Pain Archive

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.

Image: Victor_69/Getty Images

Improving range of motion, muscle strength, and weight control can help reduce pain and make your knees feel younger.

Image: © jacoblund/Thinkstock

Knee pain is common in older age, often caused by osteoarthritis (the wearing away of knee cartilage). Fortunately, there are ways to fool Father Time and postpone knee problems or even prevent them entirely. "In many cases, you can delay or avoid the need for surgical intervention, such as a knee replacement," says Dr. Lars Richardson, an orthopedic surgeon with Harvard-affiliated Massachusetts General Hospital.

The aging knee

Your knees absorb a huge amount of pressure with every step — typically one-and-a-half times your body weight. That pressure, plus regular wear and tear, takes a toll over time. Muscles and ligaments get weaker. The knee's two shock absorbers — pads of cartilage called menisci — start to deteriorate. So does the articular cartilage protecting the ends of the leg bones where they meet at the knee. If you have a family history of osteoarthritis, if you're overweight, or if you've had some knee injuries, you may be more prone to this deterioration.

It takes less force to sprain an ankle as we age. A few precautions can help to reduce the severity of these injuries or avoid them altogether.

Few of us have gone through life without spraining an ankle. Sprains are among the most common musculoskeletal injuries in people of all ages, and ankles are particularly vulnerable because of the small size of the joint and the forces exerted on it when the body is in motion. While younger people usually sustain sprains while running or jumping, for older people just stepping off a curb awkwardly or walking on an uneven ground can do it. "As you age, your balance and strength can diminish, especially if you've been immobile, increasing your risk for sprains," says Dr. Holly Johnson, a foot and ankle orthopedic surgeon at Harvard-affiliated Massachusetts General Hospital.

How sprains occur

The injury occurs when one or more of the ligaments — elastic bands of tissue that keep the ankle bones in place — are stretched or torn. The most common type of ankle sprain is an inversion injury, or lateral ankle sprain. The foot rolls inward, damaging the ligaments of the outer ankle. Less common are sprains affecting the ligaments of the inner ankle and sprains that injure the ligaments that join the two leg bones (the tibia and the fibula) just above the ankle.

This treatment approach may help provide relief for many women with chronic pelvic pain and urinary symptoms.

The exact cause of pelvic pain for many women can be elusive, despite lots of tests and scans. In some cases, the symptoms are related to a problem that is often overlooked, says Dr. Eman Elkadry, an instructor in obstetrics, gynecology, and reproductive biology at Harvard Medical School. Pelvic pain may stem from a pelvic floor muscle problem that can be helped by a specialized form of physical therapy known as pelvic physical therapy.

"Although pelvic physical therapy may not work for everyone, it can be quite effective for certain individuals," says Dr. Hye-Chun Hur, director of the Division of Minimally Invasive Gynecologic Surgery at Harvard-affiliated Beth Israel Deaconess Medical Center and associate faculty editor of Harvard Women's Health Watch. She stresses that pelvic physical therapy is normally undertaken by a trained female practitioner.

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.

Ask the doctors

Q. Is there anything I can do at home to ease sciatica pain?

A. Sciatica is a condition that causes pain that radiates down the buttock and the leg. It occurs when one of the two sciatic nerves in your body, which run from your back down to your toes, is compressed or irritated. Most often the problem is triggered by a ruptured disc or arthritis in the lower spine. This condition can be quite painful, but there are some strategies you can use at home to ease your discomfort.

Research we're watching

People with chronic pain may be more likely to have a heart attack or stroke than those without chronic pain, according to a study published online May 7, 2020, by the journal Pain Medicine.

From 2001 to 2005, researchers identified 17,614 Taiwanese people who had used pain relievers for at least three months. The most common causes of pain were spinal disorders, arthritis, and headaches; the pain relievers included both over-the-counter drugs and prescription opioids. For the comparison group, researchers used 35,228 people without chronic pain who were matched by age and sex to those in the first group.

You can ease the pain of sitting too much by getting up and moving around. Try these stretches and exercises.

An excess of inactivity isn't just bad for overall health; it can literally be a pain in the butt. You could end up with a sore backside if you sit at a desk all day long, if you're confined to a wheelchair, if you sit on hard surfaces for long periods, or if you're simply not as active as you once were. Whatever the reason for rear-end pain, it's time to stand up and get a little relief.

What's causing your pain?

When you sit in a chair, you're resting on your ischial tuberosities, or "sit bones" — the bony prominences at the bottom of your pelvis. You're also placing lots of pressure on your lower back, nerves, muscles, tendons, and ischial bursae (fluid-filled sacs near the ischial bones). Sitting can aggravate (or in some cases cause) these common sources of buttocks pain.