Pain Management

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

Heidi Godman, Executive Editor, Harvard Health Letter

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

Kay Cahill Allison, Former Editor, Harvard Health

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.

Kay Cahill Allison

Treating neck pain with a dose of exercise

Kay Cahill Allison, Former Editor, Harvard Health

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.

Peter Wehrwein

Yoga can help ease low back pain

Peter Wehrwein, Contributor, Harvard Health

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.

Carolyn Schatz

Painful, disabling interstitial cystitis often goes undiagnosed

Carolyn Schatz, Former Editor, Harvard Women's Health Watch

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 […]

Study renews caution on painkiller use after heart attack

Patrick J. Skerrett, Former Executive Editor, Harvard Health

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.

Julie Corliss

Try exercise to ease arthritis pain, stiffness

Julie Corliss, Executive Editor, Harvard Heart Letter

If you have arthritis, exercise can help keep your joints mobile and your muscles strong. Swimming and other water-based exercise are especially good because they’re easy on the joints. Harvard Health editor Julie Corliss discusses ways in which exercise can help you cope with—and even improve the symptoms of—arthritis.

Peter Wehrwein

The safety of painkillers

Peter Wehrwein, Contributor, Harvard Health

Perhaps as many as one in every 5 American adults will get a prescription for a painkiller this year, and many more will buy over-the-counter medicines without a prescription. These drugs can do wonders—getting rid of pain can seem like a miracle—but sometimes there’s a high price to be paid. Remember the heavily marketed COX-2 inhibitors? Rofecoxib, sold as Vioxx, […]

Ann MacDonald

Painkillers and drug addiction: An ongoing dilemma

Ann MacDonald, Contributor, Harvard Health

On October 16, 1846, Dr. John Collins Warren, a renowned surgeon at Massachusetts General Hospital, removed a tumor from a printer named Gilbert Abbott. The operation was noteworthy for one reason: Abbott did not scream out in pain, as virtually every surgical patient did in those days. The age of anesthesia was born. A Boston […]