Pain Archive

It's more important than ever to consider your particular health risks before popping a nonprescription pain reliever.

Have a headache, muscle strain, or maybe arthritis pain? Don't reach for just any over-the-counter (OTC) remedy. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), naproxen (Aleve), and aspirin are commonly used OTC painkillers. So is acetaminophen (Tylenol). For decades, these drugs were thought to be entirely safe — justifying the ability to purchase them without a doctor's prescription.

But the thinking on OTC painkillers has changed now that we know more about their risks. And it's especially important to navigate these medications with care. Here are guidelines to help you narrow the options.

Research we're watching

Hot cocoa may be just what the doctor ordered… for leg pain. A small study published February 14 by Circulation Research found that adults with peripheral artery disease (PAD) who drank a specially designed hot cocoa had less PAD-related leg pain when walking than those who didn't drink the cocoa.

PAD is a condition in which fatty deposits collect and reduce blood flow in arteries outside the heart — most commonly in the legs. People with PAD commonly experience pain when walking. For this study, researchers gave 44 people with PAD a specially designed cocoa-containing beverage three times a day for six months. The cocoa drinkers were able to walk on average almost 140 feet farther in a timed walking test than people who drank the same amount of the same beverage that didn't contain the cocoa. The cocoa drinkers also had some improved muscle function and blood flow into the calves. While the drinks were specially designed for the trial, the researchers speculated that cocoa may contain an ingredient that helps muscle cells using oxygen more efficiently.

Even the healthiest people can find it hard to stick with an exercise regimen — and if you suffer from the joint pain of arthritis, moving your body may be the last thing you want to think about. But regular exercise not only helps maintain joint function, it also relieves stiffness and reduces pain and fatigue.

If you have arthritis, you want to be sure your exercise routine has these goals in mind:

Most of us get back pain at some point in our lives. It may be due to a sports-related injury, an accident, or a congenital condition such as scoliosis. But most of the time, upper or lower back pain develops during the course of day-to-day life. Repetitive activities at work or home, such as sitting at a computer or lifting and carrying, may produce tension and muscle tightness that result in a backache. One solution to preventing back pain is to improve posture.

In addition to improving your posture, general physical fitness and a healthy weight are important are important, too. But the surprisingly simple act of paying attention to improving your posture can go a long way.

Exercise and movement may be the best medicine for back pain.

 
You might be considering surgery or other intervention to treat your back pain. But less may actually be more for this common problem, and in many instances the best medicine is good old-fashioned movement and exercise.

The enigma of back pain

Back pain is one of the most common medical problems in the United States, according to the National Institutes of Health. It's also a little strange as far as ailments go.

Dozens of states are cracking down on the amount of opioids doctors can prescribe.

 Image: © Darwin Brandis/Getty Images

Overdoses of powerful painkillers called opioids kill more than 115 people per day in the United States. More than 42,000 people died from opioids in 2016, five times more than in 1999. The reason? Since several of these powerful painkillers became available in pill form several decades ago, doctors have been prescribing more than patients need. "It is estimated that a large part of leftover opioids are diverted to the street, either deliberately or through theft," says Dr. Edgar Ross, senior clinician at the Pain Management Center at Harvard-affiliated Brigham and Women's Hospital.

The misuse of opioids is a risk many states are no longer willing to take. The rules limit the amounts that medical professionals can prescribe for temporary (acute) pain from surgery, injury, or illness.

Which pain reliever should you take, acetaminophen or NSAIDs?

What you need to know about common pain relievers, from Tylenol to Aspirin. Once upon a time, easing pain was relatively simple: take two aspirin and call the doctor in the morning. Now there are many pain relievers to choose from (see "Pain relievers at a glance").

Willow bark was one of the earliest painkillers. Extracts or teas of willow bark have been used to treat fever and pain for more than 2,000 years. Unfortunately, the active ingredient, salicylic acid, is very hard on the stomach. In 1897, a German chemist working for the Bayer Company found a way to modify salicylic acid so it was less irritating to the stomach. The compound he created, acetylsalicyclic acid, was called Aspirin. It remained the premier over-the-counter painkiller until the development of acetaminophen in 1956 and ibuprofen in 1962. Since then, more than a dozen others have come onto the market.

Research we're watching

Doctors have been overprescribing opioids for chronic musculoskeletal pain, according to a December 2019 study in The Journal of Pain. Researchers looking at data from a survey conducted between 2007 and 2015 found that doctors more often prescribed pills, either non-opioid or opioid, rather than physical therapy, counseling, or other nondrug interventions — a practice that is directly at odds with what experts now recommend, including those in the CDC Guideline for Prescribing Opioids for Chronic Pain. At their first visit with the doctor, people were most often prescribed non-opioid painkillers (40.2%) or opioids (21.5%), followed by counseling, nonpharmacological treatments, and physical therapy. Study authors say this shows there is room for improvement through education. However, it's worth noting that the time period studied (2007 through 2015) preceded much of the recent work and advocacy aimed at reducing prescriptions of opioids.

Image: © robeo/Getty Images

Ask the doctors

Q. I have uterine fibroids and am experiencing some pain and discomfort from them. Are there any alternative treatments that I can use to help manage my symptoms?

A. If you are experiencing anemia, severe pain, or difficulty with urinating that may be due to fibroids, it's important to seek the advice of a doctor. However, there are some pain management options other than medications or surgery that may help relieve symptoms related to fibroids. These strategies haven't been proven to relieve pain from fibroids, but The National Center for Complementary and Integrative Health, in a 2017 review of complementary approaches to chronic pain, found they have some promise in helping other types of chronic pain, specifically lower back pain. These include acupuncture, an alternative medicine treatment that uses small needles applied at specific sites on the body to relieve chronic pain; yoga, a type of low-impact exercise that includes a series of postures and breathing techniques; relaxation techniques, such as deep breathing and mindfulness (a practice that encourages staying focused on the present moment); tai chi, originally practiced as a form of self-defense, which incorporates slow, deliberate movements and deep breathing exercises; and massage performed by a massage therapist.