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Pain Relief, Step by Step
NY Times ^ | March 1, 2007 | Editorial

Posted on 03/01/2007 9:05:16 PM PST by 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.

(Excerpt) Read more at nytimes.com ...


TOPICS: Culture/Society; Editorial; News/Current Events
KEYWORDS: health; healthcare; medicine; pain; vioxx
The NY Times' editorial board has something useful to read for a change.

Scientific Statements and Practice Guidelines for 2006-2007

Use of Nonsteroidal Antiinflammatory Drugs. An Update for Clinicians. pdf link

1 posted on 03/01/2007 9:05:19 PM PST by neverdem
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To: neverdem

vioxx was a miracle drug for me. I hope whoever bears responsibility for the banning of vioxx has severe arthritis at some point in their lives.


2 posted on 03/01/2007 9:07:37 PM PST by common denominator
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To: common denominator

Lawyers.


3 posted on 03/01/2007 9:09:37 PM PST by Brad from Tennessee (Anything a politician gives you he has first stolen from you)
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To: neverdem

Now if we could just come up with a non-medicinal cure for migraines . . .


4 posted on 03/01/2007 9:16:40 PM PST by Think free or die
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To: neverdem

This is starting to sound a bit silly in this age of miracle drugs, diagnostic tests and the promise of growing spare parts in a test tube; now we move forward to hot pads and ice packs and $2,000 per month health insurance policies only to be treated by doctors afraid of malpractice court.


5 posted on 03/01/2007 9:29:56 PM PST by Old Professer (The critic writes with rapier pen, dips it twice, and writes again.)
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To: neverdem

When I had health insurance, my doctor told me that I would need pain meds for the rest of my days (blown disks). He saved all the Ultram pharmaceutical sample packs for me, because insurance wouldn't cover it. 1.25 a pill, 13 yrs ago. This is a great medication for chronic pain, and it is non narcotic. Needless to say, I can't afford it.

Now I stay in bed for days at a time, getting up to use the computer etc, with a heating pad slapped on my back/neck.

Btw, they're right about tylenol blowing your liver to smithereens. Especially when you wash down 3 at a time with a 2 liter bottle of Diet Coke a day:(


6 posted on 03/01/2007 9:48:29 PM PST by TheSpottedOwl
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To: Think free or die

My son started getting migraines during puberty. I did my best to elimate aged cheese and meat(pepperoni for one example), chocolate, and caffeinated beverages such as Coca Cola. It helped reduce the occurances. Oh yeah, forgot red wine and alcohol in general.

If you haven't already eliminated such foods from your diet, why not give it a try? Migraines are awful!


7 posted on 03/01/2007 9:54:14 PM PST by TheSpottedOwl
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To: Think free or die
Now if we could just come up with a non-medicinal cure for migraines . . .

FDA Warns Migraine Medicine Makers

8 posted on 03/01/2007 9:55:58 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: TheSpottedOwl
This is a great medication for chronic pain, and it is non narcotic.

That's what they say, but some folks get addicted none the less.

The opioid-like activity of tramadol derives from low affinity binding of the parent compound to µ-opioid receptors and higher affinity binding of the principal active metabolite, O-desmethyltramadol (denoted M1) to µ-opioid receptors. In animal models, M1 is up to 6 times more potent than tramadol in producing analgesia and 200 times more potent in µ-opioid binding. The contribution to human analgesia of tramadol relative to M1 is unknown.

9 posted on 03/01/2007 10:13:45 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: El Gato; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; LadyDoc; jb6; tiamat; PGalt; Dianna; ...
Awareness: Too Much Acetaminophen? Few Seem to Know

Cassini Returns Never-before-seen Views of the Ringed Planet - Saturn (1) Check all links if you like astronomy.

FReepmail me if you want on or off my health and science ping list. Anyone can post any unposted link as they see fit.

10 posted on 03/01/2007 11:32:38 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

11 posted on 03/01/2007 11:34:42 PM PST by Lancey Howard
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To: neverdem

A bullet through the head usually does the trick.


12 posted on 03/01/2007 11:36:57 PM PST by Nachoman (Error processing tagline. Abort, Fail, Retry?)
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To: Nachoman
A bullet through the head usually does the trick.

That's obvious, but do you believe in suicide?

13 posted on 03/01/2007 11:46:02 PM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

Yeah, I couldn't believe people abused the stuff, until a newspaper article mentioned it. Pain meds are too important to me to abuse. I'm on a county insurance plan(of last resort), and the doc won't prescribe any pain meds until I get a CT scan of my abdomen. I had to junk my car last month, and the only place this insurance will cover is the county hospital, which is impossible to get to without a ride. My bf does have a life, son's car is being held hostage by the local Ford dealership, so if I can ever get hold of a human at MediCal, I'll see if I can get that scan done up where I live. Easier to get a ride.


14 posted on 03/01/2007 11:52:11 PM PST by TheSpottedOwl
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To: neverdem
That's obvious, but do you believe in suicide?

Only as a last resort.
15 posted on 03/02/2007 12:01:34 AM PST by Nachoman (Error processing tagline. Abort, Fail, Retry?)
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To: Think free or die
I have had pain for 20+ years in my life (I have Fibromyalgia) - Before the doctors discovered that I had Fibromyalgia I took Tylenol for my pain. Over the years I have been on all types of drugs for my pain but I always went back to Tylenol. I also started getting migraines some 20+ years ago. The doctors said it was related to my Fibromyalgia. I have had at least one migraine a month (sometimes as many as 6 a month) for the last 20 years.

I got tired of the meds I was taking and I was just down to 2 or 4 Tylenol a day until about 1 year ago. Then 6 months ago I decided to get completely off the Tylenol. As soon as I quit taking the Tylenol I noticed I was not having any migraines at all. I have been Tylenol Free and Migraine Free for 6 months. Not even a single twitch of a migraine.

I looked it up and found that Tylenol is a big culprit of migraines and now I know it was the cause of my migraines. 20 years of migraines and Tylenol. (my liver is ok though the Tylenol did not damage it but I was worried that would as I got older.

As far as my Fibromyalgia - I deal with it... I use heat therapy, I know what my physical limits are now and I sleep when my body aches and it tells me to sleep.

If you take Tylenol at least once a day or a few times a week and if you are a migraine sufferer. I suggest you stop taking the Tylenol for about 2 months to see if your migraines cease. I'll tell you I feel like new person.
16 posted on 03/02/2007 12:17:39 AM PST by stlnative
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To: neverdem
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.

Since when did common sense become a "striking recommendation"?

17 posted on 03/02/2007 2:31:33 AM PST by raybbr (You think it's bad now - wait till the anchor babies start to vote.)
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To: neverdem
They still don't get it. Medical doctors need to get to the cause of pain and treat the cause instead of the symptoms.

It can be done but they have to change their mindset.

Joint pain is caused by inflammation caused by probably leaky gut syndrome which is caused by tiny perforations in the intestines due to drugs, antibiotics, toxins, etc.

It may be necessary to do a detoxification. I never had to do that but my sister did.

I cured my RA with Vitamin C, Pantothentic acid and Vit E. My sister's was far worse.

Vitamin C is a great pain reliever and the only side effect is a healthier body. It relieves inflammation.

Use www.curezone.com or Dr. Walt Stoll's website. Message boards are great.

18 posted on 03/02/2007 4:56:42 AM PST by Conservativegreatgrandma
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To: Think free or die
"Now if we could just come up with a non-medicinal cure for migraines . . ."

Actually, for me the cause of migraines has turned out to be gluten (in wheat, barley, rye, etc.) and casein (in milk). Avoiding both of those is a pain, but well worth it to resolve my previous almost daily migraines and other health problems. That's not the cause for everyone, but probably for far more than realize it.

19 posted on 03/02/2007 5:16:57 AM PST by TruthSetsUFree
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To: TheSpottedOwl
I have severe osteo in my back, probably my neck too...plus I have this joint in my lower back where a cyst is wrapped around a nerve and boy, that practically paralized me with pain....

I am better now....did not choose surgery...

I think fish oil has been helpful.....and I use Naprosyn.....my doc's too stingy to order much else...

good luck.....

20 posted on 03/02/2007 5:28:25 AM PST by cherry
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To: raybbr

LOL. That's a darned good question.


21 posted on 03/02/2007 5:34:59 AM PST by jammer
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To: stlnative

**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.


22 posted on 03/02/2007 5:39:20 AM PST by EEDUDE
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To: common denominator
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.
23 posted on 03/02/2007 5:44:27 AM PST by toddlintown (Six bullets and Lennon goes down. Yet not one hit Yoko. Discuss.)
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To: TheSpottedOwl

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.


24 posted on 03/02/2007 5:46:35 AM PST by KoRn
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To: neverdem

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


25 posted on 03/02/2007 10:28:34 AM PST by TomB ("The terrorist wraps himself in the world's grievances to cloak his true motives." - S. Rushdie)
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To: neverdem

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


26 posted on 03/02/2007 10:39:25 AM PST by nascarnation
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