Pain Relief, Step by Step

NY Times ^ | March 1, 2007 | Editorial

[neverdem]

Much attention has been focused on the cardiovascular risks posed by Vioxx and other so-called cox-2 inhibitors in recent years, so the American Heart Association provided an important service this week by reminding us that many other painkillers have risks associated with them. The association spelled out gradations of cardiovascular risk and recommended a step-by-step approach — starting with nonmedicinal remedies — that doctors should follow when treating joint and ligament pain.

The scientific statement applies specifically to patients who already have or are at risk of heart disease and also need relief from pain — whether caused by short-term sprains or long-term rheumatoid arthritis. But the lead author believes that everyone might benefit from the same cautious approach toward pain relief.

A lot has happened since the heart association issued a similar advisory two years ago. The evidence has gotten even stronger that the cox-2 inhibitors — Celebrex is the only one left on the market in this country — increase the risk of heart attacks and strokes. And new evidence has emerged that some other painkillers also increase the cardiovascular risks.

The most striking recommendation is that pain treatments should start with nonmedicinal approaches, like physical therapy and exercise, weight loss to reduce stress on joints, and hot or cold packs. Only if those don’t provide enough relief should drugs be used, and the doctor should take a step-by-step approach in prescribing medications, from the safest to the riskiest.

The first medication would usually be acetaminophen or aspirin at the lowest effective dose, or certain other low-risk drugs. Only if those fail should doctors progress to riskier drugs, starting with naproxen and then perhaps ibuprofen, both available over the counter. A cox-2 inhibitor should be prescribed only as a last resort.

[jammer]

LOL. That's a darned good question.

[EEDUDE]

**I suggest you stop taking the Tylenol for about 2 months to see if your migraines cease.**

Many people think that non-narcotic pain relievers like aspirin and tylenol produce no withdrawal symptoms when their use is stopped.

There is a lot of anecdotal evidence that there is "rebound pain" that does occur when these products are used for long periods of time.

[toddlintown]

I was bone on bone in my right hip, but since I was 49 my doctor wanted to try everything to avoid a hip replacement. I took Vioxx and 20 minutes later, I thought it was a miracle cure. Unfortunately, about a month later, the pain returned to the point I couldn't walk without literally crying with every step. But for those couple of weeks, I thought Vioxx was the answer.

[KoRn]

I would find a different doctor if I were you. You shouldn't have to gulp down Tylenol daily, poisoning your liver. Go find a doc that will give you something that WORKS. Most doctors totally suck when it comes to pain management, especially chronic pain.

[TomB]

I only read these threads for the wonderful anecdotes/surefire cures. ;-)

[nascarnation]

I fixed sciatica that was nearly disabling via physical therapy.
The therapy was even more painful than the original pain but after a couple of weeks of rigorous exercise building up my "core" muscles it worked by "unloading" my spine.
And I had the benefit of a much flatter stomach
:-)

but it's a lot of work to keep up - much more so than gulping down pills a few times a day