What is Pain?

Pain is an unpleasant feeling often caused by intense or damaging stimuli, such as stubbing a toe, burning a finger, putting alcohol on a cut, and bumping the "funny bone". The International Association for the Study of Pain's widely used definition states: "Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage".

Pain motivates the individual to withdraw from damaging situations, to protect a damaged body part while it heals, and to avoid similar experiences in the future. Most pain resolves promptly once the painful stimulus is removed and the body has healed, but sometimes pain persists despite removal of the stimulus and apparent healing of the body; and sometimes pain arises in the absence of any detectable stimulus, damage or disease.

Pain is the most common reason for physician consultation in the United States. It is a major symptom in many medical conditions, and can significantly interfere with a person's quality of life and general functioning. Psychological factors such as social support, hypnotic suggestion, excitement, or distraction can significantly modulate pain's intensity or unpleasantness.

Physiological Types of Pain

It is easier to understand pain, locate its cause, and treat it by using physiological explanations of it. Pain can be divided into two types of physiological explanations: Nociceptive and Neuropathic.

Nociceptive pain

The body's nervous system is working properly. There is a source of pain, such as a cut, a broken bone or a problem with the spine. The body's system of telling the brain that there is an injury starts working. This information is passed on to the brain and one becomes aware that they are hurting.

Neuropathic pain

The body's nervous system is not working properly. There is no obvious source of pain, but the body nonetheless tells the brain that injury is present.

What are types of nociceptive pain?
Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be divided into two parts, radicular or somatic.

Radicular pain: Radicular pain is pain that stems from irritation of the nerve roots, for example, from a disc herniation. It goes down the leg in the distribution of the nerve that exits from the nerve root at the spinal cord. Associated with radicular pain is radiculopathy, which is weakness, numbness, tingling or loss of reflexes in the distribution of the nerve.

Somatic pain: Somatic pain is pain limited to the back or thighs. The problem that doctors and patients face with back pain, is that after a patient goes to the doctor and has an appropriate history taken, a physical exam performed, and appropriate imaging studies (for example, X-rays, MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the time. Research has shown that most back pain that does not go away after conservative treatment usually comes from one of three structures in the back: the facet joints, the discs, or the sacroiliac joint. The facet joints are small joints in the back of the spine that provide stability and limit how far you can bend back or twist. The discs are the "shock absorbers" that are located between each of the bony building blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock area that serves in normal walking and helps to transfer weight from the upper body onto the legs.

Fluoroscopically (x-ray) guided injections can help to determine where pain is coming from. Once the pain has been accurately diagnosed, it can be optimally treated.

What are types of neuropathic pain?

• Complex regional pain syndrome(CRPS), also called reflex sympathetic dystrophy
• Sympathetically maintained pain
• Fibromyalgia
• Interstitial cystitis
• Irritable bowel syndrome

Treatment of neuropathic pain

The various neuropathic pains can be difficult to treat. However, with careful diagnosis and often a combination of methods of treatments, there is an excellent chance of improving the pain and return of function.

Medications are a mainstay of treatment of neuropathic pain. In general, they work by influencing how pain information is handled by the body. Much pain information is filtered out by the central nervous system, usually at the level of the spinal cord, so that you never need to deal with that information. For example, if you are sitting in a chair, your peripheral nerves would correctly send the response to the pressure between your body and the chair to your nervous system. But, because that information serves no usual purpose, it is filtered out in the spinal cord. Many medications to treat neuropathic pain operate on this filtering process. Amongst the types of medications are antidepressants, influencing the amount of serotonin or norepinephrine and antiseizure medications, influencing the amount of various neurotransmitters, such as GABA and glycine.

One of the most powerful tools in treating neuropathic pain is the spinal cord stimulator, which delivers tiny amounts of electrical energy directly onto the spine. The effect of this stimulation of the spinal cord is to allow the spinal cord to function normally even during a painful condition. It works by interrupting inappropriate pain information being sent up to the brain.


Types of Pain

There are several ways to categorize pain. One is to separate it into acute pain and chronic pain. Acute pain typically comes on suddenly and has a limited duration. It's frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.

Acute Pain
Also known as “warning pain”, this type of pain comes on suddenly and signals that something is wrong inside the body. A classic example of this type of pain is an injury that results in a broken bone. The pain is sudden and warns the person that something has gone wrong. Infections, tumors, and internal bleeding are other examples. Acute pain can sometimes be eliminated by treating the underlying cause. A person may respond to chronic pain with fear, anxiety, and restlessness. If the underlying cause in untreatable, the pain may develop into chronic pain.

Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It's usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it's one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributable to nerve damage.

Both acute and chronic pain can be debilitating, and both can affect and be affected by a person's state of mind. But the nature of chronic pain -- the fact that it's ongoing and in some cases seems almost constant -- makes the person who has it more susceptible to psychological consequences such as depression and anxiety. At the same time, psychological distress can amplify the pain.

About 70% of people with chronic pain treated with pain medication experience episodes of what's called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly. Sometimes it can be spontaneous or set off by a seemingly insignificant event such as rolling over in bed. And sometimes it may be the result of pain medication wearing off before it's time for the next dose.

Nondrug Treatments for Chronic Pain

In addition to drug therapy, several nondrug treatments can be helpful for chronic pain, including:

• Alternative remedies. Although doctors don’t know exactly how it works, there is good scientific evidence that acupuncture can offer significant relief from chronic pain. Other alternative remedies proven to work against pain include massage, mindfulness meditation, spinal manipulation by a chiropractor or osteopath, and biofeedback, in which a patient wearing sensors that record various bodily processes learns to control the muscle tension and other processes that can contribute to chronic pain.

• Exercise. Low-impact forms of exercise like walking, bicycling, swimming, and simply stretching can help relieve chronic pain. Some people find it particularly helpful to participate in a structured exercise program given by a local hospital.

• Physical therapy. Pain patients who work with a physical therapist or occupational therapist can learn to avoid the particular ways of moving that contribute to chronic pain.

• Nerve stimulation. Tiny jolts of electricity can help block the nerve impulses that cause chronic pain. These jolts can be delivered through the skin via transcutaneous electrical nerve stimulation (TENS) or via implantable devices.

• Psychological therapies. A form of psychotherapy known as cognitive behavioral therapy is particularly helpful for many people with chronic pain. It helps them find ways to cope with their discomfort and limit the extent to which pain interferes with daily life.

Unlike some traditional forms of psychotherapy, which focus on personal relationships and early life experiences, cognitive behavioral therapy aims to help people think realistically about their pain and find ways to work around physical limitations.

"Cognitive behavioral therapy helps people overcome the mistaken belief that they need to lie in bed until their pain is gone, or that if they go back to work they will cause permanent damage to their body," Says Chou.

Picking the Right Treatment for Chronic Pain

Given all the ways chronic pain can be treated, how is one to know which treatment, or combination of treatments, makes the most sense for your chronic pain?

"We don’t have enough evidence from studies to know just which approach is right for which patient," says Portenoy. "Picking the right treatment is a matter of clinical judgment, and it involves talking with the patient" about the specific nature of the pain and the effectiveness of any treatments that have already been tried.

Why Chewing Gum Isn't Great for Your Health

If you chew gum on a regular basis, please consider the following:

Chewing gum causes unnecessary wear and tear of the cartilage that acts as a shock absorber in your jaw joints. Once damaged, this area can produce pain and discomfort for a lifetime.

You use eight different facial muscles to chew. Unnecessary chewing can create chronic tightness in two of these muscles, located close to your temples. This can put pressure on the nerves that supply this area of your head, which can lead to chronic, intermittent headaches.

You have six salivary glands located throughout your mouth that are stimulated to produce and release saliva whenever you chew. Producing a steady stream of saliva for chewing gum is a waste of energy and resources that could otherwise be used for essential metabolic activities.

Granted, this isn't a significant cause of disease and dysfunction for most, but a physiological fact that deserves acknowledgment, in my opinion.

Most chewing gum is sweetened with aspartame. Long term use of aspartame has been linked with cancer, diabetes, neurological disorders, and birth defects.

If your gum isn't sweetened with aspartame, it is probably sweetened with sugar. Regular intake of refined sugar is most likely the single greatest dietary cause of chronic health challenges like cancer, atherosclerosis, and diabetes mellitus type 2.

Chewing gum once in a while shouldn't be problematic for most people who don't have existing health challenges in the jaw and neck regions. But our bodies definitely pay a price for chronic gum chewing. Just something to be aware of.

Drugs Used to Control Chronic Pain

A wide variety of over-the-counter and prescription medicines have been shown to help ease chronic pain, including:

• Pain relievers. Many pain patients get some relief from common pain medicines such as acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDs), and analgesics like aspirin, ibuprofen, ketoprofen, and naproxen. These drugs are considered safe, but they are not risk-free. For example, taking too much acetaminophen can cause liver damage or even death, especially in people with liver disease. NSAIDs can cause ulcers and raise the risk for heart attack and kidney trouble. Ultram is a type of narcotic-like oral pain reliever that is often prescribed to treat lower back pain, neck pain, sciatica, and related conditions. Ultram, also known as tramadol, was approved by the FDA in 1998 and acts centrally (in the brain) to modulate the sensation of pain.

• Antidepressants. Several drugs approved by the FDA to treat depression are also prescribed by doctors to help relieve chronic pain. These include tricyclic antidepressants such as amitriptyline (Elavil), imipramine (Tofranil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Sinequan), and nortriptyline (Pamelor). The pain-relieving effect of tricyclics appears to be distinct from the mood-boosting effect, so these drugs can be helpful even in chronic pain patients who are not depressed.

Other antidepressants used to treat pain include venlafaxine (Effexor) and duloxetine (Cymbalta), which the FDA has approved to treat fibromyalgia and diabetic nerve pain. These drugs are members of a class of medications known as serotonin and norepinephrine reuptake inhibitors (SNRIs). They seem to be about as effective at treating chronic pain as tricyclics, but are less likely to cause dry mouth, sedation, urinary retention, and other side effects.

When used at appropriate doses with careful monitoring, these drugs can be safe and effective treatment for chronic pain. But be sure to discuss the risks, benefits, and research behind any drug with your doctor.

• Anticonvulsants. Several drugs originally developed to treat epilepsy are also prescribed for chronic pain. These include first-generation drugs like carbamazepine (Tegretol) and phenytoin (Dilantin), as well as second-generation drugs like gabapentin (Neurontin), pregabalin (Lyrica), and lamotrigine (Lamictal). Gabapentin and Lyrica are FDA-approved to treat pain.

The first-generation drugs can cause an unstable gait (ataxia), sedation, liver trouble, and other side effects. Side effects are less of a problem with second-generation drugs.

• Opioids. Codeine, morphine, oxycodone, and other opioid medications can be very effective against chronic pain, and they can be administered in many different ways, including pills, skin patches, injections, and via implantable pumps.

Many pain patients and even some doctors are wary of opioids (also known as narcotics) because they have the potential to be addictive. Except for patients with a history of addictive behavior, pain experts say the potential benefit of narcotic therapy for chronic pain often outweighs the risk.

"It’s a matter of balance," says Chou. "People do need to be concerned about the risk posed by opioids. But as a physician, I think it is inappropriate not to use medications that can help people, if the risks can be managed."

Generally, doctors who prescribe opiod treatment monitor patients with chronic pain carefully.

10 Tips to Reduce Chronic Pain

1. Get an Endorphin Boost: Exercise

It's a Catch-22: You're hurting, so you don't exercise; but without exercise, you may lose muscle tone and strength, making pain worse. Fortunately, even mild exercise releases endorphins, the feel-good brain chemicals that lift mood and block pain. Ask your doctor if aerobic, strengthening, or stretching exercises can give your body the boost -- and relief -- it needs.

2. Breathing, Meditation, and Biofeedback

It sounds so obvious, but few of us actually take the time to stop what we're doing and calm our minds. Deep breathing, biofeedback, and meditation are all stress management techniques that relax your body, which helps ease pain. Talk to your doctor to learn more, but in the meantime, slow down, close your eyes…breathe in…breathe out.

3. Avoid Alcohol

You need a good night's sleep to help soothe the stresses pain puts on your body. Although alcohol can help you fall asleep, as it metabolizes, it promotes shallow sleep, reduces important REM sleep, and may even wake you. The result: A less restful night.

4. Cut Pain: Quit Smoking

Some people find temporary relief from stress and pain with a quick smoke. The irony is that smoking may actually contribute to pain in the long run. It slows healing, worsens circulation, and increases the risk of degenerative disc problems, a cause of low back pain. If you need an incentive to quit, pain relief just may be it. Ask your doctor about programs and medicines to kick the habit.

5. Give Your Body a Boost: Eat Better

If you're living with chronic pain, you want to do everything you can to help your body, not hinder it. One way to keep your body strong is to eat a well-balanced diet. Eating right improves blood sugar, helps maintain weight, reduces heart disease risk, and aids digestion. Aim for a diet rich in whole grains, fresh produce, and low-fat proteins.

6. Journal: Help Your Doctor Help You

Keeping a pain journal can be a great way to help your doctor understand and more effectively treat your chronic pain. At the end of each day, record a "pain score" between 1 and 10. Then note what you did that day, and how these activities made you feel. The next time you see the doctor, bring the journal and discuss your findings.

7. Schedule Relaxation, Set Limits

By taking care of your emotional and physical health, you can better manage your pain. That may mean saying no to events like parties if you need the rest. Or it may mean scheduling regular massages or setting an unbreakable dinner date with good friends to boost your spirits. How you care for you is unique to you -- and it's also up to you.

8. Distract Yourself

You already know that focusing on pain can just make it worse. That's why one potent prescription for relief is to keep busy with activities that take your mind off the pain. Take that cooking class you've had your eye on, join a garden club, try skiing lessons. Even if you can't control the pain, you can control the rest of your life. Get started!

9. Know Your Medicines

Understand the medicines you're taking, what they can do for you, and their side effects. Then educate yourself about other treatment options. Your goal is to have a normal mood and activity level -- if you don't, then a different medicine might be better for you. Your job is to be proactive, to ask questions, and look for answers.

10. You're Not Alone

As many as one person in every three is dealing with chronic pain, so you're far from alone. Reaching out is the most important habit you can develop to help you deal with chronic pain. Tell friends and family what you're feeling because they won't know otherwise. Ask for help. Learn more about your condition. Then share what you know with others.

Alternative Remedies

Alternative Treatments for Chronic Pain

If you have chronic pain and are looking for alternatives to medication and surgery, you have a lot of options. Alternative pain treatments that doctors once scoffed at are now standard at many pain centers.

"That phrase 'alternative pain treatments' doesn't mean much to me," says Seddon R. Savage, MD, incoming president of the American Pain Society. "I think the line between them and mainstream treatment is pretty blurry now."

However, not all alternative pain treatments work. Some can even be risky. Some alternative treatments may help with pain from bad backs, osteoarthritis, and headaches, but have no effect on chronic pain from fibromyalgia or diabetic nerve damage.

"You have to do your homework when you're considering alternative treatments for pain," warnsAnne Louise Oaklander, MD, PhD, an associate professor of neurology at Harvard Medical School and director of the Nerve Injury Unit at Massachusetts General Hospital in Boston."Make sure that you're trying a treatment that is likely to work in your case." And always discuss any alternative pain treatments you want to try with your regular doctor.

Here's a rundown of the most commonly used alternative treatments for chronic pain.

Acupuncture. Once seen as bizarre, acupuncture is rapidly becoming a mainstream treatment for pain. Studies have found that it works for pain caused by many conditions, including fibromyalgia, osteoarthritis, back injuries, and sports injuries.

How does it work? No one's quite sure. It could release pain-numbing chemicals in the body. Or it might block the pain signals coming from the nerves.

"I think there's good scientific evidence for acupuncture and I prescribe it," says F. Michael Ferrante, MD, director of the UCLA Pain Management Center in Los Angeles. "The nice thing is that even if it doesn't work, it doesn't do any harm."

Marijuana. Setting aside the controversy, marijuana has been shown to have medicinal properties and can help with some types of chronic pain.

There's strong evidence that marijuana has a modest effect on certain types of nerve pain -- particularly pain caused by MS and HIV, says Steven P. Cohen, MD, associate professor in the division of pain medicine at Johns Hopkins School of Medicine in Baltimore. Since it also relieves nausea, marijuana can help people who are suffering side effects from chemotherapy.

However, marijuana does have risks. For some people, Cohen says, those risks can be serious, including addiction and psychosis. Because of the dangers and the obvious potential for abuse, experts generally only turn to marijuana when all other treatments have failed.

On a practical level, you also need to be aware of the laws regarding the use of medical marijuana in your state. Could you be arrested for smoking marijuana for medical reasons? Talk to your doctor. There are also two prescription drugs, called pharmaceutical cannabinoids, that are derived from the active ingredient of marijuana. They are sometimes used for pain, although they are only FDA-approved for nausea caused by chemotherapy and HIV-related weight loss.

Exercise. Going for a walk isn't a treatment, exactly. But regular physical activity has big benefits for people with many different painful conditions. Study after study has found that physical activity can help relieve chronic pain, as well as boost energy and mood.

If you have chronic pain, you should check in with a doctor before you start an exercise routine, especially if you have any health conditions. Your doctor might have some guidance on what to avoid, at least as you get started.

Chiropractic manipulation. Although mainstream medicine has traditionally regarded spinal manipulation with suspicion, it's becoming a more accepted treatment. "I think chiropractic treatment works reasonably well for lower back pain," Oaklander tells WebMD. "Studies have shown that it's comparable to other approaches."

Supplements and vitamins. There is evidence that certain dietary supplements and vitamins can help with certain types of pain. Fish oil is often used to reduce pain associated with swelling. Topical capsaicin, derived from chili peppers, may help with arthritis, diabetic nerve pain, and other conditions. There's evidence that glucosamine can help relieve moderate to severe pain from osteoarthritis in the knee.

But when it comes to supplements, you have to be careful. They can have risks. Oaklander says that high doses of vitamin B6 can damage the nerves. Some studies suggest that supplements such as ginkgo biloba and ginseng can thin the blood and increase the risk of bleeding. This could lead to serious consequences for anyone getting surgery for chronic pain.

"Supplements can cause real harm," says Ferrante. He points out that people with chronic pain can be at higher risk of side effects from supplements. Why? They're more likely than the average person to be taking other medications or getting medical procedures or surgeries.

So treat supplements and vitamins warily, like you would treat any drug. Always check with a doctor before you start taking supplements, especially if you have any medical conditions or take other medication.

Therapy. Some people with chronic pain balk at the idea of seeing a therapist -- they think it implies that their pain isn't real. But studies show that depression and chronic pain often go together. Chronic pain can cause or worsen depression; depression can lower a person's tolerance for pain.

So consider giving therapy a try. Cohen says he's seen particularly good results with cognitive behavioral therapy, a practical approach that helps people identify and change the thought and behavior patterns that contribute to their unhappiness.

Stress-reduction techniques. "Reducing stress is really crucial in pain management," says Savage. There are number of approaches, including:

• Yoga. There's good evidence that yoga can help with chronic pain, says Cohen -- specifically fibromyalgia, neck pain, back pain, and arthritis. "I've been including yoga as part of the treatment that I prescribe since the mid-1980s," Savage says.
• Relaxation therapy. This is actually a category of techniques that help people calm the body and release tension -- a process that might also reduce pain. Some approaches teach people how to focus on their breathing. Research shows that relaxation therapy can help with fibromyalgia, headache, osteoarthritis, and other conditions.
• Hypnosis. Studies have found this approach helpful with different sorts of pain, like back pain, repetitive strain injuries, and cancer pain.
• Guided imagery. Research shows that guided imagery can help with conditions like headache pain, cancer pain, osteoarthritis, and fibromyalgia. How does it work? An expert would teach you ways to direct your thoughts by focusing on specific images.
• Music therapy. This approach gets people to either perform or listen to music. Studies have found that it can help with many different pain conditions, like osteoarthritis and cancer pain.
• Biofeedback. This approach teaches you how to control normally unconscious bodily functions, like blood pressure or your heart rate. Studies have found that it can help with headaches, fibromyalgia, and other conditions.
• Massage. It's undeniably relaxing. And there's some evidence that massage can help ease pain from rheumatoid arthritis, neck and back injuries, and fibromyalgia.

Risky Alternative Pain Treatments
Obviously, you need to be skeptical of any unproven or risky alternative pain treatments. What else should you be wary of?

Experts say you should keep your expectations for alternative pain treatments modest -- especially when it comes to "miracle cures." Controlling chronic pain is not simple. A single supplement, device, or treatment is not going to make your chronic pain disappear. Good chronic pain management usually requires time and the collaboration of experts, says Savage.

Savage says you also need to be suspicious of anyone pushing a treatment when the financial motive is blatant. That doesn't only apply to pain treatments advertised on dubious web sites asking for your credit card number.

"I think people should be careful whenever a person is making a living off of an untested pain remedy," says Savage. "So I'm concerned whenever I see providers selling their own expensive and unproven remedies. You need to be very careful."

Alternative Pain Treatments: Working With Your Doctor
If you're living with chronic pain, considering alternative treatments makes a lot of sense. But remember that even if a treatment is alternative, it has to be integrated with your overall pain management plan.

Don't try out these techniques on your own without your doctor's knowledge. Instead, you and your doctor should talk over the pros and cons of different approaches. What's most likely to help in your case? What will complement your other treatments?

Experts say that you should try to keep up to date with research into alternative treatments for chronic pain. The options for people with chronic pain are always growing -- and some of the odder treatments of today might become the mainstream treatments of tomorrow.

Anti-inflammatory Drugs

Easing Chronic Pain With Anti-Inflammatory Drugs

Even mild chronic pain -- whether from arthritis, migraines, or another condition -- can be debilitating. So it makes sense to take a pain reliever to make the hurt go away. But when you walk down the aisle of your local drug store, there are many pain pills to choose from. How do you know which pain pill to choose? And just what is the difference between aspirin, acetaminophen, and ibuprofen?

Aspirin and ibuprofen belong to a large class of drugs known as nonsteroidal anti-inflammatory drugs, commonly called NSAIDs. NSAIDs and acetaminophen can block pain and reduce fever. Together, they make up the most widely used group of drugs for treating pain conditions. Here's information you can use in working with your doctor to find out if these pain pills are right for you.

How Do Anti-inflammatories, or NSAIDs, Differ From Acetaminophen?

The primary difference between NSAIDs and acetaminophen (Actamin, Pandadol, Tylenol) lies in the way each relieves pain. Acetaminophen works primarily in the brain to block pain messages and seems to influence the parts of the brain that help reduce fever. That means it can help relieve headaches and minor pains. But it's not as effective against pain associated with inflammation.

Inflammation is a common feature of many chronic conditions as well as injuries. NSAIDs reduce the level of certain chemicals called prostaglandins that are involved in inflammation. Treatment with NSAIDs can lead to less swelling and less pain.

What Are Some Examples of NSAIDs?

You are probably already familiar with several types of NSAIDs. For instance aspirin is a widely used pain pill and at one time, aspirin was the only NSAID available without a prescription. Other NSAIDs, such as ibuprofen or naproxen sodium, began as prescription drugs. Now they are sold, usually at a lower dose, as over-the-counter pain pills.

Other examples of NSAIDs include:

• diclofenac (Cambia, Cataflam, Voltaren)
• etodolac (Lodine)
• fenoprofen (Nalfon)
• flurbiprofen (Ansaid)
• naproxen (Anaprox, Naprosyn)
• oxaprozin (Daypro)

Some pain pills, such as Excedrin Migraine, combine an NSAID -- in this case aspirin – with acetaminophen.

Another kind of NSAID -- available only by prescription – is known as a COX-2 inhibitor. These medicines provide pain relief like other NSAIDs, but they are less likely to cause stomach problems. The only COX-2 inhibitor available in the U.S. is celecoxib (Celebrex).

How Do I Know Which NSAID Will Work for My Chronic Pain?

The effectiveness of any particular pain medication varies from person to person. So it may be necessary to try several different medicines at various dosages. Side effects -- and their severity -- vary from person to person. You may not be able to take a particular NSAID because your body can't tolerate it. At the same time, your neighbor may take it and have no problem at all.

Whether you should take an over-the-counter pain reliever or a prescription-strength NSAID also varies from person to person. Remember, over-the counter painkillers are still medicines. They may be cheaper than prescription medicines and you don't need a doctor's prescription to buy them, but they can still have major effects on you. That's especially true if you are going to take a pain pill long term for chronic-pain. If you need pain medicine for more than 10 days, talk to your doctor to see which one is right for you.

Your doctor should know all the medicines you take. Your doctor can advise you if the NSAID may interact with other medications you take. Also, your doctor can suggest the right dose for you. As you continue to take the medicine, your doctor can also monitor its effect, and raise or lower the dose as needed.

Before recommending a specific pain pill, your doctor will want to consider:

• your medical history
• past surgeries
• your current health concerns
• allergies and past reactions to drugs
• other medicines you take
• the functioning of your liver and kidneys
• the drug's expense
• your overall treatment plan and goals

When you talk with your doctor, be sure to ask about anything you don't understand.

Are There Side Effects and Special Cautions Associated With NSAIDs?

Specific side effects vary from drug to drug. For instance, some NSAIDs are harsher on the stomach than others. But there are certain side effects that are common to NSAIDs as a class. Serious side effects include:

• bleeding problems
• damage to the stomach and small intestine lining that can lead to ulcers
• kidney disease
• elevated blood pressure
• muscle cramps
• hearing problems

Other side effects include:

• dizziness or headache
• nausea
• excess gas
• diarrhea or constipation
• extreme tiredness or weakness
• dry mouth

Your doctor or your pharmacist can give you specific information about the side effects of the particular drug you are taking.

In addition to side effects, there are serious health risks associated with NSAIDs. It is important to talk with your doctor before taking NSAIDs if any of the following apply to you:

• You are allergic to aspirin or any other pain reliever.
• You have more than 3 alcoholic drinks a day.
• You have stomach ulcers or bleeding in your digestive tract.
• You have liver or kidney disease.
• You have heart disease.
• You take blood-thinning medicine or have a bleeding disorder.

Although aspirin taken in low doses with a doctor's supervision can help protect some people from heart attack, certain NSAIDs can increase your risk of heart disease and stroke. They can also interfere with blood pressure medicine, making it less effective.

Children and teenagers under the age of 18 should not take aspirin unless their doctor says to. There is a risk of Reye's syndrome, a potentially fatal disease.

So Should I Take an NSAID to Manage My Chronic Pain?

Anti-inflammatory drugs have a long history of success. Many people are able to manage their chronic pain quite well using NSAIDs as part of their management plan. For most, side effects, if any, are minor. But all medications have associated risks. All medications also have benefits. Deciding to take an NSAID or any medication involves weighing the risk against the benefit.

The bottom line: talk with your doctor. Your level of risk depends on the state of your overall health. Your doctor can help you determine whether or not an NSAID would be right for you.

Most common causes of pain?

• headaches
• facial pain
• peripheral nerve pain
• coccydynia
• compression fractures
• post-herpetic neuralgia
• myofasciitis
• torticollis
• piriformis syndrome
• plantar fasciitis
• lateral epicondylitis
• cancer pain

Headaches and facial pain, including atypical facial pain and trigeminal neuralgia.

Headaches are a major source of discomfort and lost productivity in the workplace. Many effective treatments exist for persisting headaches, including medication, biofeedback, injections and implants, depending upon the precise type of headache. Botox also provides a useful means of effectively and safely treating headaches.

A typical facial pain can be debilitating. Often times it can be treated by injections into local nerve tissue (such as the sphenopalatine ganglion).

Trigeminal neuralgia, also called tic douloureux, is a condition that most commonly causes very intense intermittent shooting pain in the face.

Peripheral nerve pain - Peripheral nerve pain, or neuropathy, can be debilitating. It can respond well to simple treatments such a trigger point injections with anestheticmedicines and cryoablation (an office based procedure which involves freezing the nerves). Examples of peripheral nerve pain include intercostal neuralgia, ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve entrapment, interdigital neuroma and related nerve entrapments.

Coccydynia - Coccydynia is simply pain in the region on the tailbone, or coccyx. It can result from trauma or arise without apparent cause. The initial treatment is conservative, with oral pain relief medicines (analgesics). Oftentimes, the pain originates in the portion of the nervous system that we have no control of (involuntary or autonomic nervous system) and can respond to either a local anesthetic injection of the head of a nerve called Ganglion Impar, which is located by the coccyx or by medically destroying (ablating) the Ganglion Impar, usually using radiofrequency.

Compression fractures - Compression fractures of the bony building blocks (vertebral bodies) are common in the elderly as a result of osteoporosis, or loss of calcium in the bone. With less calcium, the bone becomes weak and can break. Like any fracture, compression fractures hurt. Like any fracture, they are treated by stabilization, in this case, by injecting cement into the bone in a procedure known as a vertebroplasty. Vertebroplasty is an effective way to treat the pain of compression fractures.

Post-herpetic neuralgia - Post herpetic neuralgia (PHN) is a painful condition occurring after a bout ofshingles. When we are young, we are almost all exposed to chickenpox, caused by the Herpes Zoster virus. Our immune system controls the virus, but it lives in a dormant state in the spinal cord. When we age, or become ill or stressed, the virus can reactivate and attack the nerve infected and adjacent skin. However, in this second attack, the body usually recognizes the Herpes Zoster virus and contains the pain to a localized area, along the course of one nerve. A patient may have the characteristic blisters, which normally heal. Sometimes, however, the Herpes Zoster virus damages the nerve, causing ongoing nerve pain that persists after the skin blisters from the shingles have healed.

The ideal way to treat the post herpetic neuralgia is to treat it before it sets in. Medications, such as acyclovir (Zovirax), steroids and injections such as sympathetic injections can help prevent the onset of PHN. After the pain is present, injections, local anesthetics, medications [duloxetine (Cymbalta) ,amitriptyline, (Elavil, Endep)] and pain medications or topical patches can be useful.

Myofasciitis and Torticollis - Myofasciitis (pain in the muscles, whether in the neck or back) often responds to conservative physical therapy treatments (for example,massage and exercise). If the pain persists, trigger point injections can be used. If the trigger point injections provide temporary relief, sometimes Botox injections can help. Botox, which is botulinum toxin, can relax the muscles for six or more months, with long-term relief of pain. It provides a safe, effective treatment for what can otherwise be a difficult, ongoing problem.

Torticollis is spasm of the muscles in the neck, forcing the sufferer to hold his or her neck tilted or rotated to the side. Botox is approved for treatment of this problem.

Piriformis Syndrome - The piriformis muscle goes from the hip to sacrum (tailbone). It is important in that the sciatic nerve passes through it. Piriformis syndrome is a spasm of the piriformis muscle. When the muscle goes into spasm, it can squeeze the sciatic nerve, causing pain going down the leg. Piriformis syndrome will usually respond to physical therapy. When pain persists, local anesthetic and/or steroid injection can help. If the pain persists, injecting Botox or Myobloc, which are both botulinum toxins, into the muscle can provide effective, safe treatment.

Plantar fasciitis and Lateral epicondylitis - Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow) are two common pain problems. Treatment starts with conservative options, such as rest, non-steroidal anti-inflammatory medications, steroid injections, over-the counter pain medications, physical therapy and, for heel pain, shoe inserts.

If the pain lasts for more than six months, Extracorporeal Shockwave Treatment is an effective, FDA approved treatment. Extracorporeal shockwave treatment is not recommended for pregnant women, children, anyone with a pacemaker, anyone on anti-coagulant therapy or anyone with a history of bleeding problems.

Cancer pain - Cancer pain can arise from many different causes, including the cancer itself, compression of a nerve or other body part, fractures or treatment of the cancer. There are many techniques to assist with treating the various pains from cancer, including medications and injections. In particular, medical destruction of nerve tissue (ablative therapies) and the use of pumps surgically placed into the body to deliver pain medication into thesubarachnoid space can be used. Pain pumps deliver medication that is targeted to pain receptors on the spinal cord. The advantage to the cancer patient is chronic pain control with decreased side effects.

Myth and Facts about Joint Pain

All joint pain is arthritis.

There are more than 50 types of arthritis, but having a swollen, achy joint does not mean you have one of them. "You need to be properly diagnosed and treated," says Elaine Husni, M.D., M.P.H., director of the Arthritis and Musculoskeletal Center Orthopedic and Rheumatologic Institute, at the Cleveland Clinic, "You may not even have arthritis, but rather a soft tissue injury or bursitis." Only a visit to a doctor will tell you for sure.

Myth: Popping knuckles causes arthritis.

Sure, we've all heard this one before. Mom always said, Stop cracking those knuckles or you'll end up giving yourself arthritis. But according to Mark A. McQuillan, M.D., associate professor in the Department of Internal Medicine, Divisions of General Medicine and Rheumatology, at the University of Michigan, popping of the knuckles is just a vacuum phenomenon. When you pull on your knuckles, a bit of excess nitrogen gas that was dissolved in your blood literally makes a popping noise. So no, you won't get arthritis from knuckle popping, though you may annoy those around you.

Myth: Dry, warm weather helps relieve joint pain.

According to Dr. McQuillan, arthritis patients feel an uncomfortable pressure in their joints on days of high humidity and low barometric pressure, especially just before a storm. A drier climate means a minimum of pressure. "Before you plan a major move, however, it's good to test out drier weather for a few weeks, to see if it works for you," says Dr. McQuillan.

Myth: Exercise can aggravate joint pain.

Exercise is beneficial for everyone, with or without arthritis, says Dr. McQuillan. Yet only 13 percent of men and 8 percent of women with knee osteoarthritis get the minimum recommended amount of weekly movement. If you are in pain, forgo intense exercise and try some light stretching, or switch to workouts that are less taxing on the joints, such as the stationary bike or swimming. "The most important thing is just to get more movement in your life. Remember: Use it or lose it," says Dr. Husni. "The more exercise you do, the better your range of motion."

Myth: Diet can be a factor in preventing arthritis.

Yes — and no. Maintaining a healthy weight can help ward off certain types of arthritis. "Keeping close to your ideal weight will be protective against osteoarthritis," says Dr. McQuillan, because obesity has been linked to osteoarthritis of the hip and knee. However, diet has not been proven to have a direct link to the cause or prevention of other forms of arthritis.

Myth: There's no way to prevent arthritis-caused joint damage.

Arthritis medications — including COX-2 inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), anti-TNF compounds, corticosteroids, and disease-modifying antirheumatic drugs (DMARDs) — can help reduce inflammation, relieve painful symptoms, and prevent joint damage. In patients who delay treatment, "we can see drastic erosions in joints in as little as three to six months, which don't grow back," says Dr. Husni. It's best to see your doctor to determine a treatment plan that can help you maintain your quality of life and better manage your condition.

Myth: No Pain, No Gain.

This myth persists among bodybuilders and weekend athletes. Yet there is no evidence to support the notion that you can build strength by exerting muscles to the point of pain. A related belief, "Work through the pain," is also mistaken. Resting to repair muscles and bring pain relief might not be macho, but it's a smart thing to do. You may also need to modify yourexercise routine with cross training; lighter, more frequent workouts; and proper shoes.

Myth: It's All In My Head.

Pain is a complex problem, involving both the mind and the body. For instance, back painhas no known cause in most cases, and stressful life events can make it worse. But that doesn't mean it isn't real. Pain is an invisible problem that others can't see, but that doesn't mean it's all in your head.

Myth: I Just Have to Live with the Pain.

There are countless options for pain relief. They include relaxation techniques, exercise, physical therapy, glucosamine supplements, over-the-counter and prescription medications, surgery, and complementary treatments such asacupuncture and massage. It may not always be possible to completely control your pain, but you can use many techniques to help manage it much better.

Myth: Only Sissies Go to the Doctor for Pain Relief.

Older adults are more prone than their kids or grandkids to "grin and bear it." Enduring the occasional headache or minor sports injury is one thing. But putting up with chronic pain can impair functioning and quality of life. It can lead to depression, fatigue from loss of sleep, anxiety, inability to work, and impaired relationships.
Most pain can be treated effectively and should be. If you are suffering from pain, you owe it to yourself to make an appointment with your doctor. Relief may be just around the corner.

Myth: I'll Get Addicted to Pain Medication.

Health care providers begin with a conservative approach to pain relief and prescribe non-narcotic pain-relief medications, which are not addictive. Doctors may prescribe narcotics, such as codeine and morphine, if pain becomes severe, such as when treating cancer pain. Many people fear that they will become addicted to narcotics. Physical dependence is not the same thing as addiction. And, physical dependence isn't a problem as long as you do not stop taking the narcotics suddenly. Addiction is rarely a problem, unless you have a history of drug or alcohol addiction. If you do, discuss this with your health care provider beforehand.

Myths About Treating Chronic Pain

When you have chronic pain, it's hard to sort out the myths from the facts. To feel better, are you supposed to rest in bed or go jogging? Should you talk to your doctor about trying potent opioid painkillers or should you steer clear? Is it worth trying that "miracle cure" that your co-worker absolutely swears cured her sciatica?

Chronic pain is a serious and debilitating condition. Many people suffering with chronic pain are so desperate for help that they're willing to believe anything -- and as a result buy into some chronic pain myths that could be unwise and even dangerous.

To help you separate the chronic pain myths from the facts, WebMD turned to noted pain management specialists. Here's what they had to say.

Myth: To Cure Chronic Pain, Just Treat the Underlying Cause
Treating chronic pain is just not that simple.Yes, sometimes treating the cause does resolve the pain: if you have a tack in your foot, you remove the tack. Anyone with chronic pain must get a complete work-up by a doctor to see if there's a treatable problem or disease, says Anne Louise Oaklander, MD, PhD, an associate professor of neurology at Harvard Medical School.But in many cases, the intersection of an underlying cause and pain is more complicated. Painful diseases might be chronic and hard to control. Sometimes pain lingers even after the original cause seems to have been resolved. Other times, the cause of pain is just plain mysterious."With some people, we run all the tests but we just can't figure out what's causing the pain," says Steven P. Cohen, MD, director of pain research at Walter Reed Army Medical Center in Washington, D.C. "We can't come up with a diagnosis."People with chronic pain often need a two-pronged approach: get treatment for the underlying cause (if there is one) and separately get treatment for the pain itself. That often means seeing a pain expert as well as other doctors.

Fact: Even Mild Chronic Pain Should Be Checked by a Doctor
Pain experts say that too many people still struggle through life with chronic pain for no reason. People think that if their pain is bearable, it's not worth asking a doctor about it.However, you need to get pain evaluated, even if it's mild. First, it could be the sign of underlying disease or health problem that needs treatment. Second, treating pain promptly can sometimes prevent it from turning into hard-to-treat chronic pain.Beyond that, it's always important to take pain seriously in its own right. Chronic pain is insidious. It sneaks up on people, worsening slowly and imperceptibly.Without realizing it, you might develop unhealthy ways of coping with it. That might include using over-the-counter painkillers for a long time or at high doses, which can have serious risks. People with chronic pain are also at higher risk of relying on alcohol or other substances to numb their pain.Over time, chronic pain can also lead to sleep deprivation, social isolation, depression, and other problems that can affect your relationships at home and at work.

Myth: Bed Rest Is Usually the Best Cure for Pain
The old medical advice for people with some types of chronic pain – such as back pain -- was to rest in bed. But that's not the case anymore."Now we know that for almost all types of chronic pain conditions, not just spinal pain, [prolonged] bed rest is almost never helpful," says Cohen. "In some cases it will actually worsen the prognosis."It turns out that for most causes of pain, keeping up your normal schedule -- including your physical activity -- will help you get better faster.Of course, there are some situations where rest is important -- especially for a day or two after an acute injury. So always follow your doctor's advice.

Myth: Increased Pain Is Inevitable as We Age
Pain experts say there is one particularly damaging myth about chronic pain. Too many people think that pain is just a sign of aging and that there's not much to be done about it.

"I think unfortunately too many doctors believe this," says Cohen. "They see an older patient with pain and don't think anything of it."

It's unquestionably true that our odds of developing a painful condition, such as arthritis, are higher as we age. But those conditions can be treated and the pain can be well-controlled. So no matter what your age, never settle for chronic pain.

Fact: Chronic Pain Is Connected With Depression
For many people, chronic pain is intertwined with depression -- as well as anxiety and other psychological conditions."There's a very complex relationship between pain and depression," says Cohen. "Pain can be a symptom of depression, and depression can certainly worsen the diagnosis of pain." It's a cruel combination. Often, it's impossible to tell where one cause ends and the other starts.Of course, some people with chronic pain don't like this idea. They feel that accepting a psychological connection to pain implies that they're making it up, that their pain is "all in their heads." But that's not the case at all.Depression and anxiety disorders are real medical conditions. Studies have also shown a clear connection between emotional trauma and pain disorders. Brain imaging studies have actually found that physical and psychological pain activates some identical areas in the brain, says Seddon R. Savage, MD, incoming president of the American Pain Society. Acknowledging that chronic pain and depression are connected in no way diminishes what you're feeling.Also, some antidepressants have been shown to help manage certain types of chronic pain. Your doctor might suggest an antidepressant for your chronic pain, even if you are not depressed.

Myth: Taking Opioid Painkillers Leads to Drug Addiction
We’ve all read sensational stories of celebrity addiction. So it’s no surprise that many people with chronic pain fear that taking opioids will result in drug addiction. As a result, some people with terrible chronic pain refuse medication that could really help them."When they're taken in the short-term and used as directed, the risk of becoming addicted to an opioid medication is very, very low," says Cohen.

There are instances where doctors need to be especially careful with opioids, says Oaklander. For instance, people who have a strong personal or family history of addiction are at higher risk. "But even they can use these drugs safely in some cases," she says, "although preferably with the guidance of a pain specialist."

Myth: Taking Opioid Painkillers Will Completely Cure Chronic Pain

Although opioids are effective at treating pain, they are not the Holy Grail of pain relief. Some people think that if they could only get their doctor to give them a prescription, their troubles would be over.

"There's a big downside to treatment with opioids," says Cohen. They're not effective with all types of pain. They can cause unpleasant side effects. A physical dependency can develop if pain management and treatment is not monitored. That's not an addiction -- instead, their bodies acclimate to the medication. Over time they need higher doses to get the same level of relief.

Opioids seem to increase the risk that other treatment approaches will fail. There's even evidence that opioids can result in chronic pain, Cohen says. A person with mild, occasional headaches might develop chronic, debilitating ones after using high doses of opioids.

So depending on the cause of your chronic pain, opioid painkillers might help. But they're not the universal "best" treatment for chronic pain. They're just one tool among many others, from anti-inflammatory medicines to alternative therapies such as acupuncture. 

Fact: There's Rarely a Single Treatment That Will Cure Chronic Pain

"People with chronic pain often have this misconception," says Savage. "They think that they'll be able to find this one perfect treatment that will cure their pain."

Maybe it's a new drug or a new surgical technique that they read about in the paper. Or maybe it's a device or a supplement they see advertised on a 3 a.m. infomercial. But they're hoping that there's one answer for them that will take their pain away completely.

Coping with chronic pain is rarely that simple. Savage says that tackling chronic pain often requires a team of experts using a combination of approaches -- different medications, physical therapy, psychological counseling, relaxation techniques, and more -- to get it the pain control.

Adopt realistic expectations. You will get better, but it will take some hard work, different treatments, and time.

Fact: Even With Good Treatment, Chronic Pain Might Not Go Away

It's unfortunate but true. "Someone who has had ongoing back pain for 18 years shouldn't expect that after few visits to a pain doctor they'll be cured," says Cohen. "Managing chronic pain is usually a long process."

But don't get discouraged. Even if experts can't make your chronic pain disappear completely, treatment can still make a big difference. Pain isn't everything, after all -- it's how your pain affects your quality of life that matters most.

Maybe you'll still have some pain after treatment. But if treatment restores your ability to do things that your chronic pain prevented -- whether it's going for long walks, or crocheting a blanket, or returning to work – it’s worthwhile.

Myths and Facts About Back Pain

The Truth About Back Pain

It might be a sharp stab. It might be a dull ache. Sooner or later, eight out of 10 of us will have back pain. Back pain is common -- and so are back pain myths. See if you can tell the myths from the facts.

Myth: Always Sit Up Straight

Okay, slouching is bad for your back. But sitting up too straight and still for long periods can also be a strain on the back. If you sit a lot, try this a few times a day: Lean back in your chair with your feet on the floor and a slight curve in your back. Even better: Try standing for part of the day, while on the phone or while reading work materials.

Myth: Don't Lift Heavy Objects

It's not necessarily how much you lift, it's how you lift. Of course you shouldn't lift anything that might be too heavy for you. When you lift, squat close to the object with your back straight and head up. Stand, using your legs to lift the load. Do not twist or bend your body while lifting or you may hurt your back.

Myth: Bed Rest Is the Best Cure

Yes, resting can help an acute injury or strain that causes back pain. But it's a myth that you should stay in bed. A day or two in bed can make your back pain worse.

Myth: Pain Is Caused by Injury

Disc degeneration, injuries, diseases, infections, and even inherited conditions can cause back pain.

Fact: More Pounds, More Pain

Staying fit helps prevent back pain. Back pain is most common among people who are out of shape, especially weekend warriors who engage in vigorous activity after sitting around all week. And as you might guess, obesity stresses the back.

Myth: Skinny Means Pain-Free

Anyone can get back pain. In fact, people who are too thin, such as those suffering from anorexia, an eating disorder, may suffer bone loss resulting in fractured or crushed vertebrae.

Myth: Exercise Is Bad for Back Pain

A big myth. Regular exercise prevents back pain. And for people suffering an acute injury resulting in lower back pain, doctors may recommend an exercise program that begins with gentle exercises and gradually increases in intensity. Once the acute pain subsides, an exercise regimen may help prevent future recurrence of back pain.

Fact: Chiropractic Care Can Help

The American College of Physicians and American Pain Society guidelines for treatment of lower back pain recommend that patients and doctors consider other options with proven benefits, such as spinal manipulation or massage therapy.

Fact: Acupuncture May Ease Pain

According to guidelines from the American College of Physicians and the American Pain Society, patients and their doctors should consider acupuncture among treatments for back pain patients who do not get relief from standard self care. Yoga, progressive relaxation, and cognitive-behavioral therapy are also suggested for consideration.

Myth: Firmer Mattresses Are Better

A Spanish study of people with longstanding, non-specific back pain showed that those who slept on a medium-firm mattress -- rated 5.6 on a 10-point hard-to-soft scale -- had less back pain and disability than those who slept on a firm mattress (2.3 on the scale) mattress. However, depending on their sleep habits and the cause of their back pain, different people may need different mattresses.

Pain Medications Mistake

If 1 Is Good, 2 Must Be Better

Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won't speed relief. But it can easily speed the onset of harmful side effects.

"The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more," Binaso says. "With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room."

If you've given your pain medication time to work, and it still does not control your pain, don't double down. See your doctor about why you're still hurting.

"This 'one is good so two must be better' thing is a common problem," Haynes says. "Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?"

Another bad idea is trying to boost the effect of one kind of pain pill by taking another.

"There may be Advil, Tylenol, Aleve, and ibuprofen in the house, and a person may take them all," Binaso says.

This can escalate into a very bad situation, Haynes says.

Duplication Overdose

People often take over-the-counter pain drugs -- and even prescription pain drugs -- without reading the label. That means they often don't know which drugs they're taking. That's never a good idea.

And if they take another over-the-counter drug -- either for extra pain relief or for other reasons -- they may be getting an overdose. That's because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.

In Joe's case, he's taken a prescription pain pill that contains acetaminophen along with a second full dose of acetaminophen from Tylenol, putting him at risk of injury.

Drinking While Taking Pain Drugs

Pain medications and alcohol generally enhance each other's effect. That's why many of these prescription medications carry a "no alcohol" sticker.

That sticker shows a martini glass covered by the international "No" sign of a circle with a slash. But it applies to wine and beer just as much as it does to spirits.

"A common misperception is people see that sticker and think, 'I'm OK as long as I don't drink liquor -- I can have a beer.' But no alcohol means no alcohol," Binaso says.

"The patient should heed that alcohol warning, because it can be a major problem if they do not," Haynes says. "Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble."

Drinking alcohol can be a problem even with over-the-counter pain drugs.

Drug Interactions

Before taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.

For example, aspirin can affect the action of some non-insulin diabetes drugs; codeine and oxycodone can interfere with antidepressants.

You should give your doctor a complete list of all the drugs, herbs, and supplements you take -- before getting any prescription.

If buying over-the-counter medications, Binaso recommends showing a list of everything else you're taking to the pharmacist.

Drugged Driving

Pain medications can make you drowsy. Different people react differently to different drugs.

"How I react to a pain medication is different from how you react," Binaso says. "It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don't take two pills and go out driving."

Sharing Prescription Medicines

Unfortunately, it's very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say -- particularly when it comes to pain medications.

"If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting -- well, this is a potential problem," Haynes says. "Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results."

Not Talking to the Pharmacist

It's not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.

"That's why I'm in the store," Binaso says. "You may have to wait a couple of minutes for me to finish what I'm doing. But you'll get the information you need to take the right medicine the right way. Just say, 'Tell me about this medicine; what should I be on the lookout for?'"

Hoarding Dead Drugs

Joe's wife is actually to blame for one of his mistakes. She should have disposed of those extra pain pills once she was over her dental pain.

Why? One reason is that pills stored at home start breaking down soon after their expiration date. That's especially true of drugs kept in the moist environment of the bathroom medicine cabinet.

"People say, "That drug is only a year past its expiration date; isn't it good?" But if you take a pill that's broken down, it may not work -- or you may end up in the emergency room because of reaction to a breakdown product. That is really common," Binaso says.

Another reason that it's dangerous to hoard is that the drugs may tempt someone else into making a very bad choice.

"Teen drug abuse is really up, especially with pain medications," Binaso says. "It is not uncommon for kids to go to their parents' or grandparents' medicine cabinet and then go to a party and put the drugs in a bowl."

Breaking Unbreakable Pills

Pills are actually little drug-delivery machines. They don't work the way they're supposed to when taken apart the wrong way.

Scored pills should be cut only across the line, Binaso says. Those without scoring should not be cut at all, unless you're specifically instructed to do so.

"When you start chopping up pills like that, the pill may not work," she says. "We find more and more people are doing this. And then they say, "Oh, that pill had a really bad taste. That is because they cut away the coating."

Sports Injury

The most common sports injuries are sprains and strains. A sprain is a tear in a ligament (a tough fibrous cord that connects a bone to another bone) caused by sudden, forceful twisting of a joint. Meanwhile, a strain occurs when a muscle or tendon (a sinewy tissue that connects muscle to bone) is overstretched or torn.

These injuries can cause varying degrees of pain and swelling. If a sprain is not allowed to heal properly, the injury may recur or worsen. On the other hand, if a strain is not allowed to heal properly, or if scar tissue forms, the affected muscle or tendon can remain weak or painful.

Ankle joint and knee injuries
The ankle is an important joint involved in weight bearing lower limb activities. Interestingly, this joint can transmit forces up to five times the body weight. However, accidents can often occur due to a lack of joint stability as the ankle joint lacks support.


Ankle: mild sprains occur when ligaments are stretched or slightly torn. Ankle: moderate sprains occur when ligaments are partially torn. Ankle: severe sprains occur when ligaments are completely torn.
The most common ankle sprain is the Lateral Ligament Sprain – the sole of the foot turns downwards and inwards, injuring the ligaments in the outer part of the ankle resulting in a painful swelling. Neglect of the injury may lead to weakening of adjacent muscles and instability, which predisposes to recurrence and chronic instability.

The Anterior Cruciate Ligament (ACL) is an important structure that holds the bones of the knee and provides stability. Often, rupture of the ACL can occur due to sudden change in direction while running. A sudden forceful loading of the joint with twisting may result in a painful large swollen knee due to bleeding in the joint from the ruptured ACL. This injury requires prompt medical attention by a doctor and a possible referral for surgery.

With proper care (R.I.C.E.D, medication, rehabilitation exercises and bracing), most ankle and knee sprains and strains heal completely without problems after completion of a course of rehabilitation exercises.

Hamstring and calf muscle strains
Muscles and tendons have an inherent elasticity and strength that allows them to be stretched while giving rise to powerful movement. However, if they are subjected to unaccustomed and sudden forceful loading, they overstretch and undergo partial or complete tears (strain).

Without adequate warm-up and proper training, the hamstring and calf muscles in the back of the leg may be strained during sprints or jumps. This result in pain, swelling, bruising and possible accumulation of blood in the muscle.

Apply R.I.C.E.D treatment and seek medical attention immediately to assess the extent of injury, and whether further treatment is needed. A course of supervised exercise therapy is usually required before resuming normal activities. Inadequate treatment may result in stiffening and weakening of musculature, and persistent pain.

Elbow Pain
Tennis elbow refers to the degenerative changes of the tendons and muscles attached to the bony knob (lateral epicondyle) on the outer side of the elbow joint. These muscles and tendons assist in wrist extension, hand gripping, and turning your palm upwards.

Playing a racket sport, or performing repetitive tasks that involves extending your wrist or rotating your forearm (eg, twisting a screwdriver, lifting heavy objects with your palm down, scrubbing) can cause tennis elbow.

The golfer's elbow occurs when the tendons and muscles attached to the bony knob of the inner part of the elbow joint (medial epicondyle) undergoes degenerative changes.

Any movement that flexes the wrist can cause this problem (eg, in a golf swing, bowling, throwing).

Soft Tissue Rheumatism

Soft tissue rheumatism refers to aches or pain that occur as a result of normal wear and tear, or repetitive stress on a particular soft tissue surrounding a joint (ie, bursae, ligaments, muscles or tendons), or due to inflammatory arthritic conditions.

Common soft tissue problems include:

• Bursitis
• Elbow Pain
• Foot Pain
• Hand Pain
• Heel Pain
• Shoulder Pain
• Frozen Shoulder
• Rotator Cuff Injuries
• Simple self-care steps for Soft Tissue Rheumatism

1. Protect the affected joint with an elastic bandage, sling or soft foam pad
2. Rest and immobilize the affected area
3. Apply ice pack
4. Compress and elevate the affected joint (eg, knee or elbow).
5. Perform stretching exercises to help restore full range of motion
6. Bursitis
7. A bursa is a small fluid-filled sac that cushions the muscles, tendons and bones in a joint. It helps keep these from rubbing against each other and reduces friction in the areas around your joints.

Bursitis refers to inflammation of the bursa. Repeated movement and pressure on the bursa can cause it to swell and become irritated and inflamed. Trauma, bacterial infection, or crystalline deposits (eg, in people with gout) can also cause bursitis. The joints that are usually affected by bursitis are the large joints such as the shoulder, hip and knee.

A person suffering from bursitis may experience pain and tenderness around the affected soft tissue, pain that worsens with movement or pressure, and visible swelling or skin redness in the area of the inflamed bursa; all of which may restrict movement and affect daily activities.

Seek medical attention as soon as you notice symptoms, if your pain doesn't subside with self-care , or if you develop fever (a sign of infection). Your doctor may prescribe you medication to relieve pain and reduce inflammation. However, if your bursitis is caused by an infection, you may be given antibiotics, and the infected bursa may be drained with a needle.

Elbow Pain

Your elbow's many tissues and bones play an important role in giving your arms and hands their complete range of motion. However, moving the elbow or hand the wrong way, or too much too often, can cause inflammation or tearing of a muscle or tendon at the elbow (epicondylitis), which results in elbow pain.

Tennis elbow refers to the inflammation of the tendons and muscles around the bony knob (lateral epicondyle) on the outer side of the elbow. The muscles and tendons that let you extend your wrist, open your hand, and turn your palm upwards are most at risk for this problem.

Playing a racket sport, or performing tasks that involves extending your wrist or rotating your forearm (eg, twisting a screwdriver, lifting heavy objects with your palm down) can cause tennis elbow.

The golfer's elbow occurs when the tendons and muscles at the bony knob of the inner elbow (medial epicondyle) become inflamed and torn. One or more muscles and tendons along the inner elbow may be injured.

Any movement that turns the arm down and flexes the wrist can cause this problem (eg, in a golf swing).

The goal of treatment is to relieve elbow pain and regain full function quickly and safely. You can help yourself by switching hands at work, resting your elbow to help it heal itself, applying ice or taking anti-inflammatory medications, and exercising to increase your flexibility.

Your doctor may suggest you wear a splint to relieve your symptoms, or refer you for physical therapy. For severe elbow pain, your doctor may give you a steroid injection into your elbow.

Foot Pain

Plantar fasciitis is a common cause of foot pain. This chronic problem is an inflammation of the plantar fascia, a band of ligament that connects the heel bone to the bones in the ball of your foot. This inflammation may result from overuse or excess body weight, which causes the plantar fascia to tear or pull away from the heel bone. Sometimes the inflamed ligament may also irritate a nerve and cause more pain. A bony spur may also develop where the fascia and heel bone meet.

The bottom or inside of your foot may hurt when you stand. The pain usually decreases after you walk a few steps, but it may return with prolonged movement. Other symptoms include sharp pain when getting out of bed, or when you stand up after sitting for a while, burning or shooting pain in your foot, and a dull ache in the foot after standing for long periods on a hard surface, or when running.

Complete recovery may take months. In the meantime, you can self-manage your foot pain by wearing properly fitted shoes and inserts (arch supports or heel pads), performing stretching exercises, massage and application of either heat or ice.

Your doctor may prescribe you with anti-inflammatory medications, custom-made orthotic supports or heel cups, night splints, physical therapy and, if needed, a steroid injection.

Hand Pain

The carpal tunnel is a narrow space inside the wrist that is surrounded by bone and ligament. This space lets certain tendons and a major nerve (the median nerve) pass from the forearm into the hand. Thickening of the tendon sheaths or fluid retention reduces the space inside the carpal tunnel and may compress the median nerve. This leads to a painful condition that affects the wrist, hand and fingers, also known as Carpal Tunnel Syndrome.

Tingling and numbness are the most common symptoms of Carpal Tunnel Syndrome. Some people also have hand pain or even a weakened grip. At first, these symptoms may disrupt your sleep at night. Eventually they may also occur during your daily routines – you may notice symptoms while you are driving or holding a newspaper. Over time, these symptoms may become more severe.

Pregnant women are particularly prone to this condition due to the mild fluid retention caused by pregnancy.

Certain repetitive hand activities may put you at higher risk for developing Carpal Tunnel Syndrome. Therefore, you should learn to modify the way you use your hands to lower your risk, such as keeping your wrist in neutral, watching your grip, minimizing repetitive movement, resting your hand, reducing the speed and force of hand movement, and performing some conditioning exercises to strengthen your hand and arm muscles.

Physiotherapy or injections can help relieve your hand pain. You may feel some soreness for 24 to 48 hours following the injection. But after that, you're likely to have symptom relief for many weeks.

Surgery may be required to relieve the pressure on the median nerve or if the symptoms become severe. Pain relief is usually immediate.

Heel Pain

The Achilles tendon, which connects the heel bone to the calf muscle, allows us to lift our heels off the ground, thereby enabling us to walk, run, jump or leap. Inflammation of the Achilles tendon (Achilles tendinitis) is a common condition that causes heel pain. Although it is a relatively common condition among runners, Achilles tendinitis can also occur in other sports, such as high jumping and gymnastics.

Achilles tendinitis is caused by sudden or repeated overuse or trauma to the Achilles tendon (eg, when exercising too fast or by wearing poorly fitted shoes), or as a result of certain medical conditions (eg, seronegative arthritis). Symptoms include pain behind the heel, ankle and lower calf when performing weight-bearing exercise.

You can take several steps to avoid potentially serious problems later. These include stopping weight-bearing exercise until the pain is gone, switching to non-weight-bearing exercise (eg, swimming), using warm soaks or cold packs, and wearing properly fitted shoes.

Warning: if you ignore your symptoms and continue to exercise, your Achilles tendon may rupture. This injury is serious and usually requires surgery or prolonged casting.

Your doctor may treat your pain with anti-inflammatory medications and physical therapy. You may also be given a heel pad to be worn inside your everyday footwear and sports shoes. Most importantly, follow your doctor's advice about resuming exercise.

Shoulder Pain

Your shoulders have the ability to perform a range of motion that no other part of your body has. This flexibility allows your arms to do all the things that you need them to do. However, it also makes your shoulders more likely to become injured, causing pain and affecting movement in your arm, hand, neck and shoulder.

The most common shoulder injuries include dislocation, sprain, separation, and fractures (broken bones). Shoulder injuries may occur when the arm is jerked or when you fall on a shoulder, outstretched arm or elbow. Whatever the cause may be, immediate treatment is needed to relieve pain and regain the use of your shoulder.

Frozen Shoulder

You may not use/move your shoulder much when you have shoulder pain. This can lead to “frozen shoulder” (also known as capsulitis), a condition where the unused shoulder becomes stiff and sometimes unable to move freely.

Painful shoulder inflammation can also cause sticky bands (adhesions) to grow around the shoulder joint. These adhesions make shoulder movement even more painful.

Women are more likely to have frozen shoulder than men. This problem also occurs more frequently in women in their 40s. In some cases, people with previous shoulder injuries may later develop frozen shoulder.

Initially you may experience nagging pain in the affected shoulder. Other symptoms include increased shoulder pain as you move your arm, shoulder pain that keeps you from sleeping, shoulder stiffness that makes it hard to perform daily tasks, and an arm that you are unable to raise or rotate beyond a certain point.

Your doctor may start you on an exercise program to restore your shoulder's flexibility and range of motion. The exercises may be painful initially, but they will help free your shoulder joint of adhesions. Some of these exercises can be done at home, while other may be done with the help of a physical therapist.

If your shoulder is severely “frozen”, your doctor may suggest further medical treatment. Anti-inflammatory medications can help relieve pain. You may also receive surgical treatment in the hospital

Keep in mind that no treatment can replace shoulder exercises. You need to maintain your shoulder mobility after treatment.

Rotator Cuff Injuries

The rotator cuff is a powerful team of muscles and connective tendons that attach your upper arm to your shoulder blade. A healthy rotator cuff gives your shoulder strength, flexibility and control to reach, throw, push, pull and lift objects.

Rotator cuff tendons can become inflamed or damaged in many ways. The most common cause of shoulder pain is wear and tear. Soft tissue can also become inflamed or torn from overuse, pinching (impingement) and calcium deposits (calcification).

A worn out rotator cuff may tear at weak areas. If this happens, you may feel and even hear a clicking or popping sound in your shoulder. A tear can result in pain, weakness and loss of normal shoulder movement.

Your treatment depends on the type of shoulder problem you have. These include rest, ice packs to relieve muscle spasm, heat to increase blood flow, pain medications and/or steroids to reduce inflammation and relieve pain, and exercise. If your injury doesn't improve, you may need surgery.

Once your shoulder has healed and you've learned how to move safely, you can resume living your normal daily life. Try not to strain your rotator cuff, and remember to exercise – it's one of the best ways to keep your shoulder fit and strong.