Pain Management

Patrick J. Skerrett

Exercise is good, not bad, for arthritis

Patrick J. Skerrett, Executive Editor, Harvard Health
Inflamed knees and ankles

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.

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Daniel Pendick

Acupuncture is worth a try for chronic pain

Daniel Pendick, Executive Editor, Harvard Men's Health Watch
Treatment by acupuncture. The doctor uses needles for treatment of the patient.

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.

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Patrick J. Skerrett

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

Patrick J. Skerrett, Executive Editor, Harvard Health
Knee physical therapy

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.

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Daniel Pendick

Rub-on pain reliever can ease arthritis discomfort

Daniel Pendick, Executive Editor, Harvard Men's Health Watch
Ointment on finger

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.

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Heidi Godman

Migraines: Stop them before they start

Heidi Godman, Executive Editor, Harvard Health Letter
Migraine pain

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.

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Kay Cahill Allison

Pain relief outside the pill bottle

Kay Cahill Allison, Editor, Special Health Reports
Painful knee

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.

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Kay Cahill Allison

Treating neck pain with a dose of exercise

Kay Cahill Allison, Editor, Special Health Reports
Neck-pain

For neck and shoulder pain, doctors once recommended rest, maybe the use of a neck brace, and waiting until the pain had ebbed away. Today there are recommending movement instead of rest. As described in Neck and Shoulder Pain, a newly updated Special Health Report from Harvard Health Publications, there is mounting scientific evidence for the role of stretching and muscle strengthening in treating people with neck and shoulder pain. After a whiplash injury, for example, people heal sooner and are less likely to develop chronic pain if they start gentle exercise as soon as possible. For those with long-term pain (called chronic pain) results from controlled studies show that exercise provides some relief. Exactly how much exercise to do, what types are best, and how often it should be done have yet to be completely hashed out.

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Peter Wehrwein

Yoga can help ease low back pain

Peter Wehrwein, Editor, Harvard Health
Three_People_Doing_Yoga

Two new studies, one from the United Kingdom and one from Seattle, show that people with lower back pain may get some relief by regularly doing yoga. In the British study, yoga classes were more effective than standard care at improving “back function,” meaning it reduced back-related problems that interfered with everyday activities like walking, standing, climbing stairs, and so on. In the Seattle study, yoga was just as good as special stretching classes designed for people with low back pain. In the real world, it’s probably easier to find a yoga class than a stretching class designed specifically for low back pain. While yoga is generally safe, if you want to use it to treat something like low back pain, talk it over with your doctor first—in both studies, yoga made back pain worse for a small percentage of people.

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Carolyn Schatz

Painful, disabling interstitial cystitis often goes undiagnosed

Carolyn Schatz, Editor, Harvard Health
Woman-stomach-pain

Millions of Americans—most of them women—suffer from a bladder condition known as interstitial cystitis. According to a new study of this disorder, fewer than 10% of women with symptoms of interstitial cystitis are actually diagnosed with the disorder, even though it severely affects their lives. Without a proper diagnosis, women with interstitial cystitis are missing [...]

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Patrick J. Skerrett

Study renews caution on painkiller use after heart attack

Patrick J. Skerrett, Executive Editor, Harvard Health
Man-pouring-pills-into-hand

A new study linking painkiller use by heart attack survivors to increased risk of heart attack or death generated some pretty scary headlines, like “NSAIDs following a heart attack greatly increase risk of a repeat heart attack” and “Painkillers risky for heart attack patients.” Although correct, they overstate the danger. Taking a nonsteroidal anti-inflammatory drug like ibuprofen, diclofenac, or Celebrex increased the chances of having a heart attack or dying from 3 to 4 per 10,000 people per year to 5 to 6 per 10,000 people per year. The results are in line with an American Heart Association recommendation to limit the use of NSAIDs if possible.

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