Pain Archive

Over-the-counter and prescription drugs known as NSAIDs pose a risk to the cardiovascular system. They include over-the-counter drugs such as ibuprofen (Motrin, Advil) and prescription drugs such as celecoxib (Celebrex). NSAIDs can cause the kidneys to hold on to salt and water, which tends to raise blood pressure. They also appear to affect the inner linings of blood vessels and alter other blood substances in a manner that promotes blood clots. People who need these pain-relieving medications should take the smallest dose for the shortest possible period of time.

Research we're watching

Doctors have long known that mental or psychological stress can lead to angina (chest pain or discomfort caused by inadequate blood to the heart). Now, new research reveals a direct correlation between angina and stress-related activity in the brain's frontal lobe. The study included 148 people with coronary artery disease with an average age of 62. All underwent brain and heart imaging tests done in conjunction with mental stress testing, which involved mental arithmetic and public speaking. Imaging tests were also done under "control" conditions, which featured simple counting and recalling a neutral event. Researchers monitored the participants for angina during the tests; they also assessed angina rates again after two years.

Activity in the inferior frontal lobe area of the brain during mental stress was linked to the severity of self-reported angina, both during the brain imaging and at the two-year follow-up. A better understanding of how the brain reacts to stress may be an important consideration for doctors who treat angina, according to the study's lead author. The study was published online Aug. 10, 2020, by the journal Circulation: Cardiovascular Imaging.

In the journals

Hold off on taking pain pills to treat a sprained ankle, strained neck, or bruised knee. A new guideline from the American College of Physicians and the American Academy of Family Physicians recommends certain topical (gels, liquids or patches placed on the skin) painkillers as the first line of defense for musculoskeletal injuries in areas other than the lower back. The new guideline, published online Aug. 17, 2020, by Annals of Internal Medicine, was based on a review of more than 200 studies including a total of 33,000 patients with short-term injuries (pain lasting less than four weeks). It recommends using a topical nonsteroidal anti-inflammatory drug (NSAID) with or without menthol (which creates a cooling sensation). Topical NSAIDs come in gel, liquid, or patch forms; diclofenac gel (Voltaren Arthritis Pain) and aspirin cream are available without a prescription. Topical NSAIDs may have fewer risks than oral NSAIDs, which raise risk for stomach ulcers and bleeding, high blood pressure, kidney damage, and heart attacks. However, if topicals don't work, the guideline says you can move to oral NSAIDs such as ibuprofen (Advil, Motrin) or the non-NSAID painkiller acetaminophen (Tylenol); acupressure; or transcutaneous electrical nerve stimulation. The guideline recommends against using opioids such as tramadol (Ultram) except in severe cases.

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Peripheral artery disease (PAD), which occurs when fatty deposits clog arteries outside the heart, is underrecognized and potentially dangerous. The hallmark symptom is leg pain that occurs with exercise, called intermittent claudication. PAD is more common among people who are older, who smoke, and who have diabetes. The recommended treatment involves short periods of walking interspersed with rest periods when pain occurs. Walking increases blood flow in the leg's smaller arteries and helps create new channels to move blood around the blockages; it also helps discourage new blockages.

Ask the doctor

Q. I have suffered from rheumatoid arthritis for many years, and recently I also developed diabetes. My doctor says they are both related to inflammation. What is inflammation, and how can two such different diseases be connected to it?

A. Inflammation is both an old and a new idea in medicine. Roman physicians 2,000 years ago noted that wounds that were healing and joints that suffered from arthritis (like yours) became red, warm, swollen, and painful. It was like they were on fire: inflammare was the verb for setting on fire. But why did a wound become red, warm, swollen, and painful? They had no idea.

Research we're watching

A recent study found that nearly one in 10 people who received opioid pain relievers following heart surgery continued to take them for three to six months — a time point when no one should still be experiencing pain from the operation.

The study included nearly 36,000 people with private health insurance who had a coronary artery bypass graft (known as CABG or bypass surgery) or a heart valve replacement between 2003 and 2016. People who were prescribed more than 40 5-mg tablets of oxycodone (Oxycontin, Roxicodone, others) or an equivalent amount of a similar drug were at a much higher risk of prolonged opioid use than people who were prescribed lower doses. Other factors that increased a person's odds of taking opioids long-term included having CABG, being female, or having a history of chronic pain or alcoholism.