Pain Management

Daniel Pendick

Acupuncture for knee arthritis fails one test but may still be worth a try

A report published this week in the Journal of the American Medical Association offers weak-to-no proof that acupuncture helps ease the pain of knee arthritis. In a group of older men and women with arthritis-related knee pain, Australian researchers compared traditional needle acupuncture against laser acupuncture, sham laser acupuncture, and no treatment. People who had needle or laser acupuncture reported slightly less pain and slightly better physical function compared with the group that had no treatment at all. Sham acupuncture worked as well as real acupuncture, suggesting the placebo effect may be at work.

Nancy Ferrari

Acetaminophen may do little for acute back pain

When back pain strikes, all you want is relief—as quickly as possible. Many folks turn to over-the-counter pain relievers to help take the edge off and keep them moving. Acetaminophen and non-steroidal anti-inflammatory drugs, or NSAIDs (ibuprofen, naproxen, aspirin), are common and reasonable choices. Australian researchers tested how well acetaminophen worked for back pain that comes on suddenly (so-called acute back pain). Not much, it turned out. Among people who took acetaminophen as needed or on a three-times-a-day schedule, it took about 17 days for the pain to go away completely. Among those who took a placebo, it took 16 days. Does this mean that you shouldn’t bother to use acetaminophen for back pain? Not necessarily. But it might be worth trying cold, heat, and light physical activity.

Daniel Pendick

After hip fracture, exercise at home boosts day-to-day function

Even after intensive rehabilitation therapy, many people who break a hip still can’t do things they used to do with ease, like dressing, rising from a chair, or climbing stairs, after . A report in this week’s Journal of the American Medical Association shows that simple exercises done at home can make a big difference in recovering from a broken hip. A set of “functional exercises” that mimic the kinds of things people normally do in their daily lives improved function and mobility among people who had broken a hip. It’s important :just do it.” At-home rehab is of no use if you don’t stick with it. These kinds of exercises can also help ward off post-fracture complications like blood clots, pneumonia, wound infections, and more. Extended bed rest after a major injury or surgery can feed a downward spiral of physical deconditioning and additional health problems.

Daniel DeNoon

Back pain often overdiagnosed and overtreated

What doctors call “routine” back pain can really, really hurt. Surprisingly, the best treatment is usually quite conservative—over-the-counter pain relievers, ice and heat, and gentle exercise. Yet for decades, many doctors have been ordering more and more unnecessary tests, narcotics, and referrals to surgery. A new study of 24,000 people treated for back pain from 1999 through 2010 shows that many were not treated according to established guidelines, which promote treatment with over-the-counter pain relievers and physical therapy when appropriate, and advise against early referral for MRI or CT scans, the use of narcotics, or early referral to other physicians for injections or surgery. For a first-time bout with low back pain, or another go-round with it, try cold and heat, rest followed by gentle exercise, and over-the-counter pain relievers, such as acetaminophen or an NSAID like aspirin, ibuprofen, or naproxen.

Patrick J. Skerrett

Exercise is good, not bad, for arthritis

When pain strikes, it’s human nature to avoid doing things that aggravate it. That’s certainly the case for people with arthritis, many of whom tend to avoid exercise when a hip, knee, ankle or other joint hurts. Although that strategy seems to make sense, it may harm more than help. Taking a walk on most days of the week can actually ease arthritis pain and improve other symptoms. It’s also good for the heart, brain, and every other part of the body. Yet a new survey from the Centers for Disease Control and Prevention shows that more than half of people with arthritis don’t walk at all for exercise, and only 23% meet the current recommendation for activity—walking for at least 150 minutes a week. Walking is good exercise for people with arthritis, but it isn’t the only one. A review of the benefits of exercise for people with osteoarthritis (the most common form of arthritis) found that strength training, water-based exercise, and balance therapy were the most helpful for reducing pain and improving function.

Daniel Pendick

Acupuncture is worth a try for chronic pain

Chronic pain in the muscles and joints can make life miserable. Standard treatments like ice and heat, anti-inflammatory medications, physical therapy, and appropriate exercises can often ease the pain. But when they don’t, acupuncture is an option with a good track record that’s worth considering. Research from an international team of experts adds to the evidence that it does provide real relief from common forms of pain. The team pooled the results of 29 studies involving nearly 18,000 participants. Overall, acupuncture relieved pain by about 50%. The study isn’t the last word on the issue, but it is one of the best quality studies to date and has made an impression. For new pain, an acupuncturist should not always be the first stop. It’s important to get a clear diagnosis of what is causing the pain to rule out serious medical conditions that should be treated right away—and then seek out acupuncture if appropriate.

Patrick J. Skerrett

Physical therapy works as well as surgery for some with torn knee cartilage

Tiny shock absorbers in the knee (each one is called a meniscus) provide a key cushion between the thighbone and the shinbone. They are prone to tearing, and sometimes just wear out. A torn meniscus can cause pain or other symptoms, like a knee that locks. But sometimes they don’t cause any symptoms. In a youngish person, when a knee-wrenching activity like skiing, ultimate Frisbee, or slipping on the ice tears a meniscus, the damage is often repaired surgically. But a torn meniscus is often seen in the 9 million Americans with knee osteoarthritis, and for them the best course of action hasn’t been crystal clear. Results of the Meniscal Tear in Osteoarthritis Research (MeTeOR) trial published yesterday in the New England Journal of Medicine indicate that physical therapy may be just as good as surgery. Both therapies led to similar improvements in knee function and pain at six and 12 months.

Daniel Pendick

Rub-on pain reliever can ease arthritis discomfort

When it comes to relieving the pain of achy joints, many people reach for a pain-relieving pill like aspirin or ibuprofen. There may be a better way. When the source of pain is close to the surface, applying a cream, gel, patch, or spray that contains a pain reliever right where it hurts can ease pain and help avoid some of the body-wide side effects of oral pain relievers. These so-called topical analgesics work best for more superficial joints like the knees, ankles, feet, elbows, and hands. The active ingredient in most topical analgesics is a nonsteroidal anti-inflammatory drug (NSAID) like ibuprofen, naproxen, aspirin, or diclofenac. These medications target inflammation, which contributes to pain, swelling, and stiffness. The advantage of using a topical analgesic is that the medication works locally. Targeting pain more precisely using a medication applied to the skin can help skirt the side effects of oral drugs. This can be a boon for people whose stomachs are sensitive to NSAIDs.

Heidi Godman

Migraines: Stop them before they start

Migraines can be debilitating events. As Harvard Health editor Christine Junge wrote in this space last year about her battle with migraine, “On the days when I couldn’t get out of bed, it felt like someone was tightening screws into the sides of my head and pounding a hammer above my left eye.” Most migraine sufferers long to prevent these painful episodes. About one-third of migraineurs could benefit from taking a preventive pill. But only a minority of them actually take advantage of this option. New treatment guidelines from the American Academy of Neurology and the American Headache Society profile the best preventive medications, and an herbal preparation, for migraine. Preventive medications include antiseizure drugs, beta blockers, antidepressants, and triptans. The guidelines also indicate that an herbal remedy made from butterbur, a plant in the daisy family, can help prevent migraine. The downside of these preventive pills is that they must be taken every day, and may cause unwanted side effects.

Kay Cahill Allison

Pain relief outside the pill bottle

The idea that pain relief resides only in a bottle of pills is a common misconception. While medication often plays an important role in quelling pain, there’s a large arsenal of drug-free pain-relief therapies and techniques. The Institute of Medicine estimates that 116 million adults experience chronic pain each year. It has called for “a cultural transformation in how the nation understands and approaches pain management and prevention.” Improved pain management should include a combination of therapies and coping techniques. Other pain-relief therapies include biofeedback, ice, heat, exercise, acupuncture, hypnosis, massage, mind-body relaxation techniques, and more. These techniques can be used alone, in combination, and even in combination with drug therapy. Using non-drug therapies can be an empowering experience. Most of these therapies do not carry the risk of side effects as do most drugs. And many non-drug therapies are self-help techniques you can do by yourself or learn from a therapist.