments, and may occur chronically or acutely. Pain due to strain may be related to posture and/or occur as a result of overuse of the arms, shoulders and lower extremities (Smith & McDermott, 1987). Pain radiating from the shoulders is a result of supraspinatus or biceps tendinitis. Elbow pain is common, as is knee pain. Genu recurvatum (back knee) is a condition in which, because of weakness of the ligaments and muscles around the knee, there is progressive backward deformity of the knee (see Joint Deformities). To control or eliminate strain injuries and symptoms, the joints should be protected by bracing (see Bracing) or by a decrease in crutch use.

Another frequent cause of pain is degenerative joint disease. Degenerative changes, also in the spine, are exacerbated by weakened muscles and worsened by walking on unprotected joints with unusual gait movements and abnormal stresses. They can be lessened by improving support with appropriate bracing, adaptive devices (canes, crutches, corsets), special seating and postural modification.

Other pain problems that can occur are secondary nerve compression syndromes, commonly at the wrist and occasionally at the elbows (Werner & Waring, 1989). Median nerve compression, at the wrist (carpal tunnel syndrome), and ulnar nerve compression, at the elbow and wrist, are more prevalent in those who are crutch or manual wheelchair users than in the general population. Stress on the wrist and elbow can be reduced by using power carts, three-wheeled scooters, power chairs and/or by using hand splints.

A common site of pain in polio survivors, as a result of using a backward-sideward trunk lurch to substitute for weak hip muscles, is the lower back. Abnormal trunk movements transfer body weight to the small facet joints at the back of the vertebra, and they cannot tolerate the strain. The concentration of back motion at one level in the low back due to a spinal fusion or scoliosis is another cause of back pain.

Weak abdominal muscles also predispose one to chronic back strain and back injury. Abdominal binders, corsets or girdles can help substitute for weak abdominal muscles. Individuals who depend on excessive lumbosacral motion for walking may not tolerate certain corsets.

Physical therapy such as heat, massage, joint mobilization and stretching exercises can help control or resolve low back pain. A change in posture and gait pattern, such as using crutches or a rolling walker, may be needed to prevent recurrence or to resolve chronic pain. Due to increasing muscle weakness and muscle imbalance, some people may need to use a three-wheeled scooter or wheelchair to control this type of chronic pain.

Radiculopathy (disease of the nerve roots) may be the cause of pain in some polio survivors, particularly those who have abnormal posture and/or severe scoliosis, or neck or low back hyperextension due to trunk weakness. A body corset or body brace, if not being worn, may be an option in some cases, as is improved seating position. In other cases, traction and therapeutic modalities (ice, heat, massage, ultrasound, transcutaneous electrical nerve stimulation [TENS] and trigger point injections) may be beneficial. Symptomatic treatment with medications such as nonsteroidal anti-inflammatories (see Medications) may also be helpful, but their long-term use should be avoided. Surgery may also be needed in select severe cases.

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