One in 10 Americans suffers from moderate to severe chronic pain, most often due to osteoarthritis, back ailments or injury. Unfortunately, pain is often undertreated.
Pain control is not a luxury—it is a medical necessity. Chronic pain can cause muscle weakness due to inactivity, insomnia and fatigue. Chronic pain can even "rewire" the nervous system, increasing your sensitivity to pain signals and causing pain in areas that were previously pain-free.
PAIN INVENTORY
Your doctor's ability to prescribe the right treatment depends on knowing exactly where, when and how your body h:urts. Before your next appointment, create a personal pain inventory by answering the following questions…
- Where is the pain? Is it shallow and near the surface of your skin, or deep below the 85 surface? Is it worse in any particular location, or equally bad all over?
- When do you feel pain? Is it worse in the morning or at night? Does it hurt all the time, or only when you move? Which movements cause pain? Is your pain affected by stress, changes in weather, exercise or sleep?
- How bad is the pain? Rate your pain on a scale of 0 to 10 (0 represents no pain, and 10 is the worst pain you've ever had). These ratings might change during the day—for example, you may wake up with level 3 pain, but progress to level 7 by evening. Or you may have no pain most of the time, but level 8 pain with specific movements, such as sitting down, standing up or walking.
- What does the pain feel like? Is it sharp, stabbing, dull, burning or throbbing?
- How has the pain interfered with your life? Does the pain interfere with your sleep? What activities or aspects of your life are limited by pain? Physicians use this information to determine how aggressively to treat the pain, so be honest and thorough in describing how your life has changed.
- What relieves the pain? What have you tried, and what worked Include all prescription and over-the-counter (OTC) medications, ice packs, rest, applied pressure, herbal remedies, etc.
WORKING WITH YOUR DOCTOR
Most primary care physicians can diagnose and treat common causes of pain, such as back pain, headaches and osteoarthritis. Depending on your problem, your doctor may refer you to a neurologist, orthopedic surgeon, rheumatologist or other specialist. These doctors may determine that you need surgery or other procedures to treat the underlying cause of your pain.
People in pain tend to minimize movement because it hurts. But the less you move, the weaker your muscles become, which worsens the pain when you do try to move. To end this vicious cycle, engage in as much physical activity such as walking, as you can.
Your doctor may need to experiment with different drugs to see which works best for you. Often, a "cocktail" of medications, instead of just one type, offers the best pain relief. For each medication prescribed, ask the doctor how soon it will begin working and what side effects you can expect. For example, some pain relievers cause constipation.
Make a follow-up appointment before leaving the office. You may need frequent visits while your medications are being adjusted. Once your pain is controlled, you will probably need to see your doctor less often. Prepare a new pain inventory before each visit.
MEDICATIONS TO CONSIDER
Potent pain-fighting therapies, many of which are underused…
- Anti-inflammatory drugs. Because these medications both relieve pain and decrease inflammation, they are typically used to treat arthritis and other painful conditions that cause inflammation. The pain reliever acetaminophen (Tylenol does not treat inflammation. First-generation nonsteroidal anti-inflammatory drugs (NSAIDs) include ibuprofen (Motrin, Advil) and Pain Relief naproxen Naprosyn, Aleve). These medications have side effects that can limit their use, including gastrointestinal bleeding and elevated blood pressure. A second-generation NSAID, such as the prescription COX-2 inhibitor celecoxib (Celebrex), is much less likely to cause bleeding, but may increase risk for heart attack and stroke. Your doctor should weigh the risks against the benefits when recommending anti-inflammatory medication.
- Opioids. These medications are typically used to treat moderate to severe pain. Opioids include codeine, morphine, hydrocodone (Vicodin), fentanyl patches (Duragesic), oxycodone (OxyContin), and oxycodone combined with acetaminophen (Percocet). These drugs have been so stigmatized by illicit drug use that many doctors are afraid to use them to ease pain in patients who are truly suffering.
When used as directed, opioids are no more dangerous than any other drugs and can be taken indefinitely, if needed. Although most patients taking opioid analgesics for more than about three weeks become physically dependent on them, few become addicted. Physical dependency means the body has become used to the drug, and when it is stopped, withdrawal symptoms, such as muscle pain, vomiting and diarrhea, can occur. This can be avoided if your doctor tapers the drugs slowly. Addiction occurs when there is a loss of control over the drug use, continued use of the drug despite negative consequences and a mental focus on getting and using more than the prescribed amount.
- Topical analgesics. Some types of pain, especially pain on the surface of the skin—such as from shingles or joint pain due to osteoarthritis—respond well to drugs that are absorbed through the skin. Examples include the lidocaine (lidoderm) patch and capsaicin (Zostrix) cream.
- Antidepressants. Venlafaxine (Effexor and duloxetine (Cymbalta) have been shown to relieve nerve pain, such as that from shingles, and diabetic neuropathy (nerve pain in the extremities).
- Anticonvulsants. Typically used to control seizures, topiramate (Topamax) eases migraines, and gabapentin (Neurontin) is helpful for those suffering from diabetic neuropathy or shingles pain.
