Pain Archive

News briefs

When you have knee pain, you just want it to go away so you can walk without having to limp or wince with every step. And a small, randomized trial published online Jan. 12, 2021, by Annals of Internal Medicine found that one type of shoe might be best for the job. Researchers took 164 people ages 50 or older with moderate or severe knee arthritis and randomly assigned half of the group to wear stable, supportive shoes with thick soles that didn't bend much. The other half was assigned flat shoes with thin, flexible soles, which are believed by some to provide a benefit by allowing more natural movement of the leg and foot. Both groups wore their assigned shoes for six hours per day and took part in activities such as walking during that time. After six months, 58% of people in the stable, supportive shoe group reported a reduction in knee pain while walking, compared with 40% of people reporting pain reduction after wearing the flat, flexible shoes. In both groups, the pain reduction probably was a benefit of regular walking. The people wearing flexible shoes were also twice as likely to develop ankle or foot pain, compared with those wearing sturdy shoes. So if you have knee pain, keep walking — in sturdy shoes.

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Inpatient, outpatient, and at-home rehab all aim to restore your function and independence.

Have shoulder pain? Recovering from traumatic illness, surgery, or a bad fall? Your doctor may well recommend physical rehabilitation or physical therapy to get you back to your daily routine and the activities you love. There are several options available, depending on your needs.

1. Inpatient rehab

Inpatient rehab is prescribed after a hospital stay, when you're not well enough to go home. It offers comprehensive care from doctors, nurses, therapists, and other health professionals. There are two types of this rehab.

Antidepressant medications are frequently prescribed for chronic pain, particularly neck or low back pain and certain types of arthritis — though other treatments are usually tried first. An analysis of past research considered how effective antidepressants are for these types of pain, but the results are not encouraging.

The ideal workout program for osteoporosis combines weight-bearing, muscle-strengthening, flexibility, and balance exercises.

The popular mind-body practice can be one of the best ways to soothe an aching low back, as long as you are careful.

 Image: © FatCamera/Getty Images

Yoga is a gentle practice that is ideal for maintaining back strength and flexibility. It's also one of the more effective tools for helping reduce low back pain, the most common source of pain and disability among older adults.

"Yoga helps strengthen and stretch back muscles that might be tight, which improves mobility," says Dr. Lauren Elson, medical editor of the Harvard Special Health Report An Introduction to Yoga (www.health.harvard.edu/yo).

Mindfulness can help soothe short-term and chronic pain.

Your mind is a powerful pain remedy when given the chance. Science continues to show how mindfulness can manage pain — and it doesn't take years to master.

"Using mindfulness is a way for older adults to treat ongoing chronic pain and the occasional flare-up without having to always rely on medication," says Ellen Slawsby, director of pain services at Harvard-affiliated Benson-Henry Institute for Mind Body Medicine.

Research we're watching

There are a number of different approaches to treating a condition called adhesive capsulitis, better known as frozen shoulder. This common condition causes significant shoulder pain and reduced mobility. While it generally goes away on its own over time, it can take up to a year or longer to heal. But there hasn't been consensus on whether any particular therapy leads to more rapid pain relief and full range of motion.

A study published online Dec. 16, 2020, by JAMA Network Open looked at various treatment options for frozen shoulder to determine which was the most effective. Researchers analyzed 65 different studies with more than 4,000 total participants and found that the first line of therapy should be to inject a steroid directly into the joint to reduce inflammation. This treatment helped to reduce pain and led to the fastest recovery. The study authors said the steroid injection should be accompanied by a home exercise program that includes stretches and exercises to improve range of movement in the shoulder.

Exercise and recreational balls can play an important role in recovery and pain reduction.

A golf ball to ease foot pain? A kids' playground ball to recover from a knee injury? The combinations may sound foreign, but they're familiar approaches in the world of physical therapy. Here's how these tools of the trade (and the toy box) can help you.

A playground ball

This is the kind of inexpensive rubber or plastic ball (less than $10) you'll find at a grocery or big-box store. It's about the size of a soccer ball, but lighter. "We commonly use that type of ball for knee rehabilitation. We'll have someone do mini squats against the wall with the ball between the knees. Squeezing the ball strengthens the quadriceps muscles," explains Clare Safran-Norton, clinical supervisor of rehabilitation ­services at Harvard-affiliated Brigham and Women's Hospital.

It's more accessible than ever before, but is it the right medicine for you?

Medical marijuana — also referred to as medical cannabis — has enjoyed a boom in recent years. More states have legalized it, more products are available, and more people have turned to it for help, especially older adults.

A study in the April 2020 JAMA Internal Medicine found that the number of adults ages 65 and older using medical cannabis increased from 2.4% to 4.2% between 2015 and 2018.

A novel study suggests that the "nocebo effect" could be why some people believe they cannot tolerate statins.

Are you hesitant to fill your statin prescription because you're worried the drug will cause muscle aches and other side effects? Although you're far from alone (see "A royal pain?"), the reality is that all drugs have side effects, and statins aren't worse than other drugs. And fears about statin side effects may be depriving people of a potentially lifesaving medication.

The nocebo effect — the flip side of the well-known placebo effect — occurs when people experience negative effects from a drug, placebo, or other treatment based on an expectation of harm. Because of the widespread belief that statins cause muscle aches, statins have been suspected of triggering a strong nocebo effect. A recent study confirmed this observation (see "A study to assess statin side effects").