Pain Archive

News briefs

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In March, we reported that long-term use of a class of prescription painkillers known as opioids, such as oxycodone (Oxycontin), comes with the risk of dependence, addiction, falls, and even death. Now, a study published March 14, 2017, in The BMJ finds that opioid users who also take a benzodiazepine — such as alprazolam (Xanax) — for sleep or anxiety are more likely to end up in an emergency room. Researchers made the connection after looking at a sample of more than 300,000 privately insured adults (ages 18 to 64) over a 12-year period. People who were prescribed both types of drugs had twice the risk of ending up in a hospital as did people who used opioids only.

The study is observational and does not prove that using both medications increases overdose risk. However, the authors say we already know that about 30% of deadly opioid overdoses involve benzodiazepines in some way. Researchers suggest that opioids should be prescribed cautiously — even if only for a short-term course — among people who are also using benzodiazepines.

News briefs

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Many older adults have pain from knee osteoarthritis, a condition in which cartilage in the joints wears away. But when is it time for joint replacement? An observational study published March 28, 2017, in The BMJ suggests that a new knee improves quality of life only in certain cases. The study included over 7,400 middle-age and older adults who already had knee arthritis or were at high risk for the condition. Compared with people who didn't have knee replacement, those who had the surgery during the 26-year study period appeared to have a better quality of life afterward. However, the improvements were minimal, except in people who were less physically functional before the surgery because of more severe arthritis symptoms. The authors suggest that the high costs of knee replacement may be justified only in those who are severely affected by arthritis. What if your symptoms aren't severe? As we reported last month, it may be possible to delay or avoid knee surgery by strengthening your leg and core muscles, losing weight, and improving range of motion.

This ancient practice can be used alone or with conventional therapy to help ease your pain.

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Men looking for an easy and effective means to manage pain should consider acupuncture.

"There are many different types of pain — neuropathic, muscular, degenerative joint — all of which can make management complex," says Hugo Lopez, a licensed acupuncturist with Harvard-affiliated Massachusetts General Hospital Cancer Center. "Sometimes you need to treat not just the physical components, but also the psychological ones, and that is where acupuncture can help, as it addresses both problems."

Proper care and footwear can prevent these bumps from causing pain and hampering your mobility.

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Your big toe deserves some sympathy. Its position and length set it up for stubbing and other injuries. Shoes press in on the toe from the side and down on it from the top. Moreover, the toe also bears much of the body's weight with each step. And the result of the constant wear and tear is often a bunion. The medical name for bunion, hallux (big toe) valgus (turned away from the midline), provides a pretty good description of the way this problem creates a bump at the side of the foot.

How bunions develop

Dr. James P. Ioli, chief of the podiatry service at Harvard-affiliated Brigham and Women's Hospital, cites several reasons some women develop bunions, including the following.

In the journals

Studies have shown that regular activity can help older adults with arthritis stay independent. How much is enough? Research published online Dec. 28, 2016, by Arthritis Care & Research suggests you may need as little as 45 minutes per week.

Federal guidelines recommend 150 minutes of moderate activity per week to prevent premature death and serious illness. However, reaching that number is tough to reach for people with arthritis; in fact, only one in eight men with knee arthritis meet this standard. In this study, researchers tracked several years of fitness activity for 1,629 adults (44% of whom were men), ages 49 to 83, with osteoarthritis in the hip, knee, foot, or some combination. Specific exercises or activities were not recorded, only the time invested per week.

How to distinguish the symptoms from other conditions, and what to do about treatment.

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When your joints ache, you may chalk it up to an old injury or to osteoarthritis — the wearing away of cartilage that's common in older age. But for two million people in the United States, aching joints are caused by rheumatoid arthritis (RA) — when the immune system mistakenly attacks the tissues lining the joints.

"People commonly assume RA pain is due to aging, overuse, or even the flu," says Dr. Robert Shmerling, a rheumatologist at Harvard-affiliated Beth Israel Deaconess Medical Center, and medical editor of the Harvard Special Health Report Rheumatoid Arthritis (health.harvard.edu/RA).

Ask the doctor

Q. I suffer from recurrent canker sores. What is the best way to treat and prevent these mouth ulcers?

A. Canker sores, also known as aphthous ulcers, are small ulcers that appear on the inside of your cheeks and lips and sometimes on or under your tongue. They should not be confused with cold sores (fever blisters), which are due to a herpes simplex virus.