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Finding the best solution for pain relief

June 11, 2008

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Everyone hurts sometimes.

Pain is the main complaint for about 40 percent of patients visiting primary-care doctors. While many find relief in such diverse remedies as pills, patches, acupuncture, massage and counseling, according to the editors of Consumer Reports On Health, roughly half of the people with chronic or recurrent pain fail to get adequate relief.

In many ways pain remains a medical mystery. While doctors can take a person's blood pressure or temperature, they have no objective measurement for pain. They have to rely on people's perception - and some people are more sensitive than others.

According to CR On Health experts, experience and emotion also play a role in what works. Individuals may respond better or worse to treatments, depending on their expectations. So alleviating suffering can be as much art as it is science.

The subjective nature of pain leaves plenty of room for misconceptions and improper treatment. Recent research, for example, has undercut the idea that pain from fibromyalgia is mostly imagined. And doctors and patients sometimes turn to prescription painkillers when safer and cheaper over-the-counter versions will do, or underuse other treatments, including certain antidepressants and nondrug measures.

Here's what CR On Health recommends for occasional, severe and recurrent pain:

¢ Try this at home. Upon experiencing sudden or occasional pain, such as an injury, a headache or menstrual cramps, first assess how bad it is. Rate it on a scale of 0 (no pain) to 10 (the worst pain imaginable). For pain that's rated 5 or less, start by self-treating with nondrug measures, such as heat for back pain or cramps, and RICE - rest, ice, compression and elevation - to reduce pain and swelling immediately after a muscle sprain or strain.

Also try over-the-counter pain relievers, such as acetaminophen (sold as Tylenol or as a lower-cost generic), ibuprofen and naproxen, which typically suffice for this level of pain.

¢ Severe-pain solutions. For pain that's rated at 6 or higher, doesn't improve with nondrug steps and OTC drugs, or lasts longer than few days, see a doctor. The doctor might suggest a prescription nonsteroidal anti-inflammatory drug (NSAID) because a different or stronger formulation may yield additional relief. Another approach can be a prescription opioid such as oxycodone (Oxycontin and generic).

Medicines that pair an opioid with acetaminophen, aspirin or ibuprofen may be an even better choice. Those can provide greater relief because the two ingredients work in different ways, and they reduce the risk of side effects because the combination permits smaller doses of each.

¢ Recurrent pain. Even when the pain is relatively mild, chronic or recurrent pain from arthritis, headaches or other sources can seriously interfere with everyday activities. Since chronic pain often ebbs and flows, rating discomfort on the 0 to 10 pain scale can help someone decide, day to day, how to manage the problem.

A number of nondrug measures - such as losing weight, gentle exercise or identifying triggers that worsen the pain, as well as meditation, biofeedback, massage and other alternative therapies - can help keep pain manageable. Such steps can also help reduce reliance on medications. CR On Health says that's important, since all pain medications pose greater risks when used long-term.

If pain strikes despite those measures, work with a doctor to find a drug that targets it. In addition to severity, describe how it feels - a steady ache, a sharp pain or a burning sensation, for instance. In some cases, the best option might not be a traditional pain drug. For example, an antidepressant, such as amitriptyline (generic only), or an anticonvulsant, such as gabapentin (Neurontin and generic), can relieve the burning and shooting pains that arise from diabetic nerve damage.

If chronic pain interferes with daily life despite treatment, CR On Health recommends asking for a referral to a pain clinic, where a team of neurologists, anesthesiologists, psychiatrists and other specialists will collaborate on the most effective approach.

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