Rest pain is the result of severe lack of blood flow. This will cause severe pain in the toes, feet or legs. A typical symptom will be night leg pain when you raise your legs in bed. People who suffer from rest pain need to dangle their legs down to get the pain to go away.
What Causes Rest Pain?
The cause of rest pain is lack of blood flow to the legs. So why does rest pain at night? This is because most of us sleep in a bed, laying down. When our feet are down, gravity helps blood reach our feet. But, when a person with narrowed arteries lifts their legs, gravity stops helping blood reach their toes. And this lack of blood flow hurts. This is why people who suffer from rest pain dangle their feet over the side of the bed. Basically, they are trying to get more blood to reach their feet.
The most common cause for lack of blood flow is peripheral artery disease. And the most severe form of peripheral artery disease is called critical limb ischemia.
Diagnosis
If you suspect narrowed arteries, the first step is to prove it. Proving narrowed arteries is done with simple non-invasive tests. These tests do not use dye or radiation.
The first test is called pulse volume recordings and segmental pressures. Basically, blood pressure cuffs measure blood flow down the legs. If the cuff measures a lower pressure, that means less blood is reaching that part of the leg.
The second test is an ultrasound. Ultrasound uses sound waves to measure blood flow. An ultrasound can show if there is blood flow all the way to the foot. It can also show where a blockage is within an artery.
Treatment
Treating rest pain is actually urgent. If you ignore this important symptom, it can progress. Sometimes this means that gangrene can form and that is how patients might lose toes or even the whole foot or worse.
In order to treat rest pain, you actually need to treat the narrowed arteries. The goal is to get blood flowing back into the feet. This means a procedure. There are two types of procedures to treat narrowed arteries:
- Endovascular procedure. This is a procedure that uses catheters, balloons and stents. Another name for this procedure is a catheterization.
- Open surgery. There are several types of surgery to open blocked arteries. Some involve cleaning out the artery (this is called endarterectomy). Others involve bypassing the blockage.
No matter the type of procedure, the goal is to open the blockage. Typically, once you get the blood to flow better, that should take care of the nighttime leg pain.
Medications to Protect the Heart and Brain
The main goal of treatment is to restore blood flow to the feet. But if you are experiencing rest pain, that almost always means that you have artery blockages in other parts of your body. This means the heart arteries and the brain arteries. People who have severe artery blockages in the legs are at risk for a stroke or a heart attack. For this reason, opening the arteries and restoring blood flow are not enough. You also have to make sure you are taking the correct medications to protect your heart and your brain. There are several types of medications that you should think about in this situation:
- Blood thinners. There are several types of blood thinners. For instance, aspirin and clopidogrel target the platelets in your blood stream. You might also need another type of blood thinner, rivaroxaban (Xarelto).
- Medicines that reduce cholesterol. The most common medications are statins. If you have severe blockages of the arteries, you need a strong statin such as high dose atorvastatin or high dose rosuvastatin. There are other medications that reduce cholesterol including ezetimibe and PCSK9 inhibitors.
- Diabetes treatment. Diabetes is a risk factor for blocked arteries. Some diabetes medications can prevent limb loss and other bad events in patients with blocked arteries.
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